External Beam Radiation Treatment
Most of the time, we use external beam radiation treatment . We deliver this treatment to the whole breast using a machine called a linear accelerator. You receive EBRT daily, Monday to Friday. In some women, we also provide a boost dose of radiation. This entails several more radiation treatments to the surgical site. It further reduces the chance of a cancer recurrence.
Doctors deliver external beam radiation treatment in several ways. Your radiation oncologist will determine the best approach for you. We strive to deliver radiation as precisely and as safely as possible. The types of EBRT include:
- 3-D conformal radiation treatment
- Intensity-modulated radiation treatment
- Proton beam therapy: This is a newer, advanced type of external beam radiation therapy. It uses proton beams rather thanphoton beams. It allows us to be even more precise and provide even greater protection for nearby normal tissues. It is beneficial in certain cases and your doctor will discuss it with you, if appropriate.
We use one of two positions for providing radiation treatment. We select the approach that allows us to target the cancer cells while avoiding your heart and lungs. A computerized tomography scan will help us determine the best position for you. During treatment, you will either lie:
- On your back, which is often used after mastectomy, to better target your lymph nodes
- On your chest
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.
Deep Inspiratory Breath Hold
Studies have shown that it is very important to limit heart dose when treating left-sided breast cancers to prevent long-term complications such as heart attacks. On inspiration, the heart moves farther from the chest wall and breast allowing radiation to be delivered with minimal radiation exposure to the heart. Patients are instructed to take a deep breath and are monitored during treatment. The radiation beam is only turned on during inspiration and automatically shuts off if the patient needs to breathe.
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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.
Side Effects Of Radiation Therapy:
The field of radiation therapy has dramatically reduced its side effects over the last decade. CT Scan Radiation Planning has revolutionized the ability to better focus radiation on the area of cancer and avoid damaging adjacent normal tissue.
Some side effects and toxicities
- Your breast and skin can become irritated and tender
- Some constricting or shrinkage of the treated breast and surrounding tissue may occur
- Breast reconstruction and implants can be affected
- General fatigue is common
- Your breast and ribs can be sore for an extended period of time
- You cannot have radiation if you are pregnant
- There is a small risk of increasing coronary heart disease
- There are very rare cancers that can be caused by breast radiation
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Working During Radiation Therapy
Some people are able to work full-time during radiation therapy. Others can work only part-time or not at all. How much you are able to work depends on how you feel. Ask your doctor or nurse what you may expect from the treatment you will have.
You are likely to feel well enough to work when you first start your radiation treatments. As time goes on, do not be surprised if you are more tired, have less energy, or feel weak. Once you have finished treatment, it may take just a few weeks for you to feel betteror it could take months.
You may get to a point during your radiation therapy when you feel too sick to work. Talk with your employer to find out if you can go on medical leave. Check that your health insurance will pay for treatment while you are on medical leave.
Radiation Therapy To Cure Cancer
A radiation oncologist may use external beam radiation therapy or brachytherapy to treat cancer. External beam radiation therapy can be generated by a linear accelerator, which is a machine that accelerates electrons to produce x-rays or gamma rays.
Proton therapy is another form of external beam radiation therapy that uses cyclotrons or synchrotrons to produce charged atoms that destroy tumors. Radiation therapy given by radioactive sources that are put inside the patient is called brachytherapy.
The radioactive sources are sealed in needles, seeds, wires, or catheters, and implanted directly into or near a tumor on a temporary or permanent basis. Brachytherapy is a common treatment for prostate cancer, breast cancer, cervical cancer and uterine cancer.
Some cancer patients may be treated with radiation as their primary treatment. In some cases, radiation therapy is given at the same time as chemotherapy. Chemotherapy used in combination with radiation therapy can improve the local response and reduce metastatic disease.
In other cases, radiation therapy is given before or after surgery.
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What Is Breast Radiation What Is A Local Recurrence
Radiation therapy is very effective at killing cancer cells while sparing the normal surrounding tissue. This is only one component of a comprehensive treatment plan. Breast radiation is generally performed after your tumor has been surgically removed. If you are going to have a lumpectomy surgery to remove your breast cancer, then you will most likely need radiation to reduce the chance cancer will grow back in the surgical area. This is the most common use of radiation therapy for breast cancer.
Quite simply, radiation reduces the risk of local recurrence in the area where the tumor was surgically removed or in nearby areas where the cancer is at risk for recurring in the future. When a local recurrence of your cancer does occur, it is a threat to your life. When indicated, radiation reduces this risk of local recurrence, and as a result, may increase your chance of surviving breast cancer. Review our video lesson on Breast Cancer Recurrence to learn more.
