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piedmont.org

Why does radiation cause long-term side effects? "The reason radiation therapy works is because it damages the DNA of cells," he says. "Rapidly dividing cells, such as cancer cells, are more affected by radiation therapy than normal cells. The body may respond to this damage with fibrosis or scarring, though this is generally a mild process and ...

If you have undergone radiation therapy (radiotherapy) for cancer treatment, it is normal to have concerns about potential long-term side effects. Fortunately, not everyone experiences side effects and for those who do, side effects are rarely serious. Adam Nowlan, M.D., a radiation oncologist at Piedmont, shares the overall benefits of radiotherapy, the most common signs to watch for after treatment and when to see your doctor.

The benefits of radiation therapy

"While there is a risk of long-term side effects, radiation therapy is perhaps uniquely capable in the field of medicine of sterilizing microscopic disease that is embedded in normal tissue without necessarily having to cut out the normal tissue," says Dr. Nowlan. "Radiation can reduce a microscopic cluster of cancer cells into something that is nonviable. We are treating an invisible disease with invisible beams. We can treat cancer cells that remain even after chemotherapy or surgery, or shrink tumors before surgery or chemotherapy. Radiation therapy is capable of helping someone who could have died from cancer and giving them their life back."

Why does radiation cause long-term side effects?

"The reason radiation therapy works is because it damages the DNA of cells," he says. "Rapidly dividing cells, such as cancer cells, are more affected by radiation therapy than normal cells. The body may respond to this damage with fibrosis or scarring, though this is generally a mild process and typically does not cause any long-term problems that substantially affect quality of life."

Radiation oncologists are trained to deliver the right dose of radiation to the right body part on the correct schedule. They work to minimize side effects and limit overall radiation exposure so you can receive the correct dose of radiation to sterilize cancer cells while minimizing the effects on your normal, healthy cells.

Who is at risk for long-term side effects of radiation therapy?

This varies from person to person. Your risk of long-term side effects may increase with the amount of radiation you receive. Some people have a rare inherited disease that causes them to heal poorly from radiotherapy.

"If we discover a patient has this type of inherited disease or conditions such as scleroderma, we try to avoid radiation when treating their cancer," says Dr. Nowlan.

What are the most common long-term side effects of radiation?

"Generally, the side effects of radiotherapy are related only to the area of the body that was treated," says Dr. Nowlan. "The only long-term side effect of radiation that occurs outside the area that was treated is some lingering mild fatigue, which typically fades within three to six months."

He breaks down the most common potential side effects by the body part treated with radiation therapy. Consult your doctor about your individual risk, as each person is unique.

  • Breast: 

    • Minor scarring of the lung that can show up on an X-ray

    • The treated breast may be slightly smaller and firmer than the untreated breast, though this is rarely noticeable, even in a bathing suit or bra

  • Head or neck:

    • A change in the pH of saliva, allowing a new breed of bacteria to grow that can damage tooth enamel and make you more susceptible to cavities

    • A permanent alteration in taste or food preferences

    • Bone injury (Avoid dental surgery or other dental work after treatment.)

    • Difficulty swallowing

    • Mouth dryness

    • Throat pain or hoarseness

    • Tightening of the jaw

  • Brain:

    • Cataracts

    • Hair loss

    • Hearing loss

    • Memory loss ("It's hard to determine how much memory loss or cognitive dysfunction is related to a tumor and how much is related to radiotherapy," says Dr. Nowlan. Radiation oncologists limit how much of the brain is exposed to radiation whenever possible, utilizing precision treatments like the gamma knife or stereotactic radiosurgery.)

  • Pelvis:

    • Increased, looser bowel movements

    • Infertility (For patients in their childbearing years who wish to have children one day, there are options to preserve fertility prior to treatment.)

    • Reduction in bladder capacity

    • Vaginal dryness

  • Chest:

    • Increased risk of breast cancer for patients who receive chest radiation for conditions such as lymphoma during puberty

When to contact your doctor

If long-term side effects occur, they typically develop within two to three years of treatment. It is rare for a symptom to pop up eight to 10 years later. If you experience one of these symptoms, contact your primary care physician or radiation oncologist.

Learn more about cancer treatment, prevention, screenings and side effects.

Can you have radiation twice?

SO much I have read said you cant get radiation twice in the same spot, SO I AM TRYING TO THINK THIS IS A POSITIVE THING. my friend is a nurse, and she told the doctor that works with her my mom's situation and he told her in his . KarsonKimpel. 4 Comments - Posted 8 years ago. Preventative radiation for Stage IV NSCLC with great response on TKI . My wife was diagnosed Stage IV NSCLC a …

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My mother just finished radiation on right lung for tumor and chest lymph nodes. She now has 2 swollen lymph nodes in her neck. I was wondering if this has mets. can she have radiation again? Wont know for sure what it is until after pet scan tomorrow, however we think we know. Thanks

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Hi. I'm sorry to hear about your mother. My mom had 7 weeks of radiation and was initially told that it was the maximum amount she could get. However, last week we were told after her next Pet scan they may consider doing target radiation on the tumor if it hasn't completely shrank. I'll let you know what happends. I'll pray for your mom. Demika
I have had radiation twice but it cannot be in the same targeted area and mine were three years apart. I hope your mom does not have to repeat her treatments and the scan is clear, best of luck.
Go on line under TomoTherapy and bring up CTCA's web site. CTCA has a very comprehensive explanation of TomoTherapy treatments. TomoTherapy can also reradiate previously radiated tumors. TomoTherapy is a fairly recent and effective treatment for cancer. It is not a cancer cure, it is a very valuable new weapon against cancer. Many hospitals and cancer clinics in the country have recently started to offer TomoTherapy treatments for the first time. Please look into this new treatment for your mom, and share the information with her. Let her decide if it's worth further investigation. I have had the treatment, It was successful, painless, and effective, and l will use it whenever possible in the future Charlene
Hello....I am now about eight weeks post radiation, and finished three cycles of chemo. My diagnosis is "Limited 'Plus'" SCLC. All of the nodes of my left chest were metastacised by the time I was diagnosed on 18 Feb 09. Thus the "Plus" added to my staging per my chemo doc. My treatments were very difficult. I was admitted to the hospital after each cycle of cisplatin etoposide. The radiation destroyed my esophagus and although I was completely neutropenic, I could not even seem to swallow the nutriment shakes. I had split-thickness burns to my neck, chest and back midway through my 32 irradiation sessions. We had to take a ten day break to heal my skin after about the twenty-third session. At one point, I was home alone, unable to even lift myself from my bed for three days. Things seemed unsurmountable in my fight for survival several times. My doctors were extraordinary. They took deep personal concern for me. I have a team of them - 6 to be exact. Although I felt like the curtain was about to come down on me, they encouraged me on, and provided me everything possible for pain relief, blood transfusions, Neulasta, and they challenged my condition at every turn, and there were several. They never gave me any impression that they were unsure of me gaining the upper hand in this battle. Today is my seventh month anniversary in this journey. I was pronounced "in remission" on 19 Aug 09. I was to continue my treatment by receiving the administration of prophylactic irradiation to my cranium, but choose to decline this procedure. On this seventh month anniversary, my daughter happened to pick me up to go to the grocery store. Today, I was strong enough to walk the whole store, instead of having to use the store's scooter. I can vacuum my home, fix my meals, bathe and sit up and be active for the entire day. I even have an inch of hair covering my once completely bald head. I do have residual pain, congestion and miserable cough. I have infiltrates and adhesions, and have had two severe bouts of pneumonia since finishing radiation. In other words, my quality of life changes from hour to hour and day to day. But most importantly, and especially for any of you dear, wonderful people who are suffering in your battle against this life-changing disease, don't give up! My faith has allowed me to turn my helpless body and soul over into His hands minute by minute, hour by hour, day by day...and I currently have been graced to encourage all of you to not give up...no matter how dim the circumstances may appear. I have a disease that made me incapacitated and ill and unable to leave my bed for anything other than to obtain treatment...and did not believe that I would have a second chance of being strong enough to do anything that I had been doing before I became so sick. I know this remission may be temporary, and I pray God will continue to allow me to be well and strong. I have now had lots of practice in praying "Your Will, not mine, my Lord." I thank you sincerely if you have taken the time to read this lengthy testimony. I am compelled to encourage others involved with this battle to fight the good fight, and I pray that you will very soon have a day come to you like the one I am enjoying today. Peace be with you always.
Please let me know how your mom does and I will pray for her also as I do for all. Nancy
Charlene....Thanks we will keep TomoTherapy in mind...I did check and unfortunately there is not one close by. Is it good for lymph nodes in neck? thanks Nancy
What an amazing story and you are one heck of a strong person...Keep up the good work...Keep me posted....Nancy
5 questions patients might be reluctant to ask about ...

Radiation therapy for cancer raises plenty of questions – some of which you might feel nervous asking. Nina Sanford, M.D, tackles five common questions patients might be afraid to bring up with their…

External beam radiation therapy is the most common type of treatment and it delivers radiation from a source outside the body.

Getting a recommendation for radiation therapy as part of cancer treatment comes with a learning curve – and a lot of questions. More than half of all patients with cancer receive radiation therapy at some point in their care, and patients and their families want to know how radiation works and how it might affect their lives during and after treatment.

Still, we know some patients feel nervous asking questions about their cancer therapy. In a word: Don’t. Asking questions helps your doctors provide the best care.

Radiation oncologists at the UT Southwestern Harold C. Simmons Cancer Center are leaders in the field, conducting research studies and pioneering advanced radiation techniques such as stereotactic ablative radiotherapy (SAbR), brachytherapy, and novel combinations of radiotherapy with chemotherapy.

We’re always happy to share the most current radiation knowledge with our patients. So, here are answers to five of the most common questions patients have said they were nervous to ask – but were glad they did.

Top radiation therapy questions and answers

1. Will I be radioactive during or after treatment?

Some patients worry that undergoing radiation therapy can be harmful to others because they are radioactive. For example, patients sometimes think they can't cuddle with their partner or hold a grandchild on their lap until after treatment. However, most patients don’t need to worry about being radioactive. 

External beam radiation therapy is the most common type of treatment, and true to its name, it delivers radiation from a source outside the body. With this approach, you don’t need to worry about contact with family members or other people you encounter. Once you’re finished in the treatment room, there is no more radiation being delivered and you are not radioactive.

With internal radiation therapy (brachytherapy), your radiation oncologist will place a small radiation source inside the body. One example is the use of radioactive beads placed inside the prostate to deliver radiation therapy for prostate cancer. 

Related reading: Treating prostate cancer with radiation

For some types of treatments termed high-dose rate (HDR) brachytherapy, the source remains in place for a few minutes at a time and is removed once you leave the procedure room – you are not radioactive in these scenarios.

For other types of treatments termed low dose rate (LDR) brachytherapy, the source remains permanently. These sources remain active in the body for many weeks (and longer in some cases), but the radiation emitted is so low that there is a negligible risk to others. However, to be extra cautious, patients are advised to avoid close contact with children and pregnant women for up to two months.

2. Will radiation treatment harm my immune system?

Radiation therapy can potentially affect your immune system, especially if a significant amount of bone marrow is being irradiated because of its role in creating white blood cells. However, this doesn’t typically suppress the immune system enough to make you more susceptible to infections.

Certain types of chemotherapy have a higher likelihood of causing immunosuppression. If your treatment plan includes chemotherapy and radiation therapy, talk with your doctor about whether you need to take special precautions or have additional lab work to monitor your immune system during treatment. 

3. Should I take any supplements or vitamins during treatment?

In most cases, no. Radiation therapy generates molecules called free radicals that kill cancer cells, and oxygen is required in this process. Because many vitamins and supplements include antioxidants, which limit the amount of oxygen in tissue and organs, they could potentially decrease radiation’s effectiveness.

People also ask
  • How long does it take to recover from radiation treatment?

    The general effects of radiation therapy like fatigue, nausea, and headaches resolve fairly quickly after treatment. Your body just needs time to process the radiation but can recover within a few weeks. Delayed side effects of radiation therapy, on the other hand, may require further treatment to alleviate.

    For most people, the cancer experience doesn’t end on the last day of radiation therapy. Radiation therapy usually does not have an immediate effect, and it could take days, weeks or months to see any change in the cancer. The cancer cells may then keep dying for weeks or months after the end of treatment. It may be some time before you know whether the radiation therapy has controlled the cancer.

    Learn more about:

    What happens after treatment finishes?

    After radiation therapy has finished, your treatment team will give you general information about your recovery. They will tell you how to look after the treatment area and recommend ways to manage side effects. They will also suggest who to call if you have any concerns.

    Life after cancer treatment can present its own challenges. You may have mixed feelings when treatment ends, and worry that every ache and pain means the cancer is coming back.

    Some people say that they feel pressure to return to “normal life”. It is important to allow yourself time to adjust to the physical and emotional changes, and establish a new daily routine at your own pace. Your family and friends may also need time to adjust.

    Cancer Council 13 11 20 can help you connect with other people who have had cancer, and provide you with information about the emotional and practical aspects of living well after cancer.

    For more on this, see Living well after cancer.

    Follow-up appointments

    You will have regular check-ups with the radiation oncologist at the treatment centre. These will become less frequent over time.

    You may also have follow-up appointments with nurses from your treatment centre to help manage any ongoing symptoms, as well as regular check-ups with other specialists who have been involved in your treatment. You will receive continued support from allied health professionals, such as a speech pathologist or dietitian, if you need it.

