Radiation and Possible Lung Damage
Women often worry a great deal about possible lung or heart (if the left breast is involved) damage from radiation therapy. One simple response is that it makes a difference where you get your treatment. Although chemotherapy is pretty standard for early stage breast cancer (meaning, you are likely to receive the same medications and does in Boston or in South Dakota), it really matters who plans the radiation and the machines that deliver it (and please don't take this as a criticism of medicine in South Dakota). At BID, we care for many women who live at some distance from Boston and who opt to have their surgery and chemotherapy with us, but to receive the weeks of daily radiation closer to home. Our radiation oncologists are pretty direct with their recommendations, and feel comfortable with the places these women go.
There are, unfortunately, some risks and possible long term problems. Luckily, most of us avoid them. Here is a reassuring article from Medscape that may be of interest:
Long-Term Pulmonary Toxicity From Breast Irradiation
October 7, 2011 (Miami Beach, Florida) — Radiation to the whole breast for early breast cancer does not place women at increased risk for long-term pulmonary toxicity, compared with mastectomy, according to a new study presented here at the American Society for Radiation Oncology (ASTRO) 53rd Annual Meeting.
The study also found that patients with radiation-induced pneumonitis at the time of treatment were not at increased risk for pulmonary complications 25 years later.
This is study's "most important finding" — that "acute pneumonitis did not predict the development of late fibrosis," said Phillip Devlin, MD, from the Dana-Farber/Brigham and Women's Cancer Center in Boston, Massachusetts, who was not involved in the work.
These data come from a trial that dates back to a time when breast-conservation therapy (lumpectomy plus radiation) was still a controversial approach to treatment.
In that trial, 247 patients with stage I to II breast cancer were randomized to modified radical mastectomy or breast- conservation therapy (45 to 48.6 Gy whole breast, 15 to 20 Gy boost), and treated from 1979 to 1987 at the National Cancer Institute (NCI) in Bethesda, Maryland.
Twenty-five years later, 102 patients were still alive and 61 participated in the new study. These women, all of whom are now elderly, returned to the NCI campus for 2 days of diagnostic imaging and pulmonary function testing.
"This study demonstrates no difference in either radiographic evidence of pulmonary fibrosis or pulmonary symptomatology," the researchers conclude. The lead author was Nicole Simone, MD, assistant professor of radiation oncology at the Kimmel Cancer Center of Thomas Jefferson University in Philadelphia, Pennsylvania.
The 2 treatment approaches to early breast cancer have "largely equivalent pulmonary toxicity," write Dr. Simone and colleagues.