Internal Breast Cancer Radiation
Internal breast cancer radiation is also known as brachytherapy. You doctor will place a device that contains radioactive seeds in the area of the breast where the cancer was found. For a short time, internal radiation targets only the area where breast cancer is most likely to return. This causes fewer side effects. The treatment takes a week to complete.
If youve had breast-saving surgery, a doctor may treat you with both internal and external radiation to increase the boost of radiation. Doctors may only perform internal radiation as a form of accelerated partial breast radiation to speed up treatment.
Potential side effects of internal radiation include:
How Do I Know Which Breast Cancer Treatment To Choose
Your doctor will think about a few things before they recommend a treatment for you:
- The type of breast cancer you have
- The size of your tumor and how far the cancer has spread in your body, called the stage of your disease
- Whether your tumor has things called receptors for HER2 protein, estrogen, and progesterone, or other specific features.
Your age, whether youve gone through menopause, other health conditions you have, and your personal preferences also play a role in this decision-making process.
External Radiation Planning And Treatment: What To Expect
Daily external radiation treatments require careful planning to make sure the treatment area is mapped out as accurately as possible and that each day of your treatment goes smoothly.
Heres what you can generally expect from the planning session through your daily treatment routine.
Your first radiation therapy session is called a simulation. It is a planning and practice session, and you receive no radiation.
During the simulation session, your radiation oncology team maps out the area of the breast that needs treatment using imaging such as a CT scan, MRI, or X-ray.
Because it is so important to position the angles of radiation accurately, the simulation session can sometimes last up to an hour.
During the simulation session, your doctor will:
explain the pros and cons of radiation, the planning and treatment process, and answer any questions or concerns you may have
precisely identify the area where you will receive radiation
There are different kinds of immobilization devices. Some look like a cradle others look like a foam box that is shaped to your form. You will not be trapped or closed in. You may be asked to lie down in a custom-shaped mold that just touches your back and sides, or your treatment center may use a “breast board” that places your head, arm, and hand in a fixed position. If you have left-sided breast cancer, you may receive special breathing instructions to help protect your heart during radiation treatment.
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What To Expect At Radiation Therapy Appointments
During your radiation therapy treatment appointments, your healthcare team will help you prepare by explaining
- the members of your radiation treatment team, who typically include
- your radiation oncologist
- who can provide emotional support and point you to resources for financial support and transportation assistance
If your doctor recommends the deep inspiration breath hold technique to reduce the risk of radiation exposure to your heart, you will be coached on how to hold your breath before treatment begins.
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:
Answering questions about treatments
Monitoring your health during treatment
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:
Learn more about the oncology team.
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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.
Late Complications Of Radiation Therapy For Breast Cancer: Evolution In Techniques And Risk Over Time
Zachary Brownlee1, Rashi Garg1, Matthew Listo1, Peter Zavitsanos1, David E. Wazer1,2, Kathryn E. Huber1
1Department of Radiation Oncology, Tufts Medical Center and Tufts University School of Medicine , Rhode Island Hospital and Brown University School of Medicine , , USA
Contributions: Conception and design: DE Wazer, KE Huber Administrative support: KE Huber Provision of study materials or patients: None Collection and assembly of data: None Data analysis and interpretation: None Manuscript writing: All authors Final approval of manuscript: All authors.
Abstract: Radiation therapy in combination with surgery, chemotherapy, and endocrine therapy as indicated, has led to excellent local and distant control of early stage breast cancers. With the majority of these patients surviving long term, mitigating the probability and severity of late toxicities is vital. Radiation to the breast, with or without additional fields for nodal coverage, has the potential to negatively impact long term cosmetic outcome of the treated breast as well as cause rare, but severe, complications due to incidental dosage to the heart, lungs and contralateral breast. The long-term clinical side-effects of breast radiation have been studied extensively. This review aims to discuss the risk of developing late complications following breast radiation and how modern techniques can be used to diminish these risks.
Keywords: Radiation breast cancer late toxicity
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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:
Complementary And Alternative Medicine
Complementary and alternative medicine are medicines and health practices that are not standard cancer treatments. Complementary medicine is used in addition to standard treatments, and alternative medicine is used instead of standard treatments. Meditation, yoga, and supplements like vitamins and herbs are some examples.
