Radiation therapy is a treatment that uses high energy x-rays to destroy cancer cells. It is most commonly used after a lumpectomy to destroy any stray cells that were left behind in the breast and therefore reduce the chance of a recurrence. It is a local treatment, and is targeted right at the breast and sometimes the surrounding lymph node area (as opposed to a systemic treatment such as chemotherapy, which targets cancer cells found throughout the body). It is sometimes also given after a mastectomy, but only if there is a high risk of a local area recurrence.
Radiation therapy destroys the ability of cancer cells to grow and reproduce. It may also affect some nearby normal cells, but those cells are able to recover, so they are not permanently damaged. The therapy usually begins four weeks or so after surgery (when healing is completed) or after adjuvant chemotherapy is completed. It is given five days a week, for six to seven weeks. If immediate reconstruction with a tissue expander has begun and the pathology report indicates a need for chemotherapy and radiation, the exchange to permanent implant will take place after the chemotherapy ends, but before radiation begins.
Your treatment will be planned by a radiation oncologist, and carried out by a radiation therapist. On your first visit to the radiation facility the radiation oncologist will evaluate you for treatment, and explain why you need the radiation. On your next visit, the doctor and therapists will plan the exact angles at which radiation will be given. They may mark your skin with tiny tattoos so each treatment can be aimed at precisely the same region. You may also have a special mold made that will help you to get into exactly the same position each time. This first treatment planning session might take several hours, but subsequent daily treatments should be much shorter.
How it is Given
At each session you will lie on a table on your back. For some women who have very large breasts, a special table is used. They lie face down on this table and the breast is suspended through an opening in the table and treatment is given from below. Once you are in position, the radiation treatment itself takes only a few seconds. It is similar to having an x-ray. You will not feel any pain and should not have any immediate side effects. Ask if it is possible to schedule treatments for first thing in the morning if you wish to go to work right after treatment.
Radiation treatments today are very precise and there is little harm to surrounding skin or tissues. The treatments are generally very well tolerated, but after the third week or so you may notice some side effects, such as a sunburn-like effect on your skin, fatigue, discoloration of the skin, or swelling and heaviness in the breast. In some women the breast becomes smaller and firmer. Some of these effects wear off, while others may last a few months.
You should not use any deodorants or talcum powder during radiation therapy, as they can contain aluminum, which can interfere with the radiation. Ask your nurse or therapist to recommend an acceptable substitute. You might also want to avoid wearing a bra or tight-fitting clothing as they can irritate the skin. Ask your radiation oncologist if you should also avoid taking certain vitamins during radiation, as they can interfere with the effectiveness of the radiation.
Side Effects
Some people develop side effects from treatment with radiation therapy. The type and severity varies and depends on many factors. You may have some, all, or none of the side effects listed below.
Skin Reaction
During the course of radiation therapy, you will notice changes in your skin in the area being treated. After two or three weeks, your skin will become pink or tanned, and as treatment continues, it may become bright red or very dark. Your skin may also feel dry and itchy and it may look flaky. Sometimes your skin in sensitive areas, such as under the breast, under the arm, and near the collarbone, may blister, open, and peel. If this occurs, you should notify your doctor or nurse. You may need to temporarily stop treatment to allow your skin to heal. The skin reaction sometimes becomes more severe during the week after treatment is completed. If this happens, notify your doctor or nurse.
You may also lose some or all of the hair under your arm. It will usually grow back two to four months after the radiation is complete. Another skin symptom, rash, may or may not be related to the radiation. It is very important that you let your doctor know if you develop a rash.
Breast Discomfort or Swelling
Most people notice tenderness of the breast, especially at the nipple, when they begin to experience skin changes from radiation. In addition, some women develop excess fluid (edema) in the breast. This may cause sharp, stabbing sensations in the breast and you may notice that your breast or chest feels heavy or swollen. Some stiffness of the shoulder on the affected side may also occur. These sensations may persist for several months after treatment is completed. Ask your doctor or nurse for suggestions on how to manage this side effect.
Fatigue
Most people develop fatigue after two to three weeks of treatment. It is commonly described as tiredness, weariness, lack of energy, weakness, or an inability to concentrate. This gradually goes away after treatment is completed, but it may take several months.
New Directions
Partial breast treatment can be accomplished with brachytherapy, or internal radiation therapy, which delivers radiation directly into the target area rather than having it go through the skin and other tissues as it does in external beam radiation. Both high dose and low dose radiation can be delivered this way. The radiation can be delivered in the operating room after the tumor is removed, or afterwards through catheters inserted for "afterloading" with radioactive sources. The hope is that brachytherapy delivered to the breast tissue around the tumor site will be as effective as the standard of care whole breast radiation. Clinical trials are now in progress, to answer this question. Results of these trials will be measuring effectiveness of the new treatment, and the "cosmetic" outcome, or how the breast looks and feels after the brachytherapy.
