What Happens During Each Treatment Visit
External radiation treatments, done on an outpatient basis, are painless and like having a regular X-ray.
The treatment takes only a few minutes, but each session lasts about 15 minutes because of the time it takes to set up the equipment and place you in the correct position.
You will lie on the treatment table, positioned under the radiation machine. The radiation therapist may put special shields between the machine and other parts of your body to help protect normal tissues. You should remain still during the treatment, but you do not have to hold your breath.
Once you are in the correct position, the radiation therapist will go into a separate, nearby room to turn on the machine and watch you on a monitor. Youll be able to communicate with the therapist through an intercom. X-rays may be taken to confirm the accuracy of your treatment.
Radiation Therapy Timing And Breast Reconstruction
The timing of radiation treatment in your overall breast cancer treatment plan depends on your individual situation and the characteristics of the breast cancer.
In many cases, radiation therapy is given after surgery. If chemotherapy is planned after surgery, radiation usually follows chemotherapy.
If youre having mastectomy and have decided to have breast reconstruction, its important to know that radiation can cause a reconstructed breast to lose volume and change color, texture, and appearance.
In particular, radiation therapy is known to cause complications with implant reconstruction. Research also suggests that a reconstructed breast may interfere with radiation therapy reaching the area affected by cancer, though this can vary on a case-by-case basis.
For these reasons, some surgeons advise waiting until after radiation and other treatments, such as chemotherapy, are completed before breast reconstruction surgery is done.
Other surgeons may recommend a more staged approach, which places a tissue expander after mastectomy to preserve the shape of the breast during radiation treatments. Once radiation is completed and the tissues have recovered, the expander that was used to maintain the shape of the breast is removed and replaced with tissue from another part of the body or a breast implant.
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.
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How Radiation Is Used With Other Cancer Treatments
For some people, radiation may be the only treatment you need. But, most often, you will have radiation therapy with other cancer treatments, such as surgery, chemotherapy, and immunotherapy. Radiation therapy may be given before, during, or after these other treatments to improve the chances that treatment will work. The timing of when radiation therapy is given depends on the type of cancer being treated and whether the goal of radiation therapy is to treat the cancer or ease symptoms.
When radiation is combined with surgery, it can be given:
- Before surgery, to shrink the size of the cancer so it can be removed by surgery and be less likely to return.
- During surgery, so that it goes straight to the cancer without passing through the skin. Radiation therapy used this way is called intraoperative radiation. With this technique, doctors can more easily protect nearby normal tissues from radiation.
- After surgery to kill any cancer cells that remain.
Radiation Therapy For Breast Cancer
Radiation therapy uses high-energy rays or particles to destroy cancer cells. It is often used to treat breast cancer. Your healthcare team will consider your personal needs to plan the type and amount of radiation, and when and how it is given. You may also receive other treatments.
Radiation therapy is given for different reasons. You may have radiation therapy to:
- lower the risk of the cancer coming back, or recurring, after surgery
- shrink a tumour before surgery
- treat breast cancer that comes back, or recurs, in the area of a mastectomy
- relieve pain or control the symptoms of advanced breast cancer
Doctors use external beam radiation therapy to treat breast cancer. During external beam radiation therapy, a machine directs radiation through the skin to the tumour and some of the tissue around it.
Some women may not be able to have radiation therapy because they already had radiation therapy to the chest or breast. Doctors may not offer radiation therapy to women with lung problems, damaged heart muscles and certain connective tissue diseases.
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Brachytherapy Delivered Via Implantable Device
The doctor places a device inside the breast at the time of the surgery or shortly thereafter which carries targeted radiation to the tissue where the cancer originally grew . This type of radiation may take only one treatment delivered in the operating room or may take 5-7 days given on an outpatient basis in the radiation therapy department.In nearly all cases, the appropriate method is determined by the radiation oncologist based on the location and size of the tumor.
What Should I Expect
During each session, you will lie on a special table.
You may be asked to hold your breath while the radiation is given. This is one way to minimize radiation exposure to the heart.
If lymph nodes were removed during surgery and contained cancer, often the area near the lymph nodes is also treated with radiation.
Each session lasts about 10-20 minutes. Most of this time is spent positioning your body to ensure the treatment is given exactly as planned.
With any standard radiation therapy you will not be radioactive when you leave the radiation treatment center. You will not pose any radiation risk to your family or your pets.
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When Is Radiation Therapy Recommended
Radiation therapy is recommended:
- after breast-conserving surgery
- after a mastectomy if pathology results suggest the risk of recurrence is high or if the cancer has spread to the lymph nodes you may have radiation to the chest wall and lymph nodes above the collarbone
- if the sentinel node is affected you may have radiation to the armpit instead of axillary dissection.
You will usually start radiation therapy within eight weeks of surgery. If youre having chemotherapy after surgery, radiation therapy will begin about three to four weeks after chemotherapy has finished. In some circumstances, radiotherapy may be offered after neoadjuvant chemotherapy and before surgery.
What Are Clinical Trials
Cancer specialists regularly conduct studies to test new treatments. These studies are called clinical trials. Clinical trials are available through cancer doctors everywhere- not just in major cities or in large hospitals.
