ENAfter breast surgery a woman is told that radiotherapy comes next, and it almost always sounds worse than it turns out to be. She pictures burns and exhaustion, but radiotherapy for breast cancer in Germany usually means short daily sessions, after which she goes home.
This page covers why radiotherapy is needed, what the preparation involves, what German departments do to protect the heart and lungs and what life is like during the course. For the disease itself, see breast cancer treatment in Germany.
Why radiotherapy follows surgery
Surgery removes the tumour, and radiotherapy lowers the chance that the disease comes back in the same place. After breast-conserving surgery, irradiating the breast is a standard part of treatment, not an extra: the current German guideline calls for it.
After removal of the whole breast, a mastectomy, radiotherapy is not for everyone. It is discussed for certain tumour sizes, for involved lymph nodes and for a close surgical margin. The decision is made by a tumour board, not by one doctor.
Separate decisions concern the lymph node regions — above and below the collarbone, along the breastbone, in the armpit — and a “boost”, an extra dose to the bed of the removed tumour. The usual schedule under the current German guideline is about 40 gray (the unit of radiation dose) in 15–16 sessions over roughly three weeks. The method is explained in the article on how radiotherapy works; an overview in German comes from the Krebsinformationsdienst of the German Cancer Research Center.
How the course is planned
Preparation starts with a planning CT scan in exactly the position the woman will lie in at every session. The field is marked on the skin with a waterproof pen or a few tiny tattooed dots, and arm supports are made to fit. Precise repetition matters because the plan works to the millimetre: a shift would move part of the dose into healthy tissue.
The medical physicist and the doctor then distribute the dose across the breast while steering it away from the heart, the lung and the opposite breast. The plan is calculated individually, and this is the stage at which it is decided how gentle the course will be.
Sessions are usually daily on weekdays. The beam itself takes minutes; most of the time goes on positioning and checks, and the patient lives outside the hospital meanwhile. The radiation oncologists featured on the site include the director of the radiotherapy clinic at Augsburg University Hospital, Prof. Georg Stüben.
What German departments do to protect the heart and lungs
With a left-sided tumour the heart lies close to the treatment field, and this is handled technically: treatment is given in deep inspiration breath hold. On a deep breath in, the heart moves away from the chest wall and the beam, and breathing is monitored during the session. All the patient has to do is follow the instructions.
Other measures include lying face down on a dedicated couch for larger breasts, conformal and intensity-modulated (IMRT) techniques that shape the dose to the target, and daily image checks of the positioning. The technique is chosen by anatomy, not by the prestige of the method.
Partial breast irradiation, limited to the area where the tumour was, is an option for some lower-risk patients but does not suit everyone: the German guideline sets several conditions, such as age 50 or over, a small hormone-sensitive tumour and cancer-free lymph nodes. All these options are decided by the radiation oncologist together with the tumour board.
Side effects and life during the course
By the middle of the course the treated skin often turns red and dry, tiredness sets in and the breast sometimes swells a little; severe reactions are uncommon. Skin care follows the department’s instructions, with loose clothing and no irritating products.
Chemotherapy, if needed, is usually finished before radiotherapy, while endocrine (hormone) therapy is often continued during it. The sequence is set by the tumour board, and the order of the stages is not rearranged on request. Drug treatment is covered on the page on chemotherapy for breast cancer.
Afterwards come follow-up visits, checks of the skin and the breast, recovery and, if the arm swells, lymphatic drainage. When to return to work is best agreed with the doctor. Some women get through the course with almost no restrictions, but this cannot be promised.
Frequently asked questions
How long does radiotherapy for breast cancer take?
Usually about three weeks: under the current German guideline the breast is treated in 15–16 sessions on weekdays. A one-week schedule of five sessions is possible in selected cases, once the doctor has explained that long-term data are lacking and late effects may be more likely. A boost or lymph node treatment can change the schedule; the hospital states the exact length in writing.
Does a session hurt?
No. The radiation itself cannot be felt and lasts minutes. Discomfort comes from the position: the arms rest on supports, and you have to keep still while the machine runs. Later the treated skin may feel sore, but that is a tissue reaction over the weeks, not pain during the session.
Can I come to Germany for radiotherapy only?
Yes. If the operation was done at home, the radiotherapy department reviews the discharge summary, pathology report and images and decides whether radiotherapy is indicated. Do not delay: the German guideline advises starting within 8 weeks of surgery when no chemotherapy is given. After chemotherapy, radiotherapy usually begins 2 to 4 weeks after it ends.
How AlenMed arranges radiotherapy in Germany
The discharge summary, pathology report and images go to the radiotherapy department of a partner hospital, which replies in writing whether radiotherapy is indicated, how many weeks the course will take and what to bring. The company works with 86 partner hospitals in 38 German cities and 345 doctors, and its own office is in Munich; it arranges interpreters at appointments, accommodation for the course, a written cost estimate from the hospital and help with the visa. The hospital states the cost there; the breakdown is on the page on the cost of breast cancer treatment.
Settle in advance who your treating radiation oncologist will be, how many weeks you need to stay, what happens if a session is missed and which documents you take home. To compare departments, see breast cancer hospitals in Germany.
This material is for information only and is not an offer. The treatment plan is decided by a doctor at an in-person consultation.
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