What Are the Side Effects of Breast Radiotherapy, and How Can They Be Reduced?

In breast cancer treatment, radiotherapyis one of the 3 most commonly used treatments, together with chemotherapy and surgery. Breast radiotherapy has various purposes, but its most common use, after breast-conserving surgery, is adjuvant (to reduce cancer recurrence) irradiation of the breast and armpit. While the side effects of chemotherapy and breast cancer surgery are well known, information about the side effects of radiation therapy and how to manage them is limited. 

-Related topic: What Is Radiotherapy / Radiation Therapy, How Is It Administered and What Types Are There? (Detailed)

This article provides information on breast cancer radiotherapy's 

• short-term side effects, 
• long-term side effects, 
• rare side effects and 
• what can be done to reduce them.

There are two main types of radiotherapy (radiation therapy):

• External radiotherapy: Radiation treatment is delivered from an external machine to the breast and surrounding tissue. It is the most frequently preferred treatment method in breast cancer.
• Internal radiation (brachytherapy): This involves placing small radioactive pellets/seeds in the body for a short time.

The right treatment for breast cancer depends on many factors, including the cancer type and stage and the patient's age and general health. The medical oncologist, together with the breast cancer treatment team, patient and relative, will decide on the best treatment for the patient.

Short-term / early side effects of breast radiotherapy

Short-term side effects occur during or immediately after treatment, generally within 6 months.

Common short-term side effects include:

• Pain: Some people feel mild discomfort or pain around the breast or stiffness in the shoulder area. Over time, treatments should become less uncomfortable.
• Skin changes: Skin damage is a common side effect of radiation therapy, and a good skincare routine is important during treatment. Skin changes may include:
  • color changes (redness, darkening)
  • peeling or flaking
  • dry, itchy or burning skin
  • blisters
  • excessive moisture and weeping skin
• Swelling: The breast or surrounding tissue may become swollen or inflamed. Swelling should decrease a few weeks after treatment ends.
• Loss of hair in the armpit or chest: When a doctor applies radiation to lymph nodes in the armpit and chest area, it may cause hair loss in these areas (radiotherapy to the head also causes temporary scalp hair loss). 
• Sore throat: Radiation to lymph nodes around the collarbone may cause a sore throat or difficulty swallowing. This should improve when treatment is completed.
• Fatigue: Radiation may make the patient feel tired. Being in hospital and receiving other treatments such as chemotherapy may worsen this fatigue. Getting as much sleep and rest as possible during treatment is important.

- Related topic: Weakness and Fatigue in Cancer: What Causes Them and How Are They Treated?

Long-term side effects of breast radiotherapy

Long-term side effects appear months or years after treatment ends. They may include: 

• Breast changes: Breasts may become smaller or denser after radiation. Some women have reported breastfeeding problems.
• Brachial plexopathy: Radiation to the breast or chest wall may sometimes damage nerves running through the arm, wrist and hand. Nerve damage may cause numbness, pain or weakness in the area.
• Lymphedema: Lymphedema is swelling of the arm, hand or breast. Radiation may sometimes damage lymph nodes and cause lymph fluid to accumulate.

- Related topic: Advances in Surgical Treatment of Lymphedema

Rare side effects of radiotherapy in breast cancer

Rare side effects of radiation treatment may include: 

• Nausea: Radiation may cause nausea, but this side effect is very rare.
• Rib fracture: Radiation therapy may weaken ribs, causing fractures or making them more prone to fracture. However, with new treatment protocols and new radiotherapy devices , this is very rare in practice. 
• Heart problems: When older radiotherapy devices could not focus irradiation on a particular organ, cases of heart damage were reported with radiotherapy to the left breast. With new radiotherapy devices, this is now another side effect we almost never see. 
• Lung problems: Very rarely, radiation causes lung inflammation. The medical term is radiation pneumonitis, and its symptoms include shortness of breath, cough and low-grade fever. 
• A second (secondary) cancer: In very rare cases, radiation exposure may increase the risk of developing a secondary cancer .

Below, possible side effects of radiotherapy in breast cancer are illustrated.

What Can Be Done to Reduce the Side Effects of Breast Radiotherapy?

The benefits of radiation therapy for breast cancer far outweigh its risks, so do not hesitate to receive radiotherapy if your doctor considers it necessary. Breast-conserving cancer surgery is generally followed by adjuvant (preventive) radiotherapy lasting 4-5 weeks.

The following methods will help you get through radiotherapy more easily:

• Continuing light daily tasks, while having assistance with some tasks from a caregiver , may help reduce stress and fatigue.
• Using heating pads and ice packs may help a person manage pain and soreness following radiation treatment.
• Wearing loose / nonrestrictive clothing and applying moisturizer may help reduce discomfort from skin changes. To reduce stress and fatigue, a person may try:
• meditation
• eating a nutritious diet with lean protein and plenty of vegetables
• doing light exercise daily, even a short walk 
• having regular massages 
• yoga 
• keeping a mood and symptom diary 
• joining a support group 
• psycho-oncology support from a psychiatrist or psychologist specializing in this field

Any side effect, especially one experienced for the first time, should be reported to the oncologist or oncology nurse ; reporting it is very important. 

Related Topic

Music, Meditation and Yoga: Complementary Treatments in Breast Cancer Should Be Supported