Published: Thursday, May 03, 2007

1. Side effects of radiation treatments for breast cancer
2. Recommendations for the care of radiation skin reactions

1. Side effects of radiation treatments for breast cancer

Radiation to the breast is a localized treatment and most side effects are limited to structures within the treatment area. The severity of side effects is related to the dose of radiation delivered, the time over which it is delivered, and other factors such as local irritation and volume of tissue treated.¹

1. Skin - Mild to moderate erythema develops during the last days of treatment and will continue to progress for eight to ten days following treatment after which it will subside quickly. Moist desquamation may occur in the axilla or in the inframammary fold in large breasted women.
2. Fatigue - Some patients experience generalized tiredness after the first one to two weeks of treatment and for a few weeks thereafter. Most of the fatigue will be related to scheduling, travel and emotional distress. Taking regular rest breaks and reducing stress are helpful. A small amount of fatigue may be related to the radiation itself. The cause of this is unknown. See Symptom Management Guidelines for information on managing fatigue or for nursing protocols for fatigue management.
3. Esophagitis - If a direct internal mammary field is used, the esophagus is directly irradiated and esophagitis may develop during the third week but usually settles within two to three weeks of the completion of treatment. This field arrangement is rarely used, therefore this side effect is very rare. Usual symptoms of esophagitis are a feeling of a "lump in the throat", or mild swallowing difficulties. Extremes in food temperature and spicy foods should be avoided. Occasionally, softer foods or a liquid diet is required until the symptoms resolve.
4. Lung - Some part of the lung is always included in the irradiated volume. This does not usually cause any clinical symptoms or affect pulmonary function after treatment is completed. There is a rare chance of developing radiation pneumonitis, which presents as a cough six weeks to six months after the completion of treatment. Radiation pneumonitis can be treated with prednisone 75 mg. daily for two weeks and then tapered. Some patients may show changes in their chest x-ray image in the future related to prior radiation treatment.¹
   
   In patients with a prior history of tuberculosis there is a possibility of reactivation and these patients should be seen by a TB specialist. Frequently prophylactic INH is advised.
5. Heart - Symptomatic cardiac toxicity with these techniques is rare, but patients treated with internal mammary chain radiation where the heart is in the treatment field have a very small potential increased risk of coronary artery disease.
6. Lymphedema - Lymphedema may develop as a result of radiation, especially to the axilla. See the Post Surgical page for information on treatment or reducing the risk of lymphedema.

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2. Recommendations for the care of radiation skin reactions

Care of radiation skin reactions (PDF) - BC Cancer Agency resource for health care providers

References

1. BC Cancer Agency (http://www.bccancer.bc.ca). Vancouver (BC): 2006. (cited Sep 22, 2006). Available from: http://www.bccancer.bc.ca/HPI/CancerManagementGuidelines/Breast/Management/
SideEffectsofRadiationTherapy.htm