Many kinds of complementary and alternative medicine have not been tested scientifically and may not be safe. Talk to your doctor about the risks and benefits before you start any kind of complementary or alternative medicine.
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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.
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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What Can I Expect From My Treatment
When you arrive, please check in at the desk. Each treatment should only last 10 to 15 minutes. You can change your clothes in the dressing room and then wait in the lounge to be called.
During each treatment session, you will lay on a table while the technician uses the marks on your skin to locate and treat the field. It is important to be still while getting the radiation, although you should continue to breathe normally.
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.
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Tips To Help You Choose
Although there are some typical breast cancer treatment regimens, women do have choices.
- Talk with your doctor about all the risks and benefits of each treatment option and how they will affect your lifestyle.
- Think about joining a support group. Other people with breast cancer know what youre going through and can give you advice and understanding. They might help you decide on a treatment, too.
- Ask your doctor whether you should join a clinical trial, a research study that tests new treatments before theyre available to everyone.
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?
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Side Effects Of Radiation Therapy For Breast Cancer
Radiation therapy is often used to treat breast cancer after surgery. The doses of radiation used to destroy cancer cells can also hurt normal cells. The damage to these normal cells is the cause of the common side effects of radiation treatment. The possible side effects of radiation therapy are directly related to the area of the body being treated. Side effects are caused by the cumulative effect of radiation on the cells, which is why most patients do not experience any side effects until a few weeks into their treatments. While side effects may be unpleasant, there are treatments to help deal with them. Most side effects are temporary, disappearing slowly over time after therapy is complete.
Most radiation oncologists see their patients at least once a week while the patient is receiving treatment. This visit with the healthcare team is a chance for the patient to ask questions, discuss any side effects, and find ways to help relieve side effects. However, you can report concerning symptoms anytime to the treatment team.
Rapid Radiation Therapy For Gastrointestinal Cancer
Treatment times: Gastrointestinal cancers occur in the esophagus, stomach, biliary system, pancreas, small intestine, large intestine, rectum and anus. With standard radiation treatment, patients receive treatment five days a week for about six weeks. SBRT, however, reduces treatments to a total of five high-dose fractions in all. This faster treatment approach also eliminates the need for concurrent chemotherapy.
New advances: We are using 4D CT scans for treatment planning, says Kimberly Johung, MD, director of the Gastrointestinal Radiotherapy Program, who explains that the scan is essentially a video that shows the motion of a tumor as the patient breathes. These 4D planning CT scans allow the radiation field to be focused on the precise area that tumors occupy during the respiratory cycle. She explains that her department also uses technology to limit tumor motion from breathing, and to track the motion of tumors during treatment.
Who is eligible: For patients who arent receiving chemotherapy, SBRT is a treatment option in cases where the pancreatic cancer is inoperable or can only be partially removed during surgery, or for patients who are unable to have surgery for other medical reasons. Its also an option for patients who have a tumor reoccur in the same area after surgery. SBRT is also used in patients with primary liver tumors and for patients with a limited number of liver metastases.
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What Are The Types Of Radiation Therapy For Breast Cancer
There are different ways to receive radiation therapy. Your healthcare provider will choose the best method based on the cancer location, type and other factors.
Types of radiation therapy for breast cancer include:
- External beam whole-breast irradiation: During external beam whole-breast radiation therapy, a machine called a linear accelerator sends beams of high-energy radiation to the involved breast. Most people get whole-breast radiation five days a week for one to six weeks. The time frame depends on factors including lymph node involvement. In some cases, intensity-modulated radiation therapy may be used.
- External beam partial-breast: This treatment directs radiation to the tumor site only, not the entire breast over 1 to 3 weeks with 3-dimensional conformal radiation or IMRT.
- Brachytherapy: Some people get internal radiation therapy or brachytherapy. Your provider places an applicator or catheter. A radioactive seed is moved into the tumor site. The seeds give off radiation for several minutes before your provider removes them. You receive two treatments every day for five days.
- Intraoperative:Intraoperative radiation therapy takes place in the operating room before your provider closes the surgical site. Your provider delivers a high dose of radiation to the tumor area of the exposed breast tissue.
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.
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When Should I Call The Doctor
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.
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.
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