Breast cancer is a common form of cancer that, thanks to early detection and constantly developing treatment options, is now a curable cancer for the majority of patients. Today, 80-85% of patients can have breast-conserving surgery. This is a big step in terms of body image integrity, female identification and quality of life. Postoperative radiotherapy is indicated in order to reach high local control rates after breast-conserving therapy. Radiation reduces the risk of local recurrences occurring in the previously operated area and in the entire breast by around 70%. In some selected patients, the irradiation can be carried out as so-called partial breast irradiation, in some, especially older patients with a low risk of recurrence, the irradiation can be dispensed with altogether.
The preliminary stages of breast cancer (DCIS= ductal carcinoma in situ) are also treated mostly with breast-conserving therapy. Here, postoperative radiotherapy is usually recommended.
Fractionation and dosing in the past
Radiation therapy was dosed conventionally for many decades. Single doses of 1.8 to 2 Gy up to a total dose of 50 Gy were applied on each irradiation day. Patients under the age of 65 received a local dose increase, a so-called boost for 5-8 fractions. Thus, the total treatment time was 5-6 weeks.
New standard of care
The reduction of the total treatment time has been established for several years. The so-called moderate hypofractionation (shortening of the total treatment time by increasing the individual dose and reducing the total dose) enables oncologically safe treatment without adverse effects on the cosmetic result. It is currently established as a new therapy standard and leads to a reduction in the total treatment time to around 3 weeks. Even shorter therapy regimens of only 5 days (Fast Forward Trial) need to be validated.
Many patients rightly ask about the risk-benefit analysis against the background of older radiation therapy techniques, lead to a considerable dose deposit into the lungs and heart. With the modern techniques we use, radiation therapy is carried out on each of our breast cancer patients using the so-called breath-hold technique. Breathe in deeply during the irradiation and try to hold your breath for a while. The device recognizes the optimal deep inspiration for the irradiation and emits the dose in this respiratory phase. The radiation turns off if you continue to breathe. In this way, the thorax and chest are stretched away from the lungs and heart, so that optimal protection can be implemented.
It is important for you that your personal risk also depends on other factors, such as nicotine consumption, age, any existing lung diseases, heart diseases, potentially heart-damaging drugs.
If you are a non-smoker without any risk factors mentioned and we implement optimal protection of the organs for you, you have no significantly increased risk of developing lung or heart toxicity or the development of lung cancer compared to a non-irradiated patient. Therefore, please quit smoking before treatment, if possible.
You can find more detailed information in the current German and American guideline.
Which documents would you ideally bring with you to our joint discussion?
- the doctor’s letter from the institution/clinic treating you
- the surgery report
- the histological findings (histology)
- before and after chemotherapy
- with estrogen and progesterone receptor determination,
- HER-2-new determination,
- Information on the resection margin (R status)
- the decision and recommendation from tumor board
- the mammography finding, if available, MRI finding, the CT finding of the lungs (thorax) and abdomen (abdomen), the
- Whole body skeletal scintigraphy
- the address of your gynecologist and general practitioner
- your medication list
- Your chemotherapy plan (if receiving chemotherapy)
- If you have had radiation therapy before, please bring the radiation plans with you. The faster and more accurately we can
- we will advise you at your first appointment whether further radiation therapy, to what extent, fractionation and dosage
- makes sense and is justifiable.
- If you have a pacemaker, please bring your pacemaker passport with you.
What can you do to support the success of the therapy as much as possible?
- Please bring a large towel with you to every radiation session.
- Ensure a regular life with sufficient breaks for relaxation and recreation.
- Do sport and strengthen your immune system and prevent fatigue symptoms.
- During radiation therapy, avoid hot full baths, sauna, solarium, direct sunlight in the area of the irradiated region.
- Eat a varied and high-protein diet. Avoid alcohol and nicotine and discontinue all vitamin supplements (Vit C, Vit E, Vit A) during radiation therapy.
- Shower with water and skin-friendly syndets, soaps or shower gels.
- Do not apply any alcoholic substances (perfume, perfumed lotions, or alcohol-based deodorants) to the skin.
- If necessary, use a skin-friendly product for the body. We would be happy to advise you on this.
- Avoid using powder or alcohol and oil in the irradiation area.