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Radiation Simulation For Breast Cancer

How Effective Is Radiation Therapy

Cancer Therapy Basics – CT Simulation Scan for 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.

Treatment Planning For A Hybrid Machine

For MR-guided RT on a conventional linac, treatment planning is performed according to the standard practice. This includes registering the MRI scan to the planning CT scan used for delineation and producing a dose distribution using a standard treatment planning system. However, when treatment is to be delivered on a MR-guided hybrid machine, several additional factors need to be considered, all of which will be incorporated into the dedicated treatment planning systems. These factors are inherently related to the design of the hybrid machines. First, given that the magnetic field influences the path of secondary electrons, the ERE and the ESE in air have to be taken into account. Second, the influence of geometric accuracy of the MR images on treatment planning must be considered. Third, there are some restrictions for planning to bear in mind.

Impact Of Geometric Distortions

Because the breast is located peripherally in the body and geometric distortions increase with distance from the isocenter and susceptibility effects arise near tissueair interfaces , the effects of these distortions on dosimetry for breast RT may be significant . The system-specific distortions together with patient-related distortions may result in unacceptable dosimetric variations, as has already been shown for WBI . This issue still requires investigation in the context of PBI, such as investigation of the impact of distortion at the edges of the breasts, which would lead to inaccurate assignment of air vs. tissue electron density and therefore inaccurate dose calculations when these are based on the MRI. Geometric distortions inside the target region should be carefully considered in choosing adequate planning target volume margins in the context of breast RT on an hybrid machine .

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Daily Setup And Positioning Accuracy

Experiences from hospitals that have treated breast cancer patients in the adjuvant setting with the 0.35 T 60Co system have shown that initial patient setup verification based on location of lumpectomy cavity and online motion monitoring could be beneficial for PBI patients in terms of reducing the CTV to PTV margin and therefore irradiated volume and thereby the risk of late toxicity . A > 52% reduction in treatment volume was achieved by applying no PTV margin for the lumpectomy cavity with the help of online MRI for setup . Although a 0-mm PTV margin neglects correction of other uncertainties that would normally be incorporated in the CTV to PTV margin , this illustrates that online MRI for setup may help to reduce the PTV margin compared to treatment on a conventional linac. With the aid of an online motion monitoring approach, a mean difference of < 1% between planned and delivered dose to 95% of the target volume was achieved . For treatment in the neoadjuvant setting, patient setup and positioning accuracy on a hybrid machine are still to be evaluated.

What Should I Wear

RACGP

You will need to change into a hospital gown. Our changing areas are private and there is a secure locker for your clothes and belongings. It is best if you leave valuable items at home. You will need to lock up all of your belongings, including your cell phone and credit cards. If you are wearing anything metallic, such as jewelry, dentures, eyeglasses, or hearing aids that might interfere with the MRI, we will ask you to remove them. Patients who are having a brain / head MRI should not wear make-up as some brands contain metal.

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During Your Radiation Treatments

Your radiation therapists will bring you to the treatment room and help you lie on the treatment table . Youll be positioned exactly how you were during your simulation and set-up procedure. Your radiation therapists will do everything they can to make sure youre comfortable. Then, theyll leave the room, close the door, and start your treatment.

Figure 2. An example of a radiation treatment machine

Breathe normally during your treatment, but dont move. You wont see or feel the radiation, but you may hear the machine as it moves around you and is turned on and off. Your radiation therapists will be able to see you on a monitor and talk with you through an intercom during your whole treatment. Tell them if youre uncomfortable or need help.

Youll be in the treatment room for 10 to 20 minutes, depending on your treatment plan. Most of this time will be spent putting you in the correct position. The actual treatment only takes a few minutes.

Your radiation treatment wont make you or your clothes radioactive. Its safe for you to be around other people.

What Happens During Each Treatment Visit

External radiation is a lot like getting a regular x-ray. The treatment itself is painless and takes only a few minutes. But each session can last 15 to 30 minutes because of the time it takes to set up the equipment and put you in the right position.

