The Types Of Radiotherapy
The type of radiotherapy you have will depend on the type of breast cancer and the type of surgery you have. Some women may not need to have radiotherapy at all.
Types of radiotherapy include:
- breast radiotherapy after breast-conserving surgery, radiation is applied to the whole of the remaining breast tissue
- chest-wall radiotherapy after a mastectomy, radiotherapy is applied to the chest wall
- breast boost some women may be offered a boost of high-dose radiotherapy in the area where the cancer was removed however, this may affect the appearance of your breast, particularly if you have large breasts, and can sometimes have other side effects, including hardening of breast tissue
- radiotherapy to the lymph nodes where radiotherapy is aimed at the armpit and the surrounding area to kill any cancer that may be in the lymph nodes
Being Careful When Showering Or Bathing
A person should use warm rather than hot water, and avoid letting the spray from the showerhead directly hit the treatment area.
The National Cancer Institute notes that a person can shower daily. However, if they prefer bathing, they should do this every other day and avoid soaking for long periods of time.
They should avoid strong or fragranced soaps, and opt for gentle, fragrance-free, moisturizing soaps specifically for sensitive skin.
People should cleanse gently, and avoid scrubbing with loofahs or wash cloths, then, when done, use a soft towel to pat themselves dry..
Treatments For Breast Cancer
If you have breast cancer, your healthcare team will create a treatment plan just for you. It will be based on your health and specific information about the cancer. When deciding which treatments to offer for ductal carcinoma and lobular carcinoma, your healthcare team will consider:
- the stage
- if you have reached menopause
- the hormone receptor status of the cancer
- the HER2 status of the cancer
- the risk that the cancer will come back, or recur
- your overall health
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External Beam Breast Cancer Radiation
External beam radiation is the most common kind of radiation treatment for breast cancer. Its a painless treatment, like getting an X-ray. A doctor will place a machine on the outside of your body and aim the radiation beams at the area of the cancer. Your doctor will figure out where to aim the rays and how much radiation to use before each treatment. They will mark the area with temporary or permanent ink.
Each treatment only lasts a few minutes. The session setup will take longer. External radiation treatment happens five days a week for about five to seven weeks. Its the longest type of radiation treatment available.
Short-term side effects of external radiation include:
- swelling and pain in the arm or chest
- weakened and fractured ribs
- future cancer in the inner lining of your blood vessels
External radiation does not leave radiation in your body. You will not be radioactive during or after treatment.
Other Ways Of Giving 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 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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Questions To Ask The Health Care Team
Who is creating my radiation therapy treatment plan? How often will the plan be reviewed?
Which health care professionals will I see at every treatment session?
Can you describe what my first session, or simulation, will be like?
Will I need any tests or scans before treatment begins?
Will my skin be marked as part of treatment planning?
Who can I talk with if I’m feeling anxious or upset about having this treatment?
How long will each treatment session take? How often will I have radiation therapy?
Can I bring someone with me to each session?
Are there special services for patients receiving radiation therapy, such as certain parking spaces or parking rates?
Who should I talk with about any side effects I experience?
Which lotions do you recommend for skin-related side effects? When should I apply it?
How else can I take care of myself during the treatment period?
Will special precautions be needed to protect my family and others from radiation exposure during my treatment period?
What will my follow-up care schedule be?
Is Radiation Necessary For All Patients With Node Negative Disease
Researchers are evaluating whether eliminating radiation in several groups of women is ongoing but inconclusive at this time. For example doctors are trying to determine if women over 70 years who have hormone receptor-positive, HER2-positive disease or those with luminal A breast cancer can avoid radiation altogether.
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External Beam Radiation Therapy
EBRT is the most common type of radiation therapy for women with breast cancer. A machine outside the body focuses the radiation on the area affected by the cancer.
Which areas need radiation depends on whether you had a mastectomy or breast-conserving surgery and if the cancer has reached nearby lymph nodes.
- If you had a mastectomy and no lymph nodes had cancer cells, radiation will be focused on the chest wall, the mastectomy scar, and the places where any drains exited the body after surgery.
- If you had BCS, you will most likely have radiation to the entire breast . An extra boost of radiation to the area in the breast where the cancer was removed is often given if there is a high risk of the cancer coming back. The boost is often given after the treatments to the whole breast have ended. It uses the same machine, with lower amounts of radiation aimed at the tumor bed. Most women dont notice different side effects from boost radiation than from whole breast radiation.
- If cancer was found in the lymph nodes under the arm , this area may be given radiation, as well. Sometimes, the area treated might also include the nodes above the collarbone and the nodes beneath the breast bone in the center of the chest .
Why Choose To Have Your Breast Radiation Therapy At Memorial Sloan Kettering
- In order to deliver radiation in the best possible way, it takes a dedicated team of doctors, nurses, therapists, physicists, and treatment planners. Our breast cancer team is one of the largest and most experienced in the country.
- Our radiation oncologists have access to and experience with every single form of radiation therapy available. There is not just one best type of radiation for all of the women we care for. But with our deep experience, we can select the best technique for each individual woman and tailor our approach as needed.
