Radiotherapy for Breast Cancer
Procedures of Radiotherapy
The procedures for external and internal radiotherapy are different.
- External Radiation:
Since there are many methods of delivering radiation, treatment planning is a very important first step.
First, the amount of radiation necessary for that particular patient is calculated. The dose is calculated according to the size of the tumor and the tissue that is affected. Different tissues can tolerate different amounts of radiaiton.
The dose of radiation is delived in divided doses since a single dose may be too strong for the patient. Normally, the doses are given once daily from monday to saturday allowing the patient to rest on weekends. But there are different protocols - in some cases, the doses may be given every alternate day, or in others, the dose may be given 3 days a week. The radiation team decides the best method.
Before the actual treatment procedure is started, a process called simulation is started to define where to aim the radiation. The patient lies under a large machine called a CT simulator. This machine helps to plan exactly where on the body the rays are directed.
The areas to receive radiation are marked with either a temporary or permanent marker, tiny dots or a “tattoo” showing where the radiation should be aimed. Marks may also be drawn on the body with a felt-tipped pen. These should not be washed off for the duration of the treatment. If they do, they are redrawn.
The actual radiation treatment procedure takes only a few minutes every day. There is no pain, no itching or any symptoms felt during the procedure.
- Internal Radiation:The initial procedure of simulation is the same as in external radiation therapy. Then, under local or general anesthesia, thin hollow tubes or a inflatable balloon are inserted into the tissues of the breast just over the tumor.
Then radioactive wires are passed through the tubes or a radioactive source is placed in the ballon either for a few minutes every day or continuously for a few days.
The patient needs to stay in the hospital while internal radiotherapy is going on. Very few visitors are allowed, children and pregnant women are not allowed at all. Other visitors are allowed in for only a few minutes to avoid radiation exposure.
Side Effects of Radiotherapy
Radiotherapy itself is painless. Low dose treatments can cause minimal side effects but treatment with high doses can cause variable side effects. Some people have many side effects, others have hardly any. There are both immediate and delayed side effects of radiotherapy.
- Immediate Side Effects of Radiotherapy: The immediate short side effects are tiredness, feeling feverish with symptoms of flu, sore skin over the breast, redness of the skin, dry and peeling skin and itching. Since the skin becomes very dry and peels readily, there may be formation of small ulcers and sores. This can cause the skin to become wet, sore, or infected, especially under the breast in the folds of the skin. Some women develop diarrhea and nausea.
- Delayed Side Effects of Radiotherapy: Delayed side effects may first occur 6 or more months after radiation therapy is over. These are - less elasticity of the affected skin and darkening or hyperpigmentation of the skin. Some effects like inflammation of the esophagus (esophagitis) with sensations of difficulty in swallowing and lump in the throat occur within 2 to 3 weeks after starting radiation and decrease 4 to 6 weeks after radiation therapy has finished. Rarely, secondary cancers like soft tissue sarcomas (STS) amy occur in some women.
See Page 1 for: Types of Radiotherapy