Radiotherapy uses X-rays to destroy cancer cells in some parts of the body. Radiotherapy is a localised treatment, which means it only treats the area of the body it’s aimed at.

Radiotherapy may be used to treat different parts of the body that are affected by metastatic breast cancer.

If metastatic breast cancer has spread to the bones, radiotherapy may be used:

• to relieve bone pain
• to prevent or treat fractures
• to prevent and treat cancer in or around the spine that may be putting pressure on the spinal cord.

If metastatic breast cancer has spread to the brain, radiotherapy may be used:

• after surgery to treat cancer in one area of the brain
• instead of surgery to relieve symptoms of cancer in the brain.

If metastatic breast cancer has spread to other parts of the body, radiotherapy may be used:

• to relieve pain or swelling or to reduce the size of enlarged lymph nodes.

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Radiotherapy for early breast cancer

• Radiotherapy to the breast is recommended after breast conserving surgery to remove any cancer cells that may be left in the breast and to reduce the risk of breast cancer coming back in the breast.
• Radiotherapy to the chest wall is sometimes recommended after mastectomy for women at high risk of breast cancer coming back in the chest wall.
• Radiotherapy to the lymph nodes in the armpit and/or lower neck is occasionally recommended after either type of breast surgery, for women who do not have surgery to the armpit, or for those at high risk of breast cancer coming back in the lymph nodes.

Timing of radiotherapy for early breast cancer

The timing of radiotherapy will depend on when services are available, how long it takes to recover from surgery and what other treatments are being given. If a woman is having chemotherapy, radiotherapy will usually start when chemotherapy ends. If a woman is not having chemotherapy, radiotherapy will usually start after surgery.

Questions to ask about radiotherapy

Listed below are some questions that may be helpful when talking about radiotherapy.

• Is radiotherapy recommended for me?
• Where will I need to go for radiotherapy?
• If I have to travel a long way for radiotherapy, can I get financial support for travel and accommodation costs?
• How long will radiotherapy last?
• What side effects can I expect and when? How can I manage them?
• Who should I contact if side effects develop?
• Can I still work while I’m having radiotherapy?
• Can I still drive while I’m having radiotherapy?
• When will I have radiotherapy if I’m having other treatments for breast cancer?
• Will radiotherapy affect whether I can have a breast reconstruction?
• Will radiotherapy affect whether I can breastfeed?
• How much will radiotherapy cost?

Side effects

Receiving radiotherapy is painless. However, women may experience some side effects during or after treatment.

Some side effects might develop months after treatment is over. Most side effects can be managed with medical care.

Common side effects during or after radiotherapy:

• the skin of the treated breast can become red and dry like sunburn; this can begin as early as the second week of treatment and usually improves a few weeks after treatment is over
• the skin can become darker – it may stay that way for a few months after treatment but usually fades with time
• women often feel more tired than usual during treatment and for a few weeks after treatment is over.

Side effects that might be experienced during or after radiotherapy:

• tenderness, aches or ‘twinges’ in the breast or chest – this may continue for up to a year or be longer lasting but usually settle with time
• the breast may become smaller or larger and may become firmer during or after treatment
• the skin of the breast may blister or peel towards the end of treatment – this usually settles a few weeks after treatment ends
• blood vessels may become visible in the treated area, making the skin look red or purple – this is a rare side effect of radiotherapy that can occur many months or years later
• some women who have radiotherapy to the armpit develop persistent swelling in the arm, hand or chest; this is called lymphoedema and can develop a few months or years after treatment
• radiotherapy to the armpit may cause hair loss in  the treated area
• radiotherapy to the lower neck may cause a temporary sore throat (medical advice should be sought).

The following side effects of radiotherapy are very rare but can be quite serious and medical advice should be sought as soon as possible:

• a combination of dry cough, mild fever, shortness of breath and tiredness – these may be symptoms of a condition called pneumonitis in which the lung becomes inflamed; treatment is available and pneumonitis usually lasts for less than a month
• pain in the ribs – this may be due to rib fracture because the bones have become weakened by treatment.

Skin care during radiotherapy

A number of things can make skin reactions due to radiotherapy worse. These include:

• having chemotherapy at the same time as radiotherapy
• being overweight
• other health problems, such as diabetes
• having sun-damaged skin
• smoking

Skin reactions caused by radiotherapy can be reduced by washing with a mild soap or cleanser and using a light moisturising cream. Radiotherapy staff can recommend which products to use. Women with Metastatic breast cancer who are having radiotherapy to the head should use gentle hair care products.

Other suggestions, based on the experience of women having radiotherapy for breast cancer, and on doctors’ and nurses’ observations include:

• wear sun protective clothes or use sunscreen over the treated area when in the sun
• avoid irritants – protect the skin in the treated area from damage by abrasion (for example, shaving with a wet razor), chemicals (for example, perfumes, deodorants, hair dyes) and temperature extremes during radiotherapy
• keep skin folds dry.

