Radiation therapy uses high-intensity X-rays to kill unstable cancer cells, while leaving normal cells to regenerate themselves during and after treatment. With breast cancer, radiation is usually a treatment of choice along with surgery unless a radical or full mastectomy has been done. Whatever the recommendations, make sure you understand it and it feels right to you. Radiation treatment is an exact science, the body's response to it and individual cancer cells' response varies.
Your nutritional status is important during this time because the radiation treatment requires much energy on the cellular level. You may come out of treatment feeling like you have spent a long day at the beach, but radiation treatment is certainly not a day at the beach. Your body will need proper nourishment to replenish your energy during radiation treatment. (Diet is discussed in Chapter 9).
What to Expect at Your Appointments
The radiation oncologist will be doing a treatment plan for your radiation. He will first see you on a consultation visit, where a medical history and physical are done, and all your reports, such as pathology report, mammogram, MRI, and co-existing illnesses, will be reviewed. The radiation oncologist uses cell grade, type, and stage of breast cancer as well as size and the body area to be radiated to determine how much radiation should be given and where. He then determines the dose levels and how long the treatments should be. To do these he follows guidelines used by radiologists from clinical trials.
Your first appointment is the longest and usually lasts one to two hours. Precise mapping of your breast will be done through a simulator with a laser localization system. This is linked with a CAT scan of your body surface so that the right amount of radiation is delivered to the correct areas. The actual planning occurs after your visit. The radiation oncologist and a simulator therapist will mark both the simulator and the CAT scan of your body to link them. Data is electronically transferred to a medical physics department, where physicists and technicians create the treatment plan based on the radiology oncologist's prescription of dose and number of treatments. The goal is to develop a plan with radiation beams and angles that will allow for the best possible coverage of the affected breast and lymph node area. There are other specialized techniques to promote even distribution to all tissues when needed. The treatment plan is then sent back to the radiology oncologist to review and approve and then the completed plan is electronically sent to the radiation machine.
Mapping is done by a simulator and involves a technician along with the radiology oncologist to draw lines on your breast to indicate where the radiation is aimed. These lines are put on with semi-permanent markers, but during the summer months sweating can diminish the markings. Don't worry, it is all calculated and the radiology oncologist or the technician will be able to re-draw them. Also, the hand-drawn lines are not really the marks the treatment machine uses, rather the tattoos are used to line things up.
Some doctors will also use permanent tattoos to designate the area for radiation treatment. These dots are very tiny but to the one with breast cancer they may have an emotional impact — a permanent reminder that you have had radiation treatment. The radiation treatment usually goes on for six and a half weeks. A boosting dose may be used when the tumor margins are close, so additional radiation to that area is done as a safety precaution, the goal of radiation treatment being to eliminate any microscopic cancer cells that may have been left behind.
The second visit, which typically occurs four to five days after the consultation visit, is the verification visit. A test is made to make sure what was calculated in the physicists' department is what you are getting on the machine. The radiology oncologist digitally reconstructs the breast by giving a small dose, which looks similar to an x-ray, and makes final recommendations based on these findings.
The third visit is when your radiation treatments typically begin. The process may vary among breast radiation centers, but the basic guidelines are the same. The radiation process is painless, and occurs at the same time each day, usually Monday through Friday. The entire time of direct radiation is usually less than one minute. The technician will come in and position you, then leave the room and give the radiation. This will happen again or until the desired amount of radiation is given. Often, getting to the local hospital or radiation oncology department on a daily basis interferes with your work schedule or lifestyle and is more of an annoyance than the actual treatments. During radiation treatment, it is important to remain still, so it may help to use an iPod or MP3 player to listen to music while you are receiving radiation.
The Radiation Treatment
It is a good idea to bring someone for support the first time you have radiation treatment, since you don't know what to expect and it can be emotionally draining. When you have radiation treatments, you will change into a hospital johnny from the waist up. You can't wear jewelry around your neck. This includes body piercing jewelry on your breast; you may want to check with your radiology oncologist about head and neck piercings. For changing purposes, it is easier for you to wear an outfit that is two pieces. You will lie on a radiation table with a radiation machine above you. A plastic or Styrofoam pillow is placed under your head. The radiation is given at different angles. The technician will position you, leave the room, and turn on the radiation machine. You can talk with the technician through an intercom system if necessary or if you feel anxious. If you are being treated for metastatic cancer, then treatments are different and the goal is for pain relief or symptom relief. A smaller dose is usually given in ten to fifteen treatments over two-and-a-half weeks.
Skin care is important during the time you are undergoing radiation treatment. It is recommended that you use mild soap and no deodorant. You can use a small amount of cornstarch if needed, or go to a natural food store and ask for a non-aluminum deodorant. Be very careful when reading the label. Another natural skin product that is allowed during radiation treatments is aloe vera lotion. Again read the label for all ingredients.
One side effect that may occur in some women is a condition called costochondritis, which is an inflammation in the chest where the ribs and breastbone (sternum) connect. Usually this can be treated with Tylenol, aspirin, or another anti-inflammatory medication.
Fatigue is a common side effect of radiation and varies from individual to individual. It is important to remain physically active during your radiation treatments, within moderation, so that you can continue after your treatments are completed. This will help you to heal and improve your general feeling of well-being.
Partial Breast Radiation
Partial breast radiation is given to a smaller portion of the breast. There are several ways to deliver partial breast radiation. For example, temporarily implanting radioactive seeds into the breast area (either with a balloon technique or using multiple implanted tubes called interstitial brachytherapy) and external beam treatments. This is currently being studied in a national clinical trial. One approach being tested is accelerated partial breast radiation, in which only the area of the tumor, not the whole breast, is treated in fewer days than the usual five to six weeks.