Technical Advancements For Late Complication Risk Reduction
Several radiation techniques for delivering dose to the breast and regional lymphatics while sparing healthy tissue have been developed, including: 3D conformal radiotherapy and intensity modulated radiation therapy , deep-inspiration breath hold , prone positioning, accelerated partial breast radiation , hypofractionation and proton beam radiotherapy . We will discuss each of these techniques briefly below.
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:
- Fatigue
- 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 Side Effects Occur With Radiation Therapy To The Breast And Chest
Radiation treatment to the chest may cause several changes. You will notice some of these changes yourself, and your treatment team will keep an eye on these and others. For example, you may find swallowing to be difficult or painful. You may develop a cough. Or you may develop a fever, notice a change in the color or amount of mucus when you cough, or feel short of breath. It is important to let your treatment team know right away if you have any of these symptoms. Your doctor also may check your blood counts regularly, especially if the radiation treatment area on your body is large. Just keep in mind that your doctor and nurse will be alert for these changes and will help you deal with them.
Your radiation therapy plan may include implants of radioactive material a week or two after external treatment is completed. You may have some breast tenderness or a feeling of tightness while the implants are in your breast. After they are removed, you are likely to notice some of the same effects that occur with external treatment. If so, follow the advice given above and let your doctor know about any problems that persist.
After 10 to 12 months, no further changes are likely to be caused by the radiation therapy. If you see new changes in breast size, shape, appearance, or texture after this time, report them to your doctor at once.
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When Is Radiation Therapy Used
Radiation therapy can be used to treat all stages of breast cancer.
Pregnant women should not have radiation therapy because it can harm the unborn baby. Read about Treatment for Breast Cancer During Pregnancy.
Radiation therapy after lumpectomy
Radiation therapy is recommended for most people who have lumpectomy to remove breast cancer. Lumpectomy is sometimes called breast-conserving surgery. The goal of radiation after lumpectomy is to destroy any individual cancer cells that may have been left in the breast after the tumor was removed. This reduces the risk of the cancer coming back and the risk of passing away from breast cancer.
Heres a good analogy for understanding the role of radiation therapy after surgery:If you drop a glass on the kitchen floor, you must first sweep up all of the big pieces of glass and throw them away you can think of breast surgery in this way, says Marisa Weiss, M.D., founder and chief medical officer of Breastcancer.org and director of breast radiation oncology at Lankenau Medical Center. Radiation therapy is like vacuuming the area after you sweep, getting into the corners and under the furniture, to get rid of any tiny shards of glass that might be left behind.
Radiation therapy after mastectomy
Radiation therapy may be recommended after mastectomy to destroy any cancer cells that may be left behind after the surgery. During mastectomy, it’s difficult for surgeons to take out every cell of breast tissue.
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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How Does Radiation Therapy Work
Radiation therapy uses special high-energy X-rays or particles to damage a cancer cells DNA. When a cancer cells DNA is damaged, it cant divide successfully and it dies.
Radiation therapy damages both healthy cells and cancer cells in the treatment area. Still, radiation affects cancer cells more than normal cells. Cancer cells grow and divide faster than healthy cells and also are less organized. Because of this, it’s harder for cancer cells to repair the damage done by radiation. So cancer cells are more easily destroyed by radiation, while healthy cells are better able to repair themselves and survive the treatment.
The treatment area may include the breast area, the lymph nodes, or another part of the body if the cancer has spread.
Radiation treatments are carefully planned to make sure you receive the greatest benefits and the fewest side effects possible.
- Brachytherapy/Internal Radiation
- Internal radiation, called brachytherapy by doctors, uses a radioactive substance sealed in seeds or tiny tubes that are placed inside your body directly into the cancer or the place where the cancer was. Read about brachytherapy.
Another type of radiation therapy, called intraoperative radiation therapy, is a type of partial-breast radiation. With intraoperative radiation therapy, the entire course of radiation is delivered at one time during breast cancer surgery. Read more about intraoperative radiation therapy.
Side Effects Of Radiotherapy For Breast Cancer
Radiotherapy can cause side effects in the area of your body that is being treated. You may also have some general side effects, such as feeling tired.
After treatment finishes, it may be 1 to 2 weeks before side effects start getting better. After this, most side effects usually slowly go away.
Your cancer doctor, specialist nurse or radiographer will tell you what to expect. They will give you advice on what you can do to manage side effects. If you have any new side effects or if side effects get worse, tell them straight away.
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Travelling To Radiotherapy Appointments
You might have to travel a long way each day for your radiotherapy, depending on where your nearest cancer centre is. This can make you very tired, especially if you have side effects from the treatment.
You can ask the therapy radiographers for an appointment time to suit you. They will do their best, but some departments might be very busy. Some radiotherapy departments are open from 7am till 9pm.
Car parking can be difficult at hospitals. You can ask the radiotherapy staff if they can give you a hospital parking permit for free parking or advice on discounted parking. They may be able to give you tips on free places to park nearby.
The radiotherapy staff may be able to arrange transport if you have no other way to get to the hospital. Your radiotherapy doctor would have to agree. This is because it is only for people that would struggle using public transport and have no access to a car.
Some people are able to claim back a refund for healthcare travel costs. This is based on the type of appointment and whether you claim certain benefits. Ask the radiotherapy staff for more information about this.
Some hospitals have their own drivers and local charities might offer hospital transport. So do ask if any help is available in your area.
