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Santa Monica Breast Center

Radiation Oncology

In keeping with the UCLA Breast Center Santa Monica's commitment to personalized  care, we believe radiation therapy is not a one size fits all treatment modality. Many women have options when it comes to radiation delivery including partial breast irradiation delivered over one week, or hypofractionated whole breast radiation delivered over 3 weeks. Regardless of the option we choose, we want to ensure that your treatment is delivered using the most advanced treatment techniques to maximize effectiveness while minimizing treatment related toxicity. 

Commonly Asked Questions:

  1. How important is radiation therapy for women with breast cancer?
  2. How does radiation work?
  3. What are the treatment options? Are there alternatives to a standard 6.5 week course of radiation?
  4. Will I get a radiation treatment the first day I go to the Radiation Oncology Department? If not, what happens next and when do I start treatment?
  5. What happens during simulation?
  6. What happens next? When will the actual treatments start?
  7. What is the schedule for radiation delivery and what should I expect each day when I come for radiation?
  8. Will I get to see my Radiation Oncologist throughout the course of radiation therapy?
  9. What are the side effects of breast radiation?
  10. What can I do to minimize the side effects of my radiation treatment?
  11. What happens when the treatment is completed?

 

  1. How important is radiation therapy for women with breast cancer?
    In addition to surgery, chemotherapy, and endocrine therapy, radiation therapy is a critical component of standard breast cancer management. Radiation therapy is indicated for the vast majority of women who have had breast conserving surgery (or lumpectomy) and for many women who have undergone mastectomy, especially those who have positive lymph nodes or large primary breast cancers. Radiation therapy has been consistently shown to significantly decrease the risk of breast cancer recurrence by 50-70%.
  2. How does radiation work?
    Radiation therapy damages the DNA of cancer cells. DNA is the genetic material of cells and it controls how cells grow and divide. When the DNA of cancer cells is damaged, the cells are unable to effectively repair the damage and they die. Fortunately, normal cells are able to efficiently repair DNA damage. As a result, even though some normal tissue is injured during radiation treatment, the normal tissue usually recovers while the cancer cells are killed.
  3. What are the treatment options? Are there alternatives to a standard 6.5 week course of radiation?
    The Radiation Oncologist will discuss this in detail, specific to your situation. The different scenarios are the following: Radiation therapy for breast cancer can be delivered to the tumor cavity (area where the breast tumor was removed), to the whole breast following breast conserving surgery, or to the chest wall following mastectomy. Depending on the extent of your particular cancer, you may also receive radiation therapy to the surrounding lymph node regions. External beam radiation therapy is delivered at UCLA using the Varian TrueBeam which allows for pinpoint accuracy and precision. Learn more about TrueBeam at UCLA » 

