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 may be permanent. However, you have a lot of options for treating it, including medications, physical therapy, and more.

This article explains what you need to know about radiation induced breast fibrosis, including its causes, symptoms, and treatment options.

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 healthcare provider right away.

Diagnosis

Your healthcare provider 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

It may not be possible to completely cure radiation-related fibrosis. Rather, treatment is aimed at preventing progression and maintaining or restoring function. The exact approach depends on the location and nature of your fibrosis and whether it's progressed to RFS. Options include medications, non-pharmacologic therapies, and other interventions.

Pentoxifylline is a drug that promotes blood flow in small blood vessels. It can be used alone or in combination with other medications (such as tocopherol or vitamin E) to prevent or treat radiation fibrosis. Clinical trials have shown that pentoxifylline can help minimize injury to the lungs, skin, and soft tissues in patients who have received radiation therapy. Pentoxifylline can also be used for treatment, and can partially reverse fibrosis of soft tissues.

Topical steroids, creams containing hyaluronic acid, and other creams or gels may help reduce skin-related symptoms of radiation therapy. Other drugs that may help reduce symptoms include over-the counter pain medications, opioids for pain, medications for neuropathy (such as pregabalin), and muscle relaxants or trigger-point injections for spasms. Botulinum toxin (Botox) injection may also be used for muscle spasms.

Non-pharmacologic therapies may also be helpful in alleviating symptoms. This includes application of heat and use of a supportive, well-fitting bra. Physical therapy can help increase or maintain range of motion, while conventional massage and deep friction massage can improve the appearance of skin and help relieve muscle spasms.

Small studies have looked at hyperbaric oxygen therapy for treatment of radiation fibrosis, with some benefit reported. Doctors have also explored surgical options. One of these is autologous fat grafting, in which surgeons remove fat from one part of your body and inject it into the radiated skin. This has shown some promise in rejuvenating affected skin and reducing radiation-related complications.

Prevention

Modern radiation therapy techniques have been developed with the aim of minimizing the risk of radiation fibrosis. Avoiding large single doses of radiation is helpful. Other strategies work by minimizing the amount of radiation delivered to healthy tissues around the tumor.

Intensity modulated radiation therapy (IMRT) is a technique, which uses imaging and computer-controlled beams to deliver radiation to the tumor only, and spare the tissue around it. Proton-beam therapy is another type of radiation therapy that precisely delivers radiation while avoiding normal structures around the tumor. Proton-beam therapy is relatively new, but is becoming more widely available around the country.

Coping

While several treatment options may be available to you, you may still have to deal with long term symptoms. Communicate with your healthcare provider 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.

Summary

Radiation therapy is an important tool for healthcare providers treating breast cancer. A drawback of treatment is the risk of fibrosis - scar tissue which may develop in the breast, chest wall, or underlying lung tissue. Radiation fibrosis can be long-lasting, and though it may not be possible to completely cure it, there are many treatment options which can improve symptoms and reverse some of the changes. Newer radiation treatment strategies can minimize the risk that radiation-fibrosis develops at all.

A Word From Verywell

Fighting cancer sometimes involves battling not only the disease itself, but the side effects of treatment. Radiation-induced fibrosis can be a long-lasting, painful side effect of radiation therapy. There are many treatment options, but some may work better than others, and finding the best combination may turn into a long journey.

Patients do best when they can advocate for themselves. Learn about treatment options and talk to your healthcare providers about your symptoms. Be clear about how debilitating they are, and tell them which treatments help and which do not.

Prioritize your mental health. You may benefit from counseling or support groups, which may be available in your area or online.