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What Kind Of Radiation Is Used To Treat Breast Cancer

Staying On Track With Radiation Treatments

Intraoperative Radiation Therapy: How is it Used to Treat Breast Cancer?

The benefits of radiation therapy strongly depend on getting the full recommended dose without significant breaks, because:

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    The full dose of radiation is needed to get rid of any cancer cells remaining after surgery.

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    Radiation therapy is most effective when given continuously on schedule. In the past, it was given every day, 5 days a week, for 5 to 7 weeks. Accelerated, also called hypofractionated, radiation therapy schedules deliver about the same total dose of radiation over a shorter schedule usually 3 to 4 weeks, which can be more convenient. Partial breast radiation can be completed in 1 to 3 weeks. Also, by seeing your doctor regularly during and after treatment, you can best deal with any side effects.

Why you might have problems sticking to your radiation therapy plan:

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    The treatment schedule may conflict with job demands, family needs, or the distance you live from the treatment facility. This may cause you to miss or postpone appointments, even if youre on an accelerated schedule.

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    Skin irritation from radiation can cause soreness, peeling, and sometimes blisters. If you’ve also had lymph-node surgery, radiation treatment may worsen breast or underarm pain or discomfort. If you have these side effects, you might feel like stopping radiation.

Ways to overcome problems and stay on track with radiation treatment:

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.

What To Expect With External Beam Radiation

If you have external beam radiation, youll meet with your radiation oncologist and a nurse before starting treatment. They will walk you through what to expect with external beam radiation, and the risks and benefits of this treatment.

At this time, youll likely have a physical exam and go over your medical history.

Additionally, the radiation oncologist and a radiation therapist will take scans of your treatment area. This will help define the boundaries of the affected area so they know where to aim the radiation beams.

They will put marks on your skin to mark the area. You will need the marks throughout the course of your treatment. The marks will be used to line up your body, so the radiation beams target the exact area that needs to be treated.

Sometimes a body mold will be made to immobilize you during the treatment and to help keep your body still.

Each treatment will only last a few minutes. The session setup will take longer than the actual treatment. You wont feel anything when the machine is turned on for the treatment. Its a painless procedure.

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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.

How Is Radiation Therapy Given

Breast cancer radiotherapy

Radiation therapy can be given in 3 ways:

  • External radiation : uses a machine that directs high-energy rays from outside the body into the tumor. Its done during outpatient visits to a hospital or treatment center. It’s usually given over many weeks and sometimes will be given twice a day for several weeks. A person receiving external radiation is not radioactive and does not have to follow special safety precautions at home.
  • Internal radiation: Internal radiation is also called brachytherapy. A radioactive source is put inside the body into or near the tumor. With some types of brachytherapy, radiation might be placed and left in the body to work. Sometimes it is placed in the body for a period of time and then removed. This is decided based on the type of cancer. Special safety precautions are needed for this type of radiation for a period of time. But it’s important to know if the internal radiation is left in the body, after a while it eventually is no longer radioactive.
  • Systemic radiation: Radioactive drugs given by mouth or put into a vein are used to treat certain types of cancer. These drugs then travel throughout the body. You might have to follow special precautions at home for a period of time after these drugs are given.

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External Beam Radiation Therapy

EBRT is the most common type of radiation therapy for women with breast cancer. A machine outside the body focuses the radiation on the area affected by the cancer.

Which areas need radiation depends on whether you had a mastectomy or breast-conserving surgery and if the cancer has reached nearby lymph nodes.

  • If you had a mastectomy and no lymph nodes had cancer cells, radiation will be focused on the chest wall, the mastectomy scar, and the places where any drains exited the body after surgery.
  • If you had BCS, you will most likely have radiation to the entire breast . An extra boost of radiation to the area in the breast where the cancer was removed is often given if there is a high risk of the cancer coming back. The boost is often given after the treatments to the whole breast have ended. It uses the same machine, with lower amounts of radiation aimed at the tumor bed. Most women dont notice different side effects from boost radiation than from whole breast radiation.
  • If cancer was found in the lymph nodes under the arm , this area may be given radiation, as well. Sometimes, the area treated might also include the nodes above the collarbone and the nodes beneath the breast bone in the center of the chest .

External Beam Radiation Therapy For Cancer

External beam radiation therapy comes from a machine that aims radiation at your cancer.

External beam radiation therapy comes from a machine that aims radiation at your cancer. It is a local treatment, which means it treats a specific part of your body. For example, if you have cancer in your lung, you will have radiation only to your chest, not to your whole body.

External beam radiation therapy is used to treat many types of cancer.

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Types Of External Beam Radiation Therapy

There are many types of external beam radiation therapy, all of which share the goal of delivering the highest prescribed dose of radiation to the tumor while sparing the normal tissue around it. Each type relies on a computer to analyze images of the tumor in order to calculate the most precise dose and treatment path possible.