As long as the skin is not broken, it should be OK to exercise, including swimming in either the sea or chlorinated pools, without making the skin reaction worse.

When any symptoms have settled down it’s OK to go back to a normal skin care routine. However, it’s suggested that women always protect the treated area from exposure to the sun.

Travelling for radiotherapy

Not all hospitals can provide radiotherapy.

Radiotherapy is usually available in hospitals or specialised clinics in capital cities or major regional towns.

Women who have to travel long distances for treatment may be able to get help with travel and accommodation costs.

What does radiotherapy for early breast cancer involve?

Once radiotherapy for early breast cancer starts, it’s usually given once a day, 5 days a week for 3–6 weeks. An appointment time is given for each visit. Before radiotherapy starts, the woman will meet with a radiation oncologist: to plan treatment and talk about what is involved. There will usually be a planning visit with a radiation therapist to plan how radiotherapy will be given. A CT scan is taken of the chest and marks are put on the skin to show the radiation therapist where to direct the radiotherapy. The planning visit usually takes about 45 minutes.

Radiotherapy is given in a treatment room using a radiotherapy machine. The radiation therapist will leave the room while the machine is on but can still see the patient and can speak to the patient through an intercom.

Each treatment usually takes only a few minutes. However, the woman will need time to change and may need to wait for the machine to become available so could be at the hospital for up to an hour each day.

Metastatic breast cancer

Radiotherapy uses X-rays to destroy cancer cells in some parts of the body. Radiotherapy is a localised treatment, which means it only treats the area of the body it’s aimed at. Radiotherapy may be used to treat different parts of the body that are affected by metastatic breast cancer.

If metastatic breast cancer has spread to the bones, radiotherapy may be used:

• to relieve bone pain
• to prevent or treat fractures
• to prevent and treat cancer in or around the spine that may be putting pressure on the spinal cord.

If metastatic breast cancer has spread to the brain, radiotherapy may be used:

• after surgery to treat cancer in one area of the brain
• instead of surgery to relieve symptoms of cancer in the brain.

If metastatic breast cancer has spread to other parts of the body, radiotherapy may be used:

• to relieve pain or swelling or to reduce the size of enlarged lymph nodes.

What does radiotherapy for metastatic breast cancer involve?

Before radiotherapy starts, the woman will meet with a radiation oncologist to plan treatment and talk about what is involved.

There will usually be a planning visit with a radiation therapist to plan how radiotherapy will be given.The number of radiotherapy treatments will depend on:

• where the cancer is and how big it is
• the woman’s symptoms
• the woman’s general health
• whether the woman has had radiotherapy before in the same area.

Radiotherapy is given in a treatment room using a radiotherapy machine. The radiation therapist will leave the room while the machine is on but can still see the patient and can speak to the patient through an intercom.

How long does radiotherapy take?

Each treatment usually takes only a few minutes. However, the woman will need time to change and may need to wait for the machine to become available so could be at the hospital for up to an hour each day.

Questions to ask

Listed below are some questions that may be helpful when talking about radiotherapy.

• Is radiotherapy recommended for me?
• Where will I need to go for radiotherapy?
• If I have to travel a long way for radiotherapy, can I get financial support for travel and accommodation costs?
• How long will radiotherapy last?
• What side effects can I expect and when? How can I manage them?
• Who should I contact if side effects develop?
• Can I still work while I’m having radiotherapy?
• Can I still drive while I’m having radiotherapy?
• When will I have radiotherapy if I’m having other treatments for breast cancer?
• Will radiotherapy affect whether I can have a breast reconstruction?
• Will radiotherapy affect whether I can breastfeed?
• How much will radiotherapy cost?

Skin care

A number of things can make skin reactions due to radiotherapy worse. These include:

• having chemotherapy at the same time as radiotherapy
• being overweight
• other health problems, such as diabetes
• having sun-damaged skin
• smoking

Skin reactions caused by radiotherapy can be reduced by washing with a mild soap or cleanser and using a light moisturising cream. Radiotherapy staff can recommend which products to use. Women with Metastatic breast cancer who are having radiotherapy to the head should use gentle hair care products.

Other suggestions, based on the experience of women having radiotherapy for breast cancer, and on doctors’ and nurses’ observations include:

• wear sun protective clothes or use sunscreen over the treated area when in the sun
• avoid irritants – protect the skin in the treated area from damage by abrasion (for example, shaving with a wet razor), chemicals (for example, perfumes, deodorants, hair dyes) and temperature extremes during radiotherapy
• keep skin folds dry.

As long as the skin is not broken, it should be OK to exercise, including swimming in either the sea or chlorinated pools, without making the skin reaction worse.

When any symptoms have settled down it’s OK to go back to a normal skin care routine. However, it’s suggested that women always protect the treated area from exposure to the sun.

Travelling

Not all hospitals can provide radiotherapy.

Radiotherapy is usually available in hospitals or specialised clinics in capital cities or major regional towns.

Women who have to travel long distances for treatment may be able to get help with travel and accommodation costs.

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