Fibrosis From Radiation for Breast Cancer

In breast cancer treatment, radiation fibrosis—scar tissue that forms as a result of damage caused by radiation therapy—can occur in the breast and chest wall. It can also strike the lungs and bones. It often begins with inflammation during radiation therapy and is most common in the first two years post-treatment, though it can occur up to 10 years after therapy is completed.

Fibrosis is a potentially painful, life-long condition, as the tissue changes are permanent. However, you have a lot of options for treating it, including medications, physical therapy, and more.

Why It Occurs

Radiation therapy kills cancer cells, but it also affects normal cells located near the cancerous ones. The DNA of these healthy cells can be damaged, and small blood vessels in the area may become damaged or sealed off, which restricts blood flow.

When the blood supply to the normal tissue is cut off, the tissue no longer gets the nourishment it needs to function properly. Cell damage combined with inadequate blood can cause scarring.

The breast and chest wall are commonly affected, given the focus of radiation for breast cancer treatment. It's become rare due to modern techniques, but radiation for breast cancer can cause fibrosis to:

• The lungs: Radiation pneumonitis and inflammation of the lung tissues may result from treatment. If not managed, these issues can lead to pulmonary fibrosis (fibrosis of the lungs).
• The bones: Radiation may cause damage that results in fibrosis in the ribs. On rare occasions, breast cancer survivors may experience rib fractures due to this side effect.

Fibrosis is common after radiation for other types of cancer as well, especially with cancers of the head and neck.

Symptoms

In the breast and chest, fibrosis can feel like a mass and make you worry that cancer has come back. Knowing about the possibility and symptoms of fibrosis can help ease that fear.

The typical symptoms and progression of breast and chest fibrosis are:

• Tenderness
• Redness
• Firmness (over time)

If pulmonary fibrosis is developing, symptoms may include:

• Shortness of breath
• Dry cough
• Unexplained weight loss
• Muscle and joint aches
• "Clubbing" of the fingers or toes (widening and rounding of the tips)

The ribs are a common area for fibrosis due to breast cancer treatment. When fibrosis affects bones, it can cause:

• Brittle bones that fracture easily
• Osteopenia (reduced bone mass)
• Osteoporosis (more severe loss of bone mass)
• Pain

To ease your mind and get early treatment, be sure to bring up possible symptoms of fibrosis or cancer recurrence with your doctor right away.

Diagnosis

Your doctor can diagnose fibrosis or RFS using a combination of techniques:

• Physical exam
• Evaluation of medical history
• Ultrasound
• Magnetic resonance imaging (MRI)
• Contrast computed tomography (CT)
• Electroneurography (ENG) or electromyography (EMG)

The specific imaging tests will depend on the location and nature of the symptoms.

Treatment

Fibrosis can't be cured, as it's a permanent change in the tissue, and there's no single treatment for it. Rather, treatment depends on the location and nature of your fibrosis and whether it's progressed to RFS, and it is aimed at preventing progression and maintaining or restoring function.

Several drugs already on the market for other uses have been shown to help prevent or slow fibrosis. They include:

• Gleevec/Glivec (imatinib)
• Zocor (simvastatin)
• Vasotec/Epaned (enalapril)
• Decadron/Dexasone/Didex/Hexadrol/Maxidex (dexamethasone)
• Esbriet (pirfenidone)

In rare cases where fibrosis leads to osteopenia or osteoporosis, doctors may prescribe bisphosphonate drugs, which are the standard treatment for those conditions.

If symptoms of fibrosis aren't bothersome or indicative of RFS, you may not need treatment. However, you should be closely monitored for signs that it's progressing. For mild discomfort, the American Cancer Society suggests:

• Over-the-counter pain relievers
• Heat
• Supportive, well-fitting bras

While research doesn't back this up, some women report fewer symptoms when they avoid caffeine and other stimulants.

For radiation fibrosis of the lungs, pulmonary rehabilitation may be helpful.

More severe symptoms may be treated with:

• Physical therapy to increase or maintain range of motion (look for someone certified in the STAR program for cancer rehabilitation)
• Deep friction massage to break down fibrotic tissues
• Medications to control inflammation, such as corticosteroids or interferon gamma
• Neuropathy medications such as Lyrica (pregabalin) or Cymbalta (duloxetine)
• Opioids for pain
• Muscle relaxants or trigger-point injections for spasms
• Botulinum toxin (Botox) injection for spasms and some types of neuropathy
• Vascular therapy with pentoxifylline drugs (Trental or Pentoxil) or hyperbaric oxygen
• Antioxidant treatment with superoxide dismutase or vitamin E (often combined with pentoxifylline)

Prevention

Researchers are looking at methods of preventing radiation fibrosis, both during radiation therapy and during the key period of the first two years after radiation therapy.

One prevention method is delivering higher doses of radiation to the tumor and lower doses to normal tissue. This is an area of active, ongoing research, so better methods may be found, as well.

In the past, it was thought that fibrosis was completely irreversible—but that thought is changing as doctors learn more about it.

Coping

While several treatment options may be available to you, you may still have to deal with symptoms long term. Communicate with your doctor about the full range of your symptoms, how debilitating they are, and what treatments do or don't seem to help.

As both a cancer survivor and someone dealing with a chronic condition, you may benefit from mental-health counseling. Many people in your situation get a lot out of support groups, as well.