Types Of Radiation For Breast Cancer
External-beam radiation therapy is the most common form of radiation treatment for breast cancer. In this approach, a machine called a linear accelerator, or LINAC, produces radiation. The radiation is delivered as precisely targeted x-ray beams.
At MSK, we deliver external-beam radiation therapy in a variety of ways. These approaches are designed to tailor the radiation treatments as much as possible to the exact size and location of your cancer, specifically aiming at tumor cells while avoiding side effects.
We also offer internal radiation therapy in the form of brachytherapy. Brachytherapy is generally reserved for women receiving partial-breast irradiation after lumpectomy.
Learn more about the techniques our breast cancer radiation team frequently recommends.
In this method, patients lie on their stomach . Radiation is directed to the affected breast as it hangs through an opening in the treatment table. This approach may reduce radiation exposure to nearby vital organs, such as the heart and lungs. Prone breast radiation has been shown to reduce radiation burn on the skin. Research has also shown that this therapy is especially useful for women with large breasts.
In this approach, our experienced radiation therapists guide women with cancer in the left breast through a breathing technique called deep inspiration breath hold . It minimizes the risk of injury to the heart.
Skin And Hair Reactions
Your skin and hair in the treatment area will change during your radiation therapy. This is normal.
- Your skin may turn pink, red, tanned, or look like it has sunburn. The skin in the folds under your arm and breast, over your collar bone, and in other parts of the treatment area that have been in the sun may blister and peel.
- Your skin may become very sensitive and itchy.
- You may get a rash, especially in any area where your skin has been in the sun. Tell a member of your radiation therapy team if you get a rash at any time during your radiation therapy. Rashes are sometimes a sign of an infection.
- You may lose some or all of your hair under your arm on the treated side. It usually grows back in 2 to 4 months after you finish radiation therapy.
If your skin becomes open, wet, and oozing, contact your radiation team. They may prescribe a cream called Silvadene® . Your radiation oncologist may also stop your radiation therapy until your skin heals, although this is rarely needed.
Skin reactions from radiation therapy are usually strongest 1 or 2 weeks after you finish radiation therapy and then start to heal. It often takes 3 to 4 weeks for skin reactions to heal. If you have any questions or concerns, dont hesitate to contact your radiation oncologist or nurse.
Skin care guidelines
Follow these guidelines care for your skin during treatment. Keep following them until your skin gets better. These guidelines refer only to the skin in the treatment area.
What To Expect During Radiation Treatments
Treatments are usually given five days a week for six to seven weeks. If the goal of treatment is palliative treatment will last 2-3 weeks in length. Using many small doses for daily radiation, rather than a few large doses, helps to protect the healthy cells in the treatment area. The break from treatment on weekends allows the normal cells to recover.
It is very important to finish all sessions of radiation therapy. It is important not to miss or delay treatments because it can lessen how well the radiation kills tumor cells.
The radiation therapy technologist may ask you to change into a gown before treatment. It is a good idea to wear clothing that is easy to pull down, adjust, or remove when coming for treatments.
During the actual treatment sessions you will be in the treatment room between 10-30 minutes. You will be receiving radiation for 1-2 minutes of that time.
You will be asked to lie on a hard, moveable bed. The RTT will use the marks on your skin to exactly position the machine and table. In some instances, special blocks or shields are used to protect normal organs. You may be positioned using special holders, molds or boards.
It is extremely important to remain still during the radiation treatments. Breathe normally during treatments. You do not need to hold your breath. You will not feel anything during the treatment. Radiation is painless. You will not see, hear, or smell radiation.
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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.
Problems Moving Your Arm And Shoulder
Radiotherapy might make it harder to move your arm and shoulder. This can affect your activities and work. It usually improves when the treatment finishes. Your nurse or physiotherapist can give you exercises to help.
Its important to continue the arm exercise you were shown after your surgery. This will make it easier for you to lift your arm to the correct position during radiotherapy. It can also help stop your arm and shoulder from becoming stiff.
