Radiation Therapy for Breast Cancer: A Beginner's Guide

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Quick summary

When it comes to making breast cancer treatment decisions, radiation therapy is one of the most difficult areas to understand and cope with. Even some oncologists may not be fully familiar with the latest procedures available. Here's a guide to help you prepare for a discussion with the oncologist about what kind of treatment to choose for breast cancer.

Ask the right questions

Radiation therapy procedures are highly technical, which makes some of the concepts downright intimidating. What's more, a host of technological innovations over the past five years (with more coming quickly from clinical trials now underway) means there are many more options to sort through.

But don't let intimidation keep you from asking tough quesitons. Ask the doctor as many questions as you need to until you understand how the recommended procedures work. "It's very important to ask what techniques are being used and why," says oncologist Shalom Kalnicki, chairman of radiation oncology at Montefiore Medical Center and the Albert Einstein College of Medicine in New York.

Here's a guide to the range of treatment options available. For help discussing these options with your doctor, see 8 Questions to Ask About Radiation Therapy for Breast Cancer.

Internal radiation therapy for breast cancer

Radiation therapies can be internal or external. Doctors may recommend internal radiation, also called brachytherapy, when the goal is a high dose of radiation delivered internally to a small area, as in the treatment of breast cancer. The radiation is implanted or injected in the form of wires, "seeds," or capsules, then left in place for a period of time, either until it's removed or until it decays and becomes inactive.

Brachytherapy is usually done as an outpatient procedure, though it's also common to have a radioactive source implanted at the end of surgery. The root word brachy means "short distance," and brachytherapy can be thought of as concentrated radiation from a short distance. Intracavity brachytherapy indicates that the doctor places the radiation into an existing cavity, while interstitial brachytherapy is the term for placing the radiation directly in tissue. MammoSite brachytherapy is a relatively new procedure used to treat breast cancer in which radiation is delivered in the form of a balloon catheter. The balloon is surgically placed where the tumor was removed, and seeds of radiation are delivered through the catheter into the balloon.

Intraoperative radiation therapy, or IORT, refers to radiation that's delivered to the area where a tumor was removed immediately following surgery. This treatment method is common following lumpectomy. Doing this allows the radiation source to be positioned exactly where it will do the most harm to cancerous tissue, while nearby organs and healthy tissue are protected with shields. New portable radiation units now make it possible for IORT to be completed in the operating room at the end of a surgical procedure. Brachytherapy is the most common form of IORT, but for some types of cancer, doctors use external electron beam radiation immediately after surgery.

External radiation therapy for breast cancer

External radiation covers all types of therapy in which radiation is beamed into the body from an outside source, most often an X-ray machine or linear accelerator. It's usually given in the form of a sequence of treatments, typically five days a week for six to eight weeks, with weekends off to give the body time to recover. In recent years, doctors have developed another radiation schedule for women whose lives won't accommodate a six-week radiation schedule. Known as "accelerated breast irradiation," it usually involves giving higher doses of radiation over a shorter period, such as for three weeks rather than six.

Radiation can be done before a tumor is surgically removed in order to shrink it, or after surgery to catch stray cancer cells, or it can be used as a stand-alone therapy.

Standard radiation therapy, which has been in use in various forms for more than two decades, is a form of external radiation that uses large cross-firing beams from an X-ray machine or linear accelerator to target the tumor and the edge of surrounding tissue, sometimes called the margin. Many hospitals now offer a variety of more advanced radiation techniques, such as 3-D conformal radiation therapy (known as 3D-CRT), in which MRIs and other computer imaging techniques are used to map the tumor three-dimensionally so that the beams of radiation can more closely match the outlines of the tumor and damage less of the surrounding tissue.

In recent years, new computer-assisted imaging techniques, new radiation machines, and other technological advances have vastly increased the number of options available under the umbrella of external radiation. For more specific information about choosing or advocating for the latest advances in radiation therapy for breast cancer, see Guide to Intensity-Modulated Radiation Therapy and the Latest Technology.


about 3 years ago, said...

Radiation, in any degree or source should be more widely publicized as a danger to your DNA & cells at the molecular level of your body ... be it sun, dental x-rays or, at ANY age, a "check & see" mammogram without due alarm through manipulation. Any diagnostic dose above 25-rem can effect your body, as, a mammogram IS radiation exposure which could start something, if you already didn't have it. It's heart-breaking to see the suffering, especially of my young loved ones & friends. They've changed the age from 30 to 40, now 50 ... when you should get "regular" mammograms - that should tell you something.


about 3 years ago, said...

Radiation is not hard to go thru. I had 36 sessions and have been cancer free 6 yrs. My body has not been the same though. Extreme dry skin no matter what I use, and muscles seems to be weaker. I have had 2 knee surgeries and a bad sprained ankle and shoulder surgery. 97th % of the bone density test so that isn't the issue. Orth. doc said very likely the radiation/


about 3 years ago, said...

You did not mention any of the heinous side effects of radiation tx: the fatigue, the burns, the scars, the potential of knocking out axillary nerves, etc. How can anyone make an informed decision without all the facts? I was not told any of the possible side effects and believe me, if there were a side effect, I was on the receiving end of it.


about 3 years ago, said...

