NCCN Guidelines for Patients® | Stages I and II Breast Cancer - page 54

NCCN Guidelines for Patients
®
Stages I and II Breast Cancer, Version 1.2014
52
5
Radiation therapy
Should I have radiation therapy?
Should I have radiation therapy?
Deciding factors
Using the surgery results, your doctors will rate
the extent of the cancer again. This is called the
pathologic stage. The sentinel and axillary lymph node
dissections allow your doctors to know how many
axillary lymph nodes have cancer. The number of
nodes with cancer is used to recommend which areas
of the body need radiation therapy.
Radiation therapy after lumpectomy
Surgery results
Where do I need radiation?
No cancer in lymph nodes
Radiation to the whole breast with or without added boost to tumor
site. Partial breast radiation may be used for some women.
Cancer in 1 to 3 axillary lymph nodes
Radiation to the whole breast with or without added boost to tumor
site. Strongly consider treating areas around the collarbone and
internal mammary lymph nodes.
Cancer in 4 or more axillary lymph
nodes
Radiation to the whole breast and areas around the collarbone with
or without added boost to tumor site. Strongly consider treating
internal mammary lymph nodes.
After a lumpectomy, most women receive radiation
therapy. However, some women may be able to go
without it. You may be able to have a lumpectomy
without radiation therapy if all the following qualities
describe you:
• You are 70 years old or older,
• The breast tumor was smaller than 2 cm,
• The cancer cells are hormone receptor–
positive,
• No cancer was found in your lymph nodes, and
• You will be taking hormone therapy.
If you need radiation therapy, the whole breast will be
treated. This is called whole breast radiation. Other
areas of the chest may also be treated if cancer cells
were found in your axillary lymph nodes. Radiation
therapy should be given to the internal mammary
lymph nodes if tests suggest cancer is present.
However, even when test results show no cancer,
your doctors may still want to treat this area. Other
possible radiation sites are above and below the
collarbone. See
Figure 8
for possible treatment areas
other than the breast.
Radiation boost
Toward the end of radiation, you may receive extra
radiation called a boost. A boost is recommended if
you are 50 years old or younger, cancer was found in
your axillary lymph nodes, or there are cancer cells
close to the edge of the surgical margin. The boost
may be given with EBRT or by internal radiation.
Internal radiation is also called brachytherapy. It
involves placing radioactive seeds in the area where
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