Re: Radiation therapy

["Gibbs, S Julian" <s.julian.gibbs@vanderbilt.edu>]

"Lumpectomy" followed by radiation therapy is now 
recognized as a standard treatment for breast cancer, when 
it is diagnosed while still localized.  This treatment has 
been found as effective as radical mastectomy, and the 
breast is preserved.  It also avoids the functional 
impairments to the involved shoulder and arm that result 
from interruption of lymphatic drainage that accompanies 
the radical surgery.  This treatment is now more than 20 
years old.
The radiation dose to the remainder of the involved breast 
is typically 50-60 Gy, delivered over 5-6 weeks at 5 
treatments per week.  The dose is highly localized; scatter 
to the body is a very small fraction of the breast dose.  
Common deterministic biological effects are darkening of 
the skin and fibrosis (scarring) of the breast.  The result 
is a firmer but slightly smaller breast.  [Many women like 
this result and some even ask to have the other breast 
irradiated to firm it up.]  There is a small risk of 
induction of a second primary cancer, years to decades 
later.  Most find this risk acceptable if the benefit is 
elimination of a known, potentially lethal cancer.  Many 
patients will be dead of unrelated causes (heart 
disease, etc.) before the second primary becomes 
manifest.  It has been known for years that women with 
breast cancer are at increased risk of a second primary in 
the other breast--regardless of treatment or lack thereof.

***********************************************************
S. Julian Gibbs, DDS, PhD               Voice: 615-322-1477
Professor, Emeritus                       FAX: 615-322-1474
Dept. of Radiology & Radiological Sciences
Vanderbilt University Medical Center
209 Oxford House
Nashville TN 37232-4245        Email:j.gibbs@vanderbilt.edu
***********************************************************
The American Republic will endure until the day Congress
discovers that it can bribe the Public with the Public's money."
                                       Alexis de Tocqueville
                                       Democracy in America



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