Listed below is the step by step procedure of radiation therapy:
Radiation therapy is a form of curative method making use of high energy beams. Since they are released in a narrow beam, their concentration is high. Combining this with their energy levels imbibes into them the ability to destroy human body cells. It is this principle which is used to treat various diseases. Radiation therapy follows the principle of targeting only the diseased cells in the body. Healthy cells are left intact as far as possible.
Radiation therapy is useful for treating the following:
The word malignant means affected by cancer. Radiation therapy is mostly used to treat cancerous conditions. Most of the cancers respond at some stage to radiation therapy. Blood cancer, bone cancer, liver cancer, breast cancer, brain cancer, stomach cancer, skin cancer, to name a few, respond well to radiation therapy.
Benign means that which remains unaffected by cancer. Goitre (swelling of thyroid gland), spurs (bony outgrowths), several painful and inflammatory diseases of the joints like bursitis and tendonitis, diseases of the blood, skin diseases, harmless brain tumors are some examples of benign conditions which respond well when treated with radiation therapy.
Radiation therapy is not used as often for benign conditions as it is used for cancer conditions.
Radiation therapy is a science which needs a lot of study and precision. It cannot be performed by any doctor. A nuclear medicine specialist is usually entitled to perform radiation therapy. A cancer specialist who specializes in radiation therapy is known as a radiation oncologist.
The use of radiation therapy differs from patient to patient. As mentioned above, it is used mostly for cancerous conditions. Cancers are usually treated using any one of or a combination of radiation therapy, chemotherapy and surgery. The decision to opt for radiation therapy is taken by the nuclear medicine specialist. It can be employed in the following ways:
Radiation therapy can be used independently as the primary and first line of treatment.
In advanced cases of cancer, the tumor is very big, it may not be possible to directly approach it via surgical methods. In such circumstances, radiation therapy is initially administered. As some of the tumor gets destroyed, its size reduces. The smaller tumor can be more easily removed with surgery.
At times, surgery fails to remove the entire cancerous tissue from the body. Or after surgery, it may be noticed that cancer is present in adjacent organs or lymph nodes. In such cases, the remnant cancerous tissue is destroyed using radiation therapy.
In some cases of cancer, the symptoms might need multiple treatment methods to be used at a time. In such cases, chemotherapy and radiation therapy can be administered at a time or one after the other.
At times, radiation therapy can also be used to palliate symptoms. In some cases, the cancer tumor may be large enough to block blood flow, compress nerves or other adjacent organs. This may lead to additional symptoms. Radiation therapy in such cases helps to shrink the tumor and subsequently reduce the symptoms which occur.
In benign (non-cancerous) conditions, radiation therapy can be used as an independent method of treatment or in conjunction with medicinal or surgical treatment.
The decision to choose radiation therapy is taken by the doctor depending on the age and general health of the patient. If treatment is being provided for cancerous conditions, the staging of cancer also plays an important part in determining whether this therapy is to be used or not. Before the procedure is initiated, the doctor will discuss it in detail with the patient and their family. A signed consent is required from the patient's side before confirming the procedure.
In preparing for therapy, the patient needs to undergo certain investigations. CT scan, MRI scan,PET scan are needed to determine the exact location of the affected organ. EKG may be done to assess cardiac functioning.
Specific preparation for internal therapy:
For internal radiation therapy, the patient might be prescribed a laxative to clear the bowel. This depends however, on the location of the cancer as well as the surgical incision. The number and material of the radioactive pellets is determined.
Specific preparation for external therapy:
Since external therapy does not have scope of visualizing the diseased organ directly, the radiation oncologist will make arrangements for CT scan. Under CT guidance, the target organ can be located and treated accurately.
The various types of radiation therapy have been described below. They are mainly used for cancerous conditions.
X-Rays, gamma rays or high energy particles can be used in this form of therapy. In this form of treatment, radiation beams are focused on the affected organ or body part. These beams are released from a machine placed externally. There is no need to perform any surgical incision on the skin for this type of therapy.
