What is radiation fibrosis? 5 things to know

Radiation therapy is a type of cancer treatment that uses high-energy beams to kill cancer cells. It can be used alone or in combination with other therapies. 

Sometimes, radiation can also impact normal tissues that are being treated, such as the skin, connective tissue, muscles, blood vessels and lymphatic vessels. This can cause radiation fibrosis, a late side effect of radiation treatment.

As a radiation oncologist specializing in breast cancer, I often discuss the risks of radiation therapy, including radiation fibrosis, with my patients. Here, I’ll share where in the body radiation fibrosis can occur, the symptoms of radiation fibrosis and how we can help treat it.

How common is radiation fibrosis in the breast?

The chance of developing radiation fibrosis after radiation therapy can depend on several factors, including:

• the volume of tissue being treated,
• the total dose and number of radiation treatments,
• radiation therapy treatment technique and
• characteristics specific to each patient, such as age, smoking history, body mass index and other medical conditions.

Thankfully, radiation treatment for breast cancer has come a long way, even in the past five to 10 years. With modern techniques and treatments, we have been able to minimize radiation dose to healthy tissues, leading to decreased severity and fewer cases of radiation fibrosis.

Where else can radiation fibrosis occur?

Radiation fibrosis can occur in any tissue that is treated with radiation. This includes:

• skin
• soft tissues
• lungs
• organs of the gastrointestinal tract, such as the esophagus and intestines
• organs of the genitourinary tract, including the bladder

What are the symptoms of radiation fibrosis?

Radiation fibrosis is a type of altered wound healing similar to what can occur with any injury. While cancer cells can’t survive after radiation injury, cells within normal tissues are affected but able to recover. Radiation exposure first leads to inflammation of the tissues and vessels. This inflammation can lead to the formation of scar-like fibrous tissue as well as damage to the blood and lymph vessels.

Radiation fibrosis symptoms and their impact can vary, depending on the disease site. For breast cancer patients receiving radiation, radiation fibrosis may include:

• a change in texture and thickening of the skin and soft tissues of the breast,
• feeling as though the treated breast is smaller and sits higher on the chest wall,
• decreased range of motion of the shoulder and/or
• swelling of the arm called lymphedema.

Does radiation fibrosis ever go away?

Radiation fibrosis can be difficult to reverse once it develops. But early treatment can help reduce symptoms to make them manageable.

How is radiation fibrosis managed?

Physical therapy, occupational therapy, stretching, exercise and massage therapy can all be helpful. MD Anderson patients can work with our physical therapists and massage therapists.

I also encourage patients to do daily massages of the breast at home to help break down scar tissue. Keeping the area well moisturized can also help decrease the long-term effects of radiation on the skin, including skin thickening or discoloration.

Unfortunately, we do not have strong evidence that medications can help to prevent or treat radiation fibrosis. While small clinical trials have suggested that combined treatments of pentoxifylline and vitamin E may help reduce fibrosis, larger clinical trials have demonstrated little to no benefit over no treatment alone.

For severe cases of radiation fibrosis, experimental treatments, such as botulinum toxin (botox) injections, hyperbaric oxygen therapy or laser therapy can be considered, depending on the severity, type of symptom and area of the body affected.

Preventive strategies, advanced radiation techniques and early treatment can decrease radiation fibrosis symptoms and help to ease your symptoms long-term. 

Chelain Goodman, M.D., Ph.D., is a breast radiation oncologist at MD Anderson.

Request an appointment at MD Anderson online or call 1-877-632-6789.