Side Effects of Breast Radiation

breast_skin.jpg (9667 bytes)

redness of the breast and skin near completion of a course of radiation

Side Effects of Breast Radiation (read the recent reviews here and here and nursing instructions)

Generally the side effects of breast radiation do not become noticeable until the woman has received about 10 treatments, and then become somewhat more noticeable through the rest of the treatment. The most common side effects:

skin irritation - the skin that is radiated gets red, itchy and may blister (like a sun burn)
breast or chest wall tenderness or mild pain
tiredness or fatigue (some women feel a little light-headed)
are swelling or edema (usually slight, see section below about avoiding lymphedema)

the best treatment for the skin is to use moisturizing creams like Sween, Biofine, or Aloe. For itching the cortisone creams often work well, for burns switch to Silvadene unless there is an allergy to Sulfa.

The side effects generally fade away starting about 5 to 10 days after the treatments have finished. The skin discoloration may take several months to disappear and some women still have breast swelling that can last as long as a year.

See Picture short-term skin reaction (left breast) then appearance by one month (see pic); typical appearance (right breast) years after lumpectomy and radiation (see pic); and occasional situation where there has been shrinkage or fibrosis of the treated breast (right breast treated, see pic) another picture of right breast shrinkage (see pic). Most women have little evidence of previous radiation (see pic). Significant side effects from the literature are listed below.

xrt_port.gif (8152 bytes)

The radiation beams pass through the chest wall from side to side (tangentially, see diagrams of radiation one and two and skim the surface of the lung (avoiding the heart and spinal cord.) It does hit muscles and ribs and can cause some side effects (as noted below.)

For more information on arm swelling (lymphedema) go here

**Radiation Side Effects or Complications**
Side Effects	Frequency
Arm Edema (swelling)	5 - 20%
Rib Fracture	5%
Pneumonitis (lung inflammation)	1%
Brachial Plexopathy (nerve injury)	< 1%

Many of the side effects patients complain about are related to the lymph node dissection, this problem may be eliminated in the future by limited node dissections (sentinel)

**Side Effects from Lymph Node Dissection**
numbness	35%
pain	30%
arm swelling	15%
limited range of motion	8%

In the past, the radiation technique included using a Cobalt machine to radiate the internal mammary field which inadvertently radiated the heart in women with left side breast cancers. This technique is no longer used and more recent data shows the odds of a woman getting a heart attack after breast radiation is about the same for right sided cancers as for left (JNCI 2005;97:419) see below and study from MD Anderson here. There is a small but real increased risk of other cancers in women receiving radiation(go here) and sarcomas (go here).

**15 Year Cardiac Mortality for Women Receiving Breast Cancer Radiation**
Year of Diagnosis	Left Breast	Right Breast
1973-1979	13.1%	10.2%
1980-1984	9.4%	8.7%
1985-1989	5.8%	5.4%

**Side Effect Consent Form from RTOG 98-04 Breast Radiation Study**
Radiation therapy may cause 1) Fatigue: tiredness for no apparent reason is a temporary effect going away within a month or two after completion of radiation. 2) Skin damage: within the area of radiation, the skin may develop a sunburn-like area within 2-6 weeks after treatment. This will go away. The skin may also become slightly thick compared to skin on the untreated breast. Treated skin will also be more sensitive to sun exposure in the future. 3) Swelling: the breast will feel heavy, almost like a pre-menstrual breast, during treatment and for several months afterwards. 4) Muscle tightness: muscles in the chest wall under the treated breast can sometimes feel “sore” or tight during and after radiation treatments. 5) Although uncommon, radiation may cause a cough and difficulty breathing in that part of the lung under the treated breast. A radiologist may see a slight change in this part of your lung on chest x-ray or CT scan or similar imaging of your chest. It is very unlikely that this will cause any decrease in exercise tolerance. 6) Although uncommon, pericarditis, (irritation of the sac surrounding the heart), myocarditis (irritation of the heart muscle), or rib fractures may occur long after completion of the radiation treatments. Your physician will be checking you closely to see if any of these side effects are occurring. Side effects usually disappear after the treatment is stopped. In the meantime, your doctor may prescribe medication to keep these side effects under control.