Breast cancer Q&A - Dr. Mark Bryer, M.D., Radiation Therapist
Lake of the Ozarks, Mo. —
As part of a continuing Q&A series on the process of detecting, treating and surviving breast cancer, we hear from Dr. Mark Bryer, M.D., one of five radiation therapists on staff at Lake Regional Cancer Center.
When we talk about treating breast cancer, what sorts of radiation treatment options are out there for patients to consider?
There is a lot of variation. When people say "breast cancer" they don't realize there are stages involved, patient choices are involved. There is a whole aspect of medical oncology, whether you give chemo before or after surgery and then when radiation—which is typically done after surgery and after chemotherapy in the most common situations.
The amount we give is kind of dictated by each situation. It's pretty much the same but whether a patient needs radiation depends on her stage. Some patients with advanced stage tumor who get a mastectomy still need to have radiation therapy to the chest wall regional lymph nodes. Other patients with early stage tumor may have a choice between lumpectomy usually followed by radiation therapy or a mastectomy. There have been several trials now that have shown that those—in properly selected patients they have produced equivalent results, but then the patient participates in those decisions about what treatment she wants.
Can you give us a basic concept of how radiation therapy progresses?
The most standard course would be a course of daily treatments Monday through Friday. The treatment is given usually by a machine called a linear accelerator. The treatments only last about four or five minutes and usually a person is in and out in about 20 minutes a day. People can drive themselves to and from their treatments, they are not radioactive in between, but it does cause local side effects including skin redness, soreness, sometimes some darkening of the skin, changes to the texture of the breast, people do tell us they fell more tired than normal.
We treated patients—daycare workers, kindergarten teachers—that have worked throughout their course of therapy so they haven't missed a day.
Normally that would go on for six weeks. Sometimes after a mastectomy they might get five weeks worth of treatment, and then some specialized forms of radiation for very select patients. The most common thing would be called accelerated partial breast radiation, so instead of that six-week course of daily treatments, there are ways of just treating around where the lumpectomy was done. That can last as short as a week.
What's typical post-surgery care?
It depends on the stage of the tumor, the age of the patient. Again, patients have to have an input into that. It also depends on tumor characteristics. They check things called estrogen receptors, progesterone receptors, something called HER-2/neu which is a protein. And if those things are positive that allows a medical oncologist to use hormonal agents or drugs called perception, and that might influence whether they can go that route or whether they need chemo.
Typically, if they're going to get chemotherapy it's done before radiation therapy treatments, so it's kind of a team approach. There is the surgeon, the medical oncologist, the radiation oncologist, plus the pathologists, the people at radiology—they're all involved in the care of the patient.
What else should we know about radiation therapy?
People are always worried about radiation. While it can cause some local side effects, the majority of patients actually tolerate the treatment well. Where we treat with radiation really determines the side effects. When we're treating the breast, which tends to be away from the body, most of those patients tolerate the treatments well.
We have more sophisticated planning techniques now that allow us to miss the heart for left side tumors—not an increased risk of heart disease as there were with some older techniques. And also based on some work done at M.D. Anderson and other places we can even out the dose on all the different planes, so we actually see less skin reaction than we did five or six years ago. There have been some advances. I'm not saying it's easy, but people can get through it.
When we talk about treating breast cancer, what sorts of radiation treatment options are out there for patients to consider?
There is a lot of variation. When people say "breast cancer" they don't realize there are stages involved, patient choices are involved. There is a whole aspect of medical oncology, whether you give chemo before or after surgery and then when radiation—which is typically done after surgery and after chemotherapy in the most common situations.
The amount we give is kind of dictated by each situation. It's pretty much the same but whether a patient needs radiation depends on her stage. Some patients with advanced stage tumor who get a mastectomy still need to have radiation therapy to the chest wall regional lymph nodes. Other patients with early stage tumor may have a choice between lumpectomy usually followed by radiation therapy or a mastectomy. There have been several trials now that have shown that those—in properly selected patients they have produced equivalent results, but then the patient participates in those decisions about what treatment she wants.
Can you give us a basic concept of how radiation therapy progresses?
The most standard course would be a course of daily treatments Monday through Friday. The treatment is given usually by a machine called a linear accelerator. The treatments only last about four or five minutes and usually a person is in and out in about 20 minutes a day. People can drive themselves to and from their treatments, they are not radioactive in between, but it does cause local side effects including skin redness, soreness, sometimes some darkening of the skin, changes to the texture of the breast, people do tell us they fell more tired than normal.
We treated patients—daycare workers, kindergarten teachers—that have worked throughout their course of therapy so they haven't missed a day.
Normally that would go on for six weeks. Sometimes after a mastectomy they might get five weeks worth of treatment, and then some specialized forms of radiation for very select patients. The most common thing would be called accelerated partial breast radiation, so instead of that six-week course of daily treatments, there are ways of just treating around where the lumpectomy was done. That can last as short as a week.
What's typical post-surgery care?
It depends on the stage of the tumor, the age of the patient. Again, patients have to have an input into that. It also depends on tumor characteristics. They check things called estrogen receptors, progesterone receptors, something called HER-2/neu which is a protein. And if those things are positive that allows a medical oncologist to use hormonal agents or drugs called perception, and that might influence whether they can go that route or whether they need chemo.
Typically, if they're going to get chemotherapy it's done before radiation therapy treatments, so it's kind of a team approach. There is the surgeon, the medical oncologist, the radiation oncologist, plus the pathologists, the people at radiology—they're all involved in the care of the patient.
What else should we know about radiation therapy?
People are always worried about radiation. While it can cause some local side effects, the majority of patients actually tolerate the treatment well. Where we treat with radiation really determines the side effects. When we're treating the breast, which tends to be away from the body, most of those patients tolerate the treatments well.
We have more sophisticated planning techniques now that allow us to miss the heart for left side tumors—not an increased risk of heart disease as there were with some older techniques. And also based on some work done at M.D. Anderson and other places we can even out the dose on all the different planes, so we actually see less skin reaction than we did five or six years ago. There have been some advances. I'm not saying it's easy, but people can get through it.
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