Radiation therapy is usually administered in cycles. Each cycle could last for about 1 hour and is repeated daily for about 5-6 days consecutively. This may be repeated as long as the doctor feels necessary. The patient's body has to be placed in the same position for every cycle of radiation therapy. This is done with the help of pads or straps. To maintain the same position, the doctor may mark the patient's body with small ink or tattoo marks. This helps in predicting the correct position in which the patient is to be placed daily.
On the day of procedure when the patient arrives to receive therapy, they are given sterilized (rid of all microorganisms) clothes or gown to wear. They are asked to lie down in a pre-determined position depending on the body part to be treated. The angle of the machine is adjusted so that radiation emits at a correct angle and only the unhealthy tissue gets exposed to the beams. This angle has to be kept constant throughout the treatment unless the doctor feels it necessary to change. After the patient is ready, the doctor will administer the radiation beam of a selected intensity at the correct angle for a suitable period of time. Any of the following methods of external radiation therapy may be employed by the doctor.
As the name suggests, during this method, three dimensional images of the cancer tissue are created. This helps in visualizing the target organ better. The surrounding healthy tissue can be spared. It has been noticed that side effects are observed in lesser intensity with this form of external therapy.
In this form of therapy, the intensity of the radiation beam can be altered. This ensures that proper dose of radiation is administered.
The type of radiation used in this form of treatment is a proton beam. Protons are positively charged particles. It is a relatively new form of treatment and its full potential is yet to be explored.
This form of treatment involves administering a large dose of radiation to a relatively smaller area of cancer. Since the radiation is to be delivered to the tumor directly, the patient needs to maintain a very still posture.
Internal brachytherapy does not make use of radiation beams to treat. It involves placing radioactive substances inside the patient's body in approximation with the affected organ or body tissue. The radioactive substance is usually placed in the form of small pellets or seeds. This process is also known as seed implantation.
Preparation for brachytherapy involves deciding the radioactive substance to be chosen. Internal radiation therapy is classified in the following two manners:
Brachytherapy is considered temporary when the radioactive pellets are introduced within the patient's body and are removed sometime later. The site of insertion is chosen and cleaned with antiseptic solution. Local anesthesia may be administered to the patient at the site of incision. A needle or a catheter is inserted inside the skin and radioactive pellets are introduced inside or around the target organ. They will continue to emit radioactivity and the diseased cells get destructed. After a calculated period has passed, the radioactive pellets are removed from the body. The patient is monitored during the time between the insertion to removal of the radioactive pellets. This may necessitate admission to the hospital. It may also be possible to insert a remote controlled device into the body which introduces the radioactive pellets appropriately in or around the target organ at a specific time.
In permanent brachytherapy, the pellets are introduced in the patient's body in or around the target tissue and left there. A steady dose of radiation is provided to the affected organ till the radioactive material exhausts itself. The process of inserting the radioactive pellets is the same as is done in temporary method. The patient can be discharged to go home soon. There is no need for them to be hospitalized over night. However, this does not mean that they are not observed. Regular follow ups are done between patient and doctor to determine the level and action of radioactivity.
When the radioactive material is inserted within a body cavity, the therapy is intracavity brachytherapy
At times, the radioactive material may be inserted around the tumor or in the tumor walls. This is defined as interstitial brachytherapy.
The above described types of radiation therapy can be administered individually or in combination . If it is being used in a cancer case, radiation therapy can be used as a separate mode of treatment or in combination with surgery or medicinal therapy.
After all cycles of radiation therapy are completed and no more therapy is needed, the person is not exposed to radiation anymore. But they still have to follow up with the physician regularly. Diagnostic tests like CT scan, USG (Ultrasound Sonography) or MRI scan, may be performed to visualize the cancer ridden tissue to observe the therapeutic effect. A complete physical exam is also done to assess the patient's general health.
Every treatment procedure comes with some side effects. The same is true for radiation therapy. During or after therapy, some side effects may be experienced. They have been listed below.
The skin over the area where the radiation beams are focused may be red and itchy for a few days. This is seen in external therapy. In internal radiation therapy, the skin through which the needle is inserted could be swollen and red for some time.
