How Does Radiation Therapy Work For Breast Cancer

Questions To Ask About Radiation Therapy

Before treatment, youll be asked to sign a consent form saying that your doctor has explained how radiation therapy may help, the possible risks, the type of radiation to be used, and your other treatment options. Before signing the consent form, be sure that you have had a chance to get all your questions answered. Here are some of the things you may want to ask about:

Other Ways Of Giving Radiotherapy

Intraoperative radiotherapy

Intraoperative radiotherapy uses low-energy x-rays given from a machine in the operating theatre during breast-conserving surgery.

Radiotherapy is given directly to the area inside the body where the cancer was, once it has been removed. Usually a single dose of radiation is given in one treatment, but it may be necessary to have a short course of external beam radiotherapy to the rest of the breast.

Intraoperative radiotherapy is not suitable for everyone and is not standard treatment.

Brachytherapy

Brachytherapy involves placing a radiation source inside the body in the area to be treated. Its usually only given as part of a clinical trial.

Narrow, hollow tubes or a small balloon are put in the body where the breast tissue has been removed. Radioactive wires are inserted through the tubes or into the balloon. The radioactive wires may be left in place for a few days or inserted for a short time each day.

Depending on the type of brachytherapy you have, you may need to have your treatment as an inpatient and be kept in a single room for a short time due to the radiation.

If brachytherapy is an option your specialist will discuss it fully with you.

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Cancer Doctors Usually Treat Cancer With Radiation Therapy Surgery Or Medications Including Chemotherapy Hormonal Therapy And/or Biologic Therapy Either Alone Or In Combination

If your cancer can be treated with radiation, you will be referred to a radiation oncologist a doctor who specializes in treating patients with radiation therapy. Your radiation oncologist will work with your primary doctor and other cancer specialists, such as surgeons and medical oncologists, to oversee your care. He or she will discuss the details of your cancer with you, the role of radiation therapy in your overall treatment plan and what to expect from your treatment.

• What Questions Should I Ask My Doctor?

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Follow Up Care After Breast Cancer Treatment

Many women are relieved or excited to be finished with breast cancer treatment. But it can also be a time of worry, being concerned about the cancer coming back, or feeling lost without seeing their cancer care team as often.

For some women with advanced breast cancer, the cancer may never go away completely. These women may continue to get treatments such as chemotherapy, hormone therapy, or other treatments to help keep the breast cancer under control and to help relieve symptoms from it. Learning to live with breast cancer that doesnt go away can have its own type of uncertainty.

Even if you have completed breast cancer treatment, your doctors will want to watch you closely. Its very important to go to all of your follow-up appointments. During these visits, your doctors will ask if you are having any problems, and will probably examine you. Lab tests and imaging tests arenât typically needed after treatment for most early stage breast cancers, but they might be done in some women to look for signs of cancer or treatment side effects.

How Radiotherapy Is Given

Radiotherapy can be given in several ways and using different doses, depending on your treatment plan.

The total dose is split into a course of smaller treatments , usually given daily over a few weeks.

Its carried out by people trained to give radiotherapy, known as therapeutic radiographers.

Radiotherapy is not available in every hospital, but each breast unit is linked to a hospital that has a radiotherapy department.

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Local Recurrence After Mastectomy

Even though the entire breast is removed in a mastectomy, breast cancer can still return to the chest area. If you notice any changes around the mastectomy scar, tell your health care provider.

The more lymph nodes with cancer at the time of the mastectomy, the higher the chances of breast cancer recurrence.

Local recurrence after a mastectomy is usually treated with surgery, and radiation therapy if radiation therapy wasnt part of the initial treatment.

Treatment may also include chemotherapy, hormone therapy and/or HER2-targeted therapy.

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Radiotherapy After Breast Conserving Surgery

You usually have radiotherapy to the whole breast after having breast conserving surgery . You generally start it about 4 to 6 weeks after surgery.

If you need to have chemotherapy you have this before your radiotherapy.

People with a very low risk of the cancer coming back may only have part of the breast treated with radiotherapy. Or they may not have radiotherapy at all.

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To Cure Or Shrink Early

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.

How Can Hyperbaric Oxygen Therapy Speed Up Radiation Recovery

Hyperbaric oxygen therapy makes it possible to minimize and even reverse your radiation symptoms. It uses powerful 100% oxygen at pressures above regular atmospheric pressure to stream oxygen through your bloodstream.

