what the problem is; what is known about the problem; Why this is an important issue.Breast Cancer:

what the problem is; what is known about the problem; Why this is an important issue.Breast Cancer: Radiation TherapyWhat We Know› Radiation therapy (RT; also called radiotherapy) is usually prescribed as a component of breast-conserving therapy (BCT) for patients with breast cancer (BC). RT is initiated before surgery to decrease tumors size and is also administered after surgery to destroyremaining cancer cells in the breast, chest wall, or lymph nodes(3,4,5,12,14,15,16)• RT is non-invasive and uses high energy beams to destroy cancer cells. RT reduces riskof breast cancer recurrence by 50% in patients who undergo BCT. However, patientstreated by hormone therapy for over five years do not benefit from RT(5)• The optimal interval between BCT and the initiation of RT is not established; in a 2011study of 387 patients, researchers observed that a delay in administration of RT of > 180days was not associated with increased risk for local recurrence(3)› RT is also indicated after mastectomy in patients with locally advanced BC (i.e., tumor> 5 cm [Stage III]), as measured by mammography or ultrasound, with proven skin andchest wall muscle or chest wall skeletal involvement)(3,5,12)The administration of RT following mastectomy(5,12)-reduces BC locoregional (i.e., restricted to the region of the body in which it arose)recurrence rates-reduces mortality from BC-increases BC-free survival rates-increases mortality related to other conditions (e.g., cardiac and vascular conditions)BCT followed by administration of RT has become the preferred treatment for early-stage BC in lieu of modified radical mastectomy because of equivalent overallsurvival rates(4)-In patients undergoing BCT, RT results in a 67% reduction in risk for local recurrencecompared with lumpectomy alone(4)-Although RT to the breast and chest wall significantly reduces the rate of localBC growth, it has no therapeutic effect on the growth rate of distant metastases, ifpresent(12)Individualized regimens of RT that are administered for BC include(1,4,5,16,18)• conventional RT, which consists of receiving external beam radiation 5 days per weekfor 3-8 weeks to areas such as the whole breast, chest wall, axillary and internal mammary lymph nodes, and the supraclavicular area-On average, daily treatment is 15-30 minutes(18)-Weekend breaks from RT allow for self-repair of noncancerous tissue(18)• brachytherapy, which is the placement of radioactive seeds,wires, catheters, and needlesdirectly into the breast tissue. High dosage can be administered to target areas because of accurate positioning of the radioactive source. Brachytherapy can be administered independently or concurrently with external beam RT to add an extra boost of focusedRT to the tumor bed region after breast conserving surgery(2)-MammoSite is a form of accelerated partial breast irradiation (APBI); i.e., intensivebreast irradiation) brachytherapy in which an intracavitary balloon is inserted into the surgical cavity following lumpectomy and filled with saline solution. During eachtreatment (i.e., twice daily for 5 consecutive days), the radiation oncologist inserts aradioactive seed into the balloon via a catheter(9)- Researchers in a 2010 study reported a 4-year overall survival of 92%, and disease-specific survival of 97% in patients- In a study of 71 patients who underwent MammoSite and 245 who underwent conventional RT, researchers reported that patients in the MammoSite group were significantly more likely to develop palpable masses and telangiectasias (i.e., small dilated blood vessels near the skin surface [“spider veins” or angioextasias])(17)-Investigators conducting a randomized study of 2,135 women with early-stage BC found that APBI using external beam radiation led to increased rates of adverse cosmesis (i.e., surgical correction of disfiguring physical defect) and late radiation toxicity compared with conventional RT(16)-A treatment planning system is a computerized program used to moderate the amount of radiation administered to breast tissues in modern day brachytherapy(13)-Adjuvant RT is used at the early stages of breast cancer and assists with preventative disease care. The German Society of Radiation Oncology/DEGRO established standard guidelines of adjuvant RT consisting of hypofractionated irradiation which consists of up to 15 to 16 fractions, totaling a 40-42Gy dosage. As opposed to conventional fractioned therapy (25-28 fractions), hypofractionated irradiation is preferred. Conventional fractioned therapy is recommended when RT involves the lymph nodes(14)-Clinical studies demonstrate that in early stage BC, the addition of regional lymph node irradiation to standard radiation reduces recurrence but does not improve overall survival(6)-In a 2016 meta-analysis publication aimed at investigating the effect of altered radiation fraction size regimens greater than 2 Gy per fraction in women with BC who have had breast conserving surgery, researchers concluded that administering altered fraction size regimens does not produce a clinically meaningful effect on local recurrence(11)-In the United States, whole breast irradiation (WBI) is the most prevalent type of RT used to treat breast cancer. The American Society for Radiation Oncology (ASTRO) standardized hypofractionated whole-breast irradiation of 15(4000cGY) -16(4250cGY) fractions(19)• Newer forms of therapy such as(15,20,21,22)who were treated with MammoSite(10)-intensity-modulated radiation therapy (IMRT), delivers low-dose radiation to the tumor bed and surrounding tissues to minimize toxicity- Investigators who conducted a randomized trial of 1,145 patients concluded that IMRT resulted in superior overallcosmesis and reduced risk for skin telangiectasia compared with conventional RT(15)-3D-computerized planning techniques, which are used to assist radiation oncologists in customizing the areas to be radiated-targeted intraoperative radiotherapy (TARGIT), in which a single dose of radiation is given during surgery- Researchers in 2 large, randomized, controlled trials reported that TARGIT resulted in higher rates of recurrence butsimilar survival rates compared with conventional RT(21,22)› RT can produce side effects that greatly impair functional status and quality of life, including radiation pneumonitis, fatigue, difficulty concentrating, and localized skin damage. To encourage adherence to the prescribed regimen of RT, women with BC should be educated regarding methods to alleviate RT-related discomfort such as to(5,8,9,12,14)use alcohol-free or oil-free creams to minimize dryness and burninguse mild soap with minimal rubbing in the treated areaavoid shaving the irradiated areawear loose-fitting clothing to prevent skin irritationwear only 100% cotton garments over irritated skinavoid sun exposure, extreme cold, and extreme heatconserve energy by taking naps, prioritizing daily activities, and asking for help from family members or friendsengage in moderate physical activity such as golfing, walking, and swimming-In a study of 17 patients undergoing RT for BC, researchers found that individuals reporting the highest level of fatigue had the lowest expenditure of energy in kilocalories/day, indicating an inverse correlation between energy expenditure and fatigue; the study showed that patients with higher levels of energy expenditure in kcal/day had lower levels of fatigue and a greater propensity to preserve baseline functioning while undergoing RT(8)› RT cannot be performed in all patients with BC; contraindications to RT include pregnancy, prior RT to breast tissue (e.g., in the treatment of Hodgkin lymphoma or lung cancer), and collagen vascular disease (e.g., scleroderma)(4)• Patients for whom RT can be less beneficial include those who are > 70 years of age who do not have lymph node involvement and those with estrogen receptor positive tumors who will receive anti-estrogen therapy› Women treated with RT undergo post-RT surveillance (e.g., frequent mammography or other imaging and clinical breast examinations), which is important in order to observe for recurrence or new BC. Because RT can cause adverse effects that can develop weeks to months after the final dose of RT, patients should be encouraged to adhere to scheduled follow-up visits with their radiation oncologist(5,14)• Although rare, potential long-term effects of RT include(7) -pneumonitis, breast fibrosis, breast necrosis, and rib fracture Health Science Science Nursing NURS 334 Share QuestionEmailCopy link Comments (0)

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