Last updated date: 31-Mar-2023
Originally Written in English
The number of people living with cancer is estimated to be about 2.5 million, with over 8,00,000 cases reported and 5,00,000 deaths each year. In Indian women, carcinoma of the breast and cervix are the most prevalent cancers, but in men, the most common cancers are those of the aerodigestive tract, such as the lung, stomach, esophagus, neck, and head. Approximately two-thirds of cancer patients, or 500,000 individuals per year, require radiation therapy (RT). RT is a locoregional therapeutic method, similar to surgery. The basic goal of RT is to achieve maximum tumor control while causing the least amount of damage to healthy tissue. Over the previous 20 years, important technology advancements have greatly aided in improving treatment accuracy, resulting in improved outcomes.
What is Radiotherapy?
The use of carefully targeted x-rays to eradicate cancerous cells while minimizing the impact of radiation on healthy cells is known as radiotherapy. The length of treatment depends on a variety of factors, including cancer's origin, type, and stage, as well as if radiation therapy is combined with other therapies like chemotherapy or surgery. Radiation therapy can be used to treat cancer in a variety of locations throughout the body.
Radiotherapy Treatment Decision
Your case is reviewed in a healthcare staff meeting before a judgment is made regarding whether radiation is suitable for your condition. Representatives from all of the medical specialists participating in the treatment of your specific form of cancer will be present at this meeting.
These may include the following:
- Specialist surgeons
- Specialist medical oncologists
- Specialist radiation oncologists
Medical professionals evaluate all relevant information regarding your situation during these meetings, which may include details about your lifestyle and the results of various tests. They will then provide you with expert advice on the best strategy to treat your particular cancer.
Radiotherapy may be utilized depending on the location, type, and extent of your cancer, as well as your age and overall health:
- As the sole means of therapy
- In addition to chemotherapy
- Before undergoing surgery to reduce the tumors' size
- Following surgery to kill any residual malignant cells
- As a pain reliever and to alleviate symptoms such as bleeding
There are two types of radiotherapy, each of which employs a distinct way of delivering radiation to the body.
The following are the two primary forms of radiotherapy:
- External radiotherapy. When the radiation is delivered by a machine that is located outside the body.
- Internal radiotherapy. A type of radiotherapy in which the radiation is delivered by implants or liquids inserted inside the body.
External Beam Radiotherapy
A team of medical specialists, comprising a radiation oncologist (a medical oncology specialist) and a radiation therapist, provide external radiotherapy at the hospital (a specially trained health professional). Medical physicists and nurses, as well as other health practitioners, may be included in a course of radiation therapy.
The precise location to be treated is determined using an advanced computed tomography (CT) scanner in the radiology department before therapy is initiated. This process is known as simulation or planning. Scans such as magnetic resonance imaging (MRI) and positron emission tomography (PET) may be necessary.
Your radiation oncologist will create a personalized treatment plan for you, including the radiation dose and the specific area to be irradiated. The radiation therapist calculates it using data from the simulator as well as CT, MRI, and PET scans.
If you're getting treatment for your head or neck, your doctor may decide to build an upper-body cast. During therapy, the cast is worn to keep your head from moving.
In other circumstances, during treatment, snug-fitting supports will be fitted around your body to keep you stable. Some treatments necessitate lying face down in a special cradle or on a belly board, allowing a portion of your intestines to remain outside the treatment region.
The radiation therapist may use non-permanent markers to mark the treatment sites on your body. These markers aid in the proper alignment of the radiation equipment. After determining the best position for your treatment, the radiation therapist may use a small, permanent skin mark to ensure that any subsequent treatments are given precisely.
A contrast medium, also known as contrast material or dye, may be administered to you to swallow or injected into one of your veins. This aids in the visibility of your internal organs and tissues during treatment.
External Radiotherapy Procedure
External radiation therapy is comparable to a routine x-ray checkup. Anesthesia is not required (except for infants). In most cases, no medication is required before treatment. If your therapy is likely to induce an upset stomach, you may be given medication to take before each therapy to help prevent this.
A megavoltage machine or a linear accelerator is a device that provides high-energy x-rays.
When you have radiation, you can expect to experience the following:
- You will lie down below the apparatus on the treatment table.
- Radiation therapists will place your body to ensure that the therapy accurately targets the tumor and the treatment site. The data from your simulation or planning process, as well as the prescription from your radiation oncologist, are used to ensure accuracy.
