Radiation therapy can be intimidating, but the good news is that breast cancer treatment options have been revolutionized in the past decades. The process of getting breast radiation has been optimized to limit side effects while maintaining the effectiveness of radiation therapy.
The first step of radiation therapy is actually a specialized CT scan in which you lay down on the imaging table in the treatment position. This can either be supine (lying on your back) or prone (lying on your belly). Because this simulates how you will be positioned and treated, the scan is a called a “CT simulation.” The CT images allow your radiation oncologist to create a 3-D model of your individual anatomy so that the areas of risk (the lumpectomy cavity and surrounding breast tissue) and neighboring normal tissues (such as your heart and lungs) can be identified. Your radiation oncologist will then use this CT simulation to plan how the beams of radiation are arranged to cover the areas at risk while sparing your healthy tissues.
Patients with left-sided breast cancer might ask, what about my heart?
There are two techniques for sparing the heart. One technique is to treat only while you are holding your breath, because taking a big deep breath pushes your chest wall away from your heart. Radiation oncology centers now have software that monitors your chest wall motion and allows treatment only when you’re in a breath hold. Another technique is treatment in the prone position, which allows the treated breast to hang away from the body. Both techniques allow the radiation beams to cover the breast while excluding the heart.
How Long Does a Radiation Treatment Session Last?
A typical radiation therapy session involves being positioned on the machine for approximately 20 minutes. Most of this time is spent making sure you’re positioned correctly. Radiation beams will only be treating your body for 2-3 minutes. When the beams are on, you won’t feel or see anything because the beams are the same kind of radiation that is used for diagnostic X-rays and CTs. Just as you don’t have to sequester yourself from your family after an X-ray, you won’t be radioactive after external beam radiation, and you can be around your family.
What are the Side-Effects of Radiation Therapy?
The most common side effects of radiation therapy are fatigue and skin irritation. Most patients are able to drive themselves to and from radiation; it is not typically a debilitating fatigue. The skin irritation can evolve during radiation and even a week after radiation is completed. If you receive whole breast radiation therapy, the skin over the breast can become red like a sunburn, and it can even blister or peel. Unscented moisturizer such as Aquaphor or aloe vera can be very helpful, and your radiation doctor may prescribe a prescription ointment if you experience blisters. If you receive partial breast radiation therapy, the area of irritation will typically be much less and can often be less severe.
What are the Radiation Therapy Options for Someone with Early-Stage Breast Cancer?
The history of this has evolved dramatically. Long ago, almost all patients diagnosed with breast cancer received an extensive type of mastectomy, and this was due in part to the fact that there was no standard screening program for breast cancer. Now, in the era of mammograms, patients are frequently diagnosed with early-stage breast cancers. A landmark trial in the 1970s asked, if breast cancer is diagnosed earlier, can a smaller surgery (lumpectomy) be done? The answer turned out to be: yes, if radiation is given after the lumpectomy. In other words, radiation makes a lumpectomy equivalent to a mastectomy for patients with early-stage breast cancer.
Within breast radiation, a lot has changed since the 1970s in space and time. Let’s start first with “time.” While five weeks (Monday through Friday) of radiation were given to the whole breast in the original trial, large studies around the world found that three weeks of radiation are safe and effective after a lumpectomy for early-stage breast cancer. More recently, even one week of radiation has been found to be safe and effective.
Can Less Space Be Irradiated Within the Breast?
This depends on the patient’s age and what the pathologist sees under the microscope after the tumor is removed. In the absence of specific risk factors, partial breast has been shown to be equivalent to whole breast radiation. The advantages of partial breast radiation are less dose to surrounding tissues, likely less risk of visible capsular contracture in patients who have breast implants, and convenience as partial breast radiation can be performed in a total of 5 radiation sessions.
Guest Blog Article -- Contributed by,
Elizabeth Zhang-Velten, MD, PhD, Clinical Assistant Professor, Radiation Oncology
Keck School of Medicine, University of Southern California Buena Park and Newport Beach Clinics
Add new comment