External radiation therapy is usually given with a machine called a linear accelerator which delivers a beam of radiation. The machine has a wide arm that extends over the treatment table. The radiation comes out of this arm. The machine can move around the table to change the angle of the radiation, if needed, but it wont touch you. The radiation beams are invisible and you will not feel anything, but the machine will make noise.

Depending on the area being treated, you might need to undress, so wear clothes that are easy to take off and put on. Youll be asked to lie on the treatment table next to the radiation machine.

The radiation therapist might put special heavy shields between the machine and parts of your body that arent being treated to help protect normal tissues and organs.

Once youre in the right position, the radiation therapist will go into a nearby room to operate the machine and watch you on a TV screen. The room is shielded, or protected from the radiation so that the therapist isnt exposed to it. You can talk with the therapist over an intercom. Youll be asked to lie still during the treatment, but you wont have to hold your breath.

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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.

Sexual And Reproductive Health

The radiation oncology series: How is breast cancer treated with radiation?

You can be sexually active during your radiation therapy unless your radiation oncologist gives you other instructions. You wont be radioactive or pass radiation to anyone else. If you or the person youre sexually active with can get pregnant, its important to use birth control during your radiation therapy.

You may have concerns about how cancer and your treatment can affect your sex life. Radiation therapy can affect your sexual health physically and emotionally. Talking with your radiation oncologist or nurse about your sexual health can be hard, but its an important conversation to have. They may not bring it up unless you share your questions and concerns. You may feel uncomfortable, but most people in cancer treatment have similar questions. We work hard to make sure everyone in our care feels welcome.

Sexual health programs

We also offer sexual health programs. These programs can help you manage the ways your cancer or cancer treatment affect your sexual health or fertility. Our specialists can help you address sexual health or fertility issues before, during, or after your treatment.

Other resources

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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.

What Should Patients Receiving Hypofractionation Expect

Patients receiving hypofractionation at Yale Medicine come for care on an outpatient basis five days a week, from Monday to Friday. Treatment session take 15 to 30 minutes, but the majority of that time is spent positioning the radiation machine so it is angled correctly, and getting the patient properly aligned. The actual radiation time is about two to four minutes.

Patients typically lie on their backs at a slight angle, with the arm on the side of the body being treated placed out of the way of the radiation beam. In some cases, patients may be treated lying on their stomachs.

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Radiation For Breast Cancer

Radiation therapy is treatment with high-energy rays that destroy cancer cells. Some women with breast cancer will need radiation, in addition to other treatments.

Depending on the breast cancer’s stage and other factors, radiation therapy can be used in several situations:

  • After breast-conserving surgery, to help lower the chance that the cancer will come back in the same breast or nearby lymph nodes.
  • After amastectomy, especially if the cancer was larger than 5 cm , if cancer is found in many lymph nodes, or if certain surgical margins, such as the skin or muscle, have cancer cells.
  • If cancer has spread to other parts of the body, such as the bones, spinal cord, or brain.

Q: How Can Patients Cope With These Concerns

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A: The first step is to recognize ones fears and worries. The next step is to find a way of dealing with these worries. Information and education are essential to regain some control. Sharing ones fears and worries with loved ones, a support group, or seeking professional help can and will bring relief. It is normal to have many concerns after completing treatment for cancer and important to feel supported and accompanied in this journey.

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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:

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    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.

What Are The Advantages Of Hypofractionation

The major advantage is convenience because patients can receive the full course of radiation treatment in fewer sessions. With both conventional and hypofractionated radiation, the patient receives radiation five days a week. In the conventional regimen, though, the schedule lasts for five to six weeks, whereas hypofractionation therapy is completed in three to four weeks.

Two large clinical trials found no loss of therapeutic effectiveness in hypofractionation despite its shorter length of treatment. One of the studies also found that swelling of the breast post-treatment as well as skin irritation, skin itchiness and fatigue were less common among women who received hypofractionation compared to other forms of radiation therapy.