- Shielding, or blocking devices, will safeguard the parts of your body that don't need therapy. These are connected to or contained within the linear accelerator.
- Staff will exit the treatment room to control the system, but you will be able to communicate with them through the intercom. On a television monitor, they can also see you.
- The procedure will only take a few minutes and will be completely painless. While the linear accelerator administers the treatment, you will hear a buzzing similar to that of a vacuum cleaner.
- The radiation therapists can adjust the machine to deliver more therapy from different angles, which they can often perform remotely from outside the room.
- The radiation therapists will obtain a computerized x-ray of the treatment area during your therapy. This ensures that your treatment is accurate and allows for any small variations in position caused by body movement. These images will not allow your doctor to assess your progress.
External radiation is traditionally provided in numerous fields including back to front, side to side, or at oblique angles around your body. The linear accelerator can revolve right around you, so you don't have to move to obtain the different angles.
Computers are increasingly being utilized to modulate the form of the radiation beam to improve treatment accuracy and limit the probability of treating areas that do not have to be treated. Intensity-modulated radiation treatment is the term for this procedure. It can be provided either with the beam fixed in place or rotating around your body.
You do not become radioactive as a result of external radiation. There is no radiation in you or the room after the equipment is turned off. Without regard for their health or safety, you can come face to face with anyone outdoors.
Depending on your condition, your physician may recommend both external and internal radiotherapy.
Internal Radiotherapy (Brachytherapy)
Internal radiotherapy, also known as brachytherapy, is administered through a localized implant. In general, the technique entails:
- Hollow tubes or hollow needles of various shapes are inserted into your body through or around the tumor.
- A computer-controlled machine inserts a source of radiation into these tubes or needles.
- The length of time the radiation source is left in depends on the source's power and the dose desired.
- Treatments might be one-time or multiple-time treatments, depending on the situation.
Brachytherapy is a treatment for cancers of the cervix, uterus, vaginal canal, and prostate gland. It could possibly be used to treat other cancers.
Internal Radiotherapy (Slow and Fast Radiation)
There are two different kinds of radiation sources. Radiation seed implants, for example, work slowly over several days (low-dose rate). The other works swiftly and requires only a few minutes to administer treatment (high-dose rate).
The majority of therapies are administered via high-dose-rate sources. This could take anywhere from one to five treatments spread out over time.
Internal Radiotherapy (Implants)
Depending on the type of malignancy and the part of the body to be addressed, implants come in a variety of sizes and shapes, including needles, plastic tubes, catheters, capsules, and rods.
Some implants (known as intracavitary implants) can be implanted in pre-existing areas within the body, while others are inserted through the skin near the tumor (interstitial implant).
Under anesthetic, the implant of your choice is put into your body. Implants for brachytherapy might be temporary or lifelong.
Internal Radiotherapy (Temporary Implants)
After therapy, the temporary implant is removed. It may need to be re-inserted each time, or it may be kept in place for a few days to allow for the completion of treatments before being removed. This will be determined by the treatment's type.
Your body will produce minor traces of radioactive energy while the radiation source is inside the needles or tubes. Even if the implant is still in place, there is no radiation remained in your body once the source is removed.
Staff will be in a shielded room examining you carefully while you are being treated in the brachytherapy room or suite (which may be in an operating theater). They have the ability to start and discontinue the treatment as needed.
Most treatments are only a few minutes long and do not cause any discomfort. It is unusual to experience any symptoms once the implant is withdrawn. There may be some puffiness if needles were used. Although bleeding and infection are uncommon, they can happen and necessitate medical attention.
If you're receiving low-dose-rate radiotherapy at a hospital, the source of radiation may be kept inside the tubing for up to 40 hours, and you'll be isolated from other patients and personnel. This method of practice is becoming less popular.
Internal Radiation (Permanent Implants)
Radiation seeds are frequently used to provide a permanent implant (especially for prostate cancer). These implants do not move around. The treatment is administered over days and weeks, but depending on the type of implant utilized, the seeds weaken and finally stop being radioactive after a few months.
During the first few days after the implant is implanted, the medical personnel will separate you in a single room and limit the amount of time you spend with visitors (particularly children and pregnant women).
Because the radiation diminishes over time, other people can be near you once you've been discharged from the hospital. When the sources are still active within the body, special instructions should be given about approaching children and pregnant women.