    When a follow-up appointment or test is approaching, many people find that they think more about the cancer and may feel anxious. Talk to your treatment team or call Cancer Council 13 11 20 if you are finding it hard to manage this anxiety.

    Let your treatment team know immediately of any health problems between these follow-up appointments. Many of the long-term or late effects of radiation therapy can be managed better if identified early.

    If you have continued feelings of sadness, have trouble getting up in the morning or have lost motivation to do things that previously gave you pleasure, you may be experiencing depression. This is quite common among people who have had cancer.

    Talk to your GP, as counselling or medication – even for a short time – may help. Some people can get a Medicare rebate for sessions with a psychologist. Ask your doctor if you are eligible. Cancer Council may also run a counselling program in your area.

    For information about coping with depression and anxiety, call beyondblue on 1300 22 46 36. For 24-hour crisis support, call Lifeline on 13 11 14.

    Life After Radiation Therapy - Cancer Council NSW
  • Can You Survive Cancer twice?

    About 90 percent of those with Nodular sclerosis Hodgkin’s lymphoma survive and are likely cured ... He doesn’t have a varsity win on his resume, but he’s twice beaten cancer.
    Liberty wrestler John Notchey returned to the mat after twice beating cancer
  • What to expect during and after radiation treatments?

    Radiation cystitis. If the radiation damages the lining of the bladder, radiation cystitis can be a long-term problem that causes blood in the urine or pain when passing urine.Urinary incontinence. ...Fistulas. ...

    Continue reading below to learn more about what will happen during your radiation treatment for cancer or jump directly to the section that interests you the most by clicking on one of the questions:

    What can I expect at my first radiation treatment appointment?

    What to expect during radiation treatment for cancer depends on whether you are having external beam radiation therapy or internal radiation therapy, also called high-dose-rate (HDR) brachytherapy.

    Your first radiation therapy appointment won’t include any actual radiation therapy. Instead, you’ll come in for a CT scan, which is used to help plan your radiation therapy. You will be positioned as you would during treatment — usually lying flat on your back — and scans will be taken of the area of the body that will be treated. You also will have tiny permanent marks (sometimes referred to as “tattoos” although they look more like a freckle) that will guide the targeting of the radiation therapy during treatment. This appointment takes about 30 minutes.

    When will I start getting radiation therapy?

    After you leave your first appointment with your radiation oncologist, they will use your scans to map out the exact location of the cancer within your body as well as noting the location of any surrounding healthy organs that need to be avoided during treatment. Computer modeling is then used to simulate the dose of radiation that will be delivered to the tumor during treatment, and the model is reviewed before your treatment begins. This process can take up to two weeks before you return for your first actual radiation therapy treatment.

    When your treatment plan is developed, it will outline whether you will be receiving radiation therapy before, during, or after other treatments. Once you are ready to begin radiation therapy, you can usually be seen within one to two days at Rocky Mountain Cancers Centers.

    What can I expect if I am receiving external beam radiation therapy?

    External beam radiation treatment for cancer is typically administered every day, Monday through Friday, for five to eight weeks. About two weeks after your first radiation therapy appointment when you have the simulation scan, you’ll begin your treatments.

    Each visit will be relatively short, lasting between 15 and 30 minutes. Most of that time will be spent lying on a table while the radiation therapist gets the equipment set up around you.

    At Rocky Mountain Cancer Centers, we utilize image-guided radiation therapy, or IGRT. During each visit, new X-rays or low-dose CT scans of your body will be made and compared with the initial scan to determine if the tumor has moved — even by just a hair’s distance — and the radiation is adjusted accordingly.

    Our dosimetrist check and calibrate our equipment daily and the equipment will not run if it is not calibrated correctly. All of this is done to ensure your safety and the effectiveness of treatment.

    You will be asked to lie still for the actual treatment, which will last only a few minutes. The treatment itself is painless and is similar to getting an X-ray. You may hear clicking and whirring sounds during the treatment as the machine positions itself. During the treatment, the radiation therapist will be in a small room adjacent to your treatment room and watching you at all times. You will be able to communicate with your radiation therapist via intercom and should feel free to ask to stop if you feel sick or scared.

    What can I expect if I am receiving internal radiation treatment for cancer?

    Sessions for internal radiation therapy last longer than external beam radiation treatments, but there are fewer of them. Internal radiation therapy for cancer may be completed in one session or a series of three to five sessions about a week apart.

    During internal radiation therapy, you will be given local anesthetic to numb the area being treated. A catheter or catheters — small tubes sometimes called ports or applicators — will be placed at the site of the tumor. Radioactive material is then delivered directly to the tumor through the catheters. The radiation therapy comes in many forms, including pellets, seeds, ribbons, wires, needles, capsules, balloons, or tubes. Depending on the type of radioactive material used, it will be left in place for only a couple of minutes and then removed or it may be left in permanently. Radioactive material that is left in permanently gradually wears off over the course of a few weeks until it no longer gives off radiation.

    How you feel after your first radiation treatment for cancer will depend on the type of treatment you had, the location of your cancer, and other characteristics that are unique to you. In many cases, you will not experience any side effects initially, but may experience some after multiple treatments as the therapy has a cumulative effect.

    If you had internal radiation, you may experience soreness or tenderness where the catheter was inserted, and you likely will experience some degree of fatigue. You also may have side effects from any medication you were given during the treatment.

    If you had external beam radiation, you may experience skin changes and fatigue following your initial treatment, or you may not have any radiation therapy side effects at all. Some people don’t develop side effects from external radiation until they’ve had several treatments.

    What to Expect During Radiation Therapy
  • How much radiation do you normally get?

    The average American has a yearly radiation dose of 6.2 mSv, evenly divided between natural and man-made sources (which includes medical scans, like X-rays or CT scans). If you don't undergo any medical imaging tests, your dose is around 3 mSv per year. More information can be found HERE.
    How much radiation? - Know Your Dose
Can Women Get More Than One Lumpectomy?

15-06-2015 · Beyond that, there are issues with wound healing, and in some cases you can get radiation-induced cancers or toxicity to other parts of the body.” Certain women older than 70 who have small, estrogen-sensitive tumors may not need radiation following a lumpectomy, making them eligible for a second lumpectomy should their cancer come back in the breast. Golshan says in some cases there is …

15-06-2015

For many women with localized breast cancer, a lumpectomy followed by breast radiation therapy may be the most effective treatment, with survival rates equal to a mastectomy. But if the cancer comes back, can women have additional lumpectomies?

Mehra Golshan, MD, FACS, director of Breast Surgical Services with the Susan F. Smith Center for Women's Cancers at Dana-Farber, meets with patients to customize breast surgery approaches.
Mehra Golshan, MD, FACS, director of Breast Surgical Services with the Susan F. Smith Center for Women’s Cancers at Dana-Farber, meets with patients to customize breast surgery approaches.

Women should not have a second lumpectomy in the same breast if they were previously treated with a lumpectomy and radiation, says Mehra Golshan, MD, FACS, director of Breast Surgical Services at the Susan F. Smith Center for Women’s Cancers at Dana-Farber. Instead, the standard course of treatment is a mastectomy (total removal of the breast), with or without reconstruction, to avoid the additional radiation that would accompany a second lumpectomy.

“Radiation not only kills cancer cells, but it also inhibits the growth of normal cells,” he says. “There’s a limited amount of radiation that parts of the body can tolerate. Beyond that, there are issues with wound healing, and in some cases you can get radiation-induced cancers or toxicity to other parts of the body.”

Certain women older than 70 who have small, estrogen-sensitive tumors may not need radiation following a lumpectomy, making them eligible for a second lumpectomy should their cancer come back in the breast. Golshan says in some cases there is also the option to receive partial breast radiation, where therapy is given only to the site of the lumpectomy. If a woman is treated with partial radiation for her first cancer, she may be eligible for a second lumpectomy and partial breast radiation if she has a recurrence in another part of the breast. These areas are being researched actively.

Women who are diagnosed for the first time with breast cancer in multiple spots traditionally have had a mastectomy. However, a new trial at Dana-Farber/Harvard Cancer Center offers these patients multiple lumpectomies followed by radiation, rather than removing the entire breast.

Should a woman who was treated with a lumpectomy and radiation in one breast be diagnosed with a second cancer in her opposite breast, she may be eligible for another lumpectomy, as the second breast did not receive radiation.

But, Golshan cautions, “it’s somewhat uncommon to get bilateral breast cancer [cancer in both breasts], so we would want to consider genetic counseling and testing before offering her another lumpectomy.”

“If she has a genetic predisposition, such as a BRCA mutation, then we would offer her a mastectomy and potentially other procedures to lessen her risk of further breast or ovarian cancer,” he adds. If there is no mutation, a lumpectomy of the opposite breast would be an option.

Radiation Therapy for Cancer - National Cancer Institute

Why People with Cancer Receive Radiation Therapy. Radiation therapy is used to treat cancer and ease cancer symptoms. When used to treat cancer, radiation therapy can cure cancer, prevent it from returning, or stop or slow its growth. When treatments are used to ease symptoms, they are known as palliative treatments.

Radiation therapy kills cancer cells or slows their growth by damaging their DNA.

Radiation therapy (also called radiotherapy) is a cancer treatment that uses high doses of radiation to kill cancer cells and shrink tumors. At low doses, radiation is used in x-rays to see inside your body, as with x-rays of your teeth or broken bones.

At high doses, radiation therapy kills cancer cells or slows their growth by damaging their DNA. Cancer cells whose DNA is damaged beyond repair stop dividing or die. When the damaged cells die, they are broken down and removed by the body.

Radiation therapy does not kill cancer cells right away. It takes days or weeks of treatment before DNA is damaged enough for cancer cells to die. Then, cancer cells keep dying for weeks or months after radiation therapy ends.

There are two main types of radiation therapy, external beam and internal.

The type of radiation therapy that you may have depends on many factors, including:

  • the type of cancer
  • the size of the tumor
  • the tumor’s location in the body
  • how close the tumor is to normal tissues that are sensitive to radiation
  • your general health and medical history
  • whether you will have other types of cancer treatment
  • other factors, such as your age and other medical conditions

External Beam Radiation Therapy

External beam radiation therapy comes from a machine that aims radiation at your cancer. The machine is large and may be noisy. It does not touch you, but can move around you, sending radiation to a part of your body from many directions.

External beam radiation therapy is a local treatment, which means it treats a specific part of your body. For example, if you have cancer in your lung, you will have radiation only to your chest, not to your whole body.

Learn more about external beam radiation therapy.

Internal Radiation Therapy

Internal radiation therapy is a treatment in which a source of radiation is put inside your body. The radiation source can be solid or liquid.

Internal radiation therapy with a solid source is called brachytherapy. In this type of treatment, seeds, ribbons, or capsules that contain a radiation source are placed in your body, in or near the tumor. Like external beam radiation therapy, brachytherapy is a local treatment and treats only a specific part of your body.

With brachytherapy, the radiation source in your body will give off radiation for a while.

Learn more about brachytherapy.

Internal radiation therapy with a liquid source is called systemic therapy. Systemic means that the treatment travels in the blood to tissues throughout your body, seeking out and killing cancer cells. You receive systemic radiation therapy by swallowing, through a vein via an IV line, or through an injection.

With systemic radiation, your body fluids, such as urine, sweat, and saliva, will give off radiation for a while.

Radiation therapy is used to treat cancer and ease cancer symptoms.

When used to treat cancer, radiation therapy can cure cancer, prevent it from returning, or stop or slow its growth.

When treatments are used to ease symptoms, they are known as palliative treatments. External beam radiation may shrink tumors to treat pain and other problems caused by the tumor, such as trouble breathing or loss of bowel and bladder control. Pain from cancer that has spread to the bone can be treated with systemic radiation therapy drugs called radiopharmaceuticals.

External beam radiation therapy is used to treat many types of cancer.

Brachytherapy is most often used to treat cancers of the head and neck, breast, cervix, prostate, and eye.

A systemic radiation therapy called radioactive iodine, or I-131, is most often used to treat certain types of thyroid cancer.

Another type of systemic radiation therapy, called targeted radionuclide therapy, is used to treat some patients who have advanced prostate cancer or gastroenteropancreatic neuroendocrine tumor (GEP-NET). This type of treatment may also be referred to as molecular radiotherapy.

For some people, radiation may be the only treatment you need. But, most often, you will have radiation therapy with other cancer treatments, such as surgery, chemotherapy, and immunotherapy. Radiation therapy may be given before, during, or after these other treatments to improve the chances that treatment will work. The timing of when radiation therapy is given depends on the type of cancer being treated and whether the goal of radiation therapy is to treat the cancer or ease symptoms.

When radiation is combined with surgery, it can be given:

  • Before surgery, to shrink the size of the cancer so it can be removed by surgery and be less likely to return.
  • During surgery, so that it goes straight to the cancer without passing through the skin. Radiation therapy used this way is called intraoperative radiation. With this technique, doctors can more easily protect nearby normal tissues from radiation.
  • After surgery to kill any cancer cells that remain.

There is a limit to the amount of radiation an area of your body can safely receive over the course of your lifetime. Depending on how much radiation an area has already been treated with, you may not be able to have radiation therapy to that area a second time. But, if one area of the body has already received the safe lifetime dose of radiation, another area might still be treated if the distance between the two areas is large enough.

Radiation not only kills or slows the growth of cancer cells, it can also affect nearby healthy cells. Damage to healthy cells can cause side effects.

Learn more about the side effects of radiation therapy.

