What you can expect

Radiation therapy usually begins three to eight weeks after surgery unless chemotherapy is planned. When chemotherapy is planned, radiation usually starts three to four weeks after chemotherapy is finished. You will likely get radiation therapy as an outpatient at a hospital or other treatment facility.

A common treatment schedule (course) includes one radiation treatment a day, five days a week (usually Monday through Friday), for about five to six weeks. Spreading out your sessions helps your healthy cells recover from radiation exposure while cancer cells die.

Whole-breast irradiation can frequently be shortened to three to four weeks. In addition, partial-breast irradiation may be completed in five days or less. Your radiation oncologist can help decide the course that is right for you.

External radiation

A typical external radiation therapy session generally follows this process:

  • When you arrive at the hospital or treatment facility, you're taken to a special room that's used specifically for radiation therapy.
  • You may need to remove your clothes and put on a hospital gown.
  • The radiation therapist helps you into the position you were in during the simulation process.
  • The therapist may take images or X-rays to ensure you are positioned correctly.
  • The therapist leaves the room and turns on the machine that delivers the radiation (linear accelerator).
  • Although the therapist isn't in the room during the treatment, he or she will monitor you from another room on a television screen. Usually you and the therapist can talk through an intercom. If you feel sick or uncomfortable, tell your therapist, who can stop the process if necessary.

Delivery of the radiation may last only a few minutes, but expect to spend 15 to 45 minutes for each session, as it can take several minutes to set you up in the exact same position each day. This step ensures precise radiation therapy delivery.

Radiation therapy is painless. You may feel some discomfort from lying in the required position, but this is generally short-lived.

After the session, you're free to go about your regular activities. Take any self-care steps at home that your doctor or nurse recommends, such as taking care of your skin.

In some cases, once the main radiation therapy sessions have been completed, your doctor may recommend a radiation boost. This commonly means four to five additional days or fractions of radiation directed at the place of highest concern. For example, after whole-breast irradiation is complete, a boost of radiation is commonly given to area where the tumor was removed from (lumpectomy cavity).

Internal radiation

For internal radiation, the radioactive source is inserted once or twice a day for a few minutes in the implanted radiation delivery device. This is usually done on an outpatient basis, and you can leave between sessions.

After the course of treatment, the radiation delivery device is removed. You may be given pain medication before the radiation delivery device is removed. The area may be sore or tender for several days or weeks as the tissue recovers from the surgery and radiation.

Nov. 15, 2017
References
  1. Radiation for breast cancer. American Cancer Society. http://www.cancer.org/cancer/breastcancer/detailedguide/breast-cancer-treating-radiation. Accessed July 5, 2017.
  2. De Los Santos JF. Adjuvant radiation therapy for women with newly diagnosed, non-metastatic breast cancer. https://www.uptodate.com/contents/search. Accessed July 5, 2017.
  3. Pierce LJ. Radiation therapy techniques for newly diagnosed, non-metastatic breast cancer. https://www.uptodate.com/contents/search. Accessed July 5, 2017.
  4. Verma V, et al. Proton beam radiotherapy as part of comprehensive regional nodal irradiation for locally advanced breast cancer. Radiotherapy and Oncology. 2017;123:294.
  5. Understanding radiation therapy. American Society of Clinical Oncology. http://www.cancer.net/navigating-cancer-care/how-cancer-treated/radiation-therapy/understanding-radiation-therapy. Accessed July 5, 2017.
  6. Radiation therapy and you: Support for people with cancer. National Cancer Institute. http://www.cancer.gov/publications/patient-education/radiation-therapy-and-you. Accessed July 5, 2017.
  7. Hieken TJ, et al. A novel treatment schedule for rapid completion of surgery and radiation in early-stage breast cancer. Annals of Surgical Oncology. 2016;23:3297.
  8. Hartmann LC, et al. Treating invasive breast cancer. In: the Mayo Clinic Breast Cancer Book. Boston, Mass.: Da Capo Press; 2012.
  9. Yang PS, et al. Radiotherapy can decrease locoregional recurrence and increase survival in mastectomy patients with T1 to T2 breast cancer and one to three positive nodes with negative estrogen receptor and positive lymphovascular invasion status. International Journal of Radiation Oncology Biology Physics Phys. 2010;77:516.
  10. Kawamura M, et al. Development of the breast immobilization system in prone setup: The effect of brain prone position to improve the breast setup error. Journal of Applied Clinical Medical Physics. In press. Accessed July 12, 2017.
  11. Barbara Woodard Lips Patient Education Center. Breast Cancer Handbook. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2012.
  12. Breast cancer. Fort Washington, Pa.: National Comprehensive Cancer Network. http://www.nccn.org/professionals/physician_gls/f_guidelines.asp. Accessed June 28, 2017.
  13. Recht A, et al. Postmastectomy radiotherapy: An American Society of Clinical Oncology, American Society for Radiation Oncology, and Society of Surgical Oncology Focused Guidelines Update. Journal of Clinical Oncology. 2016;34:4431.
  14. Flemjmer AM, et al. Impact of physiological breathing motion for breast cancer radiotherapy with proton beam scanning — An in silico study. Physica Medica. In press. Accessed July 12, 2017.
  15. Mutter R (expert opinion). Mayo Clinic, Rochester, Minn. June 16, 2017.
  16. Boland TA. Financial Planning and Analysis. Mayo Clinic, Rochester, Minn. July 10, 2017.
  17. Darby SC, et al. Risk of ischemic heart disease in women after radiotherapy for breast cancer. New England Journal of Medicine. 2013;368:987.
  18. Jethwa KR, et al. Immediate tissue expander or implant-based breast reconstruction does not compromise the oncologic delivery of post-mastectomy radiotherapy (PMRT). Breast Cancer Research and Treatment. 2017;164:237.
  19. Mutter RW, et al. Initial clinical experience of postmastectomy intensity modulated proton therapy in patients with breast expanders with metallic ports. Practical Radiation Oncology. 2017;7:e243. http://www.sciencedirect.com/science/article/pii/S1879850016302995. Accessed Aug. 17, 2017.
  20. Breast SPOREs. National Cancer Institute. https://trp.cancer.gov/spores/breast.htm. Accessed July 12, 2017.
  21. Taylor C, et al. Estimating the risks of breast cancer radiotherapy: Evidence from modern radiation doses to the lungs and heart and from previous randomized trials. Journal of Clinical Oncology. 2017;35:1641.