D Techniques And Imrt
One of the first major advancements in radiotherapy that resulted in reduced doses to normal tissues is the use of 3D imaging for the design of the radiation plan. Radiotherapy based on computed tomography-simulation with treatment planning software and image verification of patient setup allows for more accurate estimation of target and organ dosimetry. 3D planning allows for adjustment of the radiation beam angle and the addition of in field blocks to reduce underlying lung and heart dose. In addition to a static cardiac block, field-in-field techniques have shown the greatest reduction in cardiac dose, but both forward-planning and IMRT have both been employed . These techniques result in lower volumes of heart receiving high and low doses as well as a reduced complication rates. These techniques also minimize dose inhomogeneity that results in areas that receive higher than the prescribed dose within the breast tissue and at the surface of the breast leading to decreased acute skin toxicity.
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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:
- nausea/vomiting
- dehydration
- 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.
Having Radiotherapy For Breast Cancer
You will have radiotherapy as an outpatient. It is usually given using equipment that looks like a large x-ray machine. You might hear it called external beam radiotherapy .
You usually have radiotherapy as a series of short, daily treatments. These are called sessions. The treatments are given from Monday to Friday, with a rest at the weekend. The person who operates the machine is called a radiographer. They will give you information and support during your treatment.
You usually have radiotherapy for 3 weeks. Women who had breast-conserving surgery may have an extra dose to the area where the cancer was. Sometimes the booster dose is given at the same time as radiotherapy to the rest of the breast. Or it may be given at the end of the 3 weeks. This means you will need a few more treatments. Your doctor will tell you how many treatments you will need.
If you have radiotherapy to your left breast, you may be asked to take a deep breath and hold it briefly. This is called deep inspiration breath hold . You do this at each of your planning and treatment sessions. It keeps you still and also moves your heart away from the treatment area. DIBH helps protect your heart during your treatment and reduces the risk of late effects.
External radiotherapy does not make you radioactive. It is safe for you to be with other people, including children, after your treatment.
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What Advances Have There Been In Radiation Treatment That Will Directly Impact Breast Cancer Patients
Positioning and Monitoring Technology is an important one. Technology is constantly advancing to improve the safety and accuracy of radiation. Accuracy is so important when getting radiation treatment because you want to treat cancer but protect the surrounding healthy tissue and organs. AlignRT is an advanced technology that can help ensure that you are set up precisely and constantly monitored during your treatment to ensure your cancer is treated safely and precisely.
As I mentioned earlier, Deep Inspiration Breath Hold is a technique used along with AlignRT by many top cancer centers to help protect your heart. DIBH is where you take a deep breath and hold it during treatment. By doing this you move your breast tissue away from your heart and reduce the risk of heart radiation exposure. AlignRT is an advanced technology that can help ensure you are set up precisely with sub-millimeter accuracy and has an automated safety system that can pause the radiation beam if you move out of the desired position during treatment to help ensure accurate and safe treatment.
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:
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Moisturize Your Skin Often
- Start using a moisturizer when you begin treatment. This can help to minimize any skin reaction. You can use an over-the-counter moisturizer. When choosing a moisturizer pick one that does not have any fragrances or lanolin. There are a number of products that are good to use, and your nurse may suggest one of these to you. Use only one at a time unless your nurse tells you to use more.
- You may be prescribed a medication either at the start, or during, your radiation therapy to treat itchy skin. There are a number of products that are good to use, and your nurse may suggest one of these to you. Use only one at a time unless your nurse tells you to use more.
- Apply the moisturizer 2 times a day.
- Dont apply moisturizers to open areas on your skin.
What Should Patients Know When Planning For Radiation Treatment
The main thing is the importance of protecting your heart. When I first started working at Vision RT, I didnt realize that that the heart may be exposed to radiation during treatment. This exposure can cause potentially serious cardiac side effects after treatment. In one study, 27% of patients showed heart abnormalities after their treatment. The good news is there is a technique called Deep Inspiration Breath Hold and used along with AlignRT can help minimize these side effects. The second issue surrounds the marks and permanent tattoos that have been a part of the radiation treatment process for so many years. Now, because of advances in technology, tattoos and marks are no longer needed and tattoo and mark-free treatment are available.
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Radiation Therapy And Sun Exposure
During radiation treatment, its best to keep the treated area completely out of the sun. This can be especially difficult if youre having radiation therapy in areas or seasons with warmer weather. To help avoid sun exposure:
- Wear clothing or a bathing suit with a high neckline, or wear a rash guard top.
- Try to keep the area covered whenever you go outside. An oversized cotton shirt works well and allows air to circulate around the treated area.
- Avoid chlorine, which is very drying and can make any skin reactions youre having worse. Chlorine is used to disinfect most pools and hot tubs.
- If you do want to swim in a pool, you might want to spread petroleum jelly on the treated area to keep the chlorine away from your skin.
After your radiation treatment is completed, the treated skin may be more sensitive to the sun than it was in the past, so you might need to take extra protective steps when you go out in the sun:
- Use a sunblock rated 30 SPF or higher on the area that was treated.
- Apply the sunblock 30 minutes before you go out in the sun.
- Reapply the sunblock every few hours, as well as when you get out of the water.
Written by: Jamie DePolo, senior editor
This content was developed with contributions from the following experts:
Chirag Shah, M.D., breast radiation oncologist, director of breast radiation oncology and clinical research in radiation oncology at the Cleveland Clinic in Cleveland, Ohio
References
Possible Side Effects Of External Beam Radiation
The main short-term side effects of external beam radiation therapy to the breast are:
- Swelling in the breast
- Skin changes in the treated area similar to a sunburn
- Fatigue
Your health care team may advise you to avoid exposing the treated skin to the sun because it could make the skin changes worse. Most skin changes get better within a few months. Changes to the breast tissue usually go away in 6 to 12 months, but it can take longer.
External beam radiation therapy can also cause side effects later on:
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