Radiation therapy can be expensive. It uses complex machines and involves the services of many health care providers. The exact cost of your radiation therapy depends on the cost of health care where you live, what type of radiation therapy you get, and how many treatments you need.

Talk with your health insurance company about what services it will pay for. Most insurance plans pay for radiation therapy. To learn more, talk with the business office at the clinic or hospital where you go for treatment. If you need financial assistance, there are organizations that may be able to help. To find such organizations, go to the National Cancer Institute database, Organizations that Offer Support Services and search for "financial assistance." Or call toll-free 1-800-4-CANCER (1-800-422-6237) to ask for information on organizations that may help.

Radiation can cause side effects that make it hard to eat, such as nausea, mouth sores, and throat problems called esophagitis. Since your body uses a lot of energy to heal during radiation therapy, it is important that you eat enough calories and protein to maintain your weight during treatment.

If you are having trouble eating and maintaining your weight, talk to your doctor or nurse. You might also find it helpful to speak with a dietitian. For more information about coping with eating problems see the booklet Eating Hints or read more about side effects.

Some people are able to work full-time during radiation therapy. Others can work only part-time or not at all. How much you are able to work depends on how you feel. Ask your doctor or nurse what you may expect from the treatment you will have.

You are likely to feel well enough to work when you first start your radiation treatments. As time goes on, do not be surprised if you are more tired, have less energy, or feel weak. Once you have finished treatment, it may take just a few weeks for you to feel better—or it could take months.

You may get to a point during your radiation therapy when you feel too sick to work. Talk with your employer to find out if you can go on medical leave. Check that your health insurance will pay for treatment while you are on medical leave.

If you would like to reproduce some or all of this content, see Reuse of NCI Information for guidance about copyright and permissions. In the case of permitted digital reproduction, please credit the National Cancer Institute as the source and link to the original NCI product using the original product's title; e.g., “Radiation Therapy to Treat Cancer was originally published by the National Cancer Institute.”

mayoclinic.org

This content does not have an English version.This content does not have an Arabic version. Radiation therapy for breast cancer uses high-energy X-rays, protons or other particles to kill cancer…

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Radiation therapy for breast cancer uses high-energy X-rays, protons or other particles to kill cancer cells. Rapidly growing cells, such as cancer cells, are more susceptible to the effects of radiation therapy than are normal cells.

The X-rays or particles are painless and invisible. You are not radioactive after treatment, so it is safe to be around other people, including children.

Radiation therapy for breast cancer may be delivered through:

  • External radiation. A machine delivers radiation from outside your body to the breast. This is the most common type of radiation therapy used for breast cancer.
  • Internal radiation (brachytherapy). After you have surgery to remove the cancer, your doctor temporarily places a radiation-delivery device in your breast in the area where the cancer once was. A radioactive source is placed into the device for short periods of time over the course of your treatment.

Radiation therapy may be used to treat breast cancer at almost every stage. Radiation therapy is an effective way to reduce your risk of breast cancer recurring after surgery. In addition, it is commonly used to ease the symptoms caused by cancer that has spread to other parts of the body (metastatic breast cancer).

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Why it's done

Radiation therapy kills cancer cells. It's often used after surgery to reduce the risk that the cancer will come back. It can also be used to provide relief from pain and other symptoms of advanced breast cancer.

Radiation after lumpectomy

If you're having an operation to remove the breast cancer and leave the remaining breast tissue intact (lumpectomy or breast-conserving surgery), your doctor may recommend radiation after your procedure to kill any cancer cells that might remain. Adding radiation after a lumpectomy reduces the risk that cancer will return in the affected breast.

Lumpectomy combined with radiation therapy is often referred to as breast conservation therapy. This type of treatment is as effective as having all the breast tissue removed (mastectomy). In special situations where the risk of recurrence is very low, your doctor may also discuss the option of avoiding radiation after a lumpectomy.

After lumpectomy, radiation treatment options might include:

  • Radiation to the entire breast. One of the most common types of radiation therapy after a lumpectomy is external beam radiation of the whole breast (whole-breast irradiation).
  • Radiation to part of the breast. Radiation therapy to part of the breast (partial-breast irradiation) may be an option for some early-stage breast cancers. This technique directs internal or external radiation to the area around where the cancer was removed.

Radiation after mastectomy

Radiation can also be used after mastectomy. In this situation, the radiation can kill any cancer cells that might remain and reduce the risk that the cancer may recur in the remaining tissues of the chest wall or lymph nodes.

When determining whether you should undergo radiation after mastectomy, your doctor considers whether you have:

  • Lymph nodes with signs of breast cancer. Underarm (axillary) lymph nodes that test positive for cancer cells are an indication that some cancer cells have spread beyond the breast.
  • Large tumor size. A breast cancer larger than about 2 inches (5 centimeters) generally carries a higher risk of recurrence than do smaller cancers.
  • Tissue margins with signs of breast cancer. After breast tissue is removed, the margins of the tissue are examined for signs of cancer cells. Very narrow margins or margins that test positive for cancer cells are a risk factor for recurrence.

Radiation for locally advanced breast cancer

Radiation therapy can also be used to treat:

  • Breast cancers that can't be removed with surgery.
  • Inflammatory breast cancer, an aggressive type of cancer that spreads to the lymph channels of the skin covering the breast. This type of cancer is typically treated with chemotherapy before a mastectomy, followed by radiation, to decrease the chance of recurrence.

Radiation for managing metastatic breast cancer

If your breast cancer has spread (metastasized) to other parts of your body, radiation therapy may be recommended to shrink the cancer and help control symptoms such as pain.

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Risks

Side effects from radiation therapy differ significantly depending on the type of treatment and which tissues are treated. Side effects tend to be most significant toward the end of your radiation treatment. After your sessions are complete, it may be several days or weeks before side effects clear up.

Common side effects during treatment may include:

  • Mild to moderate fatigue
  • Skin irritation, such as itchiness, redness, peeling or blistering, similar to what you might experience with a sunburn
  • Breast swelling

Depending on which tissues are exposed, radiation therapy may cause or increase the risk of:

  • Arm swelling (lymphedema) if the lymph nodes under the arm are treated
  • Damage or complications leading to removal of an implant if you had breast reconstruction with an implant after mastectomy

Rarely, radiation therapy may cause or increase the risk of:

  • Rib fracture or chest wall tenderness
  • Inflamed lung tissue or heart damage
  • Secondary cancers, such as bone or muscle cancers (sarcomas) or lung cancer

How you prepare

Before your radiation treatments, you'll meet with your radiation therapy team, which may include:

  • A radiation oncologist, a doctor who specializes in treating cancer with radiation. Your radiation oncologist determines the appropriate therapy for you, follows your progress and adjusts your treatment, if necessary.
  • A radiation oncology medical physicist and a dosimetrist, who make calculations and measurements regarding your radiation dosage and its delivery.
  • A radiation oncology nurse, nurse practitioner or physician assistant, who answers questions about treatments and side effects and helps you manage your health during treatment.
  • Radiation therapists, who operate the radiation equipment and administer your treatments.

Before you begin treatment, your radiation oncologist will review your medical history with you and give you a physical exam to determine whether you would benefit from radiation therapy. Your doctor will also discuss the potential benefits and side effects of your radiation therapy.

Before external radiation therapy

Before your first treatment session, you'll go through a radiation therapy planning session (simulation), in which a radiation oncologist carefully maps your breast area to target the precise location of your treatment. During the simulation:

  • A radiation therapist helps you into the best position to target the affected area and avoid damage to surrounding normal tissue. Sometimes pads or other devices are used to help you hold the position.
  • You have a CT scan so that the radiation oncologist can locate the treatment area and normal tissues to avoid. You'll hear noise from the CT equipment as it moves around you. Try to relax and remain as still as possible to help ensure consistent, accurate treatments.
  • A radiation therapist may mark your body with semipermanent ink or with tiny permanent tattoo dots. These marks will guide the radiation therapist in administering the radiation. Take care when washing to avoid scrubbing away the marks.
  • The dosimetrist, the radiation physicist and the radiation oncologist use computer software to plan the radiation treatment you will receive. Once the simulation and planning are complete and multiple quality assurance checks are done, you can begin treatment.

Before internal radiation therapy

Before internal radiation therapy (brachytherapy) is started, a special device for placement of the radioactive material is placed in the area where the cancer was removed. This may be done during your cancer surgery or as a separate procedure several days later.

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 have radiation therapy as an outpatient at a hospital or other treatment facility.

A common treatment schedule (course) historically has included one radiation treatment a day, five days a week (usually Monday through Friday), for five or six weeks. This course is still commonly used in people who require radiation to the lymph nodes.

Increasingly, doctors are recommending shorter treatment schedules (hypofractionated treatment). Whole-breast irradiation can frequently be shortened to one to four weeks. Partial-breast irradiation may be completed in five days or less. These hypofractionated treatment schedules work as well as the longer one and may reduce the risk of some side effects. Your radiation oncologist can help decide the course that is right for you.

During 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 that 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 situations, once the main radiation therapy sessions have been completed, your doctor may recommend a radiation boost. This commonly means additional fractions of radiation directed at the place of highest concern or four to five additional days of treatment. For example, after whole-breast irradiation is complete, a boost of radiation is commonly given to the area where the cancer was removed.

During 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 this happens. The area may be sore or tender for several days or weeks as the tissue recovers from the surgery and radiation.

Results

After you complete radiation therapy, your radiation oncologist or other medical professionals will schedule follow-up visits to monitor your progress, look for late side effects and check for signs of cancer recurrence. Make a list of questions you want to ask members of your care team.

After your radiation therapy is completed, tell your medical professional if you experience:

  • Persistent pain
  • New lumps, bruises, rashes or swelling
  • Unexplained weight loss
  • A fever or cough that doesn't go away
  • Any other bothersome symptoms

Clinical trials

Explore Mayo Clinic studies of tests and procedures to help prevent, detect, treat or manage conditions.

Radiation therapy for breast cancer care at Mayo Clinic

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  2. Tepper JE, et al. Breast cancer: Stages I-II. In: Gunderson & Tepper's Clinical Radiation Oncology. 5th ed. Elsevier; 2021. https://www.clinicalkey.com. Accessed Oct. 28, 2020.
  3. Taghian A. Radiation therapy techniques for newly diagnosed, non-metastatic breast cancer. https://www.uptodate.com/contents/search. Accessed Dec. 6, 2020.
  4. Radiation therapy and you: Support for people with cancer. National Cancer Institute. https://www.cancer.gov/publications/patient-education/radiation-therapy-and-you. Accessed Dec. 6, 2020.
  5. Taghian A. Adjuvant radiation therapy for women with newly diagnosed, non-metastatic breast cancer. https://www.uptodate.com/contents/search. Accessed Dec. 6, 2020.
  6. Professions in radiation therapy. Radiologyinfo.org. https://www.radiologyinfo.org/en/info.cfm?pg=professions-radiation-therapy#part_2. Accessed Dec. 7, 2020.
  7. Office of Patient Education. Breast cancer guide. Mayo Clinic; 2017.
  8. Mutter RW (expert opinion). Mayo Clinic. Dec. 14, 2020.
  9. Breast SPOREs. National Cancer Institute. https://trp.cancer.gov/spores/breast.htm. Accessed Jan. 21, 2021.
  10. Member institutions. Alliance for Clinical Trials in Oncology. https://www.allianceforclinicaltrialsinoncology.org/main/public/standard.xhtml?path=%2FPublic%2FInstitutions. Accessed Jan. 22, 2021.
  11. Sites. Translational Breast Cancer Research Consortium. http://pub.emmes.com/study/bcrc/sites/clinical_sites2.html. Accessed Jan. 22, 2021.
  12. Member institution lists. NRG Oncology. https://www.nrgoncology.org/About-Us/Membership/Member-Institution-Lists. Accessed Jan. 22, 2021.
  13. 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; doi:10.1245/s10434-016-5321-1.
  14. Mutter RW, et al. Three fraction pencil-beam scanning proton accelerated partial breast irradiation: Early provider and patient reported outcomes of a novel regimen. Radiation Oncology. 2019; doi:10.1186/s13014-019-1417-7.
  15. Murray Brunt A, et al. Hypofractionated breast radiotherapy for 1 week versus 3 weeks (FAST-Forward): 5-year efficacy and late normal tissue effects results from a multicenter, non-inferiority, randomized, phase 3 trial. Lancet. 2020; doi:10.1016/S0140-6736(20)30932-6.
  16. Darby SC, et al. Risk of ischemic heart disease in women after radiotherapy for breast cancer. The New England Journal of Medicine. 2013; doi:10.1056/NEJMoa1209825.
  17. Jethwa KR, et al. Three-fraction intracavitary accelerated partial breast brachytherapy: Early provider and patient-reported outcomes of a novel regimen. International Journal of Radiation Oncology-Biology-Physics. 2019; doi:10.1016/j.ijrobp.2018.12.025.
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Radiation Therapy Side Effects - American Cancer Society

Radiation therapy can cause hair to be thinned or lost in the area being treated. For instance, radiation to your head may cause you to lose some or all the hair on your head (even eyebrows and lashes), but if you get treatment to your hip, you won’t lose the hair on your head. Most people find that their hair grows back after treatment ends, but it can be hard to deal with hair loss. When ...

It's very important to remember that every person reacts differently to treatment. Any side effect you might have depends on the type and location of cancer, the dose of radiation being given, and your general health. Some people have few or no side effects, while others have quite a few.

How long do side effects last?