Some clinical studies try to determine if a therapeutic approach is safe and potentially effective. Many large clinical trials compare the more commonly used treatment with a treatment that cancer experts think might be better. Patients who participate in clinical trials help doctors and future cancer patients find out whether a promising treatment is safe and effective. All patients who participate in clinical trials are carefully monitored to make sure they are getting quality care. It is important to remember that clinical trials are completely voluntary. Patients can leave a trial at any time. Clinical trials testing new treatments are carried out in phases:
Only you can make the decision about whether or not to participate in a clinical trial. Before making your decision, it is important to learn as much as possible about your cancer and the clinical trials that may be available to you. Your radiation oncologist can answer many of your questions if you are considering taking part in a trial or contact the National Cancer Institute at 1-800-4-CANCER or www.cancer.gov.
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How Should I Care For Myself During Radiation Therapy
Time To Treatment With Metastatic Breast Cancer
There is little research looking at the optimal time until treatment for metastatic breast cancer, though it appears that waiting more than 12 weeks has been linked with lower survival. In general, however, the goal of treatment with MBC is different than early stage disease. For most people, treatment for early-stage disease is aggressive, with the goal to reduce the risk of recurrence. With MBC, the goal is often to use the least amount of treatment necessary to control the disease.
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What Questions Should I Ask My Doctor
Coping with a diagnosis of cancer and researching the various treatment options can be a stressful experience. To assist you in this process, below is a list of questions you may want to ask your radiation oncologist if you are considering radiation therapy.
Questions to ask before treatment
- What type and stage of cancer do I have?
- What is the purpose of radiation treatment for my type of cancer?
- How will the radiation therapy be given? Will it be external beam or brachytherapy? What do the treatments feel like?
- For how many weeks will I receive radiation? How many treatments will I receive per week?
- What are the chances that radiation therapy will work?
- Can I participate in a clinical trial? If so, what is the trial testing? What are my benefits and risks?
- What is the chance that the cancer will spread or come back if I do not have radiation therapy?
- Will I need chemotherapy, surgery or other treatments? If so, in what order will I receive these treatments? How soon after radiation therapy can I start them?
- How should I prepare for this financially?
- What are some of the support groups I can turn to during treatment?
- If I have questions after I leave here, who can I call?
- Will radiation therapy affect my ability to have children?
- Do you take my insurance?
Questions to ask during Treatment
Questions to ask After Treatment Ends
Radiation For Metastatic Breast Cancer
For women with breast cancer that has spread to other parts of the body, radiation can be used to help with symptoms in the affected area. Radiation is particularly useful for cancer that has spread to the bone and is causing pain. Radiation can help relieve pain in approximately 80 percent of women.
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Who Is On My Radiation Therapy Team
A highly trained medical team will work together to provide you with the best possible care. This team may include the following health care professionals:
Radiation oncologist. This type of doctor specializes in giving radiation therapy to treat cancer. A radiation oncologist oversees radiation therapy treatments. They work closely with other team members to develop the treatment plan.
Radiation oncology nurse. This nurse specializes in caring for people receiving radiation therapy. A radiation oncology nurse plays many roles, including:
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Answering questions about treatments
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Monitoring your health during treatment
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Helping you manage side effects of treatment
Medical radiation physicist. This professional helps design treatment plans. They are experts at using radiation equipment.
Dosimetrist. The dosimetrist helps your radiation oncologist calculate the right dose of radiation.
Radiation therapist or radiation therapy technologist. This professional operates the treatment machines and gives people their scheduled treatments.
Other health care professionals. Additional team members may help care for physical, emotional, and social needs during radiation therapy. These professionals include:
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Social workers
Learn more about the oncology team.
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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Skin And Hair Reactions
Your skin and hair in the treatment area will change during your radiation therapy. This is normal.
- Your skin may turn pink, red, tanned, or look like it has sunburn. The skin in the folds under your arm and breast, over your collar bone, and in other parts of the treatment area that have been in the sun may blister and peel.
- Your skin may become very sensitive and itchy.
- You may get a rash, especially in any area where your skin has been in the sun. Tell a member of your radiation therapy team if you get a rash at any time during your radiation therapy. Rashes are sometimes a sign of an infection.
- You may lose some or all of your hair under your arm on the treated side. It usually grows back in 2 to 4 months after you finish radiation therapy.
If your skin becomes open, wet, and oozing, contact your radiation team. They may prescribe a cream called Silvadene® . Your radiation oncologist may also stop your radiation therapy until your skin heals, although this is rarely needed.
Skin reactions from radiation therapy are usually strongest 1 or 2 weeks after you finish radiation therapy and then start to heal. It often takes 3 to 4 weeks for skin reactions to heal. If you have any questions or concerns, dont hesitate to contact your radiation oncologist or nurse.
Skin care guidelines
Follow these guidelines care for your skin during treatment. Keep following them until your skin gets better. These guidelines refer only to the skin in the treatment area.
Studies On Time To Surgery And Survival
Several studies have been done, but there are some differences in how these were conducted that can affect the results. For example, some studies have looked at the time between a definitive diagnosis and surgery, and others have looked at the time between the onset of symptoms and the time of surgery. Some have looked at averages of all people, whereas others have separated out people based on age, tumor type, and receptor status. Studies can also be skewed, as doctors may recommend surgery sooner for women who have more aggressive tumors. Let’s look at time to surgery and survival rates in different groups of people.
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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.