How Often Will I Go For Treatment
Treatment is most often given once a day, 5 days a week, for 3-6 weeks.
The schedule of radiation sessions is designed to treat your breast cancer and varies from person to person.
Many women now get a shortened course of radiation therapy . This is called hypofractionated whole-breast irradiation.
Its like standard whole-breast radiation therapy except it uses a slightly higher dose of radiation per session . This reduces the number of treatment sessions, making the overall course shorter.
For most women with early breast cancer, hypofractionated whole-breast irradiation is as effective as standard whole-breast radiation therapy .
After radiation therapy to the whole breast, you may have more radiation to the part of the breast that had the tumor.
This boost increases the amount of radiation given to the area at highest risk for breast cancer recurrence.
Your boost radiation session is similar to a regular session.
Radiation therapy often delivers radiation to the whole breast. Partial breast irradiation delivers radiation only to the area around the tumor bed .
Its typically done in a shortened course over only 5-10 days. This reduces the number of treatment sessions. It can also be done over 3-4 weeks, similar to whole breast radiation therapy, or may be done at the same time as surgery.
Partial breast irradiation is an appropriate treatment for select people with early-stage breast cancer .
Methods of partial breast irradiation include:
What Are The Physical Side Effects
Receiving the radiation will not be painful. Side effects vary from person to person and depend on the site being treated. The most common side effects in the treatment of breast cancer are:
- Skin changes
- Uncomfortable sensations in the treated breast
Please talk to your doctor or nurse if you have concerns about side effects before you begin treatment or if you have questions about managing your side effects during treatment.
What Should I Expect Before Radiation Therapy For Breast Cancer
Most people who have breast cancer treatment receive external beam radiation therapy. The goal is to destroy any remaining cancerous cells while protecting healthy tissue.
Before your first treatment, you will have a planning session . This simulation helps your provider map out the treatment area while sparing normal tissues . This session may take one hour or longer.
During the simulation, your provider:
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Side Effects Of Radiation Therapy To Your Breast Or Chest Wall
You may have side effects from radiation therapy. The type and how strong they are depends on many things. These include the dose of radiation, the number of treatments, and your overall health. The side effects may be worse if youre also getting chemotherapy.
You may start to notice side effects about 2 weeks after you start radiation therapy. They may get worse during your radiation therapy, but theyll slowly get better over 6 to 8 weeks after your last treatment. Some side effects may take longer to go away. Follow the guidelines in this section to help manage your side effects during and after your radiation therapy.
Radioprotective Drugs For Reducing Side Effects
One way to reduce side effects is by using radioprotective drugs, but these are only used for certain types of radiation given to certain parts of the body. These drugs are given before radiation treatment to protect certain normal tissues in the treatment area. The one most commonly used today is amifostine. This drug may be used in people with head and neck cancer to reduce the mouth problems caused by radiation therapy.
Not all doctors agree on how these drugs should be used in radiation therapy. These drugs have their own side effects, too, so be sure you understand what to look for.
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Doses A Delay In Radiation Increases Risk Of Breast Cancer Recurrence
Some but not all research suggests that for women who choose to undergo breast-conserving surgery for treatment of early stage breast cancer, a longer interval between surgery and the start of radiation therapy may increases the risk of local cancer recurrence.
Among women who undergo breast-conserving therapy, prompt treatment with radiation therapy after surgery may result in better outcomes than delayed radiation therapy. To explore this issue, researchers evaluated information from a large U.S. database that links cancer registry data with Medicare claims data. Information was available for more than 18,000 women over the age of 65 who had undergone breast-conserving therapy for Stage 0-II breast cancer and did not receive chemotherapy.
The average time from surgery to start of radiation therapy was 34 days and 30% of women started radiation therapy more than six weeks after surgery.
Longer intervals between surgery and the start of radiation therapy were linked with an increased risk of local cancer recurrence. For example, women who started radiation therapy more than six weeks after surgery were 19% more likely to experience local cancer recurrence than women who had a shorter interval between surgery and radiation.
These results suggest that starting radiation therapy as soon as possible after lumpectomy may reduce the risk of local cancer recurrence.
Radiation Reduces Mortality At 15 Years In Early Breast Cancer
Researchers affiliated with the Early Breast Cancer Trialistsâ Collaborative Group evaluated breast-conserving therapy with or without radiation therapy to mastectomy with or without radiation therapy in a large analyses and found that radiation resulted in a significant difference in local regional recurrences and 15-year mortality.
