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Can You Have Radiation More Than Once For Breast Cancer

Radiation To The Pelvis

Radiation Treatment: How is Radiation Treatment Given?

Radiation therapy to the pelvis can cause bowel and bladder problems in some patients, including:

  • Urinating more than usual
  • Sexual and/or problems getting pregnant or fathering a child

Management of Side Effects during Pelvic Radiation Therapy

  • Do not eat raw fruits, vegetables or whole grains
  • Eat small, frequent meals
  • Do not drink caffeine or alcohol
  • Drink lots of fluids
  • Drink cranberry juice as part of fluid intake
  • Ask your doctor or nurse for medicine if you have painful urination or to lessen frequent loose stools
  • Use birth control to prevent pregnancy
  • Your doctor may prescribe medicines that decrease the number of bowel movements.

What Are Possible Side Effects Of Radiation Therapy

There are usually no immediate side effects from each radiation treatment given to the breast. Patients do not develop nausea or hair loss on the head from radiation therapy to the breast.

Most patients develop mild fatigue that builds up gradually over the course of therapy. This slowly goes away one to two months following the radiation therapy. Most patients develop dull aches or sharp shooting pains in the breast that may last for a few seconds or minutes. It is rare for patients to need any medication for this. The most common side effect needing attention is skin reaction. Most patients develop reddening, dryness anditching of the skin after a few weeks. Some patients develop substantial irritation.

Skin care recommendations include:

  • Keeping the skin clean using gentle soap and warm but not hot water
  • Avoiding extreme temperatures while bathing
  • Avoiding trauma to the skin and sun exposure
  • Avoiding shaving the treatment area with a razor blade
  • Avoiding use of perfumes, cosmetics, after-shave or deodorants in the treatment area
  • Using only recommended unscented creams or lotions after daily treatment

The Pressure Of Patient Expectations

A majority of surveyed physicians reported that patients want the most aggressive treatment, even if the benefit is small, and that it takes more effort to tell patients that they do not need radiation than it does to recommend it.

Its important to recognize that this is a controversial area, says Shumway. You cant say that offering radiation to older women is wrong. It really is a patient-driven decision, and it depends on the patients own values and preferences, in addition to her risk of recurrence and overall health.

As the point of first contact for breast cancer patients, surgeons have a tremendous influence on how patients choose treatment options.

Which is why Shumway thinks they could play a crucial role in counseling older women about options for less aggressive therapy.

The population is aging, and this is going to be an issue that affects more women, says Shumway. There is increasing attention given to considerations that are unique to older patients and in this case, their vulnerability for overtreatment.

Shumways future work will focus on developing interventions to help patients make fully informed decisions and understand the concept of competing causes of mortality.

Learn more about breast cancer and breast cancer treatment:

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Radiation For Breast Cancer

Radiation therapy is treatment with high-energy rays that destroy cancer cells. Some women with breast cancer will need radiation, in addition to other treatments. Radiation therapy is used in several situations:

  • After breast-conserving surgery , to help lower the chance that the cancer will come back in the same breast or nearby lymph nodes.
  • After a mastectomy, especially if the cancer was larger than 5 cm , if cancer is found in many lymph nodes, or if certain surgical margins have cancer such as the skin or muscle.
  • If cancer has spread to other parts of the body, such as the bones or brain.

The main types of radiation therapy that can be used to treat breast cancer are external beam radiation therapy and brachytherapy.

To Cure Or Shrink Early

Radiation Therapy: What You Need to Know

Some cancers are very sensitive to radiation. Radiation may be used by itself in these cases to make the cancer shrink or completely go away. In some cases, chemotherapy or other anti-cancer drugs may be given first. For other cancers, radiation may be used before surgery to shrink the tumor , or after surgery to help keep the cancer from coming back .

For certain cancers that can be cured either by radiation or by surgery, radiation may be the preferred treatment. This is because radiation can cause less damage and the part of the body involved may be more likely to work the way it should after treatment.