Remember that the type of radiation side effects you might have depends on the prescribed dose and schedule. Most side effects go away within a few months of ending treatment. Some side effects may continue after treatment ends because it takes time for the healthy cells to recover from radiation.

Side effects might limit your ability to do some things. What you can do will depend on how you feel. Some patients are able to go to work or enjoy leisure activities while they get radiation therapy. Others find they need more rest than usual and can’t do as much. If you have side effects that are bothersome and affecting your daily activities or health, the doctor may stop your treatments for a while, change the schedule, or change the type of treatment you’re getting. Tell your cancer care team about any side affects you notice so they can help you with them.

Early and late effects of radiation therapy

  • Early side effects happen during or shortly after treatment. These side effects tend to be short-term, mild, and treatable. They’re usually gone within a few weeks after treatment ends. The most common early side effects are fatigue (feeling tired) and skin changes. Other early side effects usually are related to the area being treated, such as hair loss and mouth problems when radiation treatment is given to this area.
  • Late side effects can take months or even years to develop. They can occur in any normal tissue in the body that has received radiation. The risk of late side effects depends on the area treated as well as the radiation dose that was used. Careful treatment planning can help avoid serious long-term side effects. It’s always best to talk to your radiation oncologist about the risk of long-term side effects.

Radioprotective drugs for reducing side effects

One way to reduce side effects is by using radioprotective drugs, but these are only used for certain types of radiation given to certain parts of the body. These drugs are given before radiation treatment to protect certain normal tissues in the treatment area. The one most commonly used today is amifostine. This drug may be used in people with head and neck cancer to reduce the mouth problems caused by radiation therapy.

Not all doctors agree on how these drugs should be used in radiation therapy. These drugs have their own side effects, too, so be sure you understand what to look for.

Common general side effects of radiation therapy

Fatigue

Fatigue is feeling tired physically, mentally, and emotionally. It’s very common for people with cancer and often happens with radiation therapy. Most people start to feel tired after a few weeks of radiation therapy. This happens because radiation treatments destroy some healthy cells as well as the cancer cells. Fatigue usually gets worse as treatment goes on. Stress from being sick and daily trips for treatment can make fatigue worse. Managing fatigue is an important part of care.

Fatigue felt during radiation treatment is different from the fatigue of everyday life, and it might not get better with rest. It can last a long time and can get in the way of your usual activities. But it will usually go away over time after treatment ends.  

Only you know if you have fatigue and how bad it is. No lab tests or x-rays can diagnose or describe your level of fatigue. The best measure of fatigue comes from your own report to your cancer care team. You can describe your level of fatigue as none, mild, moderate, or severe. Or you can use a scale of 0 to 10, where a 0 means no fatigue, and a 10 is the worst fatigue you could imagine.

Either way you choose, it’s important to describe your fatigue to your cancer care team. Be sure to talk with them if:

  • Your fatigue doesn’t get better, keeps coming back, or gets worse.
  • You’re more tired than usual during or after an activity.
  • You’re feeling tired, and it’s not related to something you’ve done.
  • You become confused or can’t focus your thoughts.
  • You can’t get out of bed for more than 24 hours.
  • Your fatigue disrupts your social life or daily routine.

If you need to take time off from work, talk to your employer.

Skin problems

Your skin in the radiation treatment area might look red, irritated, swollen, blistered, sunburned, or tanned. After a few weeks, your skin might become dry, flaky, or itchy, or it may peel. This is sometimes called radiation dermatitis. It’s important to let your cancer care team know about any skin changes. They can suggest ways to ease the discomfort, lessen further irritation, and prevent infection.

These problems usually go away gradually after treatment ends. In some cases, though, the treated skin will stay darker and might be more sensitive than it was before.

You need to be gentle with your skin. Here are some ways to do this:

  • Do not wear tight, rough-textured, or stiff clothes over the treatment area. This includes anything tight or elastic that squeezes the area. Instead, wear loose clothing made from soft, smooth fabrics. Do not starch your clothes.
  • Do not rub, scrub, scratch, or use adhesive tape on treated skin. If your skin must be covered or bandaged, use paper tape or other tape for sensitive skin. Try to put the tape outside the treatment area, and don’t put the tape in the same place each time.
  • Do not put heat or cold (such as a heating pad, heat lamp, or ice pack) on the treatment area without talking to your cancer care team first. Even hot water may hurt your skin, so use only lukewarm water for washing the treated area.
  • Protect the treated area from the sun. Your skin may be extra sensitive to sunlight. If possible, cover the treated skin with dark-colored or UV-protective clothing before going outside. Ask your cancer care team if you should use sunscreen. If so, use a broad spectrum sunscreen with a sun protection factor (SPF) of at least 30. Reapply the sunscreen often. Continue to give your skin extra protection from sunlight, even after radiation therapy ends.
  • Use only lukewarm water and mild soap. Just let water run over the treated area. Do not rub. Also be careful not to rub away the ink marks needed for your radiation therapy until it’s done.
  • Check with your cancer care team before shaving the treated area. They might recommend that you use an electric shaver.
  • Ask your cancer care team before using anything on the skin in the treatment area. This includes powders, creams, perfumes, deodorants, body oils, ointments, lotions, hair-removal products, or home remedies while you’re being treated and for several weeks afterward. Many skin products can leave a coating on the skin that can cause irritation, and some may even affect the dose of radiation that enters the body.

Hair loss

Radiation therapy can cause hair to be thinned or lost in the area being treated. For instance, radiation to your head may cause you to lose some or all the hair on your head (even eyebrows and lashes), but if you get treatment to your hip, you won’t lose the hair on your head.

Most people find that their hair grows back after treatment ends, but it can be hard to deal with hair loss. When it does grow back, your hair may be thinner or a different texture than it was before. Ask your cancer care team if you have any questions or concerns about hair loss.

If you do lose your hair, your scalp may be tender and you may want to cover your head. Wear a hat or scarf to protect your head when you’re in the sun. If you prefer to wear a hairpiece or wig, be sure the lining doesn’t irritate your scalp. Your local American Cancer Society office may be able to help you get wigs or hats.

Low blood counts

Rarely, radiation therapy can cause changes in your blood count levels. These blood cells help your body fight infection and prevent bleeding. If your blood tests show low blood counts, your treatment might be stopped for a week or so to allow your blood counts to return to normal. This side effect is more likely if you’re also getting chemotherapy.

Specific side effects of radiation therapy that affect parts of the body

If you’re getting radiation therapy to the brain

People with brain tumors often get stereotactic radiosurgery (radiation given in one large dose) if the cancer is in only one or a few sites in the brain. Side effects depend on where the radiation is aimed. Some side effects might show up quickly, but others might not show up until 1 to 2 years after treatment. Talk with your radiation oncologist about what to watch for and when to call your doctor.

If the cancer is in many areas, sometimes the whole brain is treated with radiation. The side effects of whole brain radiation therapy may not be noticeable until a few weeks after treatment begins.

Radiation to the brain can cause these short-term side effects:

  • Headaches
  • Hair loss
  • Nausea
  • Vomiting
  • Extreme tiredness (fatigue)
  • Hearing loss
  • Skin and scalp changes
  • Trouble with memory and speech
  • Seizures

Some of these side effects can happen because radiation has caused the brain to swell. Medicines are usually given to prevent brain swelling, but it’s important to let your cancer care team know about headaches or any other symptoms. Treatment can affect each person differently, and you may not have these particular side effects.

Radiation to the brain can also have side effects that show up later – usually from 6 months to many years after treatment ends. These delayed effects can include serious problems such as memory loss, stroke-like symptoms, and poor brain function. You may also have an increased risk of having another tumor in the area, although this is not common.

Talk with your cancer care team about what to expect from your specific treatment plan.

If you’re getting radiation therapy to the head or neck

People who get radiation to the head and neck might have side effects such as:

  • Soreness (or even open sores) in the mouth or throat
  • Dry mouth
  • Trouble swallowing
  • Changes in taste
  • Nausea
  • Earaches
  • Tooth decay
  • Swelling in the gums, throat, or neck
  • Hair loss
  • Changes in skin texture
  • Jaw stiffness

How to care for your mouth during treatment

If you get radiation therapy to the head or neck, you need to take good care of your teeth, gums, mouth, and throat. Here are some tips that may help you manage mouth problems:

  • Avoid spicy and rough foods, such as raw vegetables, dry crackers, and nuts.
  • Don’t eat or drink very hot or very cold foods or beverages.
  • Don’t smoke, chew tobacco, or drink alcohol – these can make mouth sores worse.
  • Stay away from sugary snacks.
  • Ask your cancer care team to recommend a good mouthwash. The alcohol in some mouthwashes can dry and irritate mouth tissues.
  • Rinse your mouth with warm salt and soda water every 1 to 2 hours as needed. (Use 1 teaspoon of salt and 1 teaspoon of baking soda in 1 quart of water.)
  • Sip cool drinks often throughout the day.
  • Eat sugar-free candy or chew gum to help keep your mouth moist.
  • Moisten food with gravies and sauces to make it easier to eat.
  • Ask your cancer care team about medicines to help treat mouth sores and control pain while eating.

If these measures are not enough, ask your cancer care team for advice. Mouth dryness may be a problem even after treatment is over. If so, talk to your team about what you can do.

How to care for your teeth during treatment

Radiation treatment to your head and neck can increase your chances of getting cavities. This is especially true if you have dry mouth as a result of treatment.

Before starting radiation, talk to your cancer care team about whether you should get a complete check-up with your dentist. Ask your dentist to talk with your radiation doctor before you start treatment. If you have one or more problem teeth, your dentist may suggest removing them before you start treatment. Radiation (and dry mouth) might damage them to the point where they’ll need to be removed anyway, and this can be harder to do after treatment starts.

If you wear dentures, they may no longer fit well because of swollen gums. If your dentures cause sores, you may need to stop wearing them until your radiation therapy is done to keep sores from getting infected.

Your dentist may want to see you during your radiation therapy to check your teeth, talk to you about caring for your mouth and teeth, and help you deal with any problems. Most likely, you will be told to:

  • Clean your teeth and gums with a very soft brush after meals and at least one other time each day.
  • Use fluoride toothpaste that contains no abrasives.
  • Rinse your mouth well with cool water or a baking soda solution after you brush. (Use 1 teaspoon of baking soda in 1 quart of water.)
  • If you normally floss, ask your dentist or cancer care team if this is OK during treatment. Tell your cancer care team if this causes bleeding or other problems.

If you’re getting radiation therapy to the breast

If you have radiation to the breast, it can affect your heart or lungs as well causing other side effects.

Short-term side effects

Radiation to the breast can cause:

  • Skin irritation, dryness, and color changes
  • Breast soreness
  • Breast swelling from fluid build-up (lymphedema)

To avoid irritating the skin around the breast, women should try to go without wearing a bra whenever they can. If this isn’t possible, wear a soft cotton bra without underwires.

If your shoulders feel stiff, ask your cancer care team about exercises to keep your shoulder moving freely.

Breast soreness, color changes, and fluid build-up (lymphedema) will most likely go away a month or 2 after you finish radiation therapy. If fluid build-up continues to be a problem, ask your cancer care team what steps you can take. See Lymphedema for more information.

Long-term changes to the breast

Radiation therapy may cause long-term changes in the breast. Your skin may be slightly darker, and pores may be larger and more noticeable. The skin may be more or less sensitive and feel thicker and firmer than it was before treatment. Sometimes the size of your breast changes – it may become larger because of fluid build-up or smaller because of scar tissue. These side effects may last long after treatment.

After about a year, you shouldn’t have any new changes. If you do see changes in breast size, shape, appearance, or texture after this time, tell your cancer care team about them right away.

Less common side effects in nearby areas

Although it’s rare, radiation to the breast can affect organs in the chest, including the heart and lungs. This is not as common today as it was in the past, because modern radiation therapy equipment allows doctors to better focus the radiation beams on the area with cancer, with less affect to other areas.

Rib fractures: In rare cases, radiation therapy may weaken the ribs, which could lead to a fracture. Be sure you understand what to look for and tell your cancer care team if you notice any of these side effects.

Heart complications: Radiation to the breast can also affect the heart. It can cause hardening of the arteries (which can make you more likely to have a heart attack later on), heart valve damage, or irregular heartbeats.

Lung damage (radiation pneumonitis): Getting radiation to the breast can sometimes cause an inflammation of the lungs, which is called radiation pneumonitis. See “If you’re getting radiation to the chest” below for more details.

Damage to the nerves in the shoulder and arm: Radiation to the breast can sometimes damage some of the nerves to the arm. This is called brachial plexopathy and can lead to numbness, tingling, pain, and weakness in the shoulder, arm, and hand.

Side effects of brachytherapy

If your treatment includes brachytherapy (internal radiation implants), you might notice breast tenderness, tightness, redness, and bruising. You may also have some of the same side effects that happen with external radiation treatment. Let your cancer care team know about any problems you notice.

If you’re getting radiation therapy to the chest

Radiation treatment to the chest may cause side effects such as:

  • Sore throat
  • Swallowing problems
  • Loss of appetite
  • Cough
  • Shortness of breath

Radiation can also cause other problems in the heart or lungs.

Heart complications

Getting radiation to the middle portion of the chest can raise your risk of heart disease. This risk increases with higher radiation doses and larger treatment areas in this part of your body. Radiation can also cause hardening of the arteries (which can make you more likely to have a heart attack later on), heart valve damage, or irregular heartbeats.

