February 5, 2009

Ask the Doctor: What Should I Know About Breast Cancer and Radiation Therapy?

By Marnee M. Spierer, MD

Q. I have breast cancer. Do I need radiation therapy?

A. The treatment of breast cancer often requires a combination of surgery, chemotherapy, and radiation therapy. If your surgery was a lumpectomy, it is very likely that you will need radiation therapy. If your surgery was a mastectomy, you may or may not need radiation. The need for radiation therapy after mastectomy is based on several factors, including the size of the tumor and whether the lymph nodes contain cancer.

Q. What is radiation therapy, and how does it work?

A. Radiation therapy uses high-energy X-rays to kill cancer cells. It works just like regular X-rays only it uses higher doses of radiation, which deliberately damages the DNA of cells. Normal, healthy cells are able to repair themselves, but the cancer cells cannot regenerate and die instead.

Q. Are there different kinds of radiation therapy?

A. Yes. The most common kind is called external beam. The majority of breast cancers are treated with external beam radiation delivered to the whole breast, followed by a few doses of radiation just to the area where the tumor was (called a boost). External beam radiation is done with a machine called a linear accelerator. The beams are shaped to treat the entire breast (or the chest wall in the case of mastectomy) and, in some cases, the lymph node regions surrounding the breast. You don’t see or feel the beams. Treatments are typically five days a week, Monday through Friday, for five or six weeks. They can also be delivered over a shorter period of time with a higher-radiation dose in each session. This is called hypofractionated treatment.

Rather than treat the entire breast, partial breast irradiation (PBI) is sometimes used. This technique can be accomplished by both external radiation and internal radiation, also called brachytherapy. There are several techniques to deliver breast brachytherapy. Although it is not considered the standard of care, some patients may be candidates for PBI. There is an ongoing national trial comparing whole-breast radiation to PBI. Your doctor may give you the option of enrolling in this trial.

Q. Who makes up my radiation therapy team?

A. You will meet many people during your radiation treatment. A radiation oncologist—a doctor who specializes in treating cancer with radiation—leads the team. Radiation oncology nurses help you with anything that may come up during your course of treatment. Radiation therapists are the people who actually give the daily treatments with the linear accelerator under the doctor’s supervision. Medical physicists and dosimetrists work behind the scenes to develop radiation plans according to your doctor’s prescription. You may also meet with other healthcare professionals.

Q. What can I expect during treatment?

A. Your treatment will involve several stages.

Meeting with a radiation oncologist. Your surgeon or medical oncologist will likely refer you to a radiation oncologist, who will discuss the role that radiation has in the treatment of your breast cancer. You should ask him or her all of the questions you have concerning radiation treatment. During that initial visit, you will also likely meet the nurses who will help during your treatment.

Simulation. The first appointment you will have after you meet your doctor is the planning session, or simulation. During the simulation you will be positioned on a table in the exact position that you will be in during your actual treatment. It is most common to be positioned on your back with one arm overhead (the arm on the same side as the affected breast). It is also common to lay in a device that ensures you are in the same position for your daily treatments. At the end of the simulation, you will get several ink dots, called tattoos, or several temporary lines drawn on your skin with colored markers. These help ensure that you are positioned correctly for treatment each day. Some women may be treated while lying on their stomach. How you are positioned is based on several factors, including the size of your breast.

Treatment planning. Once the simulation is finished, the radiation oncologist, physicist, and dosimetrist plan your treatment using the information obtained during the simulation. The radiation oncologist writes a prescription that outlines exactly how much and where the radiation is to be given and oversees the plan that the physicist and the dosimetrist design.

First day. The first appointment after the simulation is for films only. You lay on the treatment table in the exact position in which you will be treated. No radiation is actually given; the therapist will just take treatment verification films, which verify that the area being treated is in fact the exact area the doctor intended. Your doctor must approve the films before the first dose of radiation is given.

Daily treatments. Once your radiation therapy is to begin, you will lie on the treatment table, and the radiation therapists will position you correctly. They will then leave the room, and you will receive the radiation. It is important to stay still during the treatments, and the sessions are quick and painless. The therapists watch you on a monitor and can hear you if you call.

Weekly status checks. During treatment you will see your doctor and the nurses weekly. They will check the area that is being treated (breast or chest wall and, in some cases, lymph node regions) and monitor how you are doing. Of course, if you need to see the nurses or doctors more often, you can.

Weekly films. Once a week during treatment, you will have films taken of the treatment area. These are the same type of films you had taken the first day. This is to ensure that the area being treated is exactly the area that your doctor intended. Your doctor must approve these films each week for your treatments to continue.

Q. What are the side effects of radiation treatment?

A. There are two kinds of side effects with radiation treatment: those you get during the course of treatment (acute effects) and those you could potentially get after completing a course of radiation therapy (late effects). The acute effects are very common and include fatigue and skin changes. The late effects can occur weeks, months, or even years after your treatment is completed. They are very uncommon and can include problems with organs near the treated breast, chest wall, or lymph node regions. Your doctor will discuss all of these before you begin your treatment.

And remember…

  • Radiation therapy is an important part of breast cancer treatment.
  • The actual radiation treatments are quick and painless.
  • You will have a whole team of medical professionals helping you through your treatment.
  • You will not be radioactive during external beam radiation treatment, and you will not pose a threat to anyone around you.
  • The most common side effects are fatigue and skin changes or discomfort. It is important to use the creams your doctor provides.


Marnee M. Spierer, MD, is an attending radiation oncologist at Montefiore Medical Center, Bronx, New York, and an assistant professor at the Albert Einstein College of Medicine. She is also the residency program director of the radiation oncology training program at Montefiore. She received her medical degree from Columbia University College of Physicians and Surgeons and completed her radiation oncology residency at Memorial Sloan-Kettering Cancer Center, both in New York City. In her clinical practice, she treats a variety of malignancies and specializes in the treatment of breast cancer and pediatric cancers. She is a member of the medical editorial board for CureSearch.org, an organization that unites the Children’s Oncology Group and the National Childhood Cancer Foundation through a shared mission to cure and prevent childhood and adolescent cancer through scientific discovery and compassionate care. She is a member of several professional societies, including the American Society for Therapeutic Radiology and Oncology, the American Association for Women Radiologists, the American Board of Radiology, the New York Roentgen Society, and the Children’s Oncology Group.

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Tags: Breast Cancer, Uncategorized