For some types of cancer, radiation and chemotherapy or other types of anti-cancer drugs might be used together. Certain drugs help radiation work better by making cancer cells more sensitive to radiation. Research has shown that when anti-cancer drugs and radiation are given together for certain types of cancer, they can help each other work even better than if they were given alone. One drawback, though, is that side effects are often worse when they are given together.

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Modern Postmastectomy Radiation Trials

Mature data from three more recent randomized trials investigating postmastectomy radiation were published in 1997. The data from these trials not only provided new insights into the potential benefit of radiation but also further fueled the controversy regarding its use. These three studies clearly had a greater relevancy to modern patients than the earlier published trials because they included only patients with clinically relevant risks of LRR and those that used radiation techniques that attempted to minimize dose to the underlying heart and cardiovascular structures. Furthermore, all patients received systemic therapy, and the majority of patients were treated with chemotherapy.

The most significant finding of this study was that patients randomized to radiation had an improved overall survival rate . This survival advantage was likely a consequence of the reduced rate of LRR in the patients receiving radiation .

External Radiation Therapy Side Effects

One of the main side effects of external radiation therapy is skin changes in the treated area.

The reaction is much like a sunburn, with redness and possible itching, burning, soreness, peeling, blisters, or darkening of the skin. These skin changes happen gradually over the course of treatment and may happen only in certain areas.

Places where skin touches skin, such as the armpit and the area under the breasts, and places where you may have had a lot of sun exposure, such as the upper chest, are more likely to be affected. Some people have a change in skin color that lasts for years after treatment.

Some people may have telangiectasias develop months to years after radiation to the breast. A telangiectasia is a small patch of tiny blood vessels on the skin of the treated area that looks like a tangle of thin red lines. Telangiectasias are not a sign of cancer recurrence, but they can sometimes cause bothersome symptoms such as itching or pain. If you develop telangiectasia after radiation therapy and wish to treat it, you can talk to a dermatologist about laser therapy or other treatments.

You may be more likely to have significant skin side effects if you have fair skin, larger breasts, certain health conditions that affect skin healing , or had mastectomy or chemotherapy before radiation.

Other common side effects of external radiation therapy are:

  • swelling in the breast

Other, less common side effects that external radiation may cause are:

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Brain Radiation: The Treatment Is Worse Than The Illness Study Finds

A major study could change care for many of the hundreds of thousands of people each year who have cancer that spreads to the brain from other sites. Contrary to conventional wisdom, radiation therapy to the whole brain did not improve survival, and it harmed memory, speech and thinking skills, doctors found.

“This is the classic question: Which is worse, the disease or the treatment?” said one study leader, Dr. Jan Buckner of the Mayo Clinic. Radiation helped control the cancer, “but at the cost of cognitive decline.”

For patients, the study is not necessarily the bad news it may seem. It shows that in this case, quality of life is better with less treatment, and many people can be spared the expense and side effects of futile care.

Who Gives Radiation Therapy Treatments

Radiation Treatment: Managing Your Side Effects

During your radiation therapy, a team of highly trained medical professionals will care for you. Your team may include these people:

  • Radiation oncologist: This doctor is specially trained to treat cancer with radiation. This person oversees your radiation treatment plan.
  • Radiation physicist: This is the person who makes sure the radiation equipment is working as it should and that it gives you the exact dose prescribed by your radiation oncologist.
  • Dosimetrist: This person helps the radiation oncologist plan the treatment.
  • Radiation therapist or radiation therapy technologist: This person operates the radiation equipment and positions you for each treatment.
  • Radiation therapy nurse: This nurse has special training in cancer treatment and can give you information about radiation treatment and managing side effects.

You may also need the services of a dietitian, physical therapist, social worker, dentist or dental oncologist, pharmacist, or other health care providers.