Radiation pneumonitis

Radiation pneumonitis is inflammation of the lungs that can be caused by radiation treatment to the chest (or less often, the breast). It may occur about 3 to 6 months after getting radiation therapy. It’s more likely if you have other lung diseases, like emphysema (which involves gradual damage of lung tissue). Common symptoms of radiation pneumonitis include:

  • Shortness of breath that usually gets worse with exercise
  • Chest pain, which is often worse when taking in a deep breath
  • Cough
  • Pink-tinged sputum
  • Low-grade fever
  • Weakness

Sometimes there are no symptoms, and radiation pneumonitis is found on a chest x-ray.

Symptoms often go away on their own, but if treatment is needed, it is based on trying to decrease the inflammation. Steroids, like prednisone, are usually used. With treatment, most people recover without any lasting effects. But if it persists, it can lead to pulmonary fibrosis (stiffening or scarring of the lungs). When this happens, the lungs can no longer fully inflate and take in air.

Be sure you understand what to look for, and tell your cancer care team if you notice any of these side effects.

If you’re getting radiation therapy to the abdomen (belly)

If you are getting radiation to your stomach or some part of the abdomen (belly), you may have side effects such as:

  • Nausea
  • Vomiting
  • Belly cramps
  • Diarrhea
  • Constipation

Eating or avoiding certain foods can help with some of these problems, so diet planning is an important part of radiation treatment of the stomach or abdomen. Ask your cancer care team about what you can expect, and what medicines you should take to help relieve these problems. Check with your cancer care team about any home remedies or over-the-counter drugs you’re thinking about using.

These problems should get better when treatment is over.

Managing nausea

Some people feel queasy for a few hours right after radiation therapy. If you have this problem, try not eating for a couple of hours before and after your treatment. You may handle the treatment better on an empty stomach. If the problem doesn’t go away, ask your cancer care team about medicines to help prevent and treat nausea. Be sure to take the medicine exactly as you are told to do.

If you notice nausea before your treatment, try eating a bland snack, like toast or crackers, and try to relax as much as possible. See Nausea and Vomiting to get tips to help an upset stomach and learn more about how to manage these side effects.

Managing diarrhea

Many people have diarrhea at some point after starting radiation therapy to the abdomen. Your cancer care team may prescribe medicines or give you special instructions to help with the problem. Diet changes may also be recommended, such as:

  • Try a clear liquid diet (water, weak tea, apple juice, peach nectar, clear broth, popsicles, and plain gelatin) as soon as diarrhea starts or when you feel like it’s going to start.
  • Don’t eat foods that are high in fiber or can cause gas or cramps, such as raw fruits and vegetables, beans, cabbage, whole-grain breads and cereals, sweets, and spicy foods.
  • Eat frequent, small meals.
  • Do not drink milk or eat milk products if they irritate your bowels.
  • When the diarrhea starts to improve, try eating small amounts of low-fiber foods, such as rice, bananas, applesauce, yogurt, mashed potatoes, low-fat cottage cheese, and dry toast.
  • Be sure you take in enough potassium (it can be found in bananas, potatoes, beans, peaches, and many other foods). This is an important mineral you may lose through diarrhea.

If you’re having radiation therapy to the pelvis

Radiation therapy to the pelvis (for example, as treatment for bladder, ovarian, or prostate cancer) can cause side effects such as:

  • Bladder problems
  • Fertility problems
  • Changes in your sex life

You might also have some of the same problems people get from radiation to the abdomen, such as nausea, vomiting, diarrhea, or constipation.

Bladder problems

Radiation to the pelvis can cause problems with urination, including:

  • Pain or burning sensations
  • Trouble passing urine
  • Blood in the urine
  • An urge to urinate often

Most of these problems get better over time, but radiation therapy can cause longer-term side effects as well:

  • Radiation cystitis. If the radiation damages the lining of the bladder, radiation cystitis can be a long-term problem that causes blood in the urine or pain when passing urine.
  • Urinary incontinence. Radiation treatments for certain cancers, such as prostate and bladder cancer, may make you unable to control your urine or have leakage or dribbling. There are different types and degrees of incontinence, but it can be treated. Even if incontinence can’t be corrected completely, it can still be helped. See Bladder and Bowel Incontinence to learn more. This side effect is most often a problem for men being treated for prostate cancer, but some of the information might also be helpful for women dealing with treatment-related incontinence.
  • Fistulas. In rare cases, radiation can cause an opening called a fistula to form between organs in the pelvis, such as between the vagina and the bladder, or between the bladder and the rectum. These can be fixed with surgery.

How fertility might be affected

For women: Talk to your cancer care team about how radiation might affect your fertility (ability to have a baby). It’s best to do this before starting treatment so you are aware of possible risks to your fertility.

Depending on the radiation dose, women getting radiation therapy in the pelvic area sometimes stop having menstrual periods and have other symptoms of menopause. Report these symptoms to your cancer care and ask them how to relieve these side effects.Sometimes menstrual periods will return when radiation therapy is over, but sometimes they do not.

See Fertility and Women With Cancer to learn more.

For men: Radiation therapy to an area that includes the testicles can reduce both the number of sperm and their ability to function. If you want to father a child in the future and are concerned about reduced fertility, talk to your cancer care team before starting treatment. One option may be to bank your sperm ahead of time.

See Fertility and Men With Cancer to learn more.

How sex might be affected

With some types of radiation therapy involving the pelvis and/or sex organs, men and women may notice changes in their ability to enjoy sex or a decrease in their level of desire.

For women: During radiation treatment to the pelvis, some women are told not to have sex. Some women may find sex painful. Treatment can also cause vaginal itching, burning, and dryness. You most likely will be able to have sex within a few weeks after treatment ends, but check with your doctor first. Some types of treatment can have long-term effects, such as scar tissue that could affect the ability of the vagina to stretch during sex. Again, your cancer care team can offer ways to help if this happens to you. You can also get more information in Sex and Women With Cancer.

For men: Radiation may affect the nerves that allow a man to have erections. If erection problems do occur, they are usually gradual, over the course of many months or years. Talk with your doctor about treatment options if this is a concern for you. You can get more information in Sex and Men With Cancer.

If you get internal radiation therapy with seed implants, check with your cancer care team about safety precautions during sex

More information about side effects

For more information about the side effects mentioned here and how to manage them, see Managing Cancer-related Side Effects.

Twice-A-Day Irradiation » Radiation Oncology » College of ...

Twice-A-Day Irradiation. Radiation therapy with external beam equipment is usually given once a day, 5 days a week, over a period of 6 to 8 weeks. Altered fractionation schedules at the University of Florida consist of more than one treatment a day, most often two treatments per day, given over a slightly shorter time period in the range of 6 ...

William M. Mendenhall, MD

By William M. Mendenhall, MD

Radiation therapy with external beam equipment is usually given once a day, 5 days a week, over a period of 6 to 8 weeks.  Altered fractionation schedules at the University of Florida consist of more than one treatment a day, most often two treatments per day, given over a slightly shorter time period in the range of 6 to 6½ weeks.

Another method is once-daily treatment, four days per week, and twice-daily treatment, one day per week, for six weeks. There is evidence that altered fractionation is associated with an improved chance of curing the cancer by decreasing the overall treatment time by a week to a week and a half. Altered fractionation may also reduce the risk of late complications by reducing the dose per treatment.

Twice-a-day irradiation has been employed at the University since 1978 for patients with cancers in a variety of tumor sites.  Data published from our institution, as well as elsewhere, indicate that in certain situations, twice-a-day radiotherapy is advantageous compared with once-daily conventional radiation treatment.

Before any treatment is started, the recommended treatment, the reasons it is recommended, the procedures to be carried out, the expected or possible side effects or complications, and the expected benefits are all explained to the patient and family. The patient must give permission for treatment, based on this knowledge (“informed consent”), before treatment is given.

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Radiation Burn: What to Know

There’s no standard treatment for radiation burns. Your doctor may recommend moisturizing emollient creams or prescribe steroid medications that …

Medically Reviewed by Brunilda Nazario, MD on May 27, 2021

  • Symptoms
  • Treatment
  • Self-Care Tips

A radiation "burn" or rash is a common side effect of radiation therapy for cancer. It’s also called radiation dermatitis. There’s no clear way to stop it from happening. But there’s a lot you can do to take care of your skin if you get one. Here’s what you need to know.

At first, your skin may look:

  • Red
  • Irritated
  • Swollen
  • Sunburned
  • Tanned

After a few weeks, the skin may:

A radiation burn can range from mild to severe. It depends on things like which part of your body was treated, how much radiation you received, and how long. You may be more likely to get a radiation burn if you’re also doing chemotherapy.

The symptoms tend to go away slowly once you finish treatment. In some people, treated skin may stay darker and feel more sensitive.

Tell your doctor right away if you have symptoms of a radiation burn or other skin changes. They’ll tell you how to keep the irritation from getting worse and avoid an infection.

There’s no standard treatment for radiation burns. Your doctor may recommend moisturizing emollient creams or prescribe steroid medications that you put on your skin. Don’t use any OTC skin product without talking to your doctor first. They need to make sure it won’t irritate the skin or affect your radiation treatment.

In general, call the doctor if your treated skin:

  • Gets worse
  • Itches for 2 or more days
  • Bleeds
  • Causes pain or discomfort that keeps you from getting sleep
  • Forms blisters, turns bright red, or becomes crusty
  • Leaks bad-smelling pus or liquid

It’s important to go extra easy on your skin while it heals. Some things you can do are:

Wear loose clothes made of soft, smooth material. Avoid wearing tight or stiff clothes with rough textures over treated skin. Don’t starch your clothes, either.

Don’t scratch, rub, or scrub. If your doctor tells you to cover or bandage the treated skin, use tape that’s made for sensitive skin, like paper tape.

Avoid ice packs or heating pads. Don’t use them unless your doctor says it’s OK. These may aggravate your skin.

Shield your skin from sunlight. It may be more sensitive to the sun’s rays. If you can, cover the treated area with clothes that have a dark color or built-in UV protection. Also ask your doctor or nurse if you should put sunscreen on the treated skin. If they give you the OK, use a broad-spectrum sunscreen that has an SPF of at least 30. Keep protecting your skin from the sun even after you finish treatment.

Use lukewarm water and mild soap when you wash. Hot water may hurt. Let the water run over your treated skin, and don’t rub it. It’s extra important not to rub off the ink marks your health care team uses for your radiation therapy until treatment ends.

Talk to your doctor before you shave. If you got treatment on a hairy part of skin that you want to shave, the doctor may tell you to use an electric shaver. It can be safer and gentler than a razor blade.

Don’t use skin care products on the treated area. They may bother your skin. And some might affect how much radiation your body absorbs. During radiation therapy and for several weeks after, talk to your doctor before you use:

  • Powders
  • Creams
  • Perfumes
  • Deodorants
  • Body oils
  • Ointments
  • Lotions
  • Hair-removal products
  • Home remedies
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Minimizing Risks After Radioactive Iodine Treatment

Stay at least six feet away from other people, including members of the public, family members, and co-workers, for three to 11 days. This means avoiding public transportation, hotels, carpools, and in some cases, your workplace.

If radioactive iodine treatment (RAI) is recommended as part of your treatment for Graves’ disease, hyperthyroidism, or thyroid cancer, you will most likely be given it as an outpatient. Because the radioactive iodine used (known as iodine 131) may expose those around you to the effects of radiation (and theoretically negatively affect their thyroid glands), you will be given guidelines on how to prevent such exposure.

The following recommendations will give you an idea of precautions to take to avoid exposing other people (as well as pets) to iodine 131, which may be present in bodily fluids or occur as a result of close contact. The recommended timeframes are based on the size of the dosage you are receiving, so discuss the specifics with your healthcare provider prior to treatment.

Here are some ways to minimize radiation risks to other people (and pets) after you have had RAI treatment:

  • Stay at least six feet away from other people, including members of the public, family members, and co-workers, for three to 11 days. This means avoiding public transportation, hotels, carpools, and in some cases, your workplace.
  • Sleep apart from adults by at least six feet (a separate bedroom is recommended) and avoid sexual activity.
  • Avoid sleeping in the same bed with a pregnant woman, infant, or child for a period of six to 23 days. According to the Nuclear Regulatory Commission, infants and children should ideally stay outside the home for the recommended period.
  • To protect family pets, do not sleep with them for up to 21 days.

Your healthcare provider will give you specific guidelines regarding how long various restrictions should remain in place in order to protect those around you.

Be particularly careful around infants and children, who are especially at risk for exposure complications.

If you are unable to avoid direct or indirect contact with infants and young children, ask your healthcare provider about the possibility of hospitalization. It is not common in the United States to hospitalize patients after RAI, but if you are receiving a particularly high dosage of iodine 131 and have no way to protect children or babies, it may be an option.

To further avoid exposing others to radiation:

  • Do not share any towels, razors, toothbrushes, cups, spoons, forks, or dishes.
  • Do not cook for anyone else.
  • Use disposable dishes and place them in a specially marked plastic bag for disposal.
  • Wash your clothes separately.

If you will be traveling via airplane or crossing an international border in the period following RAI treatment, you must be provided with a written document from your healthcare provider stating they you have been given a medical treatment involving radiation, as security monitoring devices can detect it.

Most thyroid patients who receive RAI treatment eventually end up hypothyroid and will need to take thyroid hormone replacement drugs indefinitely.

Before you or any family members have RAI treatment, it is strongly recommended that you read up on post-RAI guidelines and speak with your healthcare providers about how they should be applied to you.

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Managing a Small Recurrence in the Previously Irradiated ...