Radiotherapy Side Effects
Radiotherapy works by destroying quickly dividing cells. This is why it is effective against cancer cells. It also explains why radiotherapy produces side effects since it affects cells that divide quickly in the body, like those in the gut lining, skin, bladder, and bone marrow.
Although one or two adverse effects are common, not everyone has them. The type and dose of radiotherapy you receive, as well as the part of your body that is being treated, will determine the side effects you experience.
Almost all side effects will go away once the treatment is over. Some may reappear months or years later, causing damage to adjacent tissues in the treated location. It's critical to talk to your doctor about side effects.
The following are some of the most common negative effects:
- Sickness or an inability to eat
- Dryness, erythema, itching, blistering, peeling, tanning, and superficial ulceration are examples of skin alterations (which will heal in three to six weeks). Heat, sunshine, harsh soaps, chemicals, dyes, and abrasive cleaning all have the potential to aggravate skin issues. Your radiation nurse will talk to you about skincare. Special gels, lotions, and dressings may be required.
- Alopecia (hair loss). This can occur in areas of the body that have been treated, such as the head, face, underarm, and pubes.
- Mouth problems such as dry mouth, difficulty feeding, and tooth caries are all common. To avoid future dental issues, you may need to contact a specialized dentist before treatment.
- Coughing, difficulty breathing, and unpleasant swallowing are all symptoms of chest difficulties.
- Diarrhea, blood (occasionally), a burning feeling when urinating, the desire to urinate more frequently, vaginal dryness, and discomfort are all hallmarks of abdominal problems. If the ovaries are present and functioning, they may stop acting for four weeks, resulting in menopause in some women. People who have had previous gastrointestinal problems, such as diverticular disease, may notice that their symptoms worsen.
If you have severe or unpleasant adverse effects that do not respond to medication, such as frequent vomiting, prolonged diarrhea, bleeding, or any other change in your health that concerns you, you should contact your doctor soon.
If you can't reach your doctor, go to the closest hospital's emergency room. Inform the staff that you are undergoing radiation.
Coping with Radiotherapy Side Effects
It's crucial to note that almost all adverse effects will go away once you've finished your therapy. Meanwhile, consider the following suggestions:
- You have to get sufficient time for rest. Plan your activities around when you will be the most active, such as in the mornings, and take naps in the afternoon if required.
- If at all possible, exercise moderately.
- Sun exposure should be avoided. Wear protective clothing such as a broad-brimmed hat and a long-sleeved shirt when you're outside. Check with your doctor if applying sunscreen to exposed skin is safe.
- Perfumes, deodorants, soaps, creams, and make-up should all be avoided. Instead, use soap-free washing.
- Clothing that is scratchy or stiff should be avoided.
- Hot baths or showers, scratchy towels, and shaving the treatment area should all be avoided. Scrub the skin around the treatment area but not over it.
- Unless your doctor says it's acceptable, don't take over-the-counter medications, natural remedies, or any other form of supplement.
- If you're sad or anxious, get help. If sharing your feelings with friends and family doesn't help, visit your doctor for guidance and a recommendation.
If you're getting radiation for your head and neck:
- If you're having head radiation, use soft shampoos and avoid harsh hair treatments including tints, perms, hair rollers, gels, and sprays (which can cause hair loss).
- Pillowcases made of satin or cotton may feel a lot more comfortable on your scalp.
- Choose foods that are high in energy. If you don't feel like eating, supplemented liquids like egg milkshakes, honey milkshakes, or supplement powders are a good option.
- If you are having radiation treatment to the head or neck, avoid over-the-counter mouthwashes, beer, and cigarettes because this treatment might induce swallowing difficulties and a dry mouth. Artificial saliva products may be prescribed by your doctor.
- If necessary, a speech therapist can evaluate swallowing and speaking problems. Too hot or cold food and drink should be avoided.
- To best manage dental issues such as decay, see your dentist before, during, and after radiation therapy.
If you're receiving chest, abdomen, or pelvic radiation:
- If you are undergoing radiotherapy to the abdomen, avoid high-fiber meals because this therapy can induce nausea and diarrhea. Simple things like toast or dry biscuits are ideal. It's possible that you'll need to take a certain prescription. Foods that are hot or contain seeds should be avoided.
- Instead of three big meals, try to eat frequently throughout the day.
