What To Expect During Radiation For Breast Cancer

Other Ways Of Giving Radiotherapy

Intraoperative 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;

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.;;

How Do I Take Hormonal Therapy

All the hormonal therapy medicines EXCEPT Faslodex and Soltamox are pills that are taken once a day. Most doctors recommend taking hormonal therapy at the same time each day so you remember to take the medication. Hormonal therapy medicines can be taken with or without food.

Faslodex is a liquid that is given once a month as an injection into a muscle. You usually get a Faslodex injection in your doctor’s office.

Soltamox is the liquid form of tamoxifen and is taken orally.

What To Expect With Internal Radiation

Before you get any internal radiation, youll meet with your radiation oncologist. They will:

• do a physical exam
• ask about your medical history
• go over what your internal radiation treatment will entail

Most internal radiation, or brachytherapy, is given with a catheter. This is a small, flexible tube thats surgically placed into the space left from breast-conserving surgery.

At the end of the catheter is a device that can be inflated inside your breast so that it stays in place for the duration of the treatment.

During your treatment, radiation pellets or seeds are put down the tube and into the inflatable device. They usually stay there for about 10 to 20 minutes or longer, and then theyre removed. How long the radiation pellets stay in place depends on:

• your type of cancer
• other cancer treatments that youve had

Once your course of treatment is over, the catheter and inflatable device will be removed.

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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.

Your Role On Your Radiation Therapy Team

Youll have a team of healthcare providers working together to care for you. Youre part of that team, and your role includes:

• Getting to your appointments on time.
• Asking questions and talking about your concerns. Weve included a list of possible questions at the end of this resource.
• Telling someone on your radiation therapy team when you have side effects.
• Telling someone on your radiation therapy team if youre in pain.
• Caring for yourself at home by:
• Quitting smoking if you smoke. If you want to quit, call MSKs Tobacco Treatment Program at .
• Caring for your skin following your radiation therapy teams instructions.
• Drinking liquids following your radiation therapy teams instructions.
• Eating the foods your radiation therapy team suggests.
• Staying around the same weight.

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What Are Potential Side Effects Of Hypofractionation

As with any form of radiation therapy, a common side effect of hypofractionation is some degree of skin irritation, much like a sunburn. Usually, skin irritation flares up during treatment; sometimes, it arises after. Some patients also get an itchy, bumpy rash in the area where the radiation hit the skin, which usually starts near the end of treatment.

Another common side effect is fatigue, which usually builds as treatment progresses.;

Scar tissue may also potentially form in the breast after radiation treatment, particularly in and around the surgical site. The breast may feel a little firmer or bumpier there. In a minority of women, scar-tissue formation from the combination of surgery and radiation can distort the shape of the breast. But something on the order of 85 percent of women are happy with their cosmetic outcome, says Suzanne Buckley Evans, MD, MPH, a radiation oncologist in the;Department of Therapeutic Radiology.

There is also a small risk of developing a second cancer from the radiation. This is a possibility with any form of radiation, whether its from the sun, a chest X-ray, a mammogram, a CT scan or a radiation treatment, says Dr. Evans. Its a very, very small risk, and the benefits of radiation far outweigh the small association with second cancer.

What Can I Expect If I Am Receiving External Beam Radiation Therapy

External beam radiation treatment for cancer is typically administered every day, Monday through Friday, for five to eight weeks. About two weeks after your first radiation therapy appointment when you have the simulation scan, youll begin your treatments.

Each visit will be relatively short, lasting between 15 and 30 minutes. Most of that time will be spent lying on a table while the radiation therapist gets the equipment set up around you.

At Rocky Mountain Cancer Centers, we utilize image-guided radiation therapy, or IGRT. During each visit, new X-rays or low-dose CT scans of your body will be made and compared with the initial scan to determine if the tumor has moved even by just a hairs distance and the radiation is adjusted accordingly.

Our dosimetrist check and calibrate our equipment daily and the equipment will not run if it is not calibrated correctly. All of this is done to ensure your safety and the effectiveness of treatment.

You will be asked to lie still for the actual treatment, which will last only a few minutes. The treatment itself is painless and is similar to getting an X-ray. You may hear clicking and whirring sounds during the treatment as the machine positions itself. During the treatment, the radiation therapist will be in a small room adjacent to your treatment room and watching you at all times. You will be able to communicate with your radiation therapist via intercom and should feel free to ask to stop if you feel sick or scared.

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Will The Nhs Fund An Unlicensed Medicine

Itâs possible for your doctor to prescribe a medicine outside the uses itâs licensed for if theyâre willing to take personal responsibility for this âoff-licenceâ use of treatment.

Your local clinical commissioning group may need to be involved, as it would have to decide whether to support your doctorâs decision and pay for the medicine from NHS budgets.

Page last reviewed: 28 October 2019 Next review due: 28 October 2022

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.

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When Should I Call The Doctor

You should call your healthcare provider if you experience:

• Severe skin or breast inflammation.
• Signs of infection, such as fever, chills or weeping skin wounds.

