What is radiation therapy?
Radiation therapy is a form of cancer treatment that uses high energyX-rays to kill cancer cells while minimizing damage to healthy cells. When used for breast cancer treatment, radiation is delivered to the affected breast and, in some cases, to the lymph nodes under the arm or at the collarbone.
When is radiation therapy given for breast cancer?
Radiation therapy is usually given after a lumpectomy and sometimes after a mastectomy to reduce the risk of local recurrence of breast cancer. The treatments generally start several weeks after surgery so the area has some time to heal. If your doctors recommend chemotherapy with radiation therapy, chemotherapy might be given before you start radiation therapy. Standard whole-breast radiation therapy treatments usually involve daily treatments that are given Monday through Friday for about six weeks. However, the total duration depends on several factors.
What happens on treatment days if I am having radiation for breast cancer?
The radiation therapist will escort you into the treatment room. The therapist will help you onto the treatment table and help place you in the correct treatment position. Once the therapist is sure you are positioned correctly, he or she will leave the room and start the radiation treatment.
You will be under constant observation during the treatment. Cameras and an intercom are in the treatment room, so the therapist can always see and hear you. If you should have a problem, you can let the therapist know. It is very important that you remain still and relaxed during the treatment.
The therapist will be in and out of the room to reposition the machine and change your position. The treatment machine will not touch you and you will feel nothing during the treatment. Each treatment typically takes less than 10 minutes. Once your treatment is complete, the therapist will help you off of the treatment table.
How will the radiation therapist know I am in the correct position?
An x-ray, also known as a "port film," will be taken by the radiation therapist on the first day of treatment and about every week thereafter. Port films verify that you are being positioned accurately during your treatments.
Port films do not provide diagnostic information, so radiation therapists cannot learn about your progress from these films. However, port films are important to help the therapists maintain precision in your treatment.
What is Accelerated Partial Breast Irradiation (APBI)?
Partial breast irradiation is an alternative to the standard of care whole breast radiation, but is given in a shorter period of time. Recent technological advancements have allowed radiation therapy to be delivered safely to just a portion of the breast where the original tumor was located. There are several different types of APBI, including external X-rays, MammoSite ®, and intraoperative radiation (IORT).
The purpose of APBI is to provide a potentially more convenient treatment option compared to traditional whole breast radiation, while attempting to provide similar rates of cancer control. It is usually only appropriate for select patients with early stage breast cancer that has not spread to lymph nodes. By treating only a portion of the breast, APBI may be associated with fewer side effects. However, long-term outcomes are not available due to the relative newness of these technologies.
What is MammoSite?
MammoSite therapy is balloon-based brachytherapy, where radiation is delivered to the tumor cavity from inside the breast. At the end of the lumpectomy surgery, a special MammoSite balloon is left in the lumpectomy cavity (the space formerly occupied by the tumor). The balloon is inflated using saline solution introduced through the catheter. The balloon stays inflated throughout the treatment. A small section of the catheter is left outside the breast until the treatment is over.
Ten treatments are delivered over five days of outpatient treatment. The catheter is connected to a special machine that positions a radioactive seed inside the balloon within the lumpectomy cavity. After the treatment is completed, the seed is removed. No radioactive seeds are left in the balloon in between treatments.
After treatment, usually on the final day of treatment, the balloon is removed by your doctor through the incision made during surgery. The catheters are also removed.
What are the advantages of MammoSite treatment?
Because the radiation is inside the breast, there are fewer radiation burns and pain. Reports indicate that radiation side effects might still happen, but are less severe and over a shorter period of time. Treatment time is much shorter (five days versus six weeks). The patient is able to return to daily activities more quickly. Clinical studies are ongoing, but MammoSite has been found to be an effective treatment in cases deemed eligible by health care providers. It is also important to note that long term data is not yet available to determine if the recurrence risk is comparable to standard radiation therapy.
What is intraoperative radiation (IORT)?
IORT delivers radiation therapy directly to the site of the resected tumor at the time of surgery. It is usually given as a single dose in order to spare patients from having to undergo traditional whole breast radiation. Only select patients with early stage breast cancer are potential candidates for IORT. It is important to discuss with your doctor whether you may be eligible for this treatment.
During the surgery, your doctors make sure that the tumor is removed cleanly (with negative margins) with no spread to lymph nodes. An applicator that delivers the radiation treatment is placed carefully into the tumor cavity by the surgery team. Low dose radiation is then given over about half an hour, while you are still under anesthesia. After the treatment is completed, your surgeon will remove the applicator and complete the surgery.
On some occasions, technical factors or tumor staging studies may suggest that IORT is not enough, and standard whole breast radiation may be recommended instead or in addition to IORT. Long term clinical results of IORT for breast cancer are not yet available.
