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A. Depending on exactly where you receive radiation, a number of sideeffects can occur either on a temporary, long-term, or delayed basis. They include changes in sensation , secretions , taste, and range of motion . These sideeffects can then affect key.
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Change In Breast Shape Size And Colour
If youve had radiotherapy after breast-conserving surgery, the breast tissue on the treated side may feel firmer than before, or the breast may be smaller and look different.
Although this is normal, you may be concerned about differences in the size of your breasts, or worry that the difference is noticeable when youre dressed.
You can discuss this with your breast surgeon to see if anything can be done to make the difference less noticeable.
What Can I Expect During Radiation Treatment
I went to radiation therapy every day for five weeks. It was a really simple and fast process.
I arrived each day around 9:00 in the morning and went straight back to the changing rooms. I had to wear a gown from the waist up.
They also made me take off my wig and hat during my sessions. Since I was just in the beginning stages of hair growing out after chemo, my head was still pretty bald.
I was a bit overcome with emotion during my first treatment. You lay on the machine in a room by yourself. I felt really exposed with my arms above my head, my breasts out in the open, and my head coverings removed.
My mind couldnt help but wander since there was nothing else I could really do. They played music into the room, so I eventually tried to just focus on that.
During the treatments, I laid perfectly still and held my breath or breathed whenever the therapists asked over the intercom. The machine moved to different spots over my body. I didnt feel any pain or anything during this process.
My left arm did get pretty numb a few times. This is the arm where four lymph nodes had been removed. My circulation wasnt the greatest in this arm so it fell asleep really easily. I cant imagine what it must be like for people who have way more than four nodes removed!
The numbness got a bit worse with radiation treatment, but it is normal now that its over. So, if you are dealing with a tight arm, know that there is an end in sight!
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These Steps Can Help:
- Gently cleanse the treated area using lukewarm water and a mild soap. Donât rub your skin. Pat it dry with a soft towel, or use a hair dryer on a cool setting.
- Donât scratch or rub the treated area. Use only an electric razor if you need to shave there. Donât put on medical tape or bandages.
- Donât apply any ointment, cream, lotion, or powder to the treated area unless your doctor or nurse has prescribed it. This includes cosmetics, shaving lotions, perfumes, and deodorants.
- Choose clothes made from natural fibers like cotton rather than tight-fitting clothing or harsh fabrics like wool or corduroy.
- Avoid extreme heat or cold where youve had radiation no electric heating pads, hot water bottles, or ice packs.
- Also avoid hot tubs and tanning beds.
- Stay out of direct sunlight, especially between the hours of 10 a.m. and 2 p.m., even after youre done with treatment. The sun can intensify skin reactions and lead to severe sunburn. Choose a sunscreen of SPF 30 or higher. Wear protective clothing, such as a long-sleeved shirt, pants, and a wide-brimmed hat, too.
Side Effects Of Radiotherapy For Breast Cancer
Radiotherapy can cause side effects in the area of your body that is being treated. You may also have some general side effects, such as feeling tired.
After treatment finishes, it may be 1 to 2 weeks before side effects start getting better. After this, most side effects usually slowly go away.
Your cancer doctor, specialist nurse or radiographer will tell you what to expect. They will give you advice on what you can do to manage side effects. If you have any new side effects or if side effects get worse, tell them straight away.
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How Radiation For Breast Cancer Works
Radiation therapy kills cancer cells by destroying the genetic material that causes them to rapidly grow and divide. But Dr. Kim says this is a delicate balance, given that both healthy and cancerous cells are damaged in the process of this treatment. Even though normal cells can repair much of the damage caused by radiation, the goal is to destroy as few healthy cells and cause as little harm as possible.
Thankfully, breast cancer happens to be very sensitive to radiation, so not much is needed to control the disease or stop it in its tracks. Radiation is very effective at treating cancer cells, which typically divide quicker, whereas normal tissues are affected to a much lesser degree, says Dr. Mutter. So were able to give a relatively modest dose of radiation after surgery to reduce the risk of breast cancer recurrence.
Details Of The Trial And Results
The Mount Sinai researchers had previously developed a personalized genomic cancer vaccine, PGV-001, which showed promise in a phase 1 trial in 13 patients with solid tumors or multiple myeloma and a high risk of recurrence after surgery or autologous stem cell transplant.
Next, they worked to develop the concept further to turn the tumor into its own vaccine, which involved inducing anti-tumor responses in indolent NHL, which typically responds poorly to checkpoint blockade, by combining Ft3L, low-dose irradiation, and poly-ICLC.