Patients should be treated with a second lumpectomy and partialbreast irradiation only if the patient is refusing mastectomy and informed consent is obtained. Reirradiation should be offered Eligibility criteria for consideration in a reirradiation protocol include localized lesion on imaging studies (including MRI), pathology review to document lumpectomy with negative margins of resection, and …

ABSTRACT: Over the past 30 years, lumpectomy and radiation therapy (breast-conservation therapy, or BCT) has been the preferred treatment for early-stage breast cancer. With accumulating follow-up, we have an ever-expanding pool of patients with history of an irradiated intact breast. Routine use of every-6-month or annual screening in this population has identified an emerging clinical dilemma with respect to managing a small recurrence or a second primary tumor in the treated breast. Most women diagnosed with a second cancer in a previously irradiated breast are advised to undergo mastectomy. More recently, with an improved understanding of the patterns of in-breast failure, and with advances in the delivery of conformal radiation dose there is an opportunity to reevaluate treatment alternatives for managing a small in-breast recurrence. A limited number of publications have reported on patient outcomes after a second lumpectomy and radiation therapy for this clinical scenario. In this report, we review the controversial subject of a second chance at breast conservation for women with a prior history of breast irradiation.

Breast cancer is the most common newly diagnosed malignancy among American women. In 2008, an estimated 182,460 new cases of invasive breast cancer, and an additional 67,770 cases of in situ cancer were diagnosed. Approximately 40,480 women will die from breast cancer each year.

Up to 10%–15% of patients treated with lumpectomy and whole-breast irradiation (breast-conservation therapy, or BCT) will have a subsequent in-breast local recurrence when followed long term. Salvage mastectomy is widely accepted as the standard of care for local recurrence after BCT.[1-4] Few data in the literature have described the clinical outcome from a second conservative surgery with or without additional radiation therapy among women who do not consent to mastectomy.[5-14]

Prognostic Factors of a Second Cancer Following BCT

Several factors may influence patient outcome after local recurrence following BCT.[15-20] The various prognostic factors include tumor size, histologic subtype of recurrent disease (invasive or noninvasive), involvement of the skin and lymph nodes at the time of recurrence, location of the tumor in the breast in relation to the initially treated breast cancer, and the time interval between the first and second in-breast cancer diagnosis. Patients who have experienced a longer time interval between the two cancers have a better outcome. Kurtz et al[14] reported that when mastectomy was used to treat the recurrence, the 5-year local control rate was 92% for recurrences occurring after 5 years and only 49% for time intervals of less than 5 years.

Up to 10%–15% of breast cancer survivors with an intact breast will experience an in-breast local recurrence. In an era of personalized care, options for managing a true local recurrence or a second new primary in a previously irradiated breast need to be considered.
The clinical outcomes of a local recurrence or a second primary in a previously irradiated breast are influenced by a variety of prognostic and biologic characteristics of the second cancer event.
Although mastectomy is the standard of care for cancer in a previously irradiated breast, many women desire repeat breast conservation. Further, evolving radiotherapy techniques can deliver a conformal dose to target structures while limiting toxicity associated with a repeat course of whole-breast irradiation.

Further, some investigators have studied clinical and pathologic criteria to help distinguish between a true recurrence and a new primary. Haffty et al[21] distinguished new primaries as lesions that were far removed from the original scar, were of a different histology than the original primary tumor or had diploid tumors in the face of an aneuploid primary tumor. They observed statistically significant differences in the 5-year survival-89% for new primary tumors and 36% for lesions classified as a true recurrence. A subsequent update on this work with a mean follow-up of over 10 years confirmed the differences in outcome between a new primary tumor and a recurrent lesion.[20]

Another study[22] that used clinical and pathologic criteria to differentiate a new primary from a true recurrence observed similar findings. The mean time to the second cancer event was longer for the new primary compared to true recurrence. Both the 10-year overall and distant disease-free survival was significantly better among patients categorized as having new primaries. Of note, the 77% survival rate reported among patients with tumors classified as a new primary is comparable to what we might expect for similar-stage disease at initial presentation. These observations suggest that the prognosis of all second cancer events is not uniformly associated with poor risk. The ability to recognize biologically favorable second events may have implications for the choice of local therapy when individualizing cancer care.

Mastectomy Following Local Recurrence

Salvage mastectomy is the accepted standard of care. Studies on salvage mastectomy have, on average, reported local failure rates of less than 10% with expected control rates of greater than 90%.[23-25]

Psychological issues related to mastectomy include emotional and physical distress. Ganz et al[26] have demonstrated a clear cause-and-effect relationship between mastectomy and the patient experiencing difficulty with clothing and body self-image. In a study by Rowland et al,[27] the impact of lumpectomy, modified radical mastectomy without reconstruction, and modified radical mastectomy with subsequent reconstructive surgery was evaluated. The findings revealed the highest incidence of negative impact on sex life (45.4%) among women who had undergone modified radical mastectomy with reconstruction, and the lowest (29.8 %) among women undergoing lumpectomy. The impact of patient age was evaluated by Maunsell et al,[28] who observed that women under age 40 experienced a significantly less negative effect from undergoing conservation surgery compared to modified radical mastectomy.

Second Lumpectomy Without Radiation Therapy

TABLE 1


Outcome of Patients Treated With Conservative Surgery Alone After an In-Breast Failure

The outcome of a small number of patients managed with a second lumpectomy alone without radiation therapy has been reported. The local recurrence rates observed with this approach range from 19% to 50% ­(Table 1).[5-8,15,29] Salvadori et al[5] reported a local recurrence rate of 19% in patients treated by reexcision, compared to 4% in those undergoing salvage mastectomy. However, no difference in disease-free survival was seen between the two groups, with a mean follow-up time of 73 months (range = 1–192 months).

From a population of 979 patients, Komoike et al[8] evaluated 41 patients who developed a localized breast recurrence. The mean interval between initial treatment and recurrence was 37 months. Salvage mastectomy was performed in 11 patients, and repeat lumpectomy performed in 30. Of the 30 patients treated with repeat lumpectomy, 9 developed a second local recurrence within 3 years.

Chen et al[29] reported on 747 patients who developed an ipsilateral breast recurrence after breast-conservation surgery from the SEER database between 1998 and 2004. Almost one-quarter (24%) of the women underwent a second lumpectomy without radiation therapy, and this group of patients was found to have a survival rate inferior to that seen in women who had undergone salvage mastectomy. However, it was also noted that women in the lumpectomy group were significantly older than those in the mastectomy group (P = .03). Moreover, survival rates improved when radiation therapy followed the second lumpectomy. However, the authors did not elaborate on these results.

Remarkably, the average 33% risk for relapse after lumpectomy alone is in the same range of what has been reported in randomized trials among women with early-stage breast cancer initially managed with lumpectomy alone (Table 1). These observations signify the potential therapeutic benefit gained by adding radiation therapy. One could hypothesize that most late relapses in previously irradiated breasts may represent a new primary tumor, and similar therapeutic benefit from using targeted radiation therapy techniques for primary tumors may be achieved following second lumpectomy.

Second Lumpectomy With Radiation Therapy

Salvage mastectomy, with or without immediate reconstruction
Second lumpectomy and partial-breast irradiation

The application of radiation therapy as a treatment for recurrence is often cited as an absolute contraindication due to the risk of reirradiating the breast tissue and skin. Nevertheless, since the late 1990s, accumulating evidence has suggested that partial-breast brachytherapy is safe and effective following lumpectomy for selected early-stage breast cancer.[30-33] The option of partial-breast irradiation (PBI) for conservatively treating a localized second cancer in a previously irradiated breast results from techniques that administer a highly conformal radiation dose to the target volume while sparing adjacent critical structures, such as lung, heart, and chest wall, as well as breast tissue remote from the lumpectomy cavity.

The most commonly used PBI techniques include three-dimensional (3D) conformal external-beam radiotherapy, interstitial multicatheter brachytherapy, and intracavitary Mammosite brachytherapy. All three techniques have distinguishable variability in technique and dosimetric considerations. Given these factors, the safety and clinical outcomes of reirradiation are not directly transferable between PBI techniques. Hence, the feasibility of reirradiation using any given technique of PBI has to be individually evaluated. Protocols for the specific technique should define absolute dose prescription to target and dose constraints of adjoining normal structures.

FIGURE 1

Interstitial Low–Dose-Rate Brachytherapy TechniqueFIGURE 2


Survival After Low–Dose-Rate Brachytherapy for Local Recurrence

• Low Dose Rate-The selection of low–dose-rate brachytherapy for retreatment is mostly based on the fact that practitioners have had the longest clinical experience with this technique. Moreover, the low–dose-rate approach may be radiobiologically safer in the retreatment setting, by limiting the risk of late effects while potentially delivering higher radiation doses in the tumor cavity. This technique, however, requires that the physician be experienced in brachytherapy.

The feasibility and safety of brachytherapy to reirradiate a recurrent tumor bed in the breast using a dose of 30 Gy was studied at Beth Israel Medical Center.[9] The target volume was identified as the lumpectomy cavity plus 1- to 2-cm margin, and the prescription isodose was defined as the dose encompassing the target volume. In cases where the skin proximity was of concern, the calculated skin dose was maintained at ≤ 20 Gy.

After administering a dose of 30 Gy, no major toxicity was observed over a follow-up period of 1 year, so the prescribed dose for all subsequent patients on the study was increased to 45 Gy.

The combined experience from Allegheny General Hospital[10] and Beth Israel Medical Center[9] includes 38 patients treated with second lumpectomy and partial-breast reirradiation with interstitial low–dose-rate brachytherapy to a dose of 45–55 Gy (Figure 1). The investigators reported the following median results: Time from initial primary to in-breast recurrence was 11.5 years; age at diagnosis of the in-breast cancer was 61 years; tumor size was 1 cm; and follow-up after salvage brachytherapy was 45.5 months. The 5-year actuarial overall survival rate after salvage brachytherapy was 87.9% (95% confidence interval [CI] = 77.4%–99.8%; Figure 2A). The 5-year mastectomy-free survival rate was 94.4% (95% CI = 95.5–100; Figure 2B).

Most patients had some degree of baseline asymmetry due to the deficit in breast volume from the second lumpectomy. With breast asymmetry as a given, the postbrachytherapy cosmetic result observed in 35 patients has been good to excellent. Three patients have grade 3 (or fair) cosmesis as per the Harvard scoring criteria. On further analysis, the negative contributing factor among all three of these patients was the minimal residual breast tissue at the implant site after the second lumpectomy. This observation illustrates that patient selection criteria should include focused evaluation of the anatomic site. Further, prescription dose constraints should be clearly defined when the dosimetry is less than ideal. In summary, among properly selected patients, we observed good cosmetic results, high levels of local control, and freedom from mastectomy.

TABLE 2


Brachytherapy Alone After Second Lumpectomy for Breast Cancer

Experience using low–dose-rate brachytherapy as a reirradiation modality has been reported in a combined experience from Hannoun-Levi at the Marseille and Nice Cancer Institute including 69 patients (Table 2).[12] In this study, patients treated with second lumpectomy and low–dose-rate interstitial brachytherapy represented only a select 14.6% of all local failures. Patients treated at Nice received 30 Gy, whereas 45 to 50 Gy was delivered to all patients treated at Marseille. The investigators observed an association between brachytherapy dose and toxicity. The incidence of grade 2/3 complications was 0%, 28%, and 32% with brachytherapy doses of 30 Gy, 45 to 46 Gy, and 50 Gy, respectively (P = .01). The 5-year overall survival rate was 91.8%, and the 5-year freedom from second local recurrence and disease-free-survival rates were 77.4% and 68.9%, respectively. On multivariate analysis, factors associated with a higher overall survival included absence of axillary lymph node metastases at initial presentation, time interval between initial and in-breast cancer, and the site of relapse in a quadrant other than that of the initial primary cancer. Also, patients treated with a fewer number of interstitial catheters and who received lower brachytherapy doses were at a higher risk for local failure.

Mastectomy is the accepted standard of care. Patients should be treated with a second lumpectomy and partialbreast irradiation only if the patient is refusing mastectomy and informed consent is obtained.
Reirradiation should be offered
Eligibility criteria for consideration in a reirradiation protocol include localized lesion on imaging studies (including MRI), pathology review to document lumpectomy with negative margins of resection, and node-negative disease.
Prior to considering a repeat course of radiotherapy, clinical evaluation should include determination of the baseline state of previously irradiated skin and subcutaneous tissue, and assessment of whether the residual breast volume is appropriate for reirradiation. Ineligibility criteria should include a short time interval between the initial diagnosis and the in-breast cancer, and anatomic limitations that would preclude delivering the reirradiation dose prescription to tumor bed and normal structures.
Eligible patients may be enrolled in the RTOG phase II trial when it is open to accrual.

The report by Maulard et al[34] included 38 patients with isolated local relapses who underwent salvage treatment with perioperative or split-course low–dose-rate interstitial brachytherapy. With a mean follow up of 40 months (range = 16–64 months), 21% (8 patients) experienced a local relapse after salvage treatment. The overall 5-year survival rate was 55%.

Severe complications requiring a mastectomy occurred in three patients (skin necrosis in one and severe breast pain in two). The lack of stringent selection criteria and inclusion of patients with large tumors that required higher radiation doses resulted in toxicity and inferior cosmetic outcomes.

Resch et al[13] reported that when using pulsed–dose-rate brachytherapy alone, prescribing a dose of 40.2 to 50 Gy limited the toxicity to moderate grade 1/2 fibrosis only.

