Deep Inspiration Breath Hold
Various techniques are used to minimise the exposure of the heart to radiation. One technique is to voluntarily hold a deep breath for 20-30 seconds while the radiation is delivered, as this expands the lungs and moves the heart away from the radiation field. Pre-treatment assessment of lung capacity and breathing patterns is carried out and the patient is given instruction on breath-holding for the required time.
To accurately maintain a deep inspiration breath hold, some centres use an active breathing co-ordinator device. Using this, patients are taught to take and hold a measured deep breath while the radiation dose is delivered. Using this method, patients can monitor their own breathing and the machine links to the linear accelerator ensuring that the radiation dose is only delivered when optimal breath hold is reached and maintained.
Both methods have been shown to reduce the exposure of the heart to radiation.
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:
- Carefully positions your body in an immobilization device on the treatment table. This device helps you stay in the correct position for all treatments.
- Uses techniques to reduce the dose to the heart and lungs
- Uses a tattoo device to mark the corners of the treatment areas . The freckle-sized tattoos are permanent. These markings help your provider align the radiation treatment in the same manner each time.
Radiation Therapy Benefits All Early
The risk of recurrence was lower when early-stage hormone-receptor-positive, HER2-negative breast cancer at low risk of recurrence was treated with radiation and hormonal therapy after surgery, compared to treatment with hormonal therapy alone, according to a study.
The research was presented on April 28, 2019, at the European Society for Radiotherapy and Oncology Congress in Milan, Italy. Read the abstract of “Antihormones with or without irradiation in breast cancer: 10-year results of the ABCSG 8A trial.”
Doctors call treatments given after breast cancer surgery adjuvant treatments.
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Expert Review And References
- Bursein HJ, Harris JR, Morrow M. Malignant tumors of the breast. Devita, V. T., Jr., Lawrence, T. S., & Rosenberg, S. A. Cancer: Principles & Practice of Oncology. 8th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2008: 43.2: pp. 1606-54.
- Foxson SB, Lattimer JG & Felder B. Breast cancer. Yarbro, CH, Wujcki D, & Holmes Gobel B. . Cancer Nursing: Principles and Practice. 7th ed. Sudbury, MA: Jones and Bartlett; 2011: 48: pp. 1091-1145.
- National Cancer Institute. Breast Cancer Treatment Health Professional Version. Bethesda, MD: National Cancer Institute; 2010.
- Breast cancer. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology. National Comprehensive Cancer Network; 2010.
- Tripathy D, Eskenazi LB, Goodson, WH, et al. Breast. Ko, A. H., Dollinger, M., & Rosenbaum, E. Everyone’s Guide to Cancer Therapy: How Cancer is Diagnosed, Treated and Managed Day to Day. 5th ed. Kansas City: Andrews McMeel Publishing; 2008: pp. 473-514.
Will The Nhs Fund An Unlicensed Medicine
It’s possible for your doctor to prescribe a medicine outside the uses it’s licensed for if they’re willing to take personal responsibility for this ‘off-licence’ use of treatment.
Your local clinical commissioning group may need to be involved, as it would have to decide whether to support your doctor’s decision and pay for the medicine from NHS budgets.
Page last reviewed: 28 October 2019 Next review due: 28 October 2022
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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:
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.
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.
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.
How Is Breast Cancer Treated With Radiation Therapy
Breast cancer is typically treated by a team of doctors, consisting of surgeons, medical oncologists and radiation oncologists. Patients usually have more than one type of treatment, determined by the cancers stage and the;patients overall health, age and medical history.
A treatment plan may include surgery to remove the tumor and affected tissue, chemotherapy to slow the tumors growth and/or kill cancer cells, hormone therapy and targeted therapy. Often, patients with breast cancer will also require radiation treatment to the breast, chest wall and, possibly, the lymph nodes. Radiation therapy uses high-energy radiation to damage the DNA inside cancer cells, killing the cells or preventing them from dividing and spreading.
Radiotherapy To Part Of The Breast
Less commonly, some women are given radiotherapy to part of the breast instead of the whole breast. There are different ways of doing this.
