I. Radiotherapy after breast-conserving surgery for breast cancer
Radiotherapy is required after breast-conserving surgery. The specific scope of irradiation is as follows.
For negative axillary lymph nodes, whole breast irradiation + tumor bed push irradiation.
For 1-3 positive axillary lymph nodes, whole-breast irradiation + tumor bed push irradiation, and consider radiotherapy to the supraclavicular region, and consider internal breast lymph node irradiation if the internal breast lymph nodes are clinically or pathologically positive.
If there are more than 4 positive axillary lymph nodes, whole breast irradiation + tumor bed thrust irradiation + supraclavicular irradiation should be performed, and internal breast lymph node irradiation should be considered if the internal breast lymph nodes are clinically or pathologically positive.
Radiation therapy after radical surgery and modified radical surgery for breast cancer
1. Those with more than 4 metastases or subclavian lymph nodes with metastases should be radiated, irradiating the chest wall and supraclavicular area. If the internal breast lymph nodes are clinically or pathologically positive, consider irradiating the internal breast lymph nodes.
2.Radiotherapy is recommended for 1-3 metastases in axillary lymph nodes (controversial), irradiating the supraclavicular and chest wall, and consider internal breast lymph node irradiation if the internal breast lymph nodes are clinically or pathologically positive.
3, Axillary lymph node negative but tumor size more than 5 cm or positive cut margin, irradiate chest wall.
4.With lymphatic vessels or vascular cancer emboli, consider chest wall radiotherapy.
Generally, radiotherapy is not done in the axilla to avoid serious complications, but for those who have residual lesions in the axilla, which are difficult to be removed by surgery more than 2cm, or those who have cancer embolus formation in the axillary vessels, axillary irradiation can be added.
Radiation therapy for simple local recurrence of breast cancer
Patients who have undergone total mastectomy should undergo excision of local lesions and radiotherapy of the involved area (provided that there is no previous radiotherapy, or additional radiotherapy is safe). Radiation therapy should be given to unresectable recurrent chest wall lesions that have not received prior radiation therapy. Patients who have recurred after breast-conserving surgery should undergo total mastectomy. After local treatment, chemotherapy or endocrine therapy should be considered.
Side effects of radiotherapy for breast cancer and their management
Radiotherapy can cause different degrees of side effects for each breast cancer patient, some of them are mild, some have no obvious symptoms, while some patients have severe reactions. The most common side effects are
(1) Fatigue.
②Dry or itchy or cracked or blistered skin.
③Produce digestive system reactions such as nausea, stomach pain, abnormal taste, and loss of appetite.
④ Other side effects, such as loss of axillary hair for brain radiotherapy, dry mouth and tinnitus for head radiotherapy, and dry cough without sputum and itchy throat for pleural and lung radiotherapy.
Once the above mentioned side effects occur during radiotherapy, most of them will disappear with time, and some of them can be reduced after treatment and life conditioning. If the side effects are particularly serious, radiotherapy can be interrupted. The following are the relevant, simple and practical treatment methods for reference.
(1) Fatigue: Fatigue is caused by the great energy consumed by the body during radiotherapy, as well as the effect of radiotherapy on normal cells. When patients feel fatigue, they should take sufficient rest, arrange their life well, and ensure sleep and sufficient nutritional supplements.
(2) Skin side effects: Clear oil can be used to deal with dry skin, and some corn flour can be withdrawn if the skin is too moist. When the skin reddens or turns brown, pay attention not to expose the treatment area to sunlight, and it usually disappears within a few weeks after the radiotherapy is finished. If you find skin cracking and blistering, you must seek medical treatment. Do not use powder, creams, ointments and many other commercially available skin care products indiscriminately.
(3) Axillary hair loss: It is difficult to prevent hair loss, but after radiation therapy, hair will grow back in the axilla of most patients.
(4) Gastrointestinal reactions: Good eating habits, nutritious meals and recipe variety may stimulate appetite and make it improve. If the gastrointestinal reaction is severe, radiotherapy may be discontinued.