Radiation Therapy

Radiation therapy for breast cancer is using higher doses of radiation than typically used for x-rays to destroy any remaining cancer cells that might not have been taken out with surgery or destroyed by chemotherapy and/or the targeted drug therapies. It works by damaging the cancer cells over and over again. You have the treatment daily so that the cancer cells do not have the time to repair between treatments. Eventually those cancer cells will disappear while normal cells will continue to regenerate and recover.

You will meet with your Radiation Oncologist to go over your history and treatment 2 to 3 weeks before treatment starts. Usually you are recovering from chemotherapy for about a month before radiation treatment begins. You will have a Computer Tomography or CT Simulation Scan scheduled, where they position you for your radiation treatments and record the coordinates. You will most likely get tiny dot tattoos as reference points that will be used at each radiation session. 

The first radiation treatment will take a while, about an hour or more (they will most likely take x-rays), but after that the daily radiation treatment will only be a few minutes long and you will be in and out of the hospital within 30 minutes (unless there are delays in your appointment). In the first treatment session, the technologists may use a marker or iodine to draw lines (marks) on your body. They will ask you not to wash them off and they will redraw them if they start to fade.

Throughout your treatment, they may need to do further scans and x-rays to be sure the positioning for the radiation has not changed due to swelling of the breast or other factors that could create coordinate changes. This will just add a bit of time (like your first treatment day) to your daily treatment.

Also, if you are getting a “boost” treatment, which is an extra few days or a week of treatment added to the end of the initial radiation schedule (which focuses the radiation on the surgical incision spot only), you will have another CT Simulation Scan to set up those coordinates and positioning before they start that phase of treatment. Age determines if this boost of radiation is done or not, and if you are close to the age recommendation, they may ask if you want it anyway. I was told that it can shave a certain percentage off from the cancer reoccurring – for me they told me it was up to 4%. They explained the additional radiation risk was mostly cosmetic –  scarring and hardening of skin.

If in the original scans pre-radiation, or even pre-chemotherapy treatment, they had found some abnormalities like nodules or cysts, say for example, on the lungs, they may decide to periodically schedule a scan to make sure they are not growing or changing.

You may have blood tests scheduled by your Radiation Oncologist as well. For example, renal blood work to check your kidney function. Every patient is unique with unique needs and requirements.

Finally, you will also be scheduled, probably once a week, to check in with your Radiation Oncologist to see how you are feeling and how the treatment is going. They will also inform you of any scan or test results.

You will have a lot of appointments and add-on appointments as the treatments continue. It can be overwhelming, so be patient and take it in stride. Go over your appointments each day to keep them all organized. Write your questions and concerns down as you think of them for each appointment so that you do not forget them (chemo brain!), or email yourself the lists so that you can refer to them on your mobile/cell phone if you have one, which is what I did.

After treatment, apply whatever ointment, lotion, cream or balm you decided to use (see TIP in the right column). Never use the ointment, lotion, cream or balm BEFORE treatment unless instructed otherwise. Follow your doctor’s advice. (Be sure to clean off any thickly layered cream or lotion even if applied the night before. But be gentle when cleaning the radiation area.)

Sometimes, radiation therapy is all you need. If I had not been diagnosed with the aggressive form of cancer (HER positive; aggressive), I would have only been given radiation therapy. I was in Stage 1, with In Situ tumors but unfortunately it was the aggressive form of cancer, therefore I needed chemotherapy as well as the radiation therapy. Some patients receive the radiation before or during chemotherapy. Every person will have unique requirements and schedules. Your oncologist knows what is best for you.

Radiation therapy can also be used before surgery to shrink a tumor first. Again, it depends on your unique situation.

Select Here is a great explanation of the CT Simulation process. 

Listed below are (or you can also jump to the link):

Ten Key Points About Radiation Therapy

• Radiation is a local, targeted therapy designed to kill cancer cells that may still exist after surgery. Radiation is given to the area where the cancer started or to another part of the body to which the cancer spread.
• The actual delivery of radiation treatment is painless. But the radiation itself may cause some discomfort over time. 
• External radiation treatment, the most common kind of radiation therapy, does not make you radioactive.
• Treatment is usually given 5 days a week for up to 7 weeks. Sometimes radiation may be given twice a day for 1 week.
• Since the daily appointments usually take about 30 minutes, you’ll most likely be able to follow most of your normal routine during treatment.
• Radiation will not make you lose your hair, unless radiation is given to your head.
• In the area where you are receiving radiation, your skin can turn pink, red, or tan, and may be sensitive and irritated. Creams and other medicines can soothe these symptoms.
• During your treatment course, you may feel tired. This feeling can last for a few weeks — even months — after treatment ends.
• Most radiation side effects are temporary.
• Radiation therapy can significantly decrease the risk of cancer returning after surgery.(1)

The side effects of radiation can be:

• Fatigue (which can grow over time)
• Hair loss (in the area being treated)
• Skin changes in the treated area similar to a sunburn (redness, skin peeling, darkening of the skin)
• Swelling (Edema)
• Tenderness

Long-term and Late Effects of Radiation Therapy

The side effects often get stronger throughout your treatment. Some side effects will continue past your treatment sessions. They could take weeks, months, or even years to dissipate or disappear completely.  Some can be permanent. These are called long-term effects. Some effects that can appear a long time after treatment finishes are called late effects. Examples of late effects associated with chest radiation therapy could be heart problems or lung problems. For radiation in general, a late effect can be a second cancer.

As with chemotherapy, exercise is important. Walking is the best exercise for you. With whatever exercise you choose, take it slow and stop if you are feeling too fatigued. Always listen to your body.