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These Steps Can Help:
- Gently cleanse the treated area using lukewarm water and a mild soap. Donât rub your skin. Pat it dry with a soft towel, or use a hair dryer on a cool setting.
- Donât scratch or rub the treated area. Use only an electric razor if you need to shave there. Donât put on medical tape or bandages.
- Donât apply any ointment, cream, lotion, or powder to the treated area unless your doctor or nurse has prescribed it. This includes cosmetics, shaving lotions, perfumes, and deodorants.
- Choose clothes made from natural fibers like cotton rather than tight-fitting clothing or harsh fabrics like wool or corduroy.
- Avoid extreme heat or cold where you’ve had radiation — no electric heating pads, hot water bottles, or ice packs.
- Also avoid hot tubs and tanning beds.
- Stay out of direct sunlight, especially between the hours of 10 a.m. and 2 p.m., even after you’re done with treatment. The sun can intensify skin reactions and lead to severe sunburn. Choose a sunscreen of SPF 30 or higher. Wear protective clothing, such as a long-sleeved shirt, pants, and a wide-brimmed hat, too.
Radiation Therapy Clinical Trials For Breast Cancer
Clinical trials are research studies that test new treatments to see how well they work and confirm that they are safe. Women who choose to participate in a trial at MSK receive the most advanced cancer treatments available, sometimes years before they are available anywhere else.
We offer a number of clinical trial options for women with breast cancer who are receiving radiation therapy. For example, MSK investigators are leading a national trial on the use of proton therapy to limit radiation-induced heart disease. Our team is also testing radiation in combination with new drugs, such as immunotherapy for recurrent breast cancer.
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What Questions Should I Ask My Doctor
Coping with a diagnosis of cancer and researching the various treatment options can be a stressful experience. To assist you in this process, below is a list of questions you may want to ask your radiation oncologist if you are considering radiation therapy.
Questions to ask before treatment
- What type and stage of cancer do I have?
- What is the purpose of radiation treatment for my type of cancer?
- How will the radiation therapy be given? Will it be external beam or brachytherapy? What do the treatments feel like?
- For how many weeks will I receive radiation? How many treatments will I receive per week?
- What are the chances that radiation therapy will work?
- Can I participate in a clinical trial? If so, what is the trial testing? What are my benefits and risks?
- What is the chance that the cancer will spread or come back if I do not have radiation therapy?
- Will I need chemotherapy, surgery or other treatments? If so, in what order will I receive these treatments? How soon after radiation therapy can I start them?
- How should I prepare for this financially?
- What are some of the support groups I can turn to during treatment?
- If I have questions after I leave here, who can I call?
- Will radiation therapy affect my ability to have children?
- Do you take my insurance?
Questions to ask during Treatment
Questions to ask After Treatment Ends
What Is The Prognosis After Recurrence
Many patients with a recurrence of breast cancer can be successfully treated, often with methods other than radiation if radiation was used in the initial treatment. For patients treated initially for invasive breast cancer, five percent to 10 percent will be found to have distant metastases at the time of discovery of the breast recurrence. The same proportion will have recurrences that are too extensive to be operated on. While in these cases the patient’s disease can often be managed over a period of years, the goals of treatment change from obtaining a cure to preventing further progression or managing symptoms. Five-year cure rates for patients with relapse after breast conservation therapy are approximately 60 percent to 75 percent if the relapse is confined to the breast and a mastectomy is then performed.
For patients treated initially for DCIS, about one-half of recurrences are invasive and one-half noninvasive DCIS. Long-term control rates following recurrence after initial breast conservation therapy have been high, often over 90 percent.
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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.
