Breast Cancer and its Radiotherapeutic Methods

Document Type: Review Article

Authors

1 1- Medical Radiation Department, School of Mechanical Engineering, Shiraz University, Shiraz, Iran

2 2- Radiotherapy and Oncology Department, Shiraz University of Medical Sciences, Shiraz, Iran Center for Research in Medical Physics and Biomedical Engineering, Shiraz University of Medical Sciences, Shiraz, Iran

3 Medical Radiation Department, School of Mechanical Engineering, Shiraz University, Shiraz, Iran 4- Radiation Research Center, School of Mechanical Engineering, Shiraz University, Shiraz, Iran

4 Radiotherapy and Oncology Department, Shiraz University of Medical Sciences, Shiraz, Iran

5 Medical Radiation Department, School of Mechanical Engineering, Shiraz University, Shiraz, Iran Radiation Research Center, School of Mechanical Engineering, Shiraz University, Shiraz, Iran

Abstract

Breast cancer is the most common cancer in women after skin cancer. In Iran, the presentation age of this cancer is younger than the global average. There are different therapeutic methods for treatment of breast cancer and the choice of treatment depends on the stage of the disease as well as its type and characteristics. Therapeutic methods include surgery, radiotherapy, and systemic therapies, each consisting of a variety of techniques. The two main surgical techniques are lumpectomy and mastectomy. The main systemic methods are biological therapy (immunotherapy), hormone therapy, and chemotherapy. Radiotherapy is mainly categorized into external-beam radiotherapy and brachytherapy. In this paper, we present a brief review of the different types of breast cancer and their treatments using conventional and modern radiotherapy methods, as well as the treatment efficacy and side effects of breast radiotherapy.