    For women with early stage breast cancer, common alternatives include hypofractionated whole breast radiation therapy and partial breast irradiation. For properly selected women, studies indicate that these more convenient alternatives are equivalent to the standard 6.5 week course. Hypofractionated whole breast radiation therapy is delivered over 3 weeks rather than 6.5 weeks but is otherwise identical to the standard 6.5 week course. The whole breast is treated but larger doses are used per day to allow the treatment to be completed in half the time. Studies have show that in properly selected women, this regimen is equally effective and has comparable side effects to the 6.5 week course. Partial breast irradiation is delivered over one week, twice a day. The target is different. Only the tumor cavity, the area where the breast cancer was removed, is treated. The rationale is that studies have shown the tumor cavity to be the area at highest risk for breast cancer recurrence. There are several different ways of delivering partial breast irradiation including brachytherapy techniques in which catheters are implanted in the breast to allow the treatment to be delivered from the inside out and external beam techniques which deliver radiation externally from the outside in. If you are a candidate, your radiation oncologist will describe the different techniques in detail and advise you as to which might be the most appropriate for you. Learn more about partial breast radiation at UCLA »  
  4. Will I get a radiation treatment the first day I go to the Radiation Oncology Department? If not, what happens next and when do I start treatment?
    Radiation therapy for breast cancer is complex and requires several preparation steps. Following your initial consultation in the radiation oncology department, you will be given an appointment for the next visit to the Radiation Oncology department, which is called a "simulation". This is when a CT scan of the chest is obtained to "simulate" your real treatments, and tailor the radiation fields to your specific anatomy. Daily radiation delivery typically begins one week following the CT simulation appointment.
  5. What happens during simulation?
    During this session, you will be asked to lie on your back on the treatment table and you will be positioned with your arms above your head. There will be a cradle for your arms to rest in to help maintain your arms in the desired position. You will be required to wear a gown that will open in the front to allow the team to place temporary wires on your skin to map out the area that will be treated with radiation. These wires are attached to stickers that will be placed on your skin. You will lie in this position while a CT scan of the chest is obtained. After the CT scan is complete, permanent small tattoos will be placed. These tattoos serve as reference points that the radiation therapist will later use to make sure you are reliably placed in the same position daily for each treatment session. The entire session should not take more than one hour, there is no preparation required, and no intravenous contrast dye will be administered for the CT scan.
  6. What happens next? When will the actual treatments start?
    The CT scan obtained during the simulation will be used by your radiation oncologist, and a team of physicists and dosimetrists (specialized radiation planning technicians) to generate a treatment plan. They will "simulate", using sophisticated software, the treatment that you will be receiving, i.e. deliver virtual treatments to your specific anatomy as defined by the simulation CT. This allows the fine-tuning of your treatment even before the delivery of any radiation dose to you. Radiation delivery typically begins within one week of the CT scan.
  7. What is the schedule for radiation delivery and what should I expect each day when I come for radiation?
    Breast radiation therapy is delivered daily, Monday to Friday, typically over approximately 6.5 weeks, but may be as short as 1 week or 3 weeks depending on your particular breast cancer. Radiation delivery takes approximately 10-15 minutes each day and you will be given a treatment time each day that is convenient for you. When you come for your daily radiation treatment, with the assistance of an expert team of radiation therapists, you will be positioned in the same position that you were in for simulation with your arms above your head supported by a cradle. You do see around you. The radiation treatment delivery itself lasts only few minutes. Radiation therapy delivery is painless. You won't be able to see or feel the radiation beam. You will also not feel sick during or immediately afterwards. You are not radioactive and you will not be a danger to anyone during or after your course of radiation therapy.
  8. Will I get to see my Radiation Oncologist throughout the course of radiation therapy?
    You will be seen at least once per week by the Radiation Oncologist to evaluate your progress, evaluate possible side effects, and address questions you might have. This weekly visit will occur even if you are not having any problems. Although routinely scheduled on a particular day of the week, you should not wait for that particular day to bring up your problems if you have any. Your nurse and/or your radiation oncologist will address your issues.
  9. What are the side effects of breast radiation?
    Breast radiation therapy is typically very well tolerated. The most common side effects experienced during a course of breast radiation therapy are fatigue, which is usually mild, and skin coloration changes such as redness, tanning, or darkening of the skin in the radiation field, similar to a sunburn. Radiation therapy is local, focused treatment so you will not feel sick, nauseous, or lose your hair. You may experience mild breast swelling, tenderness, soreness, or intermittent aches and pains in the treatment area. Peeling and blistering of the skin in the radiation field is possible although less common. These side effects are temporary and typically resolve within 2 to 4 weeks after the completion of radiation. Although rare, radiation therapy for breast cancer can be associated with long term side effects. These side effects can include minor changes in the look or feel of the treated breast such as persistent tanning/darkening of the skin in the treatment area; sensitivity to touch in the treatment area; or changes in the size, shape or feel of the treated breast. Risk of long term damage to the heart or lungs is very small with modern radiation therapy techniques. Radiation may add to your risk of developing lymphedema (or swelling of the arm) especially if you are receiving radiation to the surrounding lymph node regions.
  10. What can I do to minimize the side effects of my radiation treatment?
    Fortunately, there are really no restrictions during radiation therapy. You should be able to maintain your normal activity and diet throughout the course of breast radiation therapy. We advise that when you arrive for your daily treatment, the area (including the breast and underarm) should be clean and dry. We ask that you not apply any creams, lotions, or deodorant for 3 hours prior to receiving radiation. You are encouraged to use a daily aloe based moisturizer on the treatment area but it should be applied after your daily radiation treatment delivery. You may bathe or shower as usual. Avoid anything that can irritate the skin---things like bras or tight clothing that can rub or chafe, shaving, scratching, sun exposure, or temperature extremes. You should seek attention if you develop itching, pain, peeling or blistering of the skin in the treated area. We recommend that you continue the recommended skin care routine for 2-3 weeks after your radiation therapy is complete.
  11. What happens when the treatment is completed?
    When the treatment is completed, you will have a final visit to assess that the radiation side-effects have subsided and to ensure that all appropriate follow up visits have been scheduled. You will be asked to return to the radiation oncology department approximately 2-4 weeks after radiation is complete for routine follow up. Beyond the first follow-up visit, long term follow-up will continue with your breast surgeon, radiation oncologist, medical oncologist, and/or your primary care doctor. A specific schedule for follow up clinical breast exams and imaging will be recommended by your treatment team.

 

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