About breast cancer radiotherapy

Radiotherapy is cancer treatment using radiation to destroy cancer cells. It used often to treat breast cancer after surgery, including breast conserving surgery or mastectomy. A review of research trials into surgery and radiotherapy showed that radiotherapy treatment lowers the risk of the cancer coming back either in the remaining breast tissue or in lymph nodes. It also helps some women live longer. You can read a brief summary of this review of radiotherapy for early breast cancer on the Early Breast Cancer Trialists' Collaborative Group (EBCTCG) website. It is written for researchers and specialists so is not in plain English.

Overall, for women with early breast cancer the cure rate is the same whether they have lumpectomy followed by radiotherapy or have a mastectomy. Usually radiotherapy is given to the whole of the remaining breast tissue after lumpectomy (known as whole breast radiotherapy). But some trials are looking at giving radiotherapy just to the area where the breast cancer was removed using intensity modulated radiotherapy (IMRT). Other trials are looking at giving different doses of radiotherapy to particular areas of the breast. There is information about these trials on our breast cancer treatment research page.

You have to travel to hospital for radiotherapy treatment. You have your treatment in the radiotherapy outpatient department. Radiotherapy is split into a course of small treatments. If you were to have the total dose in one go, it would harm normal body tissues too much. So the dose is split into smaller doses that you have each day (or on alternate days) over a number of weeks. Each dose is known as a fraction.

You may have treatment once a day for 3 weeks, from Monday to Friday, with a rest at the weekend. This means you will need to go to the hospital every weekday for that time. Or you may have treatment on alternate weekdays for 5 weeks. The length of your course of treatment will vary, depending on your needs and the hospital where you are treated. The total dose of radiotherapy you get is usually about the same with each of these schedules. The FAST trial is looking at giving a slightly lower overall radiotherapy dose – it has now closed and we are waiting for the results.

Radiotherapy is specialist treatment and your doctor will plan it very carefully and individually for you. At your first visit you may lie under a large machine called a CT simulator (as in the picture below) or have CT scans. The doctor uses the CT simulator or CT scans to plan exactly where to give the treatment.

During planning you will have one or more pinprick tattoos made on your skin. The radiographers use these to line up the radiotherapy machine accurately every time you have treatment. You may also have marks drawn on your body with a felt tip pen. Try not to wash them off. They will fade, though. So tell your radiographer if they do and they will draw them in again.

Each treatment session only takes a few minutes. The radiographers will help position you on the couch and make sure you are comfortable.

You will be left alone for the minute or two that the machine is switched on. But the staff will be able to hear you through an intercom or video link, so you can call if you need them. The treatment doesn't hurt. You will not be able to feel it at all. You must lie very still for the few minutes it takes to treat you.

Having external radiotherapy does not make you radioactive. It is perfectly safe to be with other people, including children, throughout your treatment course.

The National Institute for Health and Clinical Excellence (NICE) have issued guidance that internal radiotherapy (also called a radiotherapy implant or breast brachytherapy) can be used to give radiation treatment after surgery, if it is used as part of a clinical trial. Brachytherapy is a way of giving radiation directly to the area where the cancer was removed.

You have a general or a local anaesthetic. Thin hollow tubes or an inflatable balloon are put into your breast. Later, radioactive wires are passed through the middle of the tubes or a small radioactive metal source is put into the balloon.

The radioactive wires may be left in place for a few days, or just inserted for a few minutes. If you are having high dose treatment, you have the treatment for a few minutes over several days. Balloon brachytherapy is always given in short daily sessions. If the wires are left in place for a few days, then you stay in hospital, in a single room. Your friends and family will only be allowed to visit for a short time each day. This is so they won't be exposed to radiation. Children and pregnant women will not be allowed to visit you at all.

The radioactivity is in the wires. So the radioactivity goes when the doctor takes the wires out. Then it is completely safe for you to be with other people including children.

There is more information about treatment with radioactive wires in the main radiotherapy section and in our breast cancer research section.

There is detailed information about radiotherapy in our main radiotherapy section. You can find information about

• What radiotherapy involves
• How your radiotherapy treatment is planned
• Possible side effects