Radiation therapy is an effective part of breast cancer treatment, but it can cause long-term changes in the treated tissues. One potential side effect is radiation fibrosis, the development of firm, scarred tissue in the radiated area. This non-cancerous condition results from the healing process in healthy tissues that were exposed to radiation during treatment.
The scarring can develop months or even years after therapy is completed. While the changes to the tissue can be permanent, they do not signify a return of the cancer, and management options are available to address symptoms.
The Biological Process of Fibrosis
Radiation therapy damages cancer cells but also affects healthy surrounding tissues, triggering an overactive wound healing response. The initial damage leads to an inflammatory phase, where the body sends immune cells and releases signaling proteins called cytokines. This inflammation, which is a normal part of healing, can become prolonged and excessive after radiation.
This persistent inflammatory environment stimulates specialized cells known as fibroblasts. In radiation fibrosis, these fibroblasts become overly active and produce an excessive amount of collagen and other components of the extracellular matrix. This leads to the buildup of dense, disorganized scar tissue that is harder and less flexible than normal breast tissue.
Several factors can influence an individual’s risk of developing radiation fibrosis. The total dose of radiation and the size of the treatment area are primary considerations. Receiving chemotherapy at the same time as radiation can also increase the likelihood of fibrosis, and some individuals may have a genetic predisposition to scarring.
Identifying Symptoms and Changes
Recognizing the signs of radiation fibrosis is important, as symptoms often develop gradually months or years after treatment. A medical evaluation is needed to confirm the cause of any changes, as some symptoms can be mistaken for other issues. Common signs include:
- A noticeable change in breast texture, where the tissue feels unusually firm, hard, or dense to the touch.
- Pain or tenderness in the treated breast, which can range from a dull ache to sharp pains and may include muscle tightness in the chest wall.
- Skin changes in the radiated area, which can become thicker, less elastic, and sometimes take on a leathery feel or appear discolored.
- Shrinking or distortion of the breast’s shape, causing it to appear smaller than the other breast or sit higher on the chest wall.
- Lymphedema, which is swelling in the breast, chest, or adjacent arm caused by damage to the lymphatic system’s ability to drain fluid.
Diagnostic Procedures
When a person has symptoms of radiation fibrosis, a healthcare provider performs a thorough clinical evaluation. This includes a physical examination of the breast and a review of the patient’s medical history, particularly their cancer treatment details. The primary goal is to confirm the tissue changes are from fibrosis and not a cancer recurrence.
Imaging tests are a standard part of this evaluation. A mammogram is often used and typically shows fibrosis as an area of increased density. An ultrasound may also be performed to get a different view of the tissue’s texture and help distinguish between solid masses and cysts.
If imaging is inconclusive, a magnetic resonance imaging (MRI) scan may be recommended. An MRI provides highly detailed images and is effective at differentiating between post-radiation scarring and a potential malignancy.
Management and Treatment Approaches
Once a diagnosis of radiation fibrosis is confirmed, the focus shifts to managing symptoms and improving quality of life, as the tissue changes may not be completely reversible. A range of treatment strategies is available and often used in combination.
Physical and Manual Therapies
Physical and manual therapies are used to address the physical limitations caused by fibrosis by increasing tissue mobility and reducing pain. A physical therapist specializing in oncology rehabilitation can create a personalized program of stretching exercises to lengthen tightened muscles. Manual therapies like myofascial release, which involves applying sustained pressure, can help break down scar tissue and improve flexibility. For lymphedema, manual lymphatic drainage can reduce swelling by redirecting fluid.
Medical Treatments
Medical treatments may also be considered to help soften the fibrotic tissue. The most studied option is a combination of pentoxifylline, a drug that improves blood flow, and tocopherol (a form of vitamin E). This combination is thought to work by reducing inflammation and inhibiting the cellular processes that lead to excessive collagen production. While some studies show benefits, results vary, and this treatment is not effective for everyone.
Surgical Interventions
For severe cases that cause significant pain, distortion, or functional impairment, surgical interventions may be an option. Fat grafting, also known as lipomodeling, is a procedure where fat is taken from another part of the body and injected into the breast. This can help soften hardened tissue and improve the breast’s contour. In very rare instances where symptoms are extreme and do not respond to other treatments, a mastectomy to remove the affected tissue might be considered.