Radiation Treatment Side Effects

During the course of therapy, patients commonly experience erythema, irritation and tenderness of the treated breast. Occasionally, there is blistering in the inframammary and anterior axillary region. Our policy on skin care is to utilize emollients copiously from the first day of therapy. Patients are carefully evaluated with regard to the fit of their bras and areas of constriction, and irritations are carefully monitored so that the patient may alter the type of undergarment worn, if necessary.

Utilizing this type of rigorous attention to skin care, approximately 10% of patients will have small areas of moist desquamation, and treatment will virtually never need to be stopped to permit such areas to heal. In addition, fatigue is a common component of therapy and may last as long as 6 months after the completion of therapy.

Long-term side effects of radiation are uncommon. Radiation pneumonitis is stated to occur in 2-3% of patients and is a transient inflammation of the small volume of pulmonary tissue in the radiation fields.

The area of lung that becomes inflamed is that directly beneath the anterior rib cage. Symptoms mimic those of pneumonia or bronchitis: cough, shortness of breath, pleuritic chest pain and fever. This side effect, when it occurs, will occur within 1 month of the completion of therapy. Moderate tapering doses of corticosteroids are adequate treatment for this condition.

In patients with normal pulmonary functions prior to treatment, this condition should be self-limiting and of no long-term consequence. It is important to remember that even patients who do not experience clinical pneumonitis may have radiographic changes at the anterior aspect of the ipsilateral lung. Occasionally, radiologists who are called upon to read a chest x-ray or computed tomography (CT) scan in such patients, and who are not provided with a full clinical history, will misinterpret these changes as other pulmonary disorders.

Therefore, it is most important for patients to understand that a small segment of lung tissue will not function properly after radiation, will appear radiographically scarred and, in rare cases, may result in a clinical syndrome of radiation pneumonitis.

Up to 2% of patients are reported to have rib fractures due to accelerated osteoporosis involving the ipsilateral anterior rib cage. Again, this is a self-limiting condition and will usually heal over time. The patient remains at risk for this occurrence over the remainder of her life. {pagebreak}

The rate of lymphedema in patients who have had limited axillary dissections is reported to be approximately 5%. Due to the fact that radiation fields need to encompass the axillary tail of breast tissue, a small portion of the axillary contents are usually irradiated, and this will result in a small increase in the rate of lymphedema to approximately 7%.

An important component of the long-term follow-up for patients who have undergone breast-conservation surgery utilizing radiation is evaluation for early evidence of lymphedema. When dealt with promptly, while at a subtle stage, this condition can almost always be controlled and, frequently, reversed entirely.