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Risk Of Heart Disease From Breast Cancer Radiation

Although radiation exposure from breast cancer treatment is associated with a small risk of subsequent heart disease, the risk is lower than it was 20 years ago, according to the results of a study published in JAMA Internal Medicine.9

Radiation is used after surgery to kill any remaining cancer cells and this decreases the risk of local recurrence and improves survival. Like any treatment however, radiation carries risksâincluding an increased risk of heart disease when radiation is used on the left breast, which is closer to the heart.

Because long-term breast cancer survival rates have improved dramatically in recent decades, researchers continue to look for ways to minimize long-term treatment-related complications. Researchers conducted an analysis to evaluate the risk of developing heart disease as a result of radiation treatment to the left breastâand found that the risk varies depending on the underlying risk of heart disease.

They report that the average risk of developing heart disease as a result of radiation exposure for breast cancer treatment is less than one percent. The risk increases for woman who already have a high underlying risk of developing heart diseaseâin these cases, the risk may be as high as 1 in 30. In contrast, women who already have a very low underlying risk of heart disease may face odds as low as 1 in 3000, which is a tiny risk.

‘cooling Cap’ Allows Patients To Keep Hair During Chemotherapy

It was one of three studies discussed Sunday at an American Society of Clinical Oncology conference in Chicago.

An estimated 400,000 patients in the United States alone each year have cancer that spreads to the brain, usually from the lungs, breast or other sites.

That is different from tumors that start in the brain, like the one that just killed Joseph R. “Beau” Biden III, the vice president’s son.

Cancer that spreads to the brain is usually treated with radiosurgery – highly focused radiation with a tool such as the Gamma Knife, followed by less intense radiation to the whole brain. The latter treatment can cause hair loss, dry mouth, fatigue and thinking problems.

Dr. Paul Brown of the University of Texas MD Anderson Cancer in Houston led a study of 213 patients with one to three tumors in the brain to see whether the risks of whole brain radiation were worth its help in controlling cancer.

Half of the patients had the usual radiosurgery and the rest had that followed by whole brain radiation. Three months later, 92 percent of patients who got both treatments had cognitive decline versus 64 percent of those given just radiosurgery.

“The negative effects far outweigh any benefits” of the combo treatment, Brown said.

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Age Is A Major Factor In Determining What Type Of Radiation Therapy Women Should Receive

The good news is that both whole-breast and partial-breast radiation therapy after a lumpectomy are effective in preventing early-stage cancers from recurring, according to Dr. McCormick. But partial-breast radiation therapy may not be right for younger women who have not gone through menopause. Breast cancer in these women tends to be more aggressive and less likely to respond to treatments.

Im very comfortable offering partial-breast irradiation to older women, Dr. McCormick says. Its a good choice for people who are interested in a short course of radiation and are not as worried about cosmetic issues.

Even for older women, though, its important to look at all the individual factors, she explains. Women should talk to their doctor in order to make the best choice.

How Long Will Radiotherapy Last

Bladder Cancer treatment options

Radiotherapy is usually given for a total of three weeks.

Treatment is given every day from Monday to Friday, with a break at the weekend. If theres a bank holiday during this time, youll usually be given an extra session at the end to make up for the one missed.

Depending on local guidelines and your personal situation, your radiotherapy may be given in a slightly different way. For example, you may have a smaller daily dose over a longer period of time. Alternatively, your treatment team may recommend five daily treatments over one week .

For several years, clinical trials have been looking at giving radiotherapy over shorter periods. One large trial has recently confirmed that people who received the shorter regime have similar results. The trial found that giving radiotherapy over the shorter time period was as safe and as effective as the longer period. The trial results so far are based on people who were followed up for five years in the two groups. The results following people up for ten years are to be published shortly.

Based on these trials, radiotherapy experts believe shortening some peoples treatment is an acceptable way to be treated.

Your appointments may be arranged for a similar time each day so you can settle into a routine but this isnt always possible.

If you have a holiday booked, tell your specialist or therapeutic radiographer before or at your planning appointment so together you can decide what arrangements to make.