The pressure of HBOT drives oxygen not just into the bloodstream, but also into lymph tissue, bone tissue, red blood cells, and other critical locations. Since oxygen is critical for all healing functions, HBOT can reduce cell death, relieve pain, stimulate new growth of blood vessels, and boost circulation.

As a result, tissues damaged by radiation or suffering from nutrient deficiencies can quickly become revitalized and enhanced. The oxygenation that occurs during HBOT promotes cellular growth that combats the harmful effects of radiation therapy and helps you recover more efficiently.

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Are Some Therapies More Effective Based On Stage

The type of radiation treatment you get depends on the stage of breast cancer. People with early to stage 3 breast cancer will benefit most from radiation treatment. Radiation can also help ease side effects in people with advanced breast cancer.

External whole breast radiation works best:

• for early stage to stage 3 breast cancer
• for tumors that are an inch or smaller
• if the cancer is in one spot
• if you had breast-saving surgery or a mastectomy

External beam radiation can also help treat side effects of advanced breast cancer.

Internal radiation works best:

• for early stage breast cancer
• if the cancer is in one spot
• if you had breast-saving surgery or a mastectomy

Sometimes, a person with advanced breast cancer will have internal radiation.

Intraoperative radiation works best:

• during early stage breast cancer
• when the tumor is too close to healthy tissue for external radiation to be possible

Not everyone can have intraoperative radiation or internal beam radiation. Whether you can have these procedures depends on:

• size and location of the tumor
• size of your breast

Having Radiotherapy For Breast Cancer

Radiotherapy uses high energy x-rays to treat cancer cells.

You might have external beam radiotherapy after breast surgery to lower the risk of the cancer coming back.

You have your treatment in the hospital radiotherapy department. You usually have it from Monday to Friday with a break at the weekend. The treatment is usually over 3 weeks. Each daily treatment is called a fraction.

There are studies looking at giving different doses of radiotherapy over a shorter time. Doctors want to try to reduce the risk of side effects. How often you have treatment may change in the future if the results show that a different treatment is better.

You need to travel to the hospital each time you have treatment. Some hospitals have rooms nearby where you can stay if you have a long way to travel.

You go to the radiotherapy department from your ward if you are staying in the hospital.

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Take Care Of Yourself During Treatment

Radiation affects each person differently. To help keep your energy up during radiation treatments:

• Get enough rest.
• Eat a well-balanced, nutritious diet.
• Pace yourself, and plan frequent rest periods.

Good nutrition will also help you recover from side effects, heal, and fight off infection. It may give you a sense of well-being, too. If you have a hard time eating, work with a dietitian to find ways to get the nutrients you need.

Many people feel fatigued after several weeks of treatment. Most often, this is mild. But some people feel more tired and may need to change their daily routines. Your doctor will let you know if they think you should limit your activities.

Why The Procedure Is Performed

Experts learned that certain cancers are most likely to return near the original surgical site. Therefore, in some cases, the whole breast may not need to receive radiation. Partial breast irradiation only treats some but not all of the breast, focusing on the area where the cancer is most likely to return.

Breast brachytherapy helps prevent breast cancer from returning. The radiation therapy is given after lumpectomy or partial mastectomy. This approach is called adjuvant radiation therapy because it is adding a treatment beyond surgery.

Because these techniques are not as well studied as whole-breast radiation therapy, there is not full agreement about who is most likely to benefit.

Types of breast cancer that may be treated with partial breast radiation include:

• Ductal carcinoma in situ
• Invasive breast cancer

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What To Expect From Your Breast Cancer Radiation Therapy

Many patients with breast cancer will receive radiation therapy at some point in their treatment course. It is often used to decrease the risk of your breast cancer recurring after surgery.

Many patients with breast cancer who are receiving radiation therapy may have had prior therapies for their cancer e.g. a lumpectomy or mastectomy, chemotherapy, or endocrine therapy.

What Are The Cosmetic Results Of Breast Conservation Therapy

Eighty percent to 90 percent of women treated with modern surgery and radiotherapy techniques have excellent or good cosmetic results that is, little or no change in the treated breast in size, shape, texture or appearance compared with what it was like before treatment.

Patients with large breasts seem to have greater shrinkage of the breast after radiation therapy than do patients with smaller breasts. However, this problem usually can be overcome with the use of higher x-ray energies or with IMRT. Partial breast radiation using brachytherapy can also be considered if the patient has a small early-stage tumor. This treatment is still undergoing clinical investigation. Certain single institution studies on brachytherapy and intraoperative radiation have shown some promising results. You would need to discuss this with your doctor before or shortly after surgery to determine if you qualify for partial breast radiation.