The next phase 1 trial showed that this approach was feasible, but preclinical modeling suggested that the addition of PD-1 blockade could improve the cure rates. The researchers therefore conducted the current trial, recruiting 10 patients with indolent NHL, metastatic breast cancer, or head and neck squamous cell carcinoma .
Patients were given local radiation therapy on days 1 and 2, and intramural Ft3L to the same tumor on day 9, followed by eight intravenous injections of poly-ICLC over 6 weeks. On day 23, they received their first of eight doses of pembrolizumab.
He explained that Ft3L is a human growth factor that simulates dendritic cells, “which I always say are the professor cells of the immune system,” as they tell the body “what’s good and what’s bad.”
All patients experienced treatment-related adverse events, largely comprising low-grade injection site reactions and flu-like symptoms linked to the poly-ICLC injections.
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If You Have Side Effects
Let your doctor or nurse know if you have side effects or are worried about anything.
When treatment ends you usually have regular appointments for about 5 years afterwards. You can talk to your doctor or nurse at these appointments. But you dont have to wait for your next appointment if you get a new side effect or are worried about anything. You can bring the appointment forward.
National Institute for Health and Care Excellence June 2018
Treatment of primary breast cancerScottish Intercollegiate Guidelines Network, September 2013
Postoperative radiotherapy for Breast Cancer: UK consensus statement
The Royal College of Radiologists, 2016
Early Breast Cancer: ESMO Clinical Practice Guidelines 2019F Cardoso and others
Heart And Lung Problems
Because of the location of your heart and lungs in relation to your breasts, radiation has the potential to cause heart and lung problems down the road though this is far less common than the other side effects weve covered, as radiation has improved significantly over the years.
Radiation can harm your heart by causing your arteries to harden or your heartbeat to become irregular, or it can inflict valve damage.
If your lungs are affected, this can present as chest pain, shortness of breath, or a cough or you may show no symptoms at all and the lung inflammation may only be caught on an x-ray. Symptoms typically dissipate on their own, but sometimes patients are given medications to ease the inflammation. If left untreated, the inflammation can turn ugly and cause pulmonary fibrosis, which is a permanent scarring of the lungs that can affect breath capacity.
However, todays techniques have advanced to the point where the heart and lungs are typically not affected by radiation treatment.
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Accelerated Partial Breast Irradiation
After whole breast radiation or even after surgery alone, most breast cancers tend to come back very close to the area where the tumor was removed . For this reason, some doctors are using accelerated partial breast irradiation in selected women to give larger doses over a shorter time to only one part of the breast compared to the entire breast . Since more research is needed to know if these newer methods will have the same long-term results as standard radiation, not all doctors use them. There are several different types of accelerated partial breast irradiation:
- Intraoperative radiation therapy : In this approach, a single large dose of radiation is given to the area where the tumor was removed in the operating room right after BCS . IORT requires special equipment and is not widely available.
- 3D-conformal radiotherapy : In this technique, the radiation is given with special machines so that it is better aimed at the tumor bed. This spares more of the surrounding normal breast tissue. Treatments are given twice a day for 5 days or daily for 2 weeks.
- Intensity-modulated radiotherapy : IMRT is like 3D-CRT, but it also changes the strength of some of the beams in certain areas. This gets stronger doses to certain parts of the tumor bed and helps lessen damage to nearby normal body tissues.
- Brachytherapy: See brachytherapy below.
Swelling Of The Breast
Radiotherapy can make it more difficult for fluid to drain from the breast tissue. This can cause swelling of the breast or chest area. Doctors call this lymphoedema.
The swelling usually goes down a few weeks after the treatment ends. But tell your doctor or radiographers if it doesnt. They can arrange for you to see a lymphoedema specialist. You might have a type of massage called manual lymphatic drainage.
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What Are Your Breast Cancer Treatment Options
Many patients are finding new sources of information and working to educate themselves when they have a serious illness like cancer. If you have read about an option and want to know more, be sure to ask. Your doctor will be able to explain the criteria for certain treatments and why they may or may not be a suitable option for your individual diagnosis For more information about our Breast Care Center or treatment options, please visit our website.
During Your Radiation Treatments
Your radiation therapists will bring you to the treatment room and help you lie on the treatment table . Youll be positioned exactly how you were during your simulation and set-up procedure. Your radiation therapists will do everything they can to make sure youre comfortable. Then, theyll leave the room, close the door, and start your treatment.
Figure 2. An example of a radiation treatment machine
Breathe normally during your treatment, but dont move. You wont see or feel the radiation, but you may hear the machine as it moves around you and is turned on and off. Your radiation therapists will be able to see you on a monitor and talk with you through an intercom during your whole treatment. Tell them if youre uncomfortable or need help.
