Q&A Topic: Radiation Oncology For Breast Cancer
Alfred Tinger, MD, FACRO
Q. What is radiation therapy?
A. Radiation therapy is the use of electromagnetic radiation energy in many forms to treat malignancies that can arise in or affect any organ or tissue of the human body. Radiation therapy may be delivered from a linear accelerator that produces very high energy X-rays and electrons. This type of radiation therapy is called teletherapy since the treatment is delivered at a distance from the patient, i.e. the machine or the radiation source never contacts the patient. This is distinguished from another type of therapy called brachytherapy where the radiation source is in contact or placed within a body cavity to treat cancers that are accessible in this way. Examples of brachytherapy treatment used at Northern Westchester Hospital include cancers of the uterus, cervix, vagina, prostate, and liver. Contact or superficial radiation therapy identifies the special case of brachytherapy when the radiation source comes into contact with the patient's skin, such as for skin cancer.
Q. Who should receive radiation therapy and why?
A. Radiation therapy is estimated to be appropriate for about 60% of cancer patients based on prospective randomized clinical trials performed over the past 50 years. The indications for radiation therapy vary by tumor type, tumor stage, tumor grade, patient age, patient co-morbidities, and treatment goals and are continually updated by new information and new trials. It is impossible to answer who should receive radiation therapy without a complete evaluation of the patient, his or her cancer, and their co-existing conditions, as well as their personal goals and understanding. Additionally, radiation therapy is almost always used in conjunction with surgery and/or chemotherapy so even though radiation therapy may play a key role in a patient's treatment, it is not usually the only modality used to attack a cancer.
However, evidence shows that less than 50% of cancer patients receive the radiation therapy that is recommended by nationally published guidelines. Unfortunately, there are age, race, economic, transportation, patient bias, and physician bias factors preventing patients from receiving the full known benefit of modern radiation therapy. Work needs to be done in this regard, but the most effective way is for patients to be their own advocate and ask for a radiation oncology consultation when they are diagnosed with a cancer.
Q. I understand there are different types of radiation therapy. Can you explain the difference between hypofractionated radiation therapy and standard radiation therapy and the risks and benefits associated with each?
A. Hypofractionated radiation therapy refers to the use of fewer treatments (fractions) to deliver the course of radiation therapy. The conventional course of radiation therapy has been 5 to 8.5 weeks of daily radiation treatments delivered Monday through Friday. In countries like Canada, where there are fewer radiation machines per capita, the use of fewer fractions (treatments) allows more patients to be treated within the allotted time available on their machines. The Canadians proved that a 3-week course of radiation therapy was as safe and as effective as a 6.5-week course for women with early-stage breast cancers. The side effects are essentially the same with skin redness, fatigue, lung irritation, and scar tissue being equal in both groups. The costs are lower per patient, so the hypofractionated regimen is being used more frequently in the United States.
Q. If I have to have radiation therapy, what can I expect after completing it?
A. After completing radiation therapy, patients can expect that their acute (immediate) side effects will resolve. Any skin reactions, fatigue, diarrhea, issues with swallowing and chewing, or urinary frequency will get better. They will need to follow with their radiation oncologist and with their other physicians, such as their surgeon, their medical oncologist, and their primary care physician. Additional blood and radiologic tests, in addition to physical examinations, to check on the tumor status and their overall health, may be performed periodically based on each tumor type. At Northern Westchester Hospital, patients also have access to a comprehensive wellness program and a Survivorship Program.
Northern Westchester Hospital
Chief of Radiation Oncology
Cancer Treatment & Wellness Center
Learn More About Dr. Tinger
More from Dr. Tinger: Cancer Survivorship
Northern Westchester Hospital is a proud member of Northwell Health (formerly North Shore-LIJ Health System).