- Women getting radiation treatment for cancer of the cervix, uterus, bladder, intestine, or other pelvic organs may benefit from using vaginal cylinders and hormonal cream. This will keep the vaginal lining from narrowing and drying up. Your sexual performance could be impaired, which you should address with your doctor or nurse. A referral to a gynecologist could be beneficial. Fertility and hormonal function may be impacted as well, which should be addressed with your doctors.
- Reduce acid in your urine to relieve the burning feeling when urinating or the desire to urinate more frequently, which is a common side effect of radiation to the bladder area. You can do this with medications, but if your symptoms are persistent or severe, consult a physician.
Regular Test During Radiotherapy
Throughout your treatment, your doctor will arrange diagnostic exams such as physical exams, x-rays, other scans, and blood tests to see how you are responding to the treatment. It can be difficult to evaluate how effectively radiation is working throughout treatment. After your treatment is finished, this will be evaluated.
Radiotherapy Treatment Length
Some patients have only one treatment of irradiation, while others may receive regular treatments for one to eight weeks, depending on the objective of the treatment. Radiation therapy is usually (but not always) given once a day, five times a week, and each session lasts only a few minutes.
Depending on whatever body part is involved, as well as the type and stage of the tumor, radiotherapy can be delivered using a variety of machines and technologies. External and internal radiotherapy are the two basic forms of radiotherapy.
Most people only receive external radiotherapy, but depending on the location and kind of disease, some people may require both external and internal radiotherapy.
Why People with Cancer Receive Radiotherapy?
Radiation therapy is a type of treatment that is used to treat cancer and alleviate its symptoms.
Radiation treatment can cure cancer, prevent it from recurring, or stop or decrease its progression when used to treat it.
Palliative radiotherapy treatments are those that are used to help patients cope with their symptoms. External beam radiation can be used to treat pain and other symptoms caused by malignancies, such as difficulty breathing and bowel and bladder control loss. Radiopharmaceuticals, which are systemic radiation treatment medications, can be used to relieve pain from cancer that has progressed to the bone.
Types of Cancer that are Treated with Radiotherapy
Many kinds of cancer are treated using external beam radiotherapy.
Brachytherapy is most commonly used to treat head and neck tumors, as well as breast, cervical, prostate, and eye tumors.
To treat certain kinds of thyroid cancer, a systemic radiation therapy known as radioactive iodine is commonly utilized.
Targeted radionuclide therapy is a form of systemic radiotherapy that is used to treat some individuals with advanced prostate cancer or gastroenteropancreatic neuroendocrine tumors (GEP-NET). Molecular radiotherapy is another name for this type of intervention.
Safe Lifetime Radiation Dose
The quantity of radiation that an area of your body can safely absorb over the course of your lifetime is limited. You may not be allowed to have radiotherapy in the same location a second time, depending on how much irradiation that area has already received. However, if one part of the body has already received the acceptable lifetime radiation dose, another part of the body could still be treated provided the distance between the two is wide enough.
Radiation therapy is not cheap. It makes use of automated equipment and enlists the help of numerous healthcare professionals. The cost of your radiotherapy is determined by the cost of health care in your area, the type of radiotherapy you receive, and the number of treatments you need.
Consult your health insurance company to see what services they will cover. Radiotherapy is covered by most insurance policies. For more details, visit the business office of the clinic or hospital where you are receiving treatment. There are organizations that may be able to aid you if you require financial support.
Special Diet Needs While on Radiotherapy
Radiation can produce nausea, mouth sores, and esophagitis, which are all symptoms that make it difficult to eat. Because your body expends a lot of energy healing during radiation therapy, it's critical that you eat sufficient calories and protein to stay fit and healthy.
Talk to your doctor or nurse if you're having difficulties eating and staying in shape. Speaking with a dietician may also be beneficial.
Radiotherapy is a treatment for cancer that destroys cancer cells by using high-frequency waves.
It can be administered externally using a machine (teletherapy) or internally using drugs or injections (brachytherapy) to the affected area.
The type of radiation and dose are determined by your specialist depending on the type and location of the tumor, as well as your overall health and other considerations. They figure out how much to give to destroy cancer cells while leaving healthy cells intact.
Radiotherapy can induce tiredness, skin rashes, hair loss, and other adverse effects. Other therapies or practices, on the other hand, may be able to manage or limit some adverse effects.