Late Toxicity of Radiotherapy: A Problem or a Challenge for the Radiation Oncologist?

Abstract

Background: Large randomized clinical trials have established radiotherapy in conjunction with adjuvant systemic treatment as standard treatment in breast cancer after both mastectomy and lumpectomy. Although standard radiation therapy is well tolerated by the majority of patients, some patients might suffer from late normal tissue effects. Methods: The literature on radiotherapy following surgery of breast cancer was reviewed with regard to late toxicity. Results: Radiotherapy may, to some degree, cause persistent pain in the breast, arm and shoulder in up to 30–50% of patients after 3–5 years, lymphedema in 15–25%, and restriction of arm and shoulder movement in 35%. Awareness of cardiotoxicity is needed since anthracyclines, trastuzumab, and radiotherapy may cause damage to the heart. However, using modern radiotherapy techniques, the available evidence does not suggest a higher incidence of cardiac mortality. Conclusions: This review updates the database on toxicity from radiation in breast cancer. Advances in research of radiation-induced late effects may lead to improved treatment choices for breast cancer patients including radiotherapy and may improve quality of life after surviving breast cancer.

Arabinoxylan rice bran (MGN-3/Biobran) provides protection against whole-body -irradiation in mice via restoration of hematopoietic tissues

“…However, effective use of ionizing radiation is compromised by the side effects that result from radiation-induced damage to normal tissue [1]. Vulnerability of exposure to ionizing radiation is of great concern to patients and medical personnel in the occupational setting (radiotherapy technicians, dental assistants, and research personnel).…”

Cardiac Toxicity after Radiotherapy for Breast Cancer: Myths and Facts

“…Even in the combination of radiation therapy and chemotherapy with cardiotoxic drugs (e.g. anthracyclines, trastuzumab), no increased risk due to radiotherapy was observed [25,26,27]. The cardiac risk of radiotherapy in breast cancer is certainly less than the risks of several drug therapies.…”

Die lokale Therapie des Mammakarzinoms als Mitinitiator für die Entwicklung eines ipsilateralen Milwaukee-Schulter-Syndroms?

“…EBAUGH et al [18] erwähnen eine in der Literatur dokumentierte breite Streuung der Prävalenzen für SchA-Schmerz von 9 -68 %, Bewegungseinschränkung von 1 -67 %, Kraftminderung von 9 -33 % und Lymphödem von 6 -70 %. PETERSEN et al [22] zeigen in ihrem Review, dass die Strahlentherapie 3 -5 Jahre nach der MCa-Behandlung bei 30 -50 % der Patientinnen bleibende Schmerzen im Bereich der Brust und der Schulter-Arm-Region mit einer Einschränkung der Schulterbeweglichkeit in bis zu 35 [23,24]. VERONESI et al [25] zeigten 2003 in einem prospektiven randomisierten Vergleich zwischen ALND und SLNB nach zwölf Monaten, dass axilläre Schmerzen in 39 % versus (vs.) 8 %, dauerhafte Schmerzen in 5 % vs. 1 %, Beweglichkeitseinschränkungen in 21 % vs. 0 %, Taubheitsgefühl in 68 % vs. 1 % und eine Armumfangsdifferenz über 2 cm in 12 % vs. 0 % (leichte Schwellung in 63 % vs. 7 %) vorkommen.…”