Radiation therapy (also called radiotherapy) is a cancer treatment that uses high doses of radiation to kill cancer cells and stop them from spreading. At low doses, radiation is used as an x-ray to see inside your body and take pictures, such as x-rays of your teeth or broken bones. Radiation used in cancer treatment works in much the same way, except that it is given at higher doses.

About Radiation Treatment at PAMF

• Initial Consultation
• Treatment Planning
• Radiation Treatment
• Variations in Treatment
• Side Effects
• Follow-Up Care

Initial Consultation

The initial consultation allows the radiation oncologist to get to know you and perform a physical exam to evaluate your condition. At this time, you may ask any questions you may have. Your oncologist will explain radiation therapy to you, and the advantages and disadvantages of this type of treatment. A simulation (treatment-planning session) will be scheduled if you decide radiation is the right option for you. Your written consent will be required to begin the treatment-planning process.
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Treatment Planning

Treatment planning is a several-step process that usually takes about one week to complete. In order achieve the very best treatment for you, it may be necessary to perform multiple simulations. These are a routine part of the treatment process and should not be a cause for alarm. Some details of the planning procedure and treatment will differ between patients. In all cases, we will tailor the treatment to your own individual needs and requirements in order to obtain the best treatment outcome.

Initial Simulation

Your simulation is done to localize, film and measure the area to be treated. This is done for treatment-planning purposes only. Usually the simulation lasts for about one hour. It is extremely important to lie as still as possible on the table, because movement can alter measurements and increase simulation time.

Next, X-ray films will be taken. An outline of your chest and breast will be used in treatment planning. Finally, three or four small black dots will be tattooed on the skin. These permanent tattoos serve as landmarks for your upcoming radiation therapy. Some photographs will be taken for documentation purposes.

CT Scan

A treatment-planning CT scan may be obtained depending on the individual case.

Second Simulation

If CT treatment-planning was used, you may return for a second simulation, if necessary, which lasts approximately one to one-and-a-half hours. The actual treatment fields will be set up, checked and adjusted if necessary.

New-Patient Confirmation Films

You will be scheduled for a "new patient" time, approximately 30 minutes, to take some X-rays confirming your treatment plan on the radiation machines. This will take place between 2. and 3 p.m.; this will not be your regular treatment time. Your actual radiation treatments may begin that day or on a later date.

Additional Films During Treatment

Sometimes, additional X-ray films will be taken during treatment as part of planning procedures and for quality assurance. If a "boost" (which targets a smaller area to treat the cancer more precisely) is indicated in your case, additional films may be taken. The boost usually will occur immediately after completing treatment of the entire breast. It usually is five to eight treatments.
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Radiation Treatment

Radiation treatment for breast cancer typically takes six to seven weeks. It is administered Monday through Friday, except on holidays. The treatment takes about 15 minutes per day, and the radiation beam produced by the linear accelerator is only on for a couple of minutes. You will need to remain still while the radiation is being administered. For your convenience, please wear loose-fitting, comfortable clothes, preferably pants and a blouse. (The top will be removed for treatment, and the pants will remain on.)

Please avoid herbal supplements and high-dose antioxidants such as vitamin C, E, beta-carotene and selenium during radiation since these could theoretically interfere with the radiation’s desired effect. However, a multivitamin (with no more than 100 percent of the RDA) and vitamins found in foods are acceptable.

Every Wednesday after your treatment, you will be asked to see one of our physicians. This is an opportunity for the radiation oncologist to see how you are doing and for you to express any concerns or questions you may have. Friends, family and caregivers are welcome on this day if that is your preference. Although Wednesday is the main day to see the doctor, we are happy to see you any day of the week if you are having problems or concerns.
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Variations in Treatment

Some of the possible variations in treatment are described below. Other variations may occur in your individual treatment.

• Lymph node areas may or may not be treated depending on the individual clinical situation.
  
  
• After treatments are underway, you may have another brief visit to the simulator room. This will be to set up a "boost" field to the lymph nodes below the collarbone. This part of the treatment will enter behind even though the marks are placed on the skin in front of the chest. The purpose of this "boost" is to make the dose uniform. This does not mean that there has been any change in your treatment. Only patients having certain groups of lymph nodes treated need this additional simulation and treatment.
  
  
• A "bolus" may be used during treatment. A bolus is a substance placed over the breast or over the biopsy incision site. The purpose of "bolus" is to increase the dose to the skin in this area and is required in certain situations.

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Side Effects

In general, side effects do not become apparent until about the second or third week into treatment. Most people can continue their daily activities, such as going to work and exercising, without experiencing any problems. The most common side effects include mild swelling and heaviness in the breast, sunburn-like skin changes in the treated area and fatigue. Changes in the breast tissue and skin usually go away within six to 12 months. Some women may experience swelling in the hand and arm due to fluid accumulation from impaired lymph drainage. A very small percentage of women have inflammation of the lung resulting in temporary cough and/or shortness of breath.

The nursing staff is always available for counseling or attaining resources, to help you best cope with any side effects you may experience related to the treatment.
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Follow-Up Care

After your radiation treatment, a follow-up appointment may be scheduled for you to be seen in four to six weeks. You need to continue some of the special care used during treatment, at least temporarily. For instance, you may have skin irritation for several weeks after your treatments end. Continue to be gentle with skin in the treatment area until all signs of irritation are gone. You may find you still require extra rest after your therapy is complete while your healthy tissues are recovering and rebuilding. Listen to your body and rest as needed. Take naps or sleep more at night. You will be able to resume your normal activities gradually.
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