Keywords

Main Subjects


  1. American Cancer Society, Breast Cancer Facts & Figures. 2009-2010, American Cancer Society: Atlanta.
  2. Yarnold J. The Current Status of Breast Cancer Among Resource-Limited Countries. Middle East Journal of Cancer. 2010;1(3):105-8.
  3. IRNA. The age of Breast cancer in Iran is 10 years less than world statistics. Islamic republic news agency; 2009; Available from: http://www.irna.ir.
  4. Masood S. The Current Status of Breast Cancer Among Resource-Limited Countries. Middle East Journal of Cancer. 2010;1(1):1-4.
  5. Mosleh-Shirazi M, Mohammadianpanah M, Mosleh-Shirazi MA. Breast cancer in young women. 3rd Tehran Breast cancer congress, Iranian Journal of Breast Diseases. 2010:205.
  6. Mosleh-Shirazi M, Mohammadianpanah M, Mosleh-Shirazi MA, editor. Characteristics, prognostic factors and treatment outcomes of young breast cancer patients in southern Iran. Proceedings of the 1st Research Festival of Radiological Sciences Students; 2010; Shiraz, Iran.
  7. Halperin Edward C., Perez Carlos A., Brady Luther W., E. WD. Perez and Brady's Principles and Practice of Radiation Oncology Fifth ed: Lippincott Williams & Wilkins; 2007.
  8. Rodrigo Arriagada MGL. Adjuvant Radiotherapy in Breast Cancer: The Treatment of Lymph Node Areas. Acta Oncologica. 2000;39(3):295-305.
  9. Slowik G. Are There Different Kinds Of Breast Cancer?  2011 [updated January 18th ]; Available from: http://ehealthmd.com/library/breastcancer/BRC_kinds.html.
  10. Dolinsky C, Hill-Kayser C. Breast Cancer: The Basics.  Pennsylvania2011 [updated January 18]; Available from: http://www.oncolink.org/types/article.cfm?c=3&s=5&ss=33&id=8320.
  11. American Cancer Society. Breast Cancer in Men. American Cancer Society Inc; 2011 Available from: http://www.cancer.org/Cancer/BreastCancerinMen/index.
  12. Slowik G. Breast Cancer. What treatment is available for breast cancer?  2011 [updated April 13th ]; Available from: http://ehealthmd.com/library/breastcancer.
  13. Mohammadianpanah M, Ashouri Y, Hoseini S, Ahmadloo N, Talei A, Tahmasebi S, Nasrolahi H, Mosalaei A, Omidvari S, Ansari M, Mosleh-Shirazi MA. The efficacy and safety of neoadjuvant chemotherapy +/- letrozole in postmenopausal women with locally advanced breast cancer: a randomized phase III clinical trial. Breast Cancer Res Treat. 2012;(in press).
  14. Ahmadloo N, Nazer Mozaffari MA, Mohammadianpanah M, Omidvari SH, Mosalaei A, Mosleh-Shirazi MA. Combined Neoadjuvant Chemotherapy and Celecoxib in Locally Advanced Breast Cancer. Iran Red Cresc Med J. 2009;11(4):419-24.
  15. Early BC Trialists’ Collaborative Group (EBCTCG). Effects of RT and of differences in the extent of surgery for early BC on local recurrence and 15-year survival. Lancet. 2005;366:2087-106.
  16. Perkins GH, McNeese MD, Antolak JA, Buchholz TA, Strom EA, Hogstrom KR. A custom three-dimensional electron bolus technique for optimization of postmastectomy irradiation. International journal of radiation oncology, biology, physics. 2001;51(4):1142-51.
  17. Dewar JA. Postmastectomy Radiotherapy. Clinical Oncology. [doi: DOI: 10.1016/j.clon.2005.11.006]. 2006;18(3):185-90.
  18. Mosleh-Shirazi MA, Zeinali-Rafsanjani B, Faghihi R, Hadad K, Mosalaei A, Karbasi S. Evaluation of important dosimetric parameters in chest-wall radiotherapy by kilovoltage x-rays using Monte Carlo modeling. Iranian J of Breast Diseases. 2012;Winter 1390:75.
  19. Karbasi S, Nasrollahi H, Mosleh-Shirazi MA, Mosallaei A, Omidvari Sh, Mohammadianpanah M, Ahmadloo N, Ansari M. Investigation of chest-wall dose homogeneity in kilovoltage x-ray therapy using diode in-vivo dosimetry. Iranian J of Breast Diseases. 2012;Winter 1390:58.
  20. Omidvari S, Saboori H, Mohammadianpanah M, Mosalaei A, Ahmadloo N, Jowkar F, et al. Evaluation of topical betamethasone for the prevention of acute radiation-induced dermatitis: a prospective clinical trial. Indian J Dermatol Venereol Leprol. 2007;73(209).
  21. Omidvari S, Shafizad A, Razmjou-Ghalaei S, Nasrolahi H, Ahmadloo N, Ansari M, et al. Efficacy of Topical Honey, Topical Hydrocortisone 1% and Simple Washing on Healing of Radiation-induced Dermatitis in Breast Cancer Patients. Journal of Isfahan Medical School 28. 2011 2nd week, January;113:1-9.
