Radiotherapy for breast cancer: Modern techniques explained

Radiotherapy is a common treatment after breast cancer surgery. It uses carefully targeted radiation to destroy any remaining cancer cells, and lower the risk of the cancer returning. This video explains how it works and what to expect. Radiotherapy is usually given four to six weeks after surgery; once you have recovered from your operation. Treatment can vary between 5 and 15 treatments on consecutive week days; and it is delivered as an outpatient - so you will not need to stay in hospital. Radiotherapy uses high-energy X-rays, carefully directed at the area where your cancer was found. The treatment is planned in detail to treat the breast tissue, and possibly the lymph node areas. This will depend on your particular circumstances; while also sparing as much healthy tissue as possible. A planning CT scan, performed about a week before treatment starts, helps design your specific plan. Modern techniques mean the treatment can be very precise and tailored to your situation. Invisible tattoos are used as temporary reference marks on the skin - ensuring your position is reproducible for each treatment, and that we can deliver the planned treatment precisely. On each treatment day, you will lie on a couch while the machine moves around you. The session is painless and lasts only a few minutes; and the radiographers can see and speak with you throughout. The overall treatment dose, and number of treatments, will be decided by your oncologist for your particular case. For breast cancer it will be either 5 or 15 treatments. Each radiotherapy session is called a fraction; and the radiotherapy is given daily on week days for either one or three weeks. Modern radiotherapy often uses a technique called "intensity-modulated radiotherapy"; or IMRT. This shapes the dose precisely around the treatment area - helping to spare nearby healthy tissue such as the heart and lungs from unnecessary radiation. IMRT is now used routinely in UK breast cancer care. If your cancer is on the left side of your chest, you may benefit from a breathing technique called "deep inspiration breath hold", or DIBH; to minimise the radiation dose to the heart during treatment. You will be coached to take a deep breath and hold it for 20 to 30 seconds during each treatment session. This allows you to inflate your lungs, effectively moving your heart out of the radiation field. It reduces the dose of radiation delivered to the heart, and can substantially lower the long-term risk of heart disease related to radiotherapy. For some patients with low-risk cancers; "partial breast irradiation" may be an option. This focuses radiation on the area around where the cancer was, often over a shorter course of five days. Long-term complications are less likely with a smaller volume of irradiated tissue. Side effects of radiotherapy are usually limited to the treated area: Common ones include tiredness, and skin changes such as redness; dryness; or itching. For pigmented skin types - the treated area may become darker rather than appearing red. Fatigue often builds gradually, and may peak in the weeks after treatment has ended. To look after your skin: have cool showers, wear loose clothing, and pat the area dry rather than rubbing. Avoid shaving and deodorants under the armpit for the duration of treatment, and for two to three weeks afterwards. Avoid your usual moisturisers and toiletries, and check with your team before using anything other than the prescribed ointment. Also please avoid swimming and prolonged sun exposure. Some effects of radiotherapy can appear months or years after treatment has ended. The breast may feel slightly firmer or smaller; and small red marks called telangiectasia may develop on the skin over time. Your team will monitor you at regular follow-up appointments, and answer any questions. To talk through what radiotherapy might mean for you; please get in touch with me, or my team, any time.