- Radiation in patients treated with breast-conserving therapy reduced local regional recurrences by 19%.
- 15-year mortality from breast cancer was reduced from nearly 36% to 30% in patients treated with radiation therapy following breast-conserving therapy compared to those not treated with radiation therapy.
- 15-year mortality from breast cancer was reduced from 60% to 54% in patients who received radiation therapy following a mastectomy compared to those treated with a mastectomy alone.
The researchers concluded that a reduction in the risk of local regional recurrences with the use of radiation therapy significantly reduces the long-term risk of death caused by early breast cancer.
Radiation therapy is associated with side effects such as fatigue, skin burns, and cosmetic changes. Additionally, patients often need to take time off from work in order to attend radiation treatment sessions. Therefore, clinical studies have been performed to evaluate shorter radiation treatment schedules with the goal of maintaining the highest survival benefit for patients.
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Your Role On Your Radiation Therapy Team
Youll have a team of healthcare providers working together to care for you. Youre part of that team, and your role includes:
- Getting to your appointments on time.
- Asking questions and talking about your concerns. Weve included a list of possible questions at the end of this resource.
- Telling someone on your radiation therapy team when you have side effects.
- Telling someone on your radiation therapy team if youre in pain.
- Caring for yourself at home by:
- Quitting smoking if you smoke. If you want to quit, call MSKs Tobacco Treatment Program at .
- Caring for your skin following your radiation therapy teams instructions.
- Drinking liquids following your radiation therapy teams instructions.
- Eating the foods your radiation therapy team suggests.
- Staying around the same weight.
When Does Someone With Breast Cancer Get Radiation Therapy
The timing for radiation therapy depends on several factors. The treatment may take place:
- After a lumpectomy: A lumpectomy removes the cancerous tumor, leaving most of the breast. Radiation therapy lowers your risk of cancer coming back in the remaining breast tissue or nearby lymph nodes as well as reduces your chance of passing away of breast cancer.
- After a mastectomy: Most people dont get radiation therapy after a mastectomy . Your provider may recommend radiation if the tumor was larger than 5 cm if theres cancer in surrounding lymph nodes, skin tissue or muscle or if all the cancer can’t be removed .
- Before surgery: Rarely, healthcare providers use radiation to shrink a tumor before surgery.
- Instead of surgery: Sometimes, providers use radiation therapy to shrink a tumor that they cant surgically remove . A tumor may be unresectable due to its size or location. Or you may not be a candidate for surgery because of concerns about your health.
- To treat cancer spread: Stage 4 breast cancer is cancer that spreads to other parts of the body. Your provider may use radiation therapy to treat cancer that spreads to other parts of the body.
If you had surgery, radiation therapy typically starts about one month after the incision heals if chemotherapy is not received. Some individuals receive chemotherapy after surgery, followed by radiation therapy. You may get the two treatments at the same time.
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How Effective Is Radiation Therapy
If early-stage breast cancer hasnt spread, radiation therapy after a lumpectomy significantly reduces the risk of cancer coming back by approximately 50%. Studies show that a lumpectomy followed by radiation therapy is as effective as a mastectomy without radiation therapy.
People who undergo a lumpectomy have a 20% to 40% chance of the cancer coming back at 10 to 20 years. With the addition of postsurgical radiation therapy, that risk drops to 5% to 10%. However, there are some patients who derive less benefit from radiation including patients 65 years or older with small cancers.
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.
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Types Of Radiation Therapy
- External beam radiation is most commonly used to treat breast cancer. A machine outside your body aims a beam of radiation on the area affected by the disease.
- Brachytherapy delivers radiation to the cancer through something implanted in your body.
- Proton therapy sends highly targeted radiation just to your breast tissue and not into your heart or lungs.
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.
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Radiation Therapy Clinical Trials For Breast Cancer
Clinical trials are research studies that test new treatments to see how well they work and confirm that they are safe. Women who choose to participate in a trial at MSK receive the most advanced cancer treatments available, sometimes years before they are available anywhere else.
We offer a number of clinical trial options for women with breast cancer who are receiving radiation therapy. For example, MSK investigators are leading a national trial on the use of proton therapy to limit radiation-induced heart disease. Our team is also testing radiation in combination with new drugs, such as immunotherapy for recurrent breast cancer.