Every person that knows or has BC, should research Turkeytail Mushroom therapy. Check clinicaltrials.gov Search pubmed.gov. Does no known harm and has shown to save lives. Saved 2 of my frinds.


about 3 years ago, said...

Has anyone ever heard of Rick Simpson oil? It kills cancer


about 3 years ago, said...

Questions to ask include - Why do you have to radiate more than around the tumor bed, where 85-90% of any recurrence is likely to happen? INSIST on not having heart or lungs radiated and no ribs either! INSIST on no tattoos!! A Sharpie works just as well and some hospitals don't tattoo!


about 3 years ago, said...

I don't understand why these articles make treatment for breast cancer sound so defeating and difficult. Almost 5 years ago I had 3 months of chemo, followed by a lumpectomy, followed by 7 weeks of radiation. None of it was as difficult as I was led to believe. My oncologist told me what was going to happen and I did everything I was told to do, no questions, no second-guessing, no searching out other opinions. And here I am almost 5 years later, completely cancer-free with no side effects. Articles like this really do a dissservice to cancer patients by making treatment seem difficult to understand. It's not that hard! And cancer is just a disease, it's not the end of the world! You follow your treatments, you eat as well as you can, you get as much rest as you can, and you deal with it day by day. And you get through it. Yeah, sure, I had cancer -- but I don't let it define me to the world.


about 3 years ago, said...

Each patient is different. Don't think your breast cancer is like your friend's or your co-worker's. If you have confidence in your oncologist, follow her advice and do everything she recommends. Second-guessing can make you crazy. If you don't have confidence in your oncologist, you better change doctors! I was lucky to have a wonderful team. I trusted them, followed their advice and directions to the letter, and am now a three-plus years survivor.


about 3 years ago, said...

Regarding the comment about a poor choice of pictures:: It's probably because the woman with the scarf went through chemotherapy prior to radiation therapy. In some cases, the protocol is chemo first, mastectomy, then radiation .. as it was in my partners case.


about 3 years ago, said...

Radiation was a no brainer for me. Mydoctor suggested lumpectomy and radiation, Chemo,... on the other hand,if your surgeon says it is not necessary,... run with it. I would not wish chemo on my worst enemy. 35 treatments of radiation at aprox. 5 minute sessions was a breeze. Second year after the treatment and doing great,.... hope it continues. Only God knows our expiration date, and enjoy everyday you can, because Life is but a vapor.


about 3 years ago, said...

Well Wile it's nice to be able to afford the costs, Obamacare won't be able too.. at least not for Super Seniors.. Even with Treatment, life Expectancy is only 3-5 yrs after.. They die of other things related to Old age in the meantime and since some 40 MILLION are Uninsured? You can see why all the Advertising for This and From Big Pharma for all those Drugs.. and who they are Target Marketing.. The Wealthy with Good Health Insurance and Medicare ..


about 3 years ago, said...

Why no reference to Proton Therapy? This treatment has shown to be very successful.


about 3 years ago, said...

I, too had mammosite bracytherapy following lumpectomy. There was no pain, even with the balloon and the tubes sticking out under my arm. A slight pinch when they were removed. The only side effect was that I was tired, since I continued to work while going twice a day to the hospital for my mammosite treatment. I have photos I took, and I have "walked" at least three other people on line through this therapy and have been thanked for my assistance.


about 3 years ago, said...

Why is this woman bald? Radiation does not make you lose your hair. Poor choice of photos..


about 3 years ago, said...

This does not go into any type of detail about the after effects of radiation which really should be told. It's great that they gave you an idea of types of radiation but further exploration would be helpful to those who have not gone through it that are facing that decision.


about 3 years ago, said...

sour sop is a fruit that cures cancer, have hope, they say the only reason its not on the market is the same reason marijuana is not on the market. they are plants so the government cannot track who has it and how much they have, they cant make money off of it, the chemo therepy is making the gov. millions of dollars so they tell no one of the fruit that grows from the ground. try sour sop, find it, grow it, have it grown, try it, it was found in tropical rain forests, look for it, i'm sure you can get it somewhere, gotta ask the right herbal people


about 3 years ago, said...

This picture is a misrepresentation. Radiation treatments for breast cancer do not cause hair loss. Chemo, yes. Radiation, no.


about 3 years ago, said...

My sister is 12 yrs older than I and doesn't always like to take suggestions from "little sister". The problem is, she wears a wig full time and will not allow anyone to see her without it. Her hair is quite thin but she still needs it trimmed occasionally so that it doesn't show in the back. The wig she wears is at least 15 or 20 years old! She shampoos it but it has seen better days and needs to go! I have suggested that we visit a wig shop but she gets offended and asks why I don't like her "hair". She actually thinks people don't know she is wearing a wig and will not admit to anyone but me that she is indeed wearing a wig. How should I handle this delicate subject? BTW she has been diagnosed in moderate stages of Alzheimer's. Any suggestions?