Youll be in the treatment room for 10 to 20 minutes, depending on your treatment plan. Most of this time will be spent putting you in the correct position. The actual treatment only takes a few minutes.
Your radiation treatment wont make you or your clothes radioactive. Its safe for you to be around other people.
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Moisturize Before And During Radiation Therapy
Its important to keep your skin moisturized throughout the duration of radiation therapy. Start moisturizing treated areas even before you notice any skin changes. Use fragrance-free lotions, creams, or ointments for sensitive skin, and follow your doctors recommendations. You may need to rinse off lotions or ointments before treatment.
A MyBCTeam member recommended, Use the lotions generously. Be sure to wash them off before treatment, and apply them as soon as possible afterwards. Dont wait to start using them. If you wait till you think you need them, its too late.
Another member commented, The key is to hydrate, hydrate, hydrate put lotion on your skin and drink plenty of water. One member commented on their regret of not using moisturizer sooner, saying, I made the mistake of not using it enough, and I did get a bad radiation burn.
Radiation Therapy And Risk Of A Second Cancer
In rare cases, radiation therapy to the breast can cause a second cancer.
The most common cancers linked to radiation therapy are sarcomas . For women who are long-term smokers, radiation therapy may also increase the risk of lung cancer .
The risk of a second cancer is small. If your radiation oncologist recommends radiation therapy, the benefits of radiation therapy outweigh this risk.
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Description Of The Intervention
Breastconserving therapy , involving breastconserving surgery followed by wholebreast irradiation and optionally a boost to the tumour bed, is a standard therapeutic option for women with earlystage breast cancer. Randomised controlled trials have shown that local control rates and survival in women with earlystage disease treated with BCT are comparable to treatment with mastectomy . A boost to the tumour bed means that an extra dose of radiation is applied that covers the initial tumour site where the cancer is most likely to return. The rationale for a boost of radiotherapy to the tumour bed is local recurrence occurs mostly at the site of the primary tumour because remaining microscopic tumour cells are most likely situated there and radiation can eliminate these causative microscopic tumour cells.
The main goal of adjuvant radiotherapy after BCS is to decrease local recurrence and to permit breast conservation with minimal treatmentinduced side effects. The necessity of adjuvant radiotherapy has been demonstrated by the Early Breast Cancer Trialists Collaborative Group . The metaanalysis conducted by the EBCTCG showed a reduction in the 10year first recurrence rate from 35% to 19.3%, and a breast cancer survival gain of 3.8% at 15 years when adding adjuvant radiotherapy .
Tips For Managing Side Effects From Breast Cancer Radiation
- Radiation therapy can cause various side effects, which can range in type and severity from person to person.
- Use moisturizers and skin care strategies to help manage skin changes, and stay active to help decrease fatigue and swelling during radiation treatment.
- Listen to your body and discuss any side effects from radiation with your doctor.
Radiation therapy, also known as radiotherapy, is a valuable part of many breast cancer treatment plans. While effective at killing cancer cells and shrinking tumors, radiation therapy like any medical treatment does have a potential risk of side effects.
Luckily, your cancer care team and members of MyBCTeam, the online social network for people with breast cancer, have useful tips and suggestions for dealing with side effects from radiation therapy. Take care of yourself get good nutrition, hydrate, rest, relax, and let everyone pamper you, one member encouraged another who was about to start radiation treatments.
The occurrence and severity of side effects from radiation therapy affect everyone differently. People who have larger breasts, fair skin, and conditions that affect skin healing may be more prone to side effects.
Side effects usually depend on the type of radiation and the treated area. The effects of radiation can be acute or long-term, occurring months to years later. Common acute side effects of external beam radiation therapy for breast cancer include:
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Deep Inspiration Breath Hold
Various techniques are used to minimise the exposure of the heart to radiation. One technique is to voluntarily hold a deep breath for 20-30 seconds while the radiation is delivered, as this expands the lungs and moves the heart away from the radiation field. Pre-treatment assessment of lung capacity and breathing patterns is carried out and the patient is given instruction on breath-holding for the required time.
To accurately maintain a deep inspiration breath hold, some centres use an active breathing co-ordinator device. Using this, patients are taught to take and hold a measured deep breath while the radiation dose is delivered. Using this method, patients can monitor their own breathing and the machine links to the linear accelerator ensuring that the radiation dose is only delivered when optimal breath hold is reached and maintained.
Both methods have been shown to reduce the exposure of the heart to radiation.