Radiotherapy uses radiation to kill cancer cells. Cancer cells are more sensitive to radiation than normal cells. Radiation is given as a daily treatment over several weeks. Normal cells can usually recover from the effects of radiation but cancer cells are less able to recovery.
Radiotherapy given to treat breast cancer is given to the breast or the chest wall and/or the lymph nodes. This can include the areas such as under the armpit, above and below the collar bone.
It reduces the risk of local recurrence (cancer recurring in the postsurgical area). In some cases where there is advanced disease or patients that are unfit for surgery, it can be used instead of surgery to the breast or the armpit.
It usually involves daily treatments over 5 to 6-week period. In patients over the age of 50 with small breasts are now commonly being offered approximately 3 weeks of treatment. There are other indications where shorter courses might be used.
A planning session is usually required first followed by the daily treatments. The radiation treatment will usually begin approximately 2-3 weeks after undergoing surgery. It is important for the wound to be healed before radiation is undertaken.
The radiation oncologist will carefully plan the area that requires radiation to avoid damage to organs that live close to the breast such as the heart, lungs and skin.
A CT scan will be performed in the position at which the radiation will be given. The patient will be asked to lie on flat bed and will have a CT and the planning done on a single day. A physicist and a radiation therapist will work with the radiation oncologist to develop an individual radiation treatment plan and permanent tattoos (small black marks) will be placed on the skin in order to assist with the planning. The planing usually takes about half an hour. The radiation plan is approved by the doctor and the radiotherapy is given by a machine termed a linear accelerator. The treatment itself takes about 5 minutes but the patient will be required to be in the treatment room for approximately 15 minutes in order to ensure that they are in the correct position.
Some patients will also be asked to undertake special breath holding techniques in order to avoid radiotherapy to the heart. The total time in the hospital could be up to 1 hour. However, patients that are working can usually schedule their radiation time around their working commitments and can usually attend to work on the same day. The treatment is usually given once a day with the weekends off.
There may be some reactions to the skin and therefore it is important that particular attention is paid to the skin. Some radiation oncologist will recommend a boost to the tumour bed.
Most patients will not feel any pain during the treatment but my patients will usually not feel any pain during the treatment. The machine is rather noisy and during delivery of the radiation, the patient will be alone in the room, however, will be able to speak to a radiation specialist nurse in a room close by and will be continually monitored on a monitoring screen. Patients will be required to lie very still during the radiation treatment.
Some patients are concerned that radiation treatment will make them radioactive. This is not the case. It is quite safe for patients to go about their daily activities after undergoing radiation. They are at no risks to any other person in the community including children or babies. They can have normal contact with all people.
Most patients tolerate radiation treatment very well, however, they often can feel tired during their treatment. This is particularly if they have to travel a distance to attend a radiation centre. It is usually recommended that the patients try and undergo their radiation treatment close to home as it does require daily visits as opposed to surgery that is usually in 70% of breast cancer cases involved an overnight hospital stay. The treating breast cancer surgeon is usually very happy to organise for patients to have radiation closer to home.
No specific diets or medications are recommended during radiation treatment, however, it is suggested that alcohol is consumed in moderation and that patients must not become pregnant while undergoing radiation, contraceptive precaution is necessary.
A 3 dimensional radiotherapy plan ensures that the dose of radiation is given to the exact area. A variety of common reactions are associated with radiotherapy, the most common are changes to the skin. These will usually develop around the 3rd week of treatment and involved reddening of the skin which commonly settles down a couple of weeks after the radiation finishes. Some radiation nurses will recommend Sorbolene cream to relieve the irritation and creams can be prescribed if the situation is not controlled with Sorbolene cream.
Patients will often feel quite tired particularly towards the end of treatment. This tiredness will usually resolve soon after completing the treatment. Some of them will feel pains and aches in the breasts which are usually minor. This is quite normal and can occur sometimes many years after completion of the treatment. Some patients will report loss of nipple sensation with the treatment.
Occasionally, the lymph glands at the base of the neck may be included in the treated area and therefore for some patients will report a sore throat. Unlike chemotherapy, hair will not be lost from the head as radiation is a local treatment but if the armpit area is treated underarm hair will be lost and it is unlikely to regrow.
The radiation can also cause chronic side effects which can include an increase in size or a reduction size of the breast, mild swelling or overlying redness to the breast, increased density or firmness to the breast, discomfort and sensitivity to the treated area, palor to the skin particularly over the nipple and areolar and prominent blood vessels in the area that is treated.
During the treatment, some patients will experience nausea but this is usually resolved with anti-nausea medication and blistering of the skin can also occur which will usually heal post cessation of radiotherapy.
Fractures of the ribs are uncommon and occur in few within 1 in 200 women who are treated with radiotherapy. It will usually occur in the area that has been irradiated and rib fractures will generally heal without any special treatment apart from oral pain relief.
As the breast sits in front the lungs and the chest wall, occasionally some of the lung tissue will be included in the irradiated area and about 1 in 100 women will develop some inflammation of the lungs in the 6 weeks to 6 months after the radiation has been completed. It is important that if patients have any respiratory symptoms such as shortness of breath, cough or fever or feel excessively tired that they contact their doctor to arrange a CT scan of the chest. Normally, these cases of radiation-induced pneumonitis are treated with a course of corticosteroids and antibiotics.
In approximately 1 in 1000 women the breast will excessively shrink and there is no way of defining who this will occur to. There is always the possibility that there may be some damage to the heart with radiotherapy and it is more common when patients are being treated for a left breast cancer. The treating radiation oncologist will discuss this in detail with the patient. The use of the 3 dimensional radiotherapy plan helps to ensure that the dose of radiation is given to the exact area that is needed to reduce the risk of damage to the heart.
There is a rare cancer called a sarcoma that can occur in women who have had radiotherapy anywhere in the pathway of the radiation treatment. It occurs in approximately 1 in 10,000 women usually 5-10 years after their treatment. There is also some limited evidence to suggest an increased risk of lung cancer in the patients that have undergone radiotherapy and this risk is increased in smokers. Therefore it is encouraged that all patients cease cigarette smoking before undergoing.
Careful attention must be paid to looking after the skin during radiation treatment. Skin should be treated with only mild soaps or with Sorbolene cream but avoid cosmetic perfumes and other lotions, pat the skin, do not rub it. It is important not to use aluminium-based deodorants on the armpit during treatment as these products contain metals that may make the skin irritation worse. A baby powder or a crystal stick deodorant can be used. Also, it is encouraged that patients use an electric shaver only and do not use a razor blade to shave under the arm that has been treated. Dry loose fitting cotton bras and cotton t-shirts and singlets are suggested rather than tight-fitting clothes. A supportive bra particularly if the breasts are large to reduced the rubbing and skin reaction in the fold between the breasts and the chest wall is recommended. A pad between the bra and the skin may help protect this area. Special creams that are used for burns may be applied if the skin peels such as FFD cream, silver sulfadiazine or Solugel. Dressings will be required over these creams to protect the clothes.
It is important that patients do not expose themselves to the sun shine, saunas, spa baths, electric blankets, hot water bottles, or sunlamp beds during the radiation treatment. After the treatment is finished and the skin is completely healed the patients may return to using their usual cosmetics creams and lotions that they used before commencing radiation.