FIGURE 3


External-Beam Radiotherapy for Local Recurrence

• High Dose Rate-Limited data are available for the use of high–dose-rate brachytherapy for retreatment. A preliminary experience in 10 patients was reported by Trombetta et al[10] using the intracavitary MammoSite balloon technique. With a reirradiation dose of 3.4 Gy × 10 fractions, these investigators’ observations suggest acceptable toxicity and good cosmesis. However, the authors suggest alternative intracavitary techniques might achieve better dosimetry when the tumor bed is in proximity to the skin of the breast or the rib. The authors caution that these preliminary observations warrant additional study, with specific attention to technique and dose fraction schedule.

Protocols using high–dose-rate brachytherapy will need to establish safe dose thresholds for breast, skin, and subcutaneous tissues. The established high–dose-rate brachytherapy dosimetric guidelines used when prescribing PBI as primary treatment for the initial diagnosis of breast cancer may not necessarily be the optimal dose for reirradiation.

External-Beam Radiotherapy

Recht et al[18] reported on a single case of in-breast recurrence treated with wide excision and postoperative external irradiation; the patient was disease free at 72 months postprocedure. Mullen et al[35] published an initial report describing a series of patients retreated with external-beam therapy at a dose of 5,000 cGy (200 cGy/fraction) to the involved quadrant only. All patients had a prior history of receiving 4,500 to 5,040 cGy at 180 to 200 cGy/fraction as part of initial BCT. Deutsch[11] later expanded the series reporting on 39 patients, with in-breast invasive ductal carcinoma in 31 and DCIS in 8 patients. Five patients had positive margins of resection at the time of reirradiation. The 5-year disease-free and overall survival rates were 68.5% and 77.9 %, respectively. The reported cosmetic results were good in 12 patients, fair in 15 patients, and poor in 9 patients (Figures 3A and 3B).

• RTOG Phase II Trial-A proposed Radiation Therapy Oncology Group (RTOG) phase II study will include patients experiencing an in-breast recurrence after lumpectomy and whole-breast irradiation for primary early-stage breast carcinoma (personal communication, D. Arthur, 2009). Patients with biopsy-proven recurrent tumors ≤ 3 cm in greatest dimension, and with mammographic or magnetic resonance imaging (MRI) documenting no evidence of multicentric disease are eligible. Patients with ≤ 1 year between whole-breast radiation therapy and recurrence will be ineligible.

Case Report: A Woman With a Local Breast Recurrence Who Refuses Mastectomy

A 54-year-old female diagnosed in 1988 with stage T1, cN0 infiltrating duct cell cancer at the 12 o’clock axis of the right breast was treated with lumpectomy and axillary dissection followed by external-beam radiation therapy, receiving a total dose of 60 Gy. She also received adjuvant cyclophosphamide, methotrexate, and fluorouracil chemotherapy followed by tamoxifen for a period of 3 years.FIGURE

Cosmetic result at 36 months’ (left) and at 74 months’ (right) follow-up.In February 2003, on self-exam the woman palpated an approximately 1-cm freely mobile mass in the lower outer quadrant of the right breast. Pathology confirmed a 1.5-cm poorly differentiated infiltrating duct cell cancer. The workup included a bilateral MRI that reported no additional lesions.

The patient refused the recommended mastectomy and signed an informed consent to participate in an IRB-approved reirradiation protocol to have a second lumpectomy and partial breast brachytherapy. In April 2003, following lumpectomy and pathologically documented negative margins, a multicatheter interstitial implant was performed. The patient received 45 Gy at 9 Gy per day low–dose-rate brachytherapy using Ir-192 ribbons. With the exception of breast asymmetry secondary to volume loss from the second lumpectomy, the cosmetic result achieved was good and has remained stable. At last follow-up (6/17/09) the patient was alive and well with an intact breast and no evidence of disease (see Figure).

The retreatment will consist of a second lumpectomy followed by a hyperfractionated regimen of 1.5 Gy twice daily for a total dose of 45 Gy delivered in 30 treatments over 15 days using the 3D-conformal PBI technique. The protocol will include only one PBI technique, to gain meaningful and interpretable results without adding the confounding variable of varying dosimetry within the target. The 3D conformal technique was also selected because its reproducibility has been established in the National Surgical Adjuvant Breast and Bowel Project (NSABP) B39/RTOG 0413 phase III trial, and it is the most common PBI technique used by the participating institutions. Concerns about clinical safety and toxicity of reirradiating normal tissues weighed on the choice of the dose fractionation schedule (personal communication, D. Arthur, 2009).

It is anticipated that approximately 69 patients are needed to answer the primary goal of the trial and, with the participation of multiple centers, that enrollment will be completed in a 2-year period. The endpoints of the study will include incidence of acute and late toxicity, cosmetic results, local control rate, and freedom-from-mastectomy rate. In addition, a translational study is incorporated in the protocol as a secondary endpoint to evaluate the rate of circulating tumor cells in this patient population as well as their significance and predictive ability with regard to outcome. With a prospective national study, we will gain additional clinical experience in this controversial treatment approach.

Conclusions

In an era of individualized care, the treatment options for second cancer events in a previously irradiated breast need to be redefined. Due to the accepted bias that a second lumpectomy and reirradiation is associated with unacceptable soft-tissue toxicity and cosmesis, the alternative to mastectomy has never been primarily studied in a large clinical trial. In light of recent advances on many fronts-including improved understanding of the biology of breast disease, imaging modalities, and advances in targeted radiation therapy techniques-there is a renewed interest in studying the alternative of breast conservation for patients presenting with a small recurrence in the previously irradiated breast.

Better selection using biologic markers may be forthcoming. Studies suggest that new primary tumors in a breast previously treated for cancer have a more favorable outcome than true local recurrences. Further research in the area of genetic fingerprinting will provide more accurate means of distinguishing between true recurrence and a new primary by identifying a true clonogenic recurrence from de novo cancer.

With careful selection criteria, there may be opportunities to individualize treatment options and to offer women a second chance at breast conservation. Early data on a second chance at breast conservation, as published in the literature, suggest that mastectomy may not be the only treatment option for women who have a small second cancer in a previously irradiated breast. Finally, as proposed by the RTOG, a prospective multi-institutional trial would be the appropriate means of addressing this controversial clinical issue.

Acknowledgements:The authors would like to thank Dr. Doug Arthur for his contribution on the details about the proposed RTOG trial mentioned in this paper.

Financial Disclosure:The authors have no significant financial interest or other relationship with the manufacturers of any products or providers of any service mentioned in this article.

References:

1. Osborne MP, Simmons RM: Salvage surgery for recurrence after breast conservation. World J Surg 18:93-97, 1994.2. Huston TL, Simmons RM: Locally recurrent breast cancer after conservation therapy. Am J Surg 189:229-235, 2005.3. Stotter AS, Kroll S, McNeese M, et al: Salvage treatment for loco-regional recurrence following breast conservation therapy for early stage breast cancer. Eur J Surg Oncol 17:231-236, 1991.4. Kennedy MJ, Abeloff MD: Management of locally recurrent breast cancer. Cancer 71:2395-2409, 1993.5. Salvadori B, Marubini E, Miceli R, et al: Reoperation for locally recurrent breast cancer in patients previously treated with conservative surgery. Br J Surg 86:84-87, 1999.6. Voogd AC, Tienhoven G, Peterse HL, et al: Local recurrence after breast conservation therapy for early stage breast carcinoma. Cancer 85:437-446, 1999.7. Dalberg K, Mattson A, Kerstin S, et al: Outcome of treatment for ipsilateral breast tumor recurrence in early-stage breast cancer. Br Cancer Res Treat 49:69-78, 1998.8. Komoike Y, Motomura K, Inaji H, et al: Repeat lumpectomy for patients with ipsilateral breast tumor recurrence after breast-conserving surgery. Oncology 64:1-6, 2003.9. Chadha M, Feldman S, Boolbol S, et al: The feasibility of a second lumpectomy and breast brachytherapy for localized cancer in a breast previously treated with lumpectomy and radiation therapy for breast cancer. Brachytherapy 7:22-28, 2008.10. Trombetta M, Julian TB, Miften M, et al: The use of the MammoSite® balloon applicator in re-irradiation of the breast. Brachytherapy 7:316-319, 2008.11. Deutsch M: Repeat high-dose external beam irradiation for in-breast tumor recurrence after previous lumpectomy and whole breast irradiation. Int J Radiat Oncol Biol Phys 53:687-691, 2002.12. Hannoun-Levi J, Houvenaeghel G, Ellis S, et al Partial breast irradiation as second conservative treatment for local breast cancer recurrence Int J Radiat Oncol Biol Phys 60:1385-1392, 2004.13. Resch A, Fellner C, Mock U, et al: Locally recurrent breast cancer: Pulse dose rate brachytherapy for repeat irradiation following lumpectomy-a second chance to preserve the breast. Radiology 225:713-718, 2002.14. Kurtz JM, Jacquemier J, Amalric R, et al: Is breast conservation after local recurrence feasible? Eur J Cancer 27:24-244, 1991.15. Abner AL, Recht A, Eberlein T, et al: Prognosis following salvage mastectomy for recurrence in the breast after conservative surgery and radiation therapy for early-stage breast cancer. J Clin Oncol 11:44-48, 1993.16. Solin LJ, Fourquet A, Vicini F, et al: Salvage treatment for local recurrence after breast conserving surgery and radiation as initial treatment for mammographically detected ductal carcinoma in situ of the breast. Cancer 91:1090-1097, 2001.17. Fortin A, Larochelle M, Laverdiere J, et al: Local failure is responsible for the decrease in survival of patients with breast cancer treated with conservative surgery and postoperative radiotherapy. J Clin Oncol 17:101-109, 1999.18. Recht A, Schnitt SJ, Connolly JL, et al: Prognosis following local or regional recurrence after conservative surgery and radiotherapy for early stage breast carcinoma. Int J Radiat Oncol Biol Phys 16:3-9, 1989.19. Kurtz J, Spitalier J, Amalric R, et al: The prognostic significance of late local recurrence after breast-conserving therapy. Int J Radiat Oncol Biol Phys 18:87-93, 1990.20. Smith TE, Lee D, Turner BC, et al: True recurrence vs. new ipsilateral breast tumor relapse: An analysis of clinical and pathologic differences and their implications in natural history, prognoses, and therapeutic management. Int J Radiat Oncol Biol Phys 48:1281-1289, 2000.21. Haffty BG, Fischer D, Beinfield M, et al: Prognosis following local recurrence in the conservatively treated breast cancer patient. Int J Radiat Oncol Biol Phys 21:293-298, 1991.22. Huang E, Buchholtz TA, Meric F, et al: Classifying local disease recurrences after breast conservation therapy based on location and histology: New primary tumors have more favorable outcomes than true local disease recurrences. Cancer 95:2059-2067, 2002.23. Kurtz JM, Amalric R, Brandone H, et al: Results of salvage surgery for mammary recurrence following breast-conserving therapy. Ann Surg 207:347-351, 1988.24. Ries LAG, Miller BA, Hankey BF, et al (eds): SEER Cancer Statistics Review, 1973-1991. NIH pub no. 94-2789. Bethesda, Md; US Dept of Health and Human Services, National Cancer Institute; 1994.25. Cajucom CC, Tsangaris TN, Nemoto T, et al: Results of salvage mastectomy for local recurrence after breast-conserving surgery without radiation therapy. Cancer 57:1174-1779, 1993.26. Ganz PA, Schag AC, Lee JJ, at al: Breast conservation versus mastectomy. Is there a difference in psychological adjustment or quality of life in the year after surgery? Cancer 69:1729-1738, 1992.27. Rowland JH, Desmond KA, Meyerowtiz BE, et al: Role of breast reconstructive surgery in physical and emotional outcomes among breast cancer survivors. J Natl Cancer Inst 92:1422-1429, 2000.28. Maunsell E, Brisson J, Deschenes L: Psychological distress after initial treatment for breast cancer: A comparison of partial and total mastectomy. J Clin Epidemiol 42:765-771, 1989.29. Chen SL, Martinez SR: The survival impact of the choice of surgical procedure after ipsilateral breast cancer recurrence. Am J Surg 196:495-499, 2008.30. Kuske RR, Bolton JS, Wilenzick RM, et al: Brachtherapy as the sole method of breast irradiation in Tis, T1, T2, N0-1 breast cancer (abstract). Int J Radiat Oncol Biol Phys 30(suppl 1):245, 1994.31. Vicini FA, Chen PY, Fraile M, et al: Low-dose-rate brachytherapy as the sole radiation modality in the management of patients with early-stage breast cancer treated with breast conserving therapy: Preliminary results of a pilot trial. Int J Radiat Oncol Biol Phys 38:301-310, 1997.32. Polgar C, Major T, Fodor J, et al: High-dose rate brachytherapy alone versus whole breast radiotherapy with or without tumor bed boost after breast-conserving surgery: Seven-year results of a comparative study. Int J Radiat Oncol Biol Phys 60:1173-1181, 2004.33. Wallner P, Arthur D, Bartelink H, et al: Workshop on partial breast irradiation: State of the art and the science; Bethesda, Md; Dec 8–10, 2002. J Natl Cancer Inst 96:175-184, 2004.34. Maulard C., Housset M., Brunel P, et al: Use of perioperative or split-course interstitial brachytherapy techniques for salvage irradiation of isolated local recurrences after conservative management of breast cancer. Am J Clin Oncol 18:348-352 1995.

