Radiation Therapy

What is Radiation Therapy?

Radiation therapy is treatment with high-energy rays (or particles) that destroy cancer cells. Some women with breast cancer will need radiation, in addition to other treatments. Radiation therapy is used in several situations:

• After a lumpectomy (removal of the tumor), to help lower the chance that the cancer will come back in the same breast or nearby lymph nodes.
• After mastectomy in certain cases (if the cancer was larger than 5 cm, if cancer is found in many lymph nodes, or if certain surgical margins have cancer such as the skin or muscle.
• If cancer has spread to other parts of the body, such as the bones or brain.

The main type of radiation therapy that we use to treat breast cancer is external beam radiation therapy (EBRT). A machine outside the body focuses the radiation on the area affected by the cancer.

Timing Of The Treatment

If you will need external radiation therapy after surgery, it is usually not started until your surgery wound has healed, which often takes a month or longer. If you are getting chemotherapy as well, radiation treatments are usually delayed until chemotherapy is complete.

Where will it be focused?

This will carefully be determined and planned by your radiation oncology team and will depend on many factors. Before your radiation starts, you will be given an appointment for a special CT scan called a planning scan.

• If you had a mastectomy and no lymph nodes had cancer cells but the cancer was very big or the margins are close, radiation is focused on the chest wall, the mastectomy scar, and the places where any drains exited the body after surgery.
• If you had a lumpectomy, you will most likely have radiation to the entire breast (called whole breast radiation), and an extra boost of radiation to the area in the breast where the cancer was removed (called the tumor bed) to help prevent it from coming back in that area.
• If cancer was found in the lymph nodes in the armpit (axillary lymph nodes), this area may be given radiation. The area treated might also include the nodes above the collarbone (supraclavicular lymph nodes) and the nodes beneath the breast bone in the center of the chest (internal mammary lymph nodes).

How to Prepare for Treatment

Before your treatment starts, the radiation team will carefully figure out the correct angles for aiming the radiation beams and the proper dose of radiation. They will make some ink marks or small tattoos on your skin to focus the radiation on the right area. External radiation therapy is much like getting an X-ray, but the radiation is stronger. The procedure itself is painless. Each treatment lasts only a few minutes, but the setup time—getting you into place for treatment—usually takes longer. The whole process should not take longer than 15-20 minutes.

Duration of Treatment

This may vary from patient to patient and from hospital to hospital. It also depends on whether you will receive whole breast radiation, accelerated partial breast radiation, chest wall radiation, or lymph node radiation. On average, most patients will be offered radiation therapy every day of the week (Monday- Friday) between 3-6 weeks. In the case of accelerated partial radiation, only one week of radiation will be done.

Possible side-effects of Beam Radiation

Unlike chemotherapy, most of the side effects is LOCAL to the skin of the breast. This is usually temporary and recovers fairly quickly once the treatment is stopped. Most skin changes get better within a few months.

You may experience:

• Swelling and tenderness in the breast/ chest wall/ armpit
• Skin changes in the treated area similar to a sunburn (redness, skin peeling, darkening of the skin)
• Some women may find that radiation therapy causes the breast to become smaller and firmer.
• Radiation may affect your options for breast reconstruction later on. It can also raise the risk of problems with appearance and healing if it’s given after reconstruction.
• Women who have had breast radiation may have problems breastfeeding.
• Radiation to the breast can sometimes damage some of the nerves in the arm. This is called brachial plexopathy and can lead to numbness, pain, and weakness in the shoulder, arm, and hand but this is quite rare.
• Radiation to the underarm lymph nodes might cause lymphoedema (as with the removal of the lymph nodes) but this is usually rare or minimal.
• Radiation therapy may weaken the ribs, which could lead to a fracture but this is very rare
• In the past, parts of the lungs and heart were more likely to get some radiation, which could lead to long-term damage of these organs in some women. Modern radiation therapy equipment better focuses the radiation beams, so these problems are rare today.
• A very rare complication of radiation to the breast is the development of another cancer called angiosarcoma

How to manage and minimize side-effects

Taking care of your skin.

• At the beginning of treatment, before you have any side effects, moisturize the skin after your daily treatment with an ointment such Eucerin, Aquaphor, or Radiacare. You can also use coconut oil and Aquas Cream
• Make sure to follow the instructions given to you by your oncology team carefully.
• AVOID any sun exposure to the area, it is best to stay out of direct sunlight all together while getting your radiation therapy
• AVOID applying any ointments or creams to the skin that are not approved by your team as this may cause further harm
• Wear loose-fitting shirts, preferably cotton.
• When showering: Use warm rather than hot water and try to not let shower water fall directly on your breast. Avoid harsh soaps and soaps with fragrances.
• Regularly dust the breast area and inside skin folds with corn starch (Maizena) to absorb moisture, reduce friction, and keep you smelling fresh. Apply it with a clean makeup brush or put some cornstarch into a single knee-high nylon or thin sock knot it at the top and pat gently over the area.
• With or without radiation, yeast infections are common in the skin fold under each breast — particularly during warm weather in women with large breasts. Signs of yeast infections are redness, itchiness, and sometimes a faint white substance on the skin. If you have a yeast infection, take care of it before radiation starts and notify your doctor. An anti-fungal cream (such as athlete’s foot medicine) usually works well.
• For mild pinkness, itching, and burning during treatment, apply an aloe vera gel. You can also use 1% hydrocortisone cream (available without a prescription at any drugstore). Spread the cream thinly over the affected area 3 times a day.
• If your symptoms worsen ask your doctor for a stronger steroid cream available by prescription.
• Some people get some relief by blowing air on the area with a hair dryer setting on “cool” or “air” (no heat) or standing in front of a fan.
• If your skin becomes dry and flaky during the course of your treatment, moisturize frequently with fragrance-free moisturizer or something natural like coconut oil and cleanse skin gently.
• If your skin forms a blister or peels in a wet way, leave the top of the blister alone! The bubble keeps the area clean while the new skin grows back underneath. If the blister opens, the exposed raw area can be painful and weepy. Keep the area relatively dry and wash it with warm water only. Patch the area dry and then apply a NON–STICKY dressing – apply coconut oil or petroleum jelly before putting anything against the skin and notify your doctor.
• If the pain is very severe, take a painkiller like paracetamol and Brufen.
• AVOID swimming and chlorine.
• After treatment make sure to always wear sunblock and keep up caring for your skin to achieve optimal healing.