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Cyberknife Treatment For Cancer Recurrences

Cancer recurrence, or relapse, is the return of cancer after treatment and after a period of time during which the cancer cannot be detected. The same cancer can come back where it first started or somewhere else in the body. The odds of a cancer recurring depend on the type of cancer and its extent within the body at the time of treatment.

Recurrence of cancer is often emotionally deflating for patients and their loved ones who have endured treatment and hope of recovery only to face the same issues again.

Far too often, patients treated with traditional radiation require additional treatment. Radiotherapy with CyberKnife can manage and reduce future cancer recurrences. Learn more about CyberKnife, request an appointment online.

The accuracy CyberKnife provides allows clinicians to deliver high doses of radiation more safely than traditional radiation therapy and more efficiently than other radiotherapy treatmentsbecause the small size of the radiation field and its ability to avoid giving critical parts of the body around the recurrent tumor any significant amount of additional treatment.

Anova Cancer Cares CyberKnife radiotherapy treatment may be an appropriate therapy option for recurrent cancers, including the most common ones listed below.

Genetics And Family History

Treatment for breast cancer may depend partly on having a close relative with a history of breast cancer or testing positive for a gene that increases the risk of developing breast cancer.

Patients with these factors may choose a preventive surgical option, such as a bilateral mastectomy.

Clinical trials are studies in which patients volunteer to try new drugs, combinations of drugs, and methods of treatment under the careful supervision of doctors and researchers. Clinical trials are a crucial step in discovering new breast cancer treatment methods.

Emerging treatments for breast cancer being studied in clinical trials include:

  • PARP inhibitors that block protein used to repair DNA damage that occurs during cell division are being used and tested for TNBC.
  • Drugs that block androgen receptors or prevent androgen production are being used and tested for TNBC.

If youre interested, ask your oncologist for information about available trials.

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Targeted Therapy For Breast Cancer

Targeted therapy refers to a variety of drugs that enter the bloodstream and treat cancer throughout the body. Targeted therapy drugs aim to attack cancer cells without harming healthy cells, and tend to have fewer side effects than chemotherapy drugs.

Targeted therapies are often used to treat HER2-positive breast cancers. These are cancers that have an excess of a protein called HER2 that promotes the growth of cancer cells.

Common targeted therapy drugs for HER2-positive breast cancers include:

  • Monoclonal antibodies like trastuzumab are synthetic antibodies designed to attach to HER2 proteins and stop cells from growing.
  • Antibody-drug conjugates like ado-trastuzumab emtansine attach to HER2 proteins on cancer cells and help chemotherapy reach them.
  • Kinase inhibitors like Lapatinib block HER2 proteins.

Targeted therapies are also used to treat hormone receptor-positive breast cancer along with hormone therapy.

Common targeted therapy drugs for people with hormone receptor-positive cancers include:

  • CDK4/6 inhibitors, which block CDK proteins in cancer cells to stop them from dividing and slow cancer growth.
  • mTOR inhibitors, which block mTOR proteins in cancer cells to stop them from dividing and growing. This treatment is believed to help hormone therapy drugs work more efficiently.
  • PI3K inhibitors, which block the PI3K proteins in cancer cells and helps prevent them from growing.

Common targeted therapy drugs for people with TNBC include:

When Should I Call The Doctor

An Introduction to Radiation Therapy

You should call your healthcare provider if you experience:

  • Severe skin or breast inflammation.
  • Signs of infection, such as fever, chills or weeping skin wounds.

A note from Cleveland Clinic

Radiation therapy can lower the risk of cancer recurrence and cancer spread. The treatment affects everyone differently. Most side effects go away in a few months after treatments end. Some problems last longer. You should tell your healthcare provider about any problems you have while getting treatment. Your provider may change the therapy slightly to minimize issues while still effectively treating the cancer.

Last reviewed by a Cleveland Clinic medical professional on 03/19/2021.

References

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