- Our team of medical physicists ensures that the radiation dose each woman receives is accurately and safely targeted to cancer tissue and spares nearby normal tissue.
- We consider the details of each unique woman. Our publications have demonstrated that our personalized care leads to superior outcomes.
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An Acceptable Choice For Many Women
The two methods of radiation therapy produced similar, if not statistically equivalent, results, noted Frank Vicini, M.D., of 21st Century Oncology of Michigan, who presented the findings of the US study in San Antonio. The less burdensome radiation method of APBI may be an acceptable choice for many women, he added.
Dr. Vicini said that although APBI produced good results for a large population of women and does remain a good option, the study results also suggested that there are limits to the extent that we can cut back on the schedule and dose of radiation for certain patients and still achieve good outcomes.
More research is needed to develop tools such as biomarkers that could help predict which patients with early-stage breast cancer might benefit most from WBI or APBI, according to Dr. Korde.
Treatment Of Breast Cancer Stages I
The stage of your breast cancer is an important factor in making decisions about your treatment.
Most women with breast cancer in stages I, II, or III are treated with surgery, often followed by radiation therapy. Many women also get some kind of systemic drug therapy . In general, the more the breast cancer has spread, the more treatment you will likely need. But your treatment options are affected by your personal preferences and other information about your breast cancer, such as:
- If the cancer cells have hormone receptors. That is, if the cancer is estrogen receptor -positive or progesterone receptor -positive.
- If the cancer cells have large amounts of the HER2 protein
- How fast the cancer is growing
- Your overall health
- If you have gone through menopause or not
Talk with your doctor about how these factors can affect your treatment options.
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Before Each Treatment Session
The radiographers help you to get onto the treatment couch. You lie on a special board called a breast board. If you have had a shell made the radiographers will fix this in place. You might need to raise your arms over your head.
The radiographers line up the radiotherapy machine using the marks on your body or on the shell. Once you are in the right position, they leave the room.
It is important to continue the arm exercise you were shown after your surgery. This helps to stop your arm and shoulder from becoming stiff during your radiotherapy treatment.
Following Patients For More Than A Decade
The NCI-supported National Surgical Adjuvant Breast and Bowel Project , now part of NRG Oncology, led the US phase 3 trial. NSABP researchers randomly assigned 4,216 patients with breast cancer who had recently received a lumpectomy to treatment with APBI or WBI.
Of this group, 25% had ductal carcinoma in situ , 65% had stage 1 breast cancer, and 10% had stage 2 breast cancer. Eighty-one percent of the patients had hormone receptorpositive cancer, and 61% of the patients were postmenopausal.
After a median follow-up of 10.2 years, 161 patients had a breast cancer recurrence: 90 patients who received APBI and 71 who received WBI. There were modest differences between the groups in terms of side effects.
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Skin Irritation In The Treated Area
This may range from mild sunburn to peeling or occasionally blistering. This side effect may not develop until treatment completion. It is usually at its most severe for one to two weeks and then settles over the following three to four weeks.
Its important to try and reduce friction between your skin and clothing to reduce the risk of skin breakdown or blistering. You will be advised how to take care of your skin. For instance:
- Avoid hot water, lotions or other possible irritants on the skin in the treatment area. Using gentle soaps doesn’t seem to increase skin irritation.
- Wear loose, light clothing over the area being treated.
- Avoid heat from hair dryers, electric hot pads, hot water bottles and sun in the treatment area.
- No adhesive tapes or sticking plasters should be applied to the skin in the treatment area
Some patients choose to use a transparent, breathable film dressing applied to the skin in the treatment area to try to reduce the skin reaction. Your radiation oncologist will be able to advise you on these products. Your radiation oncologist will also discuss with you the use of appropriate topical creams for the skin, depending on your skin reaction.
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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How Long Will Radiotherapy Last
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.
Listen To What Your Body Is Telling You
Most patients experience little or no side effects during cancer treatment, while some experience any of a number of side effects. Side effects can occur the same day or after treatment.
Thats because while radiation therapy mostly affects cancerous cells, it can impact healthy cells as well. When good cells are affected, patients may experience various side effects.
The location of the body targeted by radiation therapy can cause different side effects including:
- weight loss
Throughout your treatment, listen to your body and adjust your diet according to what it is telling you. You may find only some foods taste good on a given day. Be flexible and make adjustments to the foods you eat during radiation treatment.
Your radiation diet may include switching to a bland diet or adding lots of flavorful foods to your meals. Tell your doctor if you begin to experience any side effects from your radiation therapy.
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Why People With Cancer Receive Radiation Therapy
Radiation therapy is used to treat cancer and ease cancer symptoms.
When used to treat cancer, radiation therapy can cure cancer, prevent it from returning, or stop or slow its growth.
When treatments are used to ease symptoms, they are known as palliative treatments. External beam radiation may shrink tumors to treat pain and other problems caused by the tumor, such as trouble breathing or loss of bowel and bladder control. Pain from cancer that has spread to the bone can be treated with systemic radiation therapy drugs called radiopharmaceuticals.
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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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.