35. Mullen EE, Deutsch M, Bloomer WD, et al: Salvage radiotherapy for local failures of lumpectomy and breast irradiation. Radiother Oncol 42:25-29, 1997.

cancerresearchuk.org

29-10-2014 · Normal cells close to the cancer can also become damaged by radiation, but most recover and go back to working normally. If radiotherapy doesn't kill all of the cancer cells, they will regrow at some point in the future. We have more information about radiotherapy treatment. Immunotherapy or targeted cancer drugs Immunotherapy uses our immune system to fight cancer. Targeted cancer …

29-10-2014

This page tells you about how cancer can sometimes come back after treatment. There is information about

Why cancer might come back

Cancer might come back some time after the first treatment. This idea can be frightening. There are different reasons for why cancer might come back. These reasons are:

  • the original treatment didn't get rid of all the cancer cells and those left behind grew into a new tumour
  • some cancer cells have spread elsewhere in the body and started growing there to form a tumour

After surgery

Cancer can come back after surgery because:

  • some cancer cells were left behind during the operation
  • some cancer cells had already broken away from the primary cancer but were too small to see (micrometastasesOpen a glossary item)

Surgeons do their best to remove all of the cancer during surgery. But it is always possible to leave behind a small group of cancer cells. Your surgeon may recommend more treatment if they feel that there is a risk that the cancer could come back. This is sometimes called adjuvant treatment.

The extra treatment might be chemotherapy, radiotherapy, hormone therapy or a targeted cancer drug.Open a glossary item These treatments aim to try to control or kill any cancer cells left.

You can read about surgery for cancer.  

After cancer drug treatment or radiotherapy

Cancer may sometimes come back after cancer drug treatment or radiotherapy. This can happen because the treatment didn't destroy all the cancer cells. 

Chemotherapy drugs kill cancer cells by attacking cells that are in the process of doubling to form 2 new cells. But not all the cells in a cancer divide at the same time. Normal cells go into a long rest period between divisions. Cancer cells do too, although the rest period may be much shorter. 

Giving chemotherapy in a series of treatments helps to catch as many cells dividing as possible. Cells that were resting when you had your first treatment, may be dividing when you have your next and so will be more likely to die.

But it is unlikely that any chemotherapy treatment kills every single cancer cell in the body. Doctors try to reduce the number of cancer cells as much as possible. The immune system kills off the remaining cells or they may die off. 

You might find it helpful to read more about how chemotherapy works. 

Radiotherapy makes small breaks in the DNA inside the cells. These breaks stop cancer cells from growing and dividing and often make them die. Normal cells close to the cancer can also become damaged by radiation, but most recover and go back to working normally. If radiotherapy doesn't kill all of the cancer cells, they will regrow at some point in the future.

We have more information about radiotherapy treatment. 

Immunotherapy or targeted cancer drugs
Immunotherapy uses our immune systemOpen a glossary item to fight cancer. Targeted cancer drugs work by ‘targeting’ the differences in cancer cells that help them to grow and survive. Some drugs work in more than one way and may be both a targeted and immunotherapy treatment 

Some immunotherapies or targeted cancer drugs may get rid of a cancer completely. Others may shrink the cancer or control it for some months or years. So a cancer may seem to have gone and may not show up on any scans or blood tests. But there may be a small group of cells that remain in the body. They can start to grow again after a while or when the treatment stops.

You can read more about immunotherapy and targeted cancer drugs.

Cancers can become resistant to treatment

Sometimes cancer can become resistant to cancer drug treatment. Cancers develop from normal cells that have changed or mutated to become cancerous. The mutationOpen a glossary item happens in the genes of the cell. These gene changes make the cell behave differently to a normal cell. Cancer cells can continue to mutate so that they become more and more abnormal.

Some mutations can make the cells resistant to cancer drugs such as chemotherapy, targeted cancer drugs or hormone therapy. You can sometimes have a different type of treatment if this happens. But sometimes cancers develop resistance to many drugs at the same time. This is called multi drug resistance. 

Scientists have found a group of genetic mutations that they think can cause drug resistance. These mutations mean that the cancer cell can keep the drugs out. The resistant cells have high levels of a substance called p-glycoprotein. P-glycoprotein is a protein found in cell walls. The protein acts as a pump and removes toxins from cells. Cells with high p-glycoprotein levels are very good at keeping cancer drugs out.

Researchers have been looking at drug resistance for almost as long as they have used cancer drugs. To make cancer drug treatment more effective, we need to find a way of overcoming resistance.

Cure or remission

These days, doctors are able to cure many cancers. But some cancers can come back many years after treatment. So you may find that your doctor is very unwilling to use the word 'cure', even though there is no sign that you have any cancer left. Doctors usually say that your cancer is in remission. This means that there is no sign of cancer in your body. If there are any cancer cells left:

  • there are too few to find
  • there are too few to cause any symptoms
  • they are in an inactive state and are not growing

Doctors can't be sure that the cancer has completely gone after treatment. So they may suggest that you have some type of long term treatment. This might include hormone therapy or a targeted cancer drug. This is called adjuvant treatment. 

Adjuvant treatment can also be a course of chemotherapy or radiotherapy after surgery. The aim of this treatment is to try to prevent cancer from coming back.

Living with uncertainty

It can be very difficult to live with the fact that your cancer may come back. Even if doctors tell you that they are 95% certain your cancer has gone for good, you may find it very upsetting that no one can say for sure that you're cured.

Some people find that they can't stop thinking about it even after the end of their treatment. You might feel a little frightened of planning anything in the future. Or you may feel sad or depressed.

For most people who are in this situation, each day lowers the risk of a recurrence. Most cancers that are going to come back will do so in the first 2 years or so after treatment. After 5 years, you are even less likely to get a recurrence. For some types of cancer, after 10 years your doctor might say that you are cured.

Some types of cancer can come back many years after they were first diagnosed. Some people find it very difficult to cope with this idea, but there are some things you can do to help. 

Getting help and support

You may find it helpful to talk to other people in the same situation if you are finding it hard to cope with the fact that you have had cancer. Or you could talk to a trained counsellor. This can help you to find ways of dealing with the fear and worry. 

You can get in touch with a counsellor by contacting one of the counselling organisations.

You can phone the Cancer Research UK nurses if you would like to talk to someone outside your own friends and family. Talk to the Cancer Research UK nurses on freephone 0808 800 4040, from 9am to 5pm, Monday to Friday. 

You can also look at our section about coping emotionally with cancer.

Or you can share your experiences with other people and find out how they coped by using our online forum, Cancer Chat.

Related information

You may find it helpful to read our information about:

  • how cancers grow
  • how cancer can spread
  • cancer treatments
What to Expect When Having Radiation Therapy

22-03-2013 · During your treatment, your radiation oncologist will check how well it is working. Typically, this will happen at least once a week. If needed, they may adjust your treatment plan. Personal care. Many people experience fatigue, sensitive skin at the site of radiation exposure, and emotional distress during radiation therapy. It is important to rest and take care of yourself during radiation therapy. Consider …

22-03-2013

It is normal to feel worried or overwhelmed when you learn that you will need radiation therapy. However, learning more about this type of cancer treatment may help you feel more prepared and comfortable. The information in this article can help you prepare for your first treatment.

Who is on my radiation therapy team?

A highly trained medical team will work together to provide you with the best possible care. This team may include the following health care professionals:

Radiation oncologist. This type of doctor specializes in giving radiation therapy to treat cancer. A radiation oncologist oversees radiation therapy treatments. They work closely with other team members to develop the treatment plan.

Radiation oncology nurse. This nurse specializes in caring for people receiving radiation therapy. A radiation oncology nurse plays many roles, including:

  • Answering questions about treatments

  • Monitoring your health during treatment

  • Helping you manage side effects of treatment

Medical radiation physicist. This professional helps design treatment plans. They are experts at using radiation equipment.

Dosimetrist. The dosimetrist helps your radiation oncologist calculate the right dose of radiation.

Radiation therapist or radiation therapy technologist. This professional operates the treatment machines and gives people their scheduled treatments.

Other health care professionals. Additional team members may help care for physical, emotional, and social needs during radiation therapy. These professionals include:

  • Social workers

  • Nutritionists or dietitians

  • Rehabilitation therapists, such as physical therapists or speech therapists

  • Dentists

Learn more about the oncology team.

What happens before radiation therapy treatment?

Each treatment plan is created to meet a patient's individual needs, but there are some general steps. You can expect these steps before beginning treatment:

Meeting with your radiation oncologist. The doctor will review your medical records, perform a physical exam, and recommend tests. You will also learn about the potential risks and benefits of radiation therapy. This is a great time to ask any questions or share concerns you may have.

Giving permission for radiation therapy. If you choose to receive radiation therapy, your health care team will ask you to sign an "informed consent" form. Signing the document means:

  • Your team gave you information about your treatment options.

  • You choose to have radiation therapy.

  • You give permission for the health care professionals to deliver the treatment.

  • You understand the treatment is not guaranteed to give the intended results.

Simulating and planning treatment. Your first radiation therapy session is a simulation. This means it is a practice run without giving radiation therapy. Your team will use imaging scans to identify the tumor location. These may include:

  • A computed tomography (CT) scan

  • Magnetic resonance imaging (MRI)

  • An x-ray

Depending on the area being treated, you may receive a small mark on your skin. This will help your team aim the radiation beam at the tumor.

You may also be fitted for an immobilization device. This could include using:

  • Tape

  • Foam sponges

  • Headrests

  • Molds

  • Plaster casts

These items help you stay in the same position throughout treatment.

For radiation therapy to the head or neck, you may receive a thermoplastic mask. This is a mesh mask that is molded to your face and secured to the table. It gently holds your head in place.

It is important for your body to be in the same position for each treatment. Your radiation oncology team cares about your comfort. Talk with the team to find a comfortable position that you can be in every time you come in for radiation therapy. Tell them if you experience anxiety lying still in an immobilization device. Your doctor can prescribe medication to help you relax.

After the simulation at your first session, your radiation therapy team will review your information and design a treatment plan. Computer software helps the team develop the plan.

What happens during radiation therapy treatment?

What happens during your radiation therapy treatment depends on the kind of radiation therapy you receive.

External-beam radiation therapy

External-beam radiation therapy delivers radiation from a machine outside the body. It is the most common radiation therapy treatment for cancer.

Each session is quick, lasting about 15 minutes. Radiation does not hurt, sting, or burn when it enters the body. You will hear clicking or buzzing throughout the treatment and there may be a smell from the machine. Typically, people have treatment sessions 5 times per week, Monday through Friday. This schedule usually continues for 3 to 9 weeks, depending on your personal treatment plan.

This type of radiation therapy targets only the tumor. But it will affect some healthy tissue surrounding the tumor. While most people feel no pain when each treatment is being delivered, effects of treatment slowly build up over time and may include discomfort, skin changes, or other side effects, depending on where in the body treatment is being delivered. The 2-day break in treatment each week allows your body some time to repair this damage. Some of the effects may not go away until the treatment period is completed. Let the health care professionals if you are experiencing side effects. Read more about the side effects of radiation therapy.

Internal radiation therapy

Internal radiation therapy is also called brachytherapy. This includes both temporary and permanent placement of radioactive sources at the site of the tumor.

Typically, you will have repeated treatments across a number of days and weeks. These treatments may require a brief hospital stay. You may need anesthesia to block the awareness of pain while the radioactive sources are placed in the body. Most people feel little to no discomfort during this treatment. But some may experience weakness or nausea from the anesthesia.

You will need to take precautions to protect others from radiation exposure. Your radiation therapy team will provide these instructions. The need for such precautions ends when:

  • The permanent implant loses it radioactivity

  • The temporary implant is removed

Weekly reports

During your treatment, your radiation oncologist will check how well it is working. Typically, this will happen at least once a week. If needed, they may adjust your treatment plan.

Personal care

Many people experience fatigue, sensitive skin at the site of radiation exposure, and emotional distress during radiation therapy. It is important to rest and take care of yourself during radiation therapy. Consider these ways to care of yourself:

Learn more about coping during treatment. And, be sure to talk with your health care team about how you are feeling throughout your treatment period.

What happens after radiation therapy treatment ends?

Once treatment ends, you will have follow-up appointments with the radiation oncologist. It's important to continue your follow-up care, which includes:

  • Checking on your recovery

  • Watching for treatment side effects, which may not happen right away

As your body heals, you will need fewer follow-up visits. Ask your doctor for a written record of your treatment. This is a helpful resource as you manage your long-term health care.

Questions to ask the health care team

  • Who is creating my radiation therapy treatment plan? How often will the plan be reviewed?

  • Which health care professionals will I see at every treatment session?

  • Can you describe what my first session, or simulation, will be like?

  • Will I need any tests or scans before treatment begins?

  • Will my skin be marked as part of treatment planning?

  • Who can I talk with if I'm feeling anxious or upset about having this treatment?

  • How long will each treatment session take? How often will I have radiation therapy?

  • Can I bring someone with me to each session?

  • Are there special services for patients receiving radiation therapy, such as certain parking spaces or parking rates?

  • Who should I talk with about any side effects I experience?

  • Which lotions do you recommend for skin-related side effects? When should I apply it?

  • How else can I take care of myself during the treatment period?

  • Will special precautions be needed to protect my family and others from radiation exposure during my treatment period?

  • What will my follow-up care schedule be?

Related Resources

Understanding Radiation Therapy

Side Effects of Radiation Therapy

ASCO Cancer Treatment and Survivorship Care Plans

More Information

RTAnswers.org: What to Expect