Vitamins To Avoid During Radiation Therapy
Your radiation oncologist may tell you to avoid taking certain antioxidant vitamin supplements, such as vitamins C, A, D, and E, while you’re having radiation therapy. These vitamins might interfere with radiation’s ability to destroy cancer cells.This is because radiation works in part by creating free radicals highly energized molecules that damage cancer cells. Free radicals in the environment can damage all cells, but in the case of radiation treatment they are focused on the cancer cells. Antioxidants help keep free radicals from forming or neutralize them if they do form.
Because of the potential conflict between the goal of radiation therapy and the goal of antioxidants , it makes sense to stop taking any antioxidant supplements during radiation therapy. When radiation is finished, you can resume taking your supplements.
Throughout your treatment, do your best to eat a well-balanced diet that contains all of the vitamins you need. Vitamins that come naturally from food are unlikely to interfere with treatment.
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Easing Worries About Radiation Therapy
Its normal to worry about possible side effects of radiation therapy.
Talk with your health care provider about your concerns.
Your provider may be able to suggest a hospital social worker, patient navigator, psychologist or support group to help ease anxiety related to radiation therapy .
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.
Learn more about support groups.
What Are The Side Effects Of Radiation Therapy
Radiation is very good at killing cancer cells, but it can also affect normal cells. This can lead to side effects. The most common ones are:
- Feeling very tired.
- Skin changes in the area treated with radiation. The skin may be red, dry, and sore.
- Swelling and heaviness in your breast.
Most side effects will go away within a few weeks after you finish your treatments. But it may take longer to get your energy back.
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Treating Stage Iii Breast Cancer
In stage III breast cancer, the tumor is large or growing into nearby tissues , or the cancer has spread to many nearby lymph nodes.
If you have inflammatory breast cancer: Stage III cancers also include some inflammatory breast cancers that have not spread beyond nearby lymph nodes. Treatment of these cancers can be slightly different from the treatment of other stage III breast cancers. You can find more details in our section about treatment for inflammatory breast cancer.
There are two main approaches to treating stage III breast cancer:
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.
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Being Careful When Showering Or Bathing
A person should use warm rather than hot water, and avoid letting the spray from the showerhead directly hit the treatment area.
The National Cancer Institute notes that a person can shower daily. However, if they prefer bathing, they should do this every other day and avoid soaking for long periods of time.
They should avoid strong or fragranced soaps, and opt for gentle, fragrance-free, moisturizing soaps specifically for sensitive skin.
People should cleanse gently, and avoid scrubbing with loofahs or wash cloths, then, when done, use a soft towel to pat themselves dry..
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
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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.
When Is Radiation Used For Early
Radiation therapy is given to most people with early-stage breast cancer who choose breast-conserving surgery such as lumpectomy. Their other surgery option is mastectomy, which removes the whole breast. Many women choose breast-conserving surgery plus radiation so they can keep their breast.
Women who have breast-conserving surgery plus radiation have the same survival rates as women who have mastectomy.footnote 1
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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:
What Happens Before Radiation Therapy Treatment
Each treatment plan is created to meet a patient’s individual needs, but there are some general steps. You can expect these steps before beginning treatment:
Meeting with your radiation oncologist. The doctor will review your medical records, perform a physical exam, and recommend tests. You will also learn about the potential risks and benefits of radiation therapy. This is a great time to ask any questions or share concerns you may have.
Giving permission for radiation therapy. If you choose to receive radiation therapy, your health care team will ask you to sign an “informed consent” form. Signing the document means:
Your team gave you information about your treatment options.
You choose to have radiation therapy.
You give permission for the health care professionals to deliver the treatment.
You understand the treatment is not guaranteed to give the intended results.
Simulating and planning treatment. Your first radiation therapy session is a simulation. This means it is a practice run without giving radiation therapy. Your team will use imaging scans to identify the tumor location. These may include:
Depending on the area being treated, you may receive a small mark on your skin. This will help your team aim the radiation beam at the tumor.
You may also be fitted for an immobilization device. This could include using:
These items help you stay in the same position throughout treatment.
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