It is very common to experience a sensation of feeling tired, weak and fatigued after a session of radiation therapy. This could be the effect of the high energy radiation in case of external therapy and the radioactive material used in case of brachytherapy.
Depending on the part of body involved, radiation therapy could cause local symptoms. This could be due to the effect of radiation on the cells surrounding the unhealthy tissue.
Radiation therapy may predispose a person to develop infections. This has been observed in external therapy as well as brachytherapy. This may be dealt with by administering antibiotics on prophylactic basis. In brachytherapy, infections could arise from the site of surgical incision needed for the insertion of needle.
Exposure of healthy organs to radiation leads to their damage. Damage to reproductive organs due to radiation is known to cause infertility. This complication poses a problem for men and women in their reproductive age.
The main aim of radiation therapy is to target affected cells and leave the healthy tissue untouched. But in some cases, there may be possibility that the healthy tissue next to the diseased tissue gets exposed to radiation. This could lead to symptoms related to that particular tissue or organ.
External radiation therapy can at times be responsible for development of symptoms like nausea, vomiting, blood in stool.
People taking radiation therapy have often complained of hair loss. There may be thinning of hair or increased hair fall or both.
Medical studies have revealed that exposure to radiation of high intensity or for a long time can be a precipitating factor for development of cancer. Hence, while undergoing radiation therapy, the dose of radiation is kept to optimum levels and the duration is not exceeded more than the doctor feels necessary.
These risk factors can be treated with medicines or auxiliary treatment like home remedies. It is not mandatory for all these complications to develop in each patient undergoing radiation therapy. But if the patient feels any discomfort during or after therapy, they should inform their physician about it. Though it is not in the patient's hand to control the development of complications, there are certain precautions which can be taken to avoid further health problems. These have been described in the next section.
Radiation therapy is performed on out patient basis. This means that a patient undergoing the procedure does not need to be admitted to the hospital. It is administered in cycles of 5-6 days. During and after the procedure, the patient must follow certain precautions. These factors are helpful to prevent certain health problems for the patient as well as the people around them.
In external radiation therapy, the radiation beams are administered from outside, as has been described above. But in brachytherapy, the radioactive substance is introduced inside the patient's body. Due to this, these patients tend to emit radiation waves. Hence, precautions for brachytherapy are more than those required for external therapy.
External radiation therapy tends to affect the skin as has been described above. Skin can be cared for by washing it with cold water and using mild soap over it. This can help to prevent development of skin rash and redness.
It is advisable to avoid close contact with the person who is undergoing brachytherapy. Others may come in contact with the radioactive waves. The patient is advised to abstain from keeping sexual relations until after the doctor sees fit.
Women who have conceived should avoid being in close proximity of patients undergoing radiation therapy. This may be harmful for the development of the fetus. If the patient herself is pregnant, then great care and planning is needed prior to administering radiation therapy. Children below the age of 18 years should not come in contact with the patient.
Patients undergoing radiation therapy, should take extra care to maintain good hygiene. After using the toilet, they should take care to clean it properly as urine may also emit radiation. Body fluids of such patients should not come in contact with others and care should be taken to dispose them properly. Their clothes must be washed separately. They must keep their bathing towels and soap separate.
For patients undergoing radiation therapy, it is important to keep separate utensils for cooking their food. Left over food from their plate should not be eaten by others. Patients should take care to wash their hands before handling common food and utensils.
A. Radiation therapy is not the job of one doctor only. In cancer patients, radiation therapy planning and execution is done by a team of health care professionals including the oncologist, oncosurgeon, nuclear medicine specialist who are directly involved in planning the treatment. A nutritionist is also often included in the team. They provide proper dietary advise to individuals who suffer from loss of appetite, nausea and vomiting as a side effect of radiation therapy.
A. Radiation therapy has been used since a long time to treat cancers and non cancerous conditions successfully. It does have some complications which have been elaborated in detail previously in the article, but most of the times, the risk of developing complications is far less than the risk of the disease for which radiation therapy needs to be given to the patient. Utmost care is taken to avoid occurrence of the complications. If they do, medical methods are available to treat them. Radiation therapy is safe and can be used with very good results.
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