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Starting With Neoadjuvant Therapy

Most often, these cancers are treated with neoadjuvant chemotherapy . For HER2-positive tumors, the targeted drug trastuzumab is given as well, sometimes along with pertuzumab . This may shrink the tumor enough for a woman to have breast-conserving surgery . If the tumor doesnt shrink enough, a mastectomy is done. Nearby lymph nodes will also need to be checked. A sentinel lymph node biopsy is often not an option for stage III cancers, so an axillary lymph node dissection is usually done.

Often, radiation therapy is needed after surgery. If breast reconstruction is done, it is usually delayed until after radiation is complete. In some cases, additional chemo is given after surgery as well.

After surgery, some women with HER2-positive cancers will be treated with trastuzumab for up to a year. Many women with HER2-positive cancers will be treated first with trastuzumab followed by surgery and then more trastuzumab for up to a year. If after neoadjuvant therapy, any residual cancer is found at the time of surgery, trastuzumab may be changed to a different drug, called ado-trastuzumab emtansine, which is given every 3 weeks for 14 doses. For people with hormone receptor-positive cancer in the lymph nodes who have completed a year of trastuzumab, the doctor might also recommend additional treatment with an oral drug called neratinib for a year.

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 you’ve 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 you’re 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.

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How Is The Procedure Performed

Permanent brachytherapy:

Permanent brachytherapy inserts needles pre-filled with radioactive seeds into the tumor. The doctor will remove the needle and leave the seeds behind. Seeds may also be implanted using a device that inserts them individually at regular intervals. The procedure may use medical imaging to help position the seeds. The doctor may do more imaging tests later to verify seed placement.

Temporary brachytherapy:

Temporary brachytherapy places a delivery device, such as a catheter, needle, or applicator into the tumor. Medical imaging helps position the radiation sources. The doctor may insert the delivery device into a body cavity such as the vagina or uterus . Or, the doctor may insert an applicator into body tissues .

High dose-rate treatments deliver radiation over 10 to 20 minutes per session. Low dose-rate treatments deliver radiation over 20 to 50 hours. Pulsed dose-rate treatments deliver radiation in periodic pulses.

LDR treatment delivers radiation at a continuous rate over one to two days. It requires an overnight stay at the hospital. This allows the delivery device to remain in place throughout the treatment period. PDR treatment delivers radiation similarly using periodic pulses . The doctor may insert the material through the delivery device by hand and remove it later once treatment is complete.

Once treatment is complete, the doctor removes the delivery device from the patient.

How Is Radiation Therapy For Breast Cancer Performed

Most people lie on their back during the treatment though some breast treatments are performed while lying on your stomach . You place your arm above your head .

During the treatment, your treatment team:

• Positions and secures your body in the immobilization device. If you had a mastectomy, your provider might place a bolus on top of the treatment area to increase the radiation dose to the surface.
• Lines up the machine with the first treatment field. To protect themselves from radiation exposure, providers leave the room. Your provider can still hear and see you.
• Turns on the machine. You will hear a whirring noise, but you wont see the radiation beams. You must remain still. Depending on the radiation type and dose, treatment can take 30 seconds to several minutes.
• Returns to the room to position the machine to treat a different treatment field. Most people get treatment on two to five fields each day.
• Takes daily/weekly X-rays of the treatment field to make sure the radiation is hitting the correct area.

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What Happens After Radiation Therapy Treatment Ends

Once treatment ends, you will have follow-up appointments with the radiation oncologist. It’s important to continue your follow-up care, which includes:

• Checking on your recovery

• Watching for treatment side effects, which may not happen right away

As your body heals, you will need fewer follow-up visits. Ask your doctor for a written record of your treatment. This is a helpful resource as you manage your long-term health care.

Does Radiation Therapy Affect Pregnancy Or Fertility

Females: Its important not to become pregnant while getting radiation it can harm the growing baby. If theres a chance you might become pregnant, be sure to talk to your doctor about birth control options.

If you are or might be pregnant, let your doctor know right away.

If the area getting radiation in your body includes the ovaries, it is possible that the dose of radiation can cause the ovaries to no longer work , and that you would be unable to have children. it is important to know the risk of this possibility in advance of receiving radiation therapy. If you are thinking about radiation therapy that will affect the ovaries, talk to your doctor about how this might affect having children in the future.

Males: Not much is known about radiations effect on the children conceived by men while getting radiation therapy. Because of this, doctors often advise men to not get a woman pregnant during and for some weeks after treatment. Talk to your doctor to find out more about this.

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