  22. De Steene JV, Vinh-Hung V, Cutuli B, Storme G. Adjuvant radiotherapy for breast cancer: effects of longer follow-up. Radiotherapy and Oncology. [doi: 10.1016/j.radonc.2004.04.004]. 2004;72(1):35-43.
  23. Erven K, Van Limbergen E. Regional lymph node irradiation in breast cancer. Future Oncol. 2007 Jun;3(3):343-52.
  24. Bentel G, Marks LB, Hardenbergh P, Prosnitz L. Variability of the location of internal mammary vessels and glandular breast tissue in breast cancer patients undergoing routine CT-based treatment planning. International Journal of Radiation Oncology*Biology*Physics. [doi: 10.1016/S0360-3016(99)00123-6]. 1999;44(5):1017-25.
  25. Wazer DE, Arthur DW, Vicini FA. Accelerated Partial Breast Irradiation, Techniques and Clinical Implementation. Heilmann DU, editor: Springer; 2006.
  26. Bedford JL, Childs PJ, Nordmark Hansen V, Mosleh-Shirazi MA, Verhaegen F, Warrington AP. Commissioning and quality assurance of the Pinnacle(3) radiotherapy treatment planning system for external beam photons. Br J Radiol. 2003 Mar;76(903):163-76.
  27. Hurkmans CW, Cho BC, Damen E, Zijp L, Mijnheer BJ. Reduction of cardiac and lung complication probabilities after breast irradiation using conformal radiotherapy with or without intensity modulation. Radiother Oncol. 2002 Feb;62(2):163-71.
  28. Pignol JP, Olivotto I, Rakovitch E, Gardner S, Sixel K, Beckham W, et al. A multicenter randomized trial of breast intensity-modulated radiation therapy to reduce acute radiation dermatitis. J Clin Oncol. 2008 May 1;26(13):2085-92.
  29. Clinical research news.  New York2012; Available from: http://www.columbiasurgery.org/news/research/2007_apbi.html.
  30. Donovan E, Bleakley N, Denholm E, Evans P, Gothard L, Hanson J, et al. Randomised trial of standard 2D radiotherapy (RT) versus intensity modulated radiotherapy (IMRT) in patients prescribed breast radiotherapy. Radiother Oncol. 2007 Mar;82(3):254-64.
  31. Bhide SA, Nutting CM. Recent advances in radiotherapy. BMC Medicine. 2010;8(1):25.
  32. Van Limbergen E, Weltens C. New trends in radiotherapy for breast cancer. Curr Opin Oncol. 2006 Nov;18(6):555-62.
  33. Dogan N, Cuttino L, Lloyd R, Bump EA, Arthur DW. Optimized dose coverage of regional lymph nodes in breast cancer: the role of intensity-modulated radiotherapy. Int J Radiat Oncol Biol Phys. 2007 Jul 15;68(4):1238-50.
  34. Beckham WA, Popescu CC, Patenaude VV, Wai ES, Olivotto IA. Is multibeam IMRT better than standard treatment for patients with left-sided breast cancer? Int J Radiat Oncol Biol Phys. 2007 Nov 1;69(3):918-24.
  35. Partridge M, Evans PM, Mosleh-Shirazi A, Convery D. Independent verification using portal imaging of intensity-modulated beam delivery by the dynamic MLC technique. Med Phys. 1998 Oct;25(10):1872-9.
  36. Mosleh-Shirazi MA. Safe and Judicious Use of Advanced Radiotherapy Techniques and Equipment: A Medical Physicist's Perspective on Recent Accident Reports. Middle East J of Cancer 2010;1(2):59-63
  37. Hall EJ. Intensity-modulated radiation therapy, protons, and the risk of second cancers. Int J Radiat Oncol Biol Phys. 2006 May 1;65(1):1-7.
  38. Mosleh-Shirazi MA, Evans PM, Swindell W, Webb S, Partridge M. A cone-beam megavoltage CT scanner for treatment verification in conformal radiotherapy. Radiother Oncol. 1998 Sep;48(3):319-28.
  39. Hasan Y, Kim L, Martinez A, Vicini F, Yan D. Image guidance in external beam accelerated partial breast irradiation: comparison of surrogates for the lumpectomy cavity. Int J Radiat Oncol Biol Phys. 2008 Feb 1;70(2):619-25.
  40. Mosleh-Shirazi MA, Evans PM, Swindell W, Symonds-Tayler JR, Webb S, Partridge M. Rapid portal imaging with a high-efficiency, large field-of-view detector. Med Phys. 1998 Dec;25(12):2333-46.
  41. Sixel KE, Aznar MC, Ung YC. Deep inspiration breath hold to reduce irradiated heart volume in breast cancer patients. Int J Radiat Oncol Biol Phys. 2001 Jan 1;49(1):199-204.
  42. Korreman SS, Pedersen AN, Nottrup TJ, Specht L, Nystrom H. Breathing adapted radiotherapy for breast cancer: comparison of free breathing gating with the breath-hold technique. Radiother Oncol. 2005 Sep;76(3):311-8.
