Breast Fibrosis From Radiation Therapy for Breast Cancer

Radiation fibrosis is simply fibrosis—scar tissue—which forms in the breast and chest wall as a result of damage caused by radiation therapy for breast cancer. Fibrosis often begins with inflammation during radiation therapy and it's most common in the first two years post-treatment, but 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.

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.

Breast cancer radiation treatments often affect:

• The lungs: Radiation can cause radiation pneumonitis in the lungs and inflammation of the lung tissues. If untreated, that can lead to pulmonary fibrosis (fibrosis of the lungs).
• The bones: Radiation may cause damage resulting 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.

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 fibrosis are:

• Tenderness
• Redness
• Eventually, the area becomes firm

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)

Radiation can make bones brittle and prone to injury. Fibrosis in the ribs can make the bones fracture easily. Osteopenia (reduced bone mass) and osteoporosis (more severe loss of bone mass) may result, as well.

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.

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.

Fibrosis can't be cured, as it's a permanent change in tissues, and there's no single treatment for it. Treatment is aimed at preventing further fibrosis 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:

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

If symptoms aren't bothersome, you may not need treatment. For mild discomfort, The American Cancer Society suggests:

• Over-the-counter pain relievers
• Heat
• Supportive, well-fitted 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)

Treatment depends on the location and nature of your fibrosis and whether it's progressed to RFS.

Researchers are looking at methods of preventing radiation fibrosis in the breast, both during radiation therapy and during the first two years after radiation therapy when much of this scar tissue forms.

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.

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.

Remember, you've beat breast cancer. You can manage fibrosis.