Radiation therapy (or radiotherapy) uses high-energy rays to stop cancer cells from growing and dividing. Radiation therapy is often used for IBC patients to destroy any remaining breast cancer cells in the breast, chest wall, or axilla (underarm) area after surgery. Occasionally, radiation therapy is used before surgery to shrink the size of a tumor. Radiation treatment may also be used to provide temporary relief of symptoms, or to treat malignancies (cancers) that cannot be removed with surgery.

The most common type of radiation therapy used on women with IBC is called external beam radiation. External beam radiation is delivered from a source outside the body on the specific area of the body that has been affected by the cancer. IBC patients usually receive it in the axillary (underarm) area as well as the affected breast area. They may also receive it in the supraclavicular (above the collarbone) area.

Before radiation therapy begins, the physician will measure the correct angles for aiming the radiation beam at the specific area of the body and make ink marks on the patient’s skin. Sometimes discreet tattoos the size of pinheads are placed on the chest to ensure the exact positioning and accuracy of the treatment. As part of treatment after breast surgery, patients are typically treated with radiation five times per week for at least six to seven weeks in an outpatient clinical setting.

High energy x-rays are skin sparing. Because IBC requires a need for skin irradiation because of skin involvement by the cancer cells, the addition of tissue-equivalent bolus material placed over the radiation field can circumvent skin sparing. Bolus, a flabby, rubbery material, is used to 'fool' the radiation beam so it will deposit the maximum dose on the skin surface instead of a fraction of an inch deeper, as it would otherwise. Therefore, a skin reaction is almost inevitable in this scenario. Bolus is usually incorporated into radiation therapy when a surgical scar, such as a mastectomy scar, needs to receive a full dose of radiation therapy.

Each treatment generally lasts a few minutes; the entire radiation session after machine set-up typically lasts 15 to 30 minutes. The procedure itself is pain-free. The IBC patient will lay on her back on the treatment table with the affected arm raised above her head. Patients are asked to remain still during the procedure. While the radiation is being administered, the technologist will leave the room and monitor the patient on a closed-circuit television. However, patients should be able to communicate with the technologist at any time over an intercom system.

Side effects of external beam therapy vary among IBC patients. These possible side effects depend on the dose and schedule of the radiation and the previous chemotheapy that the patient has received. Some patients require an antibiotic or steroidal cream or ointment. Some also need pain medication until a burn heals.

Patients who have received chemotherapy shortly before or during radiation therapy are more susceptible to a skin reaction, and the higher the dose of radiation therapy, the greater the risk of a skin reaction.

The side-effects include:

* Fatigue and malaise

* Erythema (reddened skin)

* Edema (swelling)

* Desquamation (The sloughing-off of the outer layer of skin)

* Hyperpigmentation (Increased skin pigmentation)

* Pruritus (Skin itching)

* Skin pain

* Atrophy

* Increased susceptibility to infection

* Neutropenia (reduction in white blood cells)

Radiation therapy of the axillary (underarm) lymph nodes may cause lymphedema (chronic swelling of the arm) in some IBC patients. Patients who have radiation to the lymph nodes will usually be instructed on arm exercises and other activities to help prevent lymphedema.

The following recommendations may help reduce pain from skin reactions to radiation therapy:

* Avoid any additional sun exposure to the area

* Wear loose-fitting clothing, preferably cotton or other material that 'breathes'

* Use warm or tepid water when bathing, rather than hot water

* Avoid constricting bras (if a bra must be worn at all)

* Use cool compresses (not cold or ice packs, as that may cause additional skin damage)

* Lotions or powders on the treated area are generally not recommended

* Specific creams should be approved by the radiation oncologist. Often, there should not be any substance on the skin that could affect the radiation treatment or lead to a more serious burn injury (such as oil).

* Patients should talk to their physicians about soothing oils or creams that may be allowed between (not during) treatment sessions.

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