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How you prepare

By Mayo Clinic staff

Living With Cancer

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Before you begin radiation therapy, you'll meet with your radiation therapy team, a group of health care professionals who work together to plan and provide your radiation treatment. Team members usually include:

• A radiation oncologist, a doctor who specializes in cancer treatments using radiation. He or she determines the appropriate therapy for you, follows your progress and adjusts your treatment if necessary.
• A radiation physicist and dosimetrist, who make special calculations and measurements regarding your radiation dosage and its delivery.
• A radiation oncology nurse, who specializes in caring for people undergoing radiation therapy. Your nurse can answer questions about the treatments and side effects, and help you manage your health during treatment.
• A radiation therapist, who operates the radiation equipment and administers your treatments.

During a meeting with your radiation oncologist, you'll review your medical history and undergo a physical exam to check your overall health before you begin radiation therapy. Your oncologist can also review the potential benefits and side effects of radiation therapy in your case.

External radiation therapy
Before your first treatment session, you'll go through a simulation process in which a radiation oncologist carefully maps your breast area to pinpoint the precise location of your treatment. During the simulation:

• A radiation therapist helps you into a position best suited to pinpoint the affected area and avoid damage to surrounding normal tissue. Sometimes pads or other devices are used to help you hold the position.
• Using a CT scanner, the radiation oncologist locates the area that needs to be treated. You'll hear noise from the CT equipment as it moves around you. Try to relax and remain as still as possible, because this will help ensure consistent, accurate treatments.
• Ink marks or tiny permanent tattoo dots are placed on your skin to provide reference points for the radiation therapist when administering the radiation. Be sure not to wash ink marks off until you're told to do so. If the marks can't be seen, you may need to go through the mapping process again.
• The dosimetrist, radiation physicist and radiation oncologist use computer software to plan the dosage of radiation you'll receive and how long the beam must be applied to deliver the right amount.

Once the simulation and planning are complete, you can begin treatment. For each session, you'll want to avoid wearing jewelry, latex bandages, powder, lotion or deodorant in or near your treatment area. Also, avoid use of deodorant soap before a session. These substances can interfere with delivery of the radiation.

Internal radiation therapy
Before internal brachytherapy is started, a holder for the radioactive implants is placed in the area from where the tumor was taken (tumor bed). This may be done during your cancer surgery or later as a separate procedure. If the radiation holder is implanted during a separate procedure, it often requires a brief hospital stay where you'll be placed under local, regional or general anesthesia before the procedure begins. Your radiation oncologist may use imaging scans to accurately target the area. Once the holder is implanted, you can likely go home.

There are two approaches to internal radiation therapy for breast cancer:

• Intracavitary brachytherapy. A small, deflated balloon attached to a thin tube (catheter) is inserted in the tumor bed, with the end of the tube sticking out of the breast. The balloon is filled with saline solution and left in place throughout the course of treatment, to provide a place of insertion for the radioactive implants.
• Intersitital brachytherapy. Several small catheters are inserted in the breast around the tumor bed to serve as holders for small radioactive pellets that can be inserted and removed. These catheters are generally left in place throughout treatment.

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