External Radiation Therapy Side Effects
One of the main side effects of external radiation therapy is skin changes in the treated area.
The reaction is much like a sunburn, with redness and possible itching, burning, soreness, peeling, blisters, or darkening of the skin. These skin changes happen gradually over the course of treatment and may happen only in certain areas.
Places where skin touches skin, such as the armpit and the area under the breasts, and places where you may have had a lot of sun exposure, such as the upper chest, are more likely to be affected. Some people have a change in skin color that lasts for years after treatment.
Some people may have telangiectasias develop months to years after radiation to the breast. A telangiectasia is a small patch of tiny blood vessels on the skin of the treated area that looks like a tangle of thin red lines. Telangiectasias are not a sign of cancer recurrence, but they can sometimes cause bothersome symptoms such as itching or pain. If you develop telangiectasia after radiation therapy and wish to treat it, you can talk to a dermatologist about laser therapy or other treatments.
You may be more likely to have significant skin side effects if you have fair skin, larger breasts, certain health conditions that affect skin healing , or had mastectomy or chemotherapy before radiation.
Other common side effects of external radiation therapy are:
- swelling in the breast
Other, less common side effects that external radiation may cause are:
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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.
Radiotherapy To The Lymph Nodes
Radiotherapy can be given to the lymph nodes under the arm to destroy any cancer cells that may be present there.
It may also be given to the lymph nodes in the lower part of the neck around the collarbone, or in the area near the breastbone .
If radiotherapy to the lymph nodes is recommended, your specialist will explain why.
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How Much Radiation Therapy Costs
Radiation therapy can be expensive. It uses complex machines and involves the services of many health care providers. The exact cost of your radiation therapy depends on the cost of health care where you live, what type of radiation therapy you get, and how many treatments you need.
Talk with your health insurance company about what services it will pay for. Most insurance plans pay for radiation therapy. To learn more, talk with the business office at the clinic or hospital where you go for treatment. If you need financial assistance, there are organizations that may be able to help. To find such organizations, go to the National Cancer Institute database, Organizations that Offer Support Services and search for “financial assistance.” Or call toll-free 1-800-4-CANCER to ask for information on organizations that may help.
Radiation Therapy Side Effects
The side effects of radiation therapy depend on the type of radiation therapy youre having. In general, the side effects tend to develop as treatment goes on and may be more troubling toward the end of treatment. Overall, the most common side effects are redness, swelling, and skin peeling in the area being treated. Read more about radiation therapy side effects.
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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.
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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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.
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.
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Breast Cancer Radiation Therapy
Radiation treatment is an important tool in treating breast cancer. The radiation oncologists at Mount Sinai Health System deliver high-quality care, based on a treatment plan personalized for your needs. We are actively engaged in research to improve cancer therapy. Our physicians, nurses, physicists, radiation therapists, and support staff work as a team to give you the most compassionate and advanced cancer care available. We strive to make treatment as physically and emotionally comfortable as possible. Using the latest techniques, we can pinpoint your cancer while protecting normal cells.
Generally, patients receive radiation therapy after part of the breast is removed, in a procedure called a lumpectomy or breast-conserving surgery. The radiation is used to get rid of any cancer cells that may be left in the body. This helps prevent cancer from coming back. Radiation treatment following a lumpectomy typically lasts for three to four weeks.
We may also use radiation therapy after removing the entire breast . Generally, we use this approach if you have cancer in the lymph nodes or the tissue around a tumor. In this case, we direct the radiation at the reconstructed breast or the chest wall and the area where the lymph nodes had been. Postmastectomy radiation therapy typically takes five weeks.
What Is Adjuvant Therapy For Breast Cancer
But what does “adjuvant mean, and what does it indicate about the therapies to which its applied?
We asked Wendy Woodward, M.D., Ph.D., a radiation oncologist and researcher who specializes in breast cancer. Heres what she had to say.
What is adjuvant therapy and how does it differ from neo-adjuvant therapy?
Anything that happens before surgery, such as chemotherapy given to shrink the tumor, is called neo-adjuvant therapy. Any therapies that happen afterwards are considered adjuvant.
Which breast cancer patients need adjuvant therapy?
It really depends. All adjuvant treatments are based on the chances of a patient not being cured of a particular cancer by surgery and any therapy they may have received before surgery . Additional therapies are offered to reduce the risk of recurrence.
How is the need for adjuvant breast cancer therapy determined?
The first thing that happens at MD Anderson is staging. Thats how our doctors learn how large and advanced a patients cancer is, usually through imaging.
At some point during every staging process, we will ask the following questions:
What types of adjuvant therapy are typically used to treat breast cancer?
Why is it important to know a breast cancers subtype?
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