Your cancer doctor or specialist nurse will explain if any of the following treatments are options for you. They will tell you what the possible side effects are and any risks involved.
It is important to have information about all your treatment options. They can explain how these treatments compare with external radiotherapy.
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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.
Breast Cancer Treatment: Understanding And Treating Radiation Burns
Your oncologist has prescribed radiation treatments in your battle against breast cancer. Maybe youve been receiving treatment already. Or perhaps you have long since finished, yet still have lingering side effects. One of the most common side effects is radiation dermatitis, sometimes referred to as radiation burn. What is it and how can you manage this side effect?
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Where Do I Start
You first will meet with a radiation oncologist to decide if radiation therapy is a recommended treatment option for your particular situation. If you and your doctors decide to proceed, then you will have an extended consultation in which you discuss the details of your treatment. This includes the exact area to treat, the amount of radiation you will receive, the length of treatment time and potential treatment side effects. The radiation oncologist will also answer any questions you may have. These issues vary for each person, so it is important to make an individual treatment plan.
What Are Clinical Trials
Cancer specialists regularly conduct studies to test new treatments. These studies are called clinical trials. Clinical trials are available through cancer doctors everywhere- not just in major cities or in large hospitals.
Some clinical studies try to determine if a therapeutic approach is safe and potentially effective. Many large clinical trials compare the more commonly used treatment with a treatment that cancer experts think might be better. Patients who participate in clinical trials help doctors and future cancer patients find out whether a promising treatment is safe and effective. All patients who participate in clinical trials are carefully monitored to make sure they are getting quality care. It is important to remember that clinical trials are completely voluntary. Patients can leave a trial at any time. Clinical trials testing new treatments are carried out in phases:
Only you can make the decision about whether or not to participate in a clinical trial. Before making your decision, it is important to learn as much as possible about your cancer and the clinical trials that may be available to you. Your radiation oncologist can answer many of your questions if you are considering taking part in a trial or contact the National Cancer Institute at 1-800-4-CANCER or www.cancer.gov.
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Radiation For Metastatic Breast Cancer
Sometimes breast cancer spreads to other parts of the body. When this happens, the breast cancer is called metastatic or stage IV.
If youve been diagnosed with metastatic breast cancer and are having symptoms, your doctor may recommend radiation therapy to:
- ease pain
- lower the risk of a cancer-weakened bone breaking
- open a blocked airway to improve breathing
- reduce pressure on a pinched spinal cord or nerve that might be causing pain, numbness, or weakness
- treat cancer that has spread to the brain
The radiation dose and schedule to treat metastatic breast cancer depends on a number of factors, including:
- the level of pain or amount of function lost
- the size of the cancer
- the location of the cancer
- the amount of previous radiation youve had
- the schedule for any other treatments
External Beam Breast Cancer Radiation
External beam radiation uses external beam radiation, like that of a regular x-ray, but the beam is highly focused and targets the cancerous area for two to three minutes. This form of treatment usually involves multiple appointments in an outpatient radiation center as many as five days a week for five or six weeks. Certain situations may require a slightly higher dose of radiation over a shorter course of treatment, usually three to four weeks
External breast cancer radiation used to be the most common type used for breast cancer. However in more recent years internal radiation clinical trials have enabled more women to opt for this method if their cancer was caught early enough.; Internal radiation typically offers fewer noticeable side effects.
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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.
How Is Radiation Therapy For Breast Cancer Performed
Most people lie on their back during the treatment though some breast treatments are performed while lying on your stomach . You place your arm above your head .
During the treatment, your treatment team:
- Positions and secures your body in the immobilization device. If you had a mastectomy, your provider might place a bolus on top of the treatment area to increase the radiation dose to the surface.
- Lines up the machine with the first treatment field. To protect themselves from radiation exposure, providers leave the room. Your provider can still hear and see you.
- Turns on the machine. You will hear a whirring noise, but you wont see the radiation beams. You must remain still. Depending on the radiation type and dose, treatment can take 30 seconds to several minutes.
- Returns to the room to position the machine to treat a different treatment field. Most people get treatment on two to five fields each day.
- Takes daily/weekly X-rays of the treatment field to make sure the radiation is hitting the correct area.
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