What To Expect With External Beam Radiation
If you have external beam radiation, youll meet with your radiation oncologist and a nurse before starting treatment. They will walk you through what to expect with external beam radiation, and the risks and benefits of this treatment.
At this time, youll likely have a physical exam and go over your medical history.
Additionally, the radiation oncologist and a radiation therapist will take scans of your treatment area. This will help define the boundaries of the affected area so they know where to aim the radiation beams.
They will put marks on your skin to mark the area. You will need the marks throughout the course of your treatment. The marks will be used to line up your body, so the radiation beams target the exact area that needs to be treated.
Sometimes a body mold will be made to immobilize you during the treatment and to help keep your body still.
Each treatment will only last a few minutes. The session setup will take longer than the actual treatment. You wont feel anything when the machine is turned on for the treatment. Its a painless procedure.
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What Is Radiation Therapy
Radiation therapy is the use of high-energy rays or particles to treat disease. It works by killing tumor cells or inhibiting their growth and division.
Through years of clinical trials, radiation oncologists have studied the use of radiation therapy to treat breast cancer. These studies have led to the widespread use of effective and tolerable doses of radiation therapy. It is used to treat early stage breast cancer along with surgery for local control of disease. It may be used in more advanced breast cancer to control the disease or to treat symptoms, such as pain.
How Long Side Effects May Last
Radiation therapy can cause side effects during and just after treatment. These are called short-term or acute effects. It can also cause long-term or late effects months or years down the track. Most side effects go away after treatment. But sometimes radiation therapy can cause long term or late effects months or years down the track.
During treatment, tell your radiation therapy team about any side effects, as side effects can usually be controlled with the right care and medicine.
Learn more about:
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What Is Accelerated Partial Breast Irradiation
- Accelerated partial breast irradiation is radiation delivered at a more concentrated and higher dose over a shorter period of time, . APBI can be delivered using intensity modulated radiation which delivers fractionated radiation, meaning that the total dose of radiation is delivered in many small daily, or twice daily, doses or internally using brachytherapy.
- Balloon brachytherapy is an alternative way to deliver APBI. With this approach, a small balloon is inserted into the lumpectomy cavity . A catheter attached to the balloon is used to deliver radioactive âseedsâ to the site. This approach limits exposure of healthy tissue to radiation and can shorten treatment time to a week or less by delivering high doses of radiation. Because this approach requires many fewer weeks of treatment than conventional external beam radiation therapy, it may be a much more convenient.2,3 Additionally, because partial breast irradiation is more targeted, there is less exposure to vital organs like the lungs and the heart.4
- Some but not all trials have reported worse cosmetic results with APBI and patients should discuss and understand whether this has been an issue at their treating institution.
Planning Your Radiotherapy Treatment
You will have a hospital appointment to plan your treatment. You will usually have a CT scan of the area to be treated. During the scan, you need to lie in the position that you will be in for your radiotherapy treatment.
Your radiotherapy team use information from this scan to plan:
- the dose of radiotherapy
- the area to be treated.
You may have some small, permanent markings made on your skin. The marks are about the size of a pinpoint. They help the radiographer make sure you are in the correct position for each session of radiotherapy.
These marks will only be made with your permission. If you are worried about them, talk to your radiographer.
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Breast Brachytherapy And Partial Breast Radiation
The many trials supporting breast-conserving surgery followed by adjuvant radiation therapy have also shown that the risk of recurrence outside the tumor cavity is similar whether or not whole breast radiation was given. . This suggests that additional radiation given outside the tumor cavity may not be of additional benefit to patients.
Breast brachytherapy was historically used to treat the lumpectomy cavity as a boost following external whole breast radiation therapy. Many centers have now adapted the use of accelerated partial breast radiation therapy, either with interstitial needle implants, various applicators , or even through the use of 3D conformal external radiation therapy as the sole radiation treatment modality following breast-conserving surgery. By radiating less volume , higher radiation doses can be given per fraction to the tumor bed. This shortens treatment times significantly, decreasing the patients travel time when compared to daily whole breast radiation therapy.
Patients are potential candidates for accelerated partial breast radiation therapy if they have Stage 0, I, or II tumors, with a single tumor less than 3 cm in maximum dimension. Minimal nodal involvement and clear surgical margins are also required. Typically, partial breast radiation is delivered twice a day, with each treatment separated at least 6 hours apart, for a total of ten fractions.