Having radiotherapy

The unit of a dose is called the Gray (Gy for short). Each individual treatment dose given is known as a fraction. For example, a total of 40 Gy can be given in 15 fractions over 15 working days (three weeks). For each area of the body treated there is a maximum dose that may be given. This means that if breast cancer returns in the same breast, treating the area with radiotherapy again may not be possible if the maximum dose has been reached.

Guidelines for England and Wales recommend that radiotherapy for primary breast cancer is given daily (Monday to Friday) for three weeks The guidance may not yet be in place across all radiotherapy centres so don’t worry if your radiotherapy is given in a slightly different way. You will still be getting effective treatment.

Where possible, your appointments will usually be arranged for a similar time each day so you can settle into a routine.

When you go for treatment you’re asked to undress to the waist and you may be given a gown to wear. You will be asked to lie down on the treatment couch with your arm(s) above your head during the procedure.

The radiographer will help to position you carefully to make sure that you’re in the same position each time you have treatment. When you’re in the correct position you’ll be asked to stay very still. Treatment to the breast or chest wall is usually directed from a number of different angles. The radiographers responsible for your treatment will reposition the machine for each angle.

You won't feel any sensation while the treatment is being given, although you may feel a little uncomfortable staying in the same position. Treatment takes only a few minutes. Although you'll be left alone in the room, the radiographers will watch through a window or on a television screen. Most departments also have an intercom system so that the radiographers can hear you and speak to you.

Ways of receiving radiotherapy

External beam radiotherapy

External beam radiotherapy is the most common way to treat primary breast cancer. X-rays come from a machine called a linear accelerator, with the beam directed at the area to be treated.

The x-rays used do not make your body radioactive so you are safe to mix with other people, including children, at any time during your treatment.

Other ways of delivering radiotherapy

Advances in radiotherapy treatment for breast cancer are being made through clinical trials, which look at different ways of giving treatment while reducing side effects.

Brachytherapy

Brachytherapy is not commonly used to treat breast cancer and is usually only given as part of a clinical trial. It involves placing a radioactive source inside the body in the area to be treated, either for a few days or for a short time each day.

Depending on the type of brachytherapy and because of the radiation, you may need to have treatment as an inpatient and stay in a single room for a short time.

Intraoperative radiotherapy

Trials are also looking at a method of internal radiotherapy known as intraoperative radiotherapy. Instead of using high energy x-rays directed from outside the body, this type of treatment uses low energy x-rays given from a machine in the operating theatre during breast-conserving surgery.

Radiotherapy is given directly to the internal area where the cancer was once it has been removed. A single dose of radiation is given in one treatment. This may be the only dose of radiotherapy needed. It can be followed by further external beam radiotherapy treatments over a shorter period of time.

Intensity modulated radiotherapy (IMRT)

IMRT uses more radiotherapy beams for each treatment than conventional radiotherapy. It allows the dose to be delivered more precisely to the area to be treated. This may reduce the effects of the radiotherapy on the surrounding healthy tissue.

Tomotherapy

This is a new type of IMRT not yet available in most hospitals. It uses a machine that combines external beam radiotherapy with a CT (computerised tomography) scanner. The machine accurately delivers x-rays from all angles to a precise location, minimising the radiation dose to healthy tissue.

Clinical trials are also currently assessing whether radiotherapy can be given over a shorter period of time. This is sometimes referred to as hypofractionated radiotherapy.

 

Content last reviewed March 2012; next planned review 2013