Adverse Effects of Breast Irradiation

Rodrigo Arrangoiz MS, MD, FACS, FSSO
  • Tri-modality therapy for patients with breast cancer can result in complications
  • In women undergoing adjuvant radiation therapy, treatment of the regional nodes:
    • Is associated with higher rates of lymphedema
  • The published MA-20 trial:
    • Found an 8.4% rate of lymphedema with regional nodal irradiation compared with 4.5% without
  • As a part of the toxicity discussion a patient has with her provider, it is worth noting that there is no strong evidence of worse lymphedema:
    • When comprehensive post mastectomy RT is delivered using hypofractionation versus conventional fractionation:
      • Analysis of the START trials found no difference in shoulder stiffness (11% standard fractionation vs.14% hypofractionation), difficulty raising arm (17% standard fractionation vs. 14% hypofractionation), lymphedema (11% standard fractionation vs. 6% hypofractionation)
  • Shoulder dysfunction:
    • Can also be seen in patients requiring regional nodal irradiation:
      • With data documenting significant differences in shoulder function in patients with a history of breast cancer
  • Breast edema:
    • Can be noted acutely during radiotherapy as well as chronically following treatment:
      • With toxicity rates of 5%
  • There is evidence supporting an increased risk of ischemic heart disease in the years following breast radiotherapy:
    • Albeit with some criticism as these conclusions were largely based on antiquated radiation techniques
  • No data suggest an increased risk of pulmonary embolus with radiation for breast cancer
  • References
    • Shah C, Vicini FA. Breast cancer-related arm lymphedema: incidence rates, diagnostic technique, optimal management, and risk reduction strategies. Int J Radiat Oncol Biol Phys. 2011;81(4):907-914.
    • Whelan TJ, Olivotto IA, Pareulekar WR, et al. Regional nodal irradiation in early-stage breast cancer. N Engl J Med. 2015;373(4):307-316.
    • Haviland JS, Manino M, Griffin C, et al. Late normal tissue effects in the arm and shoulder following lymphatic radiotherapy: results from the UK START (Standardisation of Breast Radiotherapy) trials. Radiother Oncol. 2018;126(1):155-162.
    • Harrington S, Padua D, Battaglini C, et al. Comparison of shoulder flexibility, strength, and function between breast cancer survivors and healthy participants. J Cancer Surviv. 2011;5(2):167-174.
    • Hille-Betz U, Baske B, Bremer M, et al. Late radiation side effects, cosmetic outcomes, and pain in breast cancer patients after breast-conserving surgery and three-dimensional conformal radiotherapy: risk modifying factors. Strahlenther Onkol. 2016;192(1):8-16.
    • Darby SC, Ewertz M, McGale P. Risk of ischemic heart disease in women after radiotherapy for breast cancer. New Engl J Med. 2013;368(11):987-998.
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Published by Rodrigo Arrangoiz MS, MD, FACS, FSSO

My name is Rodrigo Arrangoiz I am a breast surgeon/ thyroid surgeon / parathyroid surgeon / head and neck surgeon / surgical oncologist that works at Center for Advanced Surgical Oncology in Miami, Florida. I was trained as a surgeon at Michigan State University from (2005 to 2010) where I was a chief resident in 2010. My surgical oncology and head and neck training was performed at the Fox Chase Cancer Center in Philadelphia from 2010 to 2012. At the same time I underwent a masters in science (Clinical research for health professionals) at the University of Drexel. Through the International Federation of Head and Neck Societies / Memorial Sloan Kettering Cancer Center I performed a two year head and neck surgery and oncology / endocrine fellowship that ended in 2016. Mi nombre es Rodrigo Arrangoiz, soy cirujano oncólogo / cirujano de tumores de cabeza y cuello / cirujano endocrino que trabaja Center for Advanced Surgical Oncology en Miami, Florida. Fui entrenado como cirujano en Michigan State University (2005 a 2010 ) donde fui jefe de residentes en 2010. Mi formación en oncología quirúrgica y e n tumores de cabeza y cuello se realizó en el Fox Chase Cancer Center en Filadelfia de 2010 a 2012. Al mismo tiempo, me sometí a una maestría en ciencias (investigación clínica para profesionales de la salud) en la Universidad de Drexel. A través de la Federación Internacional de Sociedades de Cabeza y Cuello / Memorial Sloan Kettering Cancer Center realicé una sub especialidad en cirugía de cabeza y cuello / cirugia endocrina de dos años que terminó en 2016.

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