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What Should I Expect After Radiation Therapy For Breast Cancer

You may notice fatigue as well as skin changes while undergoing radiation therapy. Your skin may become irritated, tender and swollen . People with fair skin may develop a red sunburn appearance. People with dark skin may notice darkening of the skin. This condition can also cause dry, itchy, flaky skin. Your skin may peel as you get close to finishing treatments . This skin irritation is temporary. Your provider can prescribe creams or medications to ease discomfort, if needed.

Skin discoloration can persist after treatment ends. Some people with fair skin have a slight pink or tan appearance for several years. You may also see tiny blood vessels in the radiated area. These vessels look like thin red lines or threads. These are not cause for concern.

Should I Eat Or Drink Before The Scan

What to Expect: Radiation Therapy Simulation Appointment

If you are having your abdomen scanned, you might need to fast 4-6 hours before the MRI exam. This will ensure that undigested food will not obscure the images. For some exams, you may be asked to drink some oral contrast when you arrive for your MRI exam. Most other MRI exams do not require you to fast or otherwise restrict your diet.

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Breast Reconstruction After Radiation Therapy

For patients who receive radiation after surgery, breast reconstruction is usually best left until the radiation treatments are complete. This avoids any unnecessary impact on your healthy breast tissue and any breast implants. It can also make it more difficult to target that area of the breast. Your oncology team will recommend when they feel youre far enough along in recovery to undergo breast reconstruction surgery.

How Do I Prepare For My Treatments

Before your first radiation treatment, you will have a simulation appointment. This appointment will last approximately one to two hours. During this appointment, the doctor will identify the exact fields on your body to treat with radiation. This involves lying on a table while the radiation therapist marks the field with small dots made with permanent ink. Each dot is similar to a very small tattoo. You will not receive any radiation treatment during this appointment.

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How Does Your Doctor Plan Your Radiation Treatment

Radiation is planned and given by a team of trained health care providers. The radiation oncologist is a doctor who treats cancer with radiation and oversees the care of each patient getting radiation. Working closely with the radiation oncologist, the radiation therapist gives the daily radiation treatment and positions patients for each treatment. Other professionals include the medical physicist and dosimetrist who plan and calculate the doses of radiation.

Before starting radiation therapy, your radiation oncologist will examine you, review your medical history and test results, and pinpoint the exact area to be treated. This planning session is called simulation. You might hear this referred to as the sim. Youll be asked to lie still on a table while the radiation therapist uses imaging scans to define your treatment field . These are the exact places on your body where the radiation beams will be aimed.

The simulation is very important and may take some time. It’s used to plan exactly where the treatment will be on or in your body. The radiation can then be delivered as directly as possible to the tumor while affecting normal, healthy tissues as little as possible.

Nerve Damage Around The Treatment Area

La Simulación

Scaring from radiotherapy may cause nerve damage in the arm on the treated side. This can develop many years after your treatment. Symptoms include tingling, numbness, pain, and weakness. In some people, it may cause some loss of movement in the arm and shoulder.

Speak to your doctor if you notice any of these symptoms.

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What Is External Beam Radiation Therapy

During external beam radiation therapy, a beam of radiation is directed through the skin to the cancer and the immediate surrounding area in order to destroy the main tumor and any nearby cancer cells. To minimize side effects, the treatments are typically given five days a week, Monday through Friday, for a number of weeks. This allows doctors to get enough radiation into the body to kill the cancer while giving healthy cells time each day to recover.

The radiation beam is usually generated by a machine called a linear accelerator. The linear accelerator, or linac, is capable of producing high-energy X-rays and electrons for the treatment of your cancer. Using high-tech treatment planning software, your treatment team controls the size and shape of the beam, as well as how it is directed at your body, to effectively treat your tumor while sparing the surrounding normal tissue. Several special types of external beam therapy are discussed in the next sections. These are used for specific types of cancer, and your radiation oncologist will recommend one of these treatments if he or she believes it will help you.

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