RADIOTHERAPY
In cases where there is a high risk of local recurrence the chest wall is treated with radiation especially in patients that have undergone breast conserving surgical mastectomy. During radiotherapy beams of radiation are delivered locally to the chest and/or the axilla depending on the extend of the axillary surgery (if all the axillary nodes are removed then there will be no irradiation of the axilla to avoid the development of lymphedema). Radiation aims to kill cancer cells that may still be present after the surgical removal of the tumour. Radiation is targeting all types of cells and does not differentiate between healthy and cancerous cells. In contrast to the cancerous cells the normal cells still have the mechanisms in place to repair the damages caused by the radiation. There two techniques used external beam radiation and brachytherapy.
External beam radiation
Radiotherapy usually starts a 2-4 weeks after surgery to allow treatment to commence. Before the treatment starts ink marks, which will help to align the radiation beams at the right position, are placed on the body and the field that will be irradiated are determined with the help of simulator machine during a planning session. This machine helps collect information on the specific location of the target area by emitting low energy X-rays through the target area to obtain an image on a screen or a film. External beam radiation sessions are a lot like getting an X-ray. The radiation beams are delivered by an X-ray machine onto the target area and the treatment only takes a few minutes. Based on the characteristics of the tumour removed and the size of the target area the radiation treatment will usually follow one of the following treatment plans:
1. 15 treatments of 40Gy over three weeks
2. 20 treatments of 40Gy over four weeks
3. 25 treatments of 40Gy over five weeks
Side effects vary with each individual and they may include fatigue, skin reactions, nausea and dysphagia.
Fatigue is a common symptom which tents to increase over the course of the radiotherapy and subsides after around three months. Skin reactions occur to most of the patients undergoing radiotherapy. The reactions may vary from a mild erythema to flanking or opening of the skin which can cause inflammation of the treated area. Creams are usually used ti treat the skin and patients are advised to us lukewarm water and baby soap while showering, avoid the use of deodorants, perfumes and lotions, expose the area to the air foe about 20-30 minutes and wear loose comfortable clothes. Nausea and dysphagia are not that common. Some toxic wastes from the dying cells may stimulate the chemoreceptors trigger zone in the brain causing nausea but in many case nausea can be caused due to apprehension or nerves of the patient.
Finally some side effects may occur months or even years after treatment and are usually rare. Late symptoms include fibrosis of the breast or axillary area, transient cough, weakening of the underlying ribs that can lead to fractures, cardiac problems, lymphedema and other conditions related to the irradiated area.
Brachytherapy or internal radiation therapy
During this treatment radioactive wires, seeds or rods, most commonly containing radioactive iridium, sealed in a small container are implanted close or directly at the site of the removed tumour. The patients must undergo general anaesthesia and during surgery a small incision is made to insert hollow tubes at the target area. Those tubes are later used to insert the radioactive material into the breast. Based on the radioactive material that is being used the seeds are either left in the breast throughout the treatment or they are replaced once or twice a day. Brachytherapy is an inpatient treatment which means that the patients will have to stay in the hospital during the treatment and be confined as the patients themselves are a source of radiation.
A new form of brachytherapy called partial breast irradiation for post-operative lumpectomies only requires one week of radiation and has shown remarkable results so far.
Palliative radiotherapy
In non-operative advanced cancers with distant metastases radiotherapy can be used to shrink or eradicate tumours and help with symptoms of pain and ulcerations. When there is lymph node involvement the surrounding nodes in the axilla and clavicle should be irradiated together with the breast and chest. In some cases of bone and soft tissue metastases radiation can help with the symptoms of pain or as therapeutic tool for isolated bony metastases.
In cases where there is a high risk of local recurrence the chest wall is treated with radiation especially in patients that have undergone breast conserving surgical mastectomy. During radiotherapy beams of radiation are delivered locally to the chest and/or the axilla depending on the extend of the axillary surgery (if all the axillary nodes are removed then there will be no irradiation of the axilla to avoid the development of lymphedema). Radiation aims to kill cancer cells that may still be present after the surgical removal of the tumour. Radiation is targeting all types of cells and does not differentiate between healthy and cancerous cells. In contrast to the cancerous cells the normal cells still have the mechanisms in place to repair the damages caused by the radiation. There two techniques used external beam radiation and brachytherapy.
External beam radiation
Radiotherapy usually starts a 2-4 weeks after surgery to allow treatment to commence. Before the treatment starts ink marks, which will help to align the radiation beams at the right position, are placed on the body and the field that will be irradiated are determined with the help of simulator machine during a planning session. This machine helps collect information on the specific location of the target area by emitting low energy X-rays through the target area to obtain an image on a screen or a film. External beam radiation sessions are a lot like getting an X-ray. The radiation beams are delivered by an X-ray machine onto the target area and the treatment only takes a few minutes. Based on the characteristics of the tumour removed and the size of the target area the radiation treatment will usually follow one of the following treatment plans:
1. 15 treatments of 40Gy over three weeks
2. 20 treatments of 40Gy over four weeks
3. 25 treatments of 40Gy over five weeks
Side effects vary with each individual and they may include fatigue, skin reactions, nausea and dysphagia.
Fatigue is a common symptom which tents to increase over the course of the radiotherapy and subsides after around three months. Skin reactions occur to most of the patients undergoing radiotherapy. The reactions may vary from a mild erythema to flanking or opening of the skin which can cause inflammation of the treated area. Creams are usually used ti treat the skin and patients are advised to us lukewarm water and baby soap while showering, avoid the use of deodorants, perfumes and lotions, expose the area to the air foe about 20-30 minutes and wear loose comfortable clothes. Nausea and dysphagia are not that common. Some toxic wastes from the dying cells may stimulate the chemoreceptors trigger zone in the brain causing nausea but in many case nausea can be caused due to apprehension or nerves of the patient.
Finally some side effects may occur months or even years after treatment and are usually rare. Late symptoms include fibrosis of the breast or axillary area, transient cough, weakening of the underlying ribs that can lead to fractures, cardiac problems, lymphedema and other conditions related to the irradiated area.
Brachytherapy or internal radiation therapy
During this treatment radioactive wires, seeds or rods, most commonly containing radioactive iridium, sealed in a small container are implanted close or directly at the site of the removed tumour. The patients must undergo general anaesthesia and during surgery a small incision is made to insert hollow tubes at the target area. Those tubes are later used to insert the radioactive material into the breast. Based on the radioactive material that is being used the seeds are either left in the breast throughout the treatment or they are replaced once or twice a day. Brachytherapy is an inpatient treatment which means that the patients will have to stay in the hospital during the treatment and be confined as the patients themselves are a source of radiation.
A new form of brachytherapy called partial breast irradiation for post-operative lumpectomies only requires one week of radiation and has shown remarkable results so far.
Palliative radiotherapy
In non-operative advanced cancers with distant metastases radiotherapy can be used to shrink or eradicate tumours and help with symptoms of pain and ulcerations. When there is lymph node involvement the surrounding nodes in the axilla and clavicle should be irradiated together with the breast and chest. In some cases of bone and soft tissue metastases radiation can help with the symptoms of pain or as therapeutic tool for isolated bony metastases.