Types of external beam radiation therapy include:

How Are Photon And Proton Beam Therapies Different From Each Other

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

Although both photon and proton therapies are forms of radiation therapy, there are 2 main differences.a) The type of particle that is aimed at the tumor: Photons such as X-rays are delivered as waves which do not have any charge. They pass through the body and release energy all along the way. A proton is an invisibly-small positively-charged particle. How deeply a proton travels into the body depends on the speed of the proton when it leaves the machine. 15

b) The effect of radiation on cells surrounding the tumor: The energy in photon beams gets absorbed gradually as the beams pass through tissues. Because of this, they cause damage to the tissues they pass through as they travel towards the targeted tumor. If the remaining energy of the beam is not fully absorbed by the tumor, a photon beam can continue to pass through and damage or kill more healthy cells until it exits the patients body.15

Protons release their energy all at once. They do not damage cells they pass through until they release their energy in a single burst. The distance that a proton travels before it releases its energy is determined by how fast it is moving. Proton beams are delivered at speeds that cause almost all of the energy to be released inside the tumor. Because all the radiation energy is targeted at the tumor, little energy is released into the tissues beyond the tumor. This saves the surrounding tissue from any damage.16

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What To Expect When Receiving Radiation For Breast Cancer

During your first appointment, the technicians will take measurements of the treatment area. These precise measurements help minimize the amount of healthy tissue affected by the high-energy beams of radiation.

The team typically makes identifying marks on your skin to ensure they are targeting the right areas. They may also create a mold of your body to help keep you in the correct position during the treatment.

If you require brachytherapy treatments, the team will fit you with a catheter that will remain in place for the duration of your radiation therapy.

Setting up for the treatment will take longer than the radiation itself. Radiation therapy only takes a few minutes .

Your oncology team will monitor your progress throughout the treatment process, answer any questions you might have, and help keep you comfortable.

What Is The Recovery Process After Radiation Therapy For Breast Cancer

Most people find that it takes a few weeks after their radiation therapy to start feeling normal again. This is the amount of time it takes for your body to process the radiation.

Consult your oncology team if side effects like fatigue and skin irritation are not dissipating within a few weeks. They may have suggestions that can help speed up your recovery. These symptoms may also be a sign that further treatment is required.

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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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What To Expect When The Catheter Is Removed

Internal Radiation Therapy For Breast Cancer

Once you finish treatment with LDR or HDR implants, the catheter will be removed. Here are some things to expect:

  • You will get medicine for pain before the catheter or applicator is removed.
  • The area where the catheter or applicator was might be tender for a few months.
  • There is no radiation in your body after the catheter or applicator is removed. It is safe for people to be near you-even young children and pregnant women.

For a week or two, you may need to limit activities that take a lot of effort. Ask your doctor what kinds of activities are safe for you and which ones you should avoid.

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Types Of Radiation Therapy

  • External beam radiation is most commonly used to treat breast cancer. A machine outside your body aims a beam of radiation on the area affected by the disease.
  • Brachytherapy delivers radiation to the cancer through something implanted in your body.
  • Proton therapy sends highly targeted radiation just to your breast tissue and not into your heart or lungs.

What Are The Types Of Radiation Therapy Used For Cancer Treatment

Radiation therapy is one of the most common forms of cancer treatment. It uses high-energy X-rays to pinpoint and destroy cancer cells. Radiation damages the cancer cells causing them to stop multiplying.We asked radiation oncologist Valerie Reed, M.D., to explain some of the most common types of radiation therapy and how they are used. Heres what she shared.

Some types of radiation therapies are used to treat cancers near sensitive organs.

Four types of radiation therapy are frequently used at MD Anderson when a tumor is close to sensitive organs. These can be used to treat many types of cancer:

Internal radiation therapies use a radioactive source in or near the cancer site

Three common types of internal radiation therapy include:

External beam radiation therapies are delivered through a specialized machine directly to the cancer site

These include the following types of radiation therapy:

Before finalizing a radiation treatment plan, our doctors review the patients clinical history, pathology reports and imaging studies to determine the optimal radiation treatment for each patient.

As each treatment plan is customized, it is important to discuss your radiation treatment options with your doctor before starting treatment.

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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.

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Complementary And Alternative Medicine

Radiation Therapy For Breast Cancer

Complementary and alternative medicine are medicines and health practices that are not standard cancer treatments. Complementary medicine is used in addition to standard treatments, and alternative medicine is used instead of standard treatments. Meditation, yoga, and supplements like vitamins and herbs are some examples.

Many kinds of complementary and alternative medicine have not been tested scientifically and may not be safe. Talk to your doctor about the risks and benefits before you start any kind of complementary or alternative medicine.

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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.

Interactions Between Radiotherapy And Systemic Treatments

No significant interaction was observed between radiation dose and chemotherapy or tamoxifen administration. The odds ratio for a local dose of radiation higher than 1Gy associated with chemotherapy was 1.0 , compared to a null or lower radiation dose in the absence of chemotherapy . Similarly, the odds ratio associated with doses over 1Gy and tamoxifen was 1.3 . The estimates of the radiation doseresponse relationship were not modified by the adjustment for chemotherapy and/or duration of tamoxifen treatment.

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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.

Possible Side Effects Of External Beam Radiation

Image Guided Radiotherapy

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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