  43. Remouchamps VM, Vicini FA, Sharpe MB, Kestin LL, Martinez AA, Wong JW. Significant reductions in heart and lung doses using deep inspiration breath hold with active breathing control and intensity-modulated radiation therapy for patients treated with locoregional breast irradiation. Int J Radiat Oncol Biol Phys. 2003 Feb 1;55(2):392-406.
  44. Pieper breast ancer communique.  2010; Available from: http://us1.forward-to-friend.com/forward/preview?u=403a793d624165bc846b57b53&id=15d2601b9f.
  45. Veronesi U, Marubini E, Mariani L, Galimberti V, Luini A, Veronesi P, et al. Radiotherapy after breast-conserving surgery in small breast carcinoma: long-term results of a randomized trial. Ann Oncol. 2001 Jul;12(7):997-1003.
  46. Orecchia R, Fossati P. Partial breast irradiation: ready for routine? Breast. 2007 Dec;16 Suppl 2:S89-97.
  47. Sauer R, Sautter-Bihl ML, Budach W, Feyer P, Harms W, Souchan R, et al. Accelerated partial breast irradiation: consensus statement of 3 German Oncology societies. Cancer. 2007 Sep 15;110(6):1187-94.
  48. Radiation oncology UCLA. Available from: http://radonc.ucla.edu/body.cfm?id=360.
  49. Radiation oncologists PC.  2011; Available from: http://www.radiation-treatment.com/specialties/brachy.html.
  50. Harris EER. Cardiac Mortality and Morbidity After Breast Cancer Treatment. Cancer Control. 2008;15(2):120-9.
  51. Kunkler I. Adjuvant irradiation for breast cancer. BMJ. 2000 June 3, 2000;320(7248):1485-6.
  52. Haybittle JL, Brinkley D, Houghton J, A'Hern RP, Baum M. Postoperative radiotherapy and late mortality: evidence from the Cancer Research Campaign trial for early breast cancer. British Medical Journal. 1989 June 17, 1989;298(6688):1611-4.
  53. Giordano SH, Kuo Y-F, Freeman JL, Buchholz TA, Hortobagyi GN, Goodwin JS. Risk of Cardiac Death After Adjuvant Radiotherapy for Breast Cancer. Journal of the National Cancer Institute. 2005 March 16, 2005;97(6):419-24.
  54. Orzan F, Brusca A, Conte MR, Presbitero P, Figliomeni MC. Severe coronary artery disease after radiation therapy of the chest and mediastinum: clinical presentation and treatment. British Heart Journal. 1993 June 1, 1993;69(6):496-500.
  55. Jin J-Y, Klein EE, Kong F, Li Z. An Improved Internal Mammary Irradiation Technique in Treatment of Locally Advanced Breast Cancers. Journal of Applied Clinical Medical Physics. 2005; 6(1):84-93.
  56. Sebag-Montefiore D, Hope-Stone H. Radiation induced coronary heart disease. British Heart Journal. 1993 June 1, 1993;69(6):481-2.
  57. Brosius FC, Waller BF, Roberts WC. Radiation heart disease: analysis of 16 young (aged 15-33 years) necropsy patients who received over 3500 rads to the heart. Am J Med. 1981;70:519-30.
  58. Cuzick J, Stewart H, Peto R, et al. Overview of randomised trials of postoperative adjuvant radiotherapy in breast cancer. Cancer Treat Rep. 1987;71:15-29.
  59. Haybittle JL, Brinkley D, Houghton J, A'Hearn RP, Baum M. Postoperative radiotherapy and late mortality: evidence from the Cancer Research Campaign trial for early breast cancer. BMJ. 1989;298:1611-4.
  60. Mosleh-Shirazi MA, Cornes PGS, Tait DM, Kamangari N, Ahmad R, JP G. Computation of cardiac dose in two-phase radiotherapy for esophageal cancer. Radiother Oncol. 2002;64(Supl 1):S77
  61. Cominos M, Mosleh-Shirazi MA, Tait D, Henrys A, Cornes P. Quantification and reduction of cardiac dose in radical radiotherapy for oesophageal cancer. Br J Radiol. 2005 Dec;78(936):1069-74.
  62. Buijsen J, Jager JJ, Bovendeerd J, Voncken R, Borger JH, Boersma LJ, et al. Prone breast irradiation for pendulous breasts. Radiother Oncol. 2007 Mar;82(3):337-40.
  63. Stegman LD, Beal KP, Hunt MA, Fornier MN, McCormick B. Long-term clinical outcomes of whole-breast irradiation delivered in the prone position. Int J Radiat Oncol Biol Phys. 2007 May 1;68(1):73-81.
  64. Chino JP, Marks LB. Prone positioning causes the heart to be displaced anteriorly within the thorax: implications for breast cancer treatment. Int J Radiat Oncol Biol Phys. 2008 Mar 1;70(3):916-20.