1. THE ROLE OF RADIATION THERAPY IN BREAST CANCER

2. Objectives Your cancer therapy “Journey” Why Radiation? Step by Step
Side Effects
Follow Up

3. The Patient’s Journey
After a positive diagnosis of cancer is made, the patient is referred to the Cancer Centre
The patient receives a letter in the mail for a New Patient Appointment:
Extensive history and physical done by nurse and doctor

4. The Patient’s Journey
The patient is then referred to the Multidisciplinary Breast Clinic.
Team Approach -each case is discussed in rounds prior to each discipline meeting with the patient
The best course of treatment for each patient is decided

5. Multidisciplinary Breast Clinic: A Team Approach
Includes:
Radiation Oncology
Medical Oncology
Surgery
Pathology
Supportive Care
Social Worker
Dietician
Genetics
Nurse

6. Radiation Therapy Many Reasons Breast Conserving Surgery
Reduces the need for Mastectomy
May be used in very large tumours
Making surgery easier
Reduces the risk of recurrence
In Patients with Mastectomy

7. Why Radiation Therapy?
Uses high energy x-rays to destroy microscopic disease that may be left behind after surgery and/or chemo
REDUCES THE RISK OF LOCAL RECURRENCE

8. Radiation Therapy after Mastectomy
Depends on several factors:
Number of lymph nodes involved
Tumour size and characteristics
Margin status after surgery

9. A Patient’s Journey Through the Radiation Therapy Department

10. Radiation Therapy Department

11. 1. Simulation Appointment
Patient education by RT
CT Scan done
treatment position
Reference marks (Tattoos)
Time 1 hour

12. CT SIMULATION

13. 2. Target Definition Done on computer
Critical structures outlined on CT images by radiation therapist
- spinal cord, lung, heart
Radiation Oncologist places radiation beams to cover the treatment area

14. Critical Structures and Target Definition

15. 3. Treatment Planning Info sent electronically
planning department
Custom radiation treatment plan
Complex
Takes up to 2 weeks

16. Treatment Plan

17. Treatment Plan

18. Treatment Plan

19. 4. Dry Run on Treatment Unit
Patient set-up using reference tattoos put on at time of simulation
Measurements verified
X-ray pictures (check films) taken of all treatment fields

20. Linear Accelerator

21. World Leader

22. X-Ray Pictures taken on Treatment Machine
Careful QA process

23. 5. Treatment Begins Standard: up to 25 treatments Takes ~ 15 min total
Daily, Monday-Friday
Takes ~ 15 min total
set-up 5-10 minutes
radiation on ~ 3 minutes

24. Treatment Patients are alone in room Patients closely monitored
During treatment
Reduce life time exposure to Staff
Patients closely monitored
Video camera
Intercom

25. Treatment
Do not see or feel anything
NOT radioactive

26. Acute Side Effects Begin after 2-3 weeks Skin Reaction Swelling Pain
Not everyone reacts the same
All side effects are in the treated area
Continue after treatment is complete.
Skin Reaction
Swelling
Pain
Fatigue

27. SKIN REACTION
Often worse in areas of friction
Under breast
In axilla

28. SKIN REACTION
Erythema
Dry Desquamation
Moist Desquamation

29. 6 weeks following left breast

30. 6 weeks following right breast

31. SKIN REACTION ADVICE Gentle washing with mild soap Unscented creams
Dove, Baby soap
Unscented creams
Lubriderm, Glaxal Base
Hydrocortisone cream
Allow air to get at the area
Loose, comfortable clothing
Avoid sun exposure
Deodorant – OK unless skin irritated
Use electric razor if shaving underarm

32. SWELLING Breast may Irritation / pain in area of scar Advice:
swell slightly
become tender
Irritation / pain in area of scar
Advice:
Tylenol, Advil or Tylenol #3
NO heating pads / ice packs

33. FATIGUE Usually mild Light exercise and fresh air Frequent rests
Worse in patients w/ chemo
Light exercise and fresh air
Frequent rests
Well balanced diet
Stress management techniques
Fatigue booklet & video available

34. Assessment Daily – Radiation Therapist Weekly Urgent Appointments
Radiation Oncologist
Nurse
Urgent Appointments
if necessary

35. Late Toxicities Hypo / hyper-pigmentation skin Telangiectasia
Lymphedema
Radiation Pneumonitis (<2% risk)
Costochondritis
Heart toxicity –left side

36. FOLLOW UP Appointments with Oncologist: Every 3 months for years 1-2
Annually

37. FOLLOW UP Annual bilateral mammogram Physical Exam
Other follow up tests
-Blood work
-X-Ray
-CT scan
-Ultrasound

38. QUESTIONS?