A note from Cleveland Clinic

Radiation therapy can lower the risk of cancer recurrence and cancer spread. The treatment affects everyone differently. Most side effects go away in a few months after treatments end. Some problems last longer. You should tell your healthcare provider about any problems you have while getting treatment. Your provider may change the therapy slightly to minimize issues while still effectively treating the cancer.

Last reviewed by a Cleveland Clinic medical professional on 03/19/2021.

References

Internal Beam Radiation Or Brachytherapy

Brachytherapy is a type of radiation therapy that generates radiation from within the body. In comparison with external beam radiation, which projects particles of radiation from outside the body, brachytherapy can deliver higher doses of radiation in a precise fashion, resulting in fewer side effects and shorter treatment times.

The type of brachytherapy that doctors use depends on the location of the tumor, how much the cancer has spread, and the persons overall health.

Intracavity brachytherapy

The doctor will use a tube or cylinder to deliver a radioactive substance into the body and place it in the tumor.

Interstitial brachytherapy

The doctor will use a needle or catheter to place radioactive material within a cavity either a natural one or one that surgery has created. For breast cancer, they will place it in the breast.

Brachytherapy can also involve either high-dose-rate or low-dose-rate treatments.

High dose rate

This type consists of multiple treatment sessions in which doctors place radioactive material in the body for about 1020 minutes before removing it.

Low dose rate

This type uses substances that release a constant, low dose of radiation over 17 days, during which time a person will likely stay in the hospital. Doctors will remove the radiation source after a designated amount of time.

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Vitamins And Dietary Supplements

Its OK to take a multivitamin during your radiation therapy. Dont take more than the recommended daily allowance of any vitamin or mineral.

Dont take any other dietary supplements without talking with a member of your radiation therapy team. This includes vitamins, minerals, and herbal or botanical remedies.

Things Breast Cancer Patients Need To Know About Radiation Therapy

By Elizabeth Morey

Most of us have a general idea of what radiation is and that its used to treat various types of cancers. But how much do you really know about it?

Despite the fact that its one of the core treatments used to combat breast cancer, it tends to be less talked about than chemotherapy and mastectomies. So lets talk about it.

The more you know about radiation, the better youll be able to understand what youre in for when your doctor tells you about the treatment plan he or she is recommending for you. It will also help you make your own decision about whether or not radiation is right for you.

Below are ten things about radiation that you should know before you begin treatment.

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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 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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How Can I Make A Decision Between Mastectomy And Breast Conservation Therapy

Breast conservation therapy is often used for patients with early-stage invasive breast cancers . It is also used for patients with DCIS . Some of the reasons to not have breast conservation therapy include: personal preference; increased risk of complications from radiation therapy in individuals with certain rare medical conditions such as certain autoimmune disorders; surgery that would require removing a large amount of diseased breast tissue that would lead to a poor cosmetic result; and tumors that are more likely than average to have a relapse in the breast with breast conservation therapy.

Most patients may choose a treatment based on other factors, such as convenience or personal preference . Most women prefer to keep their breast if this is possible to do safely, but there is no right answer that is best for everyone. This decision is one that is ideally made in partnership between a patient and her physician. In some cases a pre-surgical consultation with a radiation oncologist may be helpful in answering questions about breast-conserving therapy.

Nearly all physicians will recommend patients be treated with mastectomy instead of breast conservation therapy when the risk of recurrence in the breast is more than 20 percent. This is the case if the tumor is large or multifocal . This situation occurs for only a small number of women, however.

Expectations And What To Avoid

Radiation therapy should not cause pain or discomfort during the procedure. However, minor side effects are common in the days or weeks afterward. Before beginning radiation therapy, an individual should schedule a consultation with their doctor to work out the details.

People should also take some precautions while they are receiving radiation therapy. For example, they should avoid direct sun exposure by using sunscreen and covering up areas of bare skin when outside.

Also, taking antioxidant supplements, such as vitamins A, C, D, and E, can interfere with radiation therapys effectiveness. People should, therefore, focus on eating a well-balanced diet so that their body can absorb the nutrients and vitamins it needs from food.

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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.

What Are The Side Effects Of Radiation

Radiation therapy can have side effects, and these vary from person to person.

The most common side-effects are:

• Sunburn-type skin irritation of the targeted area
• Red, dry, tender, or itchy skin
• Breast heaviness
• Discoloration, redness, or a bruised appearance
• General fatigue

What should I do about side effects from breast cancer radiation?If you experience difficulty from side effects, you should discuss them with your doctor, who may be able to suggest ways you can treat side effects and help yourself feel more comfortable. These problems usually go away over a short period of time, but there may be a lasting change in the color of your skin.Here are some good general tips for dealing with the most common side effects of radiation:

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Radiation Therapy And Risk Of A Second Cancer

In rare cases, radiation therapy to the breast can cause a second cancer.

The most common cancers linked to radiation therapy are sarcomas . For women who are long-term smokers, radiation therapy may also increase the risk of lung cancer .

The risk of a second cancer is small. If your radiation oncologist recommends radiation therapy, the benefits of radiation therapy outweigh this risk.