Risks / Benefits
How will radiation therapy for breast cancer affect my skin?
During your treatment, radiation must pass through your skin. You might notice some skin changes in the area exposed to radiation. Your breast skin might become red, swollen, warm, and sensitive — as if you had sunburn. It might peel or become moist and tender. Depending on the dose of radiation you receive, you might notice a loss of hair or decreased perspiration within the treated area.
These skin reactions are common and temporary. They will subside gradually within four to six weeks of completing treatment. The skin can become infected if it is open. Look for drainage such as pus or if skin changes appear outside the treated area, inform your doctor or primary nurse.
Long-term side effects, which can last up to a year or longer after treatment, might include:
- A slight darkening of the skin
- Enlarged pores on the breast
- Increased or decreased sensitivity of the skin
- A thickening of breast tissue or skin
- A change in the size of the breast
- Chronic tenderness at the treatment site
How can I reduce skin reactions caused by radiation therapy?
Gently cleanse the treated area using lukewarm water and a mild soap such as Ivory®, Dove®, Neutrogena®, Basis®, Castille®, or Aveeno® Oatmeal Soap. In addition:
- Do not rub your skin. Pat your skin dry with a soft towel or use a hair dryer on a cool setting.
- Do not scratch or rub the treated area.
- Do not apply any ointment, cream, lotion, or powder to the treated area unless your radiation oncologist or nurse has prescribed it for you.
- Do not apply cosmetics, shaving lotions, or perfumes on the treated area.
- Use only an electric razor if you need to shave within the treated area.
- Avoid wearing tight-fitting clothing or clothes made from harsh fabrics such as wool or corduroy. These fabrics can irritate the skin. Instead, choose clothes made from natural fibers such as cotton.
- Do not apply medical tape or bandages to the treated area.
- Do not expose the treated area to extreme heat or cold. Avoid using an electric heating pad, hot water bottle, or ice pack.
- Do not expose the treated area to direct sunlight. Sun exposure might intensify your skin reaction and lead to severe sunburn. Choose a sunblock/sunscreen of SPF 30 or higher. Protect yourself from direct sunlight even after your course of treatment has been completed.
Why are there marks on my skin?
Small marks resembling freckles will be tattooed on your skin along the treatment area by the radiation therapist. These marks provide a permanent outline of your treatment area. Do not try to wash these marks off or retouch them if they fade. The therapist will re-mark the treatment area when necessary.
Will radiation therapy make me tired?
Everyone has a different level of energy, so radiation treatment will affect each patient differently. Patients frequently experience fatigue after several weeks of treatment. For most patients, this fatigue is mild. However, a loss of energy might require some patients to change their daily routine.
If your doctor thinks it might be necessary for you to limit your activity, he or she will discuss it with you.
To minimize fatigue while you are receiving radiation treatment:
- Be sure to get enough rest.
- Eat a well-balanced, nutritious diet.
- Pace your activities and plan frequent rest periods.
What side effects are associated with accelerated partial breast irradiation?
Some patients experienced redness, pain, fluid collection, and bruising, but remember that these side effects often happen with breast surgery and traditional radiation. A patient may experience drainage from the catheter site.
Recovery and Outlook
After your radiation therapy sessions are complete, you will visit your doctor for periodic follow-up exams and diagnostic imaging studies. Your doctor will tell you how often to schedule your follow-up appointments.
Will my diet affect my treatment?
Good nutrition is an important part of recovering from the side effects of radiation therapy. When you are eating well, you have the energy to do the activities you want to do, and your body is able to heal and fight infection. Most importantly, good nutrition can give you a sense of well-being. Since eating when you don't feel good can be difficult, a dietitian can work with you. The dietitian is available to help you maintain good nutrition during your radiation therapy.
Who can I contact if I have personal concerns about my treatment?
Generally, a social worker will be available to help you during your course of treatment.
The social worker can discuss any emotional issues or other concerns about your treatment or your personal situation. The social worker can also discuss housing or transportation needs if necessary.
The social worker will provide information about appropriate resources as well.
People dealing with certain medical issues find it helpful to share experiences with others in the same situation. Your doctor can provide a list of support groups if you are interested. Your social worker can provide additional information about more support groups that might be of value to you.
How can my family members learn about my radiation treatments for breast cancer?
On the first day of your treatment, your family is encouraged to meet the radiation therapist who will show them the treatment machine and answer any questions.
Family members are also welcome to wait in the waiting area during your weekly visit with your doctor. Your family will be encouraged to join you after the doctor and nurse examine you. This will give them an opportunity to ask questions.