The Breast Cancer Patient

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					                                                                        The Breast
                                                                        Cancer Patient
                                                                        A Radiotherapy Perspective
                                                                        Carol Hurd
                                                                        Radiotherapy Manager
                                                                        The majority of the patients attending the Clinic for a course
                                                                        of radiotherapy have breast cancer. In preparation for a
                                                                        course of radiotherapy, all breast patients have a CT scan of
                                                                        their chest area. The data from the scan is then fed
                                                                        electronically into the treatment planning system where
                                                                        the radiographers and physicists look at the patient in
                                                                        3D and, from the information displayed, produce an
                                                                        individual treatment plan which is then approved by the
                                                                        clinical oncologist.

                                   This process takes about a week      correct position and checking         breakdown (similar to blisters).
                                   from the time of the CT scan. The    measurements. All patients            Radiographers and the breast care
                                   patient will then undergo what       receive verbal and written            nurse can advise on this and also
                                   we call a ‘dummy run’. Here, the     information about what to             apply dressings, if appropriate.
                                   treatment plan is downloaded         expect and the team of
                                   electronically directly to the       radiographers spend a great deal      The Role of the
                                   treatment machine from the           of time offering information and      Physicist
                                   planning system, removing the        advice. Patients are also seen by
                                   risk of any error due to the         our dedicated breast care nurse       Tony Bedford, Head Physicist and
                                   manual transfer of information.      and will routinely see their          MPE (medical physics expert)
                                   The patient is then aligned on the   consultant either on a weekly or      oversaw the commissioning of the
                                   treatment machine, and the           fortnightly basis.                    Radiotherapy machines and is
                                   position and measurements are                                              responsible for establishing the
                                                                        During the course of their
                                   checked against the treatment                                              quality       assurance         and
                                                                        treatment, patients are advised to
                                   plan. Electronic images are                                                maintenance programmes for the
                                                                        wear loose comfortable clothing
                                   also taken to verify the plan                                              equipment. He also commissioned
                                                                        and are given advise on skin care.
                                   is optimum.                                                                the treatment planning system
                                                                        Most patients continue with their
                                   The patient will then start their    normal routine, for example,          and     advises      doctors    and
                                   treatment the next day. The          continuing to work, but tiredness     radiographers on solutions to
                                   majority of patients attend          is common, and therefore patients     complex planning issues. He,
                                   treatment sessions for between       are advised to take it easy and       along      with      Carol     Hurd,
                                   five and six weeks. Each             accept offers of help or reduce       Radiotherapy manager is also a
                                   treatment (known as a fraction)      their hours. Whilst attending for     RPS      (radiation       protection
                                   takes between 10-15 minutes,         treatment patient’s skin may          supervisor) ensuring that safe
                                   with most of that time spent         become pink and itchy and some        practice and systems of works are
                                   placing the patient in the           patients     experience      some     carried out at all times.

                                    Cancer of the                       Radical radiotherapy for patients     precisely defined by special
                                                                        with prostate cancer can last up to   shielding structures (MLCs or
                                    Prostate                            7 weeks. In addition, the actual      multi-leaf collimators) within
                                    Another common tumour               planning of the patient in the        the radiotherapy machine head.
                                    treated at the Clinic is prostate   planning system is complex and        As a result of the time it takes to
                                    cancer. As with the breast          requires the clinician to actually    produce a treatment plan, there
                                    patients, all prostate patients     sit at the planning PC and draw       may be up to two weeks
                                    will have a CT scan and dummy                                             between the initial CT scan and
                                                                        around the prostate and
                                    run as part of preparation for                                            the dummy run.
                                                                        surrounding critical structures in
                                    their treatment. However,
                                                                        3D (bladder and rectum). Using        Prostate patients are also given
                                    because we “phase” the
                                                                        this, the planning system can         relevant      information     by
                                    treatment - that is shrink (in
                                    size), the tumour volume that       calculate DVH’s (dose volume          radiographers, including dietary
                                    we are treating in each phase,      histograms - showing maximum          advice, important in these cases,
                                    the patient will undergo either     and minimum radiation doses           as a small amount of bowel will
                                    one or two further CT scans to      within these areas). Furthermore,     be included in the treatment
       020 8971 8000
                                    confirm the position of the         a complex plan is produced            area causing some temporary    prostate within the pelvis.         whereby the targeted area is          side effects.

     10                                                                                                               intouch Summer 2004

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Description: The Breast Cancer Patient