Radiation Therapy Scope for Breast Cancer Treatment

The scope of electrotherapy?

My younger sister was initially diagnosed with stage I breast cancer due to a tumor in her right breast.
After tumor excision and sentinel lymph node biopsy, it was found that there was one tumor metastasis in the sentinel lymph node.
During the surgery, axillary lymph node dissection was not performed, and the diagnosis was changed to stage II.
After undergoing 8 cycles of chemotherapy, she recently consulted with the radiation oncology department regarding the radiation therapy area.
The doctor informed her that radiation would only be administered to the right breast area.
I would like to ask Director Wang if it is correct for the radiation treatment to be limited to just the right breast area, considering there is one metastasis in the sentinel lymph node.
Shouldn't the radiation also cover the right axilla and neck areas? Thank you, and I look forward to your response.

Leo, 50~59 year old female. Ask Date: 2021/09/29

Dr. Wang Yifen reply Radiology

Hello, the treatment for breast cancer includes surgical intervention, medical therapy, and radiation therapy.
The treatment approach may be adjusted based on the histopathological classification, the site of tumor invasion, and the consideration of the benefits and side effects of each treatment, as well as changes in the disease course.
It is essential for the multidisciplinary team to integrate care based on the patient's condition.
It is recommended that you consult her radiation oncologist or her original breast surgeon to assess whether additional adjuvant therapy is needed.
Please take this into consideration, and I wish you and your family good health and safety.

Reply Date: 2021/09/29

More Info

When considering radiation therapy for breast cancer treatment, especially after surgery, it is essential to understand the rationale behind the treatment plan and the specific areas that may require radiation. In your sister's case, she has undergone surgery for a right breast tumor, which was initially staged as Stage I but was later reclassified to Stage II due to the discovery of a metastatic tumor in the sentinel lymph node. Following eight cycles of chemotherapy, she is now consulting with a radiation oncologist regarding the scope of radiation therapy.

Radiation therapy is typically recommended after surgery for breast cancer to reduce the risk of local recurrence, particularly in cases where there is lymph node involvement. The primary goal is to target any remaining cancer cells in the breast area and surrounding tissues. In your sister's situation, the decision to limit radiation to only the right breast area may be based on several factors, including the extent of the disease, the specific characteristics of the tumor, and the treatment guidelines followed by the medical team.

1. Radiation Therapy Scope: The radiation oncologist's recommendation to focus on the right breast is consistent with standard practice. The radiation field usually encompasses the entire breast and may include the chest wall if a mastectomy has been performed. However, the inclusion of lymph nodes in the radiation field can vary based on the number of affected nodes and the overall treatment strategy. In cases where there is sentinel lymph node involvement, it is common to consider additional radiation to the axillary (underarm) region, especially if multiple nodes are affected or if there are other high-risk features.

2. Consideration of Axillary and Supraclavicular Areas: While the radiation oncologist may have recommended treating only the breast, it is crucial to discuss the potential need for radiation to the axillary and supraclavicular areas (the area above the collarbone). This is particularly relevant in cases where there is a single positive sentinel lymph node, as it may still indicate a risk for further spread. The decision to include these areas in the radiation field should be based on a thorough evaluation of the pathology report, the extent of lymph node involvement, and the overall treatment plan.

3. Consultation and Second Opinions: It is always advisable to have an open discussion with the radiation oncologist about the treatment plan. If there are concerns about the adequacy of the radiation field, seeking a second opinion from another radiation oncologist can provide additional insights and reassurance. The treatment plan should be tailored to your sister's specific situation, and all options should be explored to ensure comprehensive care.

4. Importance of Follow-Up: After completing radiation therapy, regular follow-up appointments are essential for monitoring any potential side effects and assessing the effectiveness of the treatment. This includes physical examinations, imaging studies, and discussions about any new symptoms that may arise.

In summary, while the initial recommendation may focus on the right breast area for radiation therapy, it is essential to consider the involvement of lymph nodes and the potential need for broader treatment. Engaging in thorough discussions with the healthcare team and considering all aspects of the treatment plan will help ensure that your sister receives the most appropriate and effective care for her breast cancer.

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