Whenever our near and dear is affected by cancer and the doctor says that the patient needs radiotherapy we have lot of questions in our mind. In fact radiotherapy is a subject of medicine about which we don’t have much information. I am writing this post to educate my readers about the common questions about radiotherapy.

 

What is radiotherapy?

Radiotherapy/ Radiation therapy is a form of cancer treatment which uses high dose of radiation to kill cancer cells and stop them from spreading. Radiation uses Gamma rays (Cobalt 60) or X-rays (Linear accelerators). The X-rays in low energy are used for diagnostic purpose like X-ray chest to see abnormalities of lungs but for therapy purpose high energy X-ray is used.

How is Radiation Therapy delivered?

• External Beam radiotherapy: Radiation is delivered from outside the body by targeting the cancer cells.
• Internal radiation/ Brachytherapy : The source of radiation is placed within the body i.e. near the cancer cells with a aim to deliver maximum dose to cancer cells.
• Both forms of radiotherapy may be given alone or combined with each other depending on tumor site.

Who are the patients treated with radiotherapy?

The patients with cancer are treated comprehensively with three forms of treatment i.e. surgery, chemotherapy and radiotherapy. The sequence of the individual treatment modality is dependent on the type of cancer, site of cancer, stage of disease presentation. In fact it is decided by the team of doctors radiation oncologist, medical oncologist, surgical oncologist.

How does radiation therapy act on cancer cells?

Radiation therapy kills cancer cells by acting on the DNA of cells either directly or indirectly. They act on the cell during its cell cycle and prevent it from further multiplying. It  can be used to treat cancer with a intention to cure or it may be used to reduce the symptoms and improve quality of life ( Palliative Radiation).

How long does radiation therapy take to kill cancer cells?

Radiation therapy does not kill cancer cells right away. It takes few days or a week for cancer cells start to die after beginning of treatment. Even after completion of treatment the effect of radiation stays for weeks to a month.

How are the healthy cells affected by radiation?

Along with the cancer cells radiation also kills the nearby normal cells but the normal cells recover  after the treatment is over.  By using better techniques like Intensity modulated radiotherapy (IMRT) , Image guided radiotherapy(IGRT), Arc Modulated Therapy (V MAT/ RAPID ARC) now we are able to target the cancer cells more precisely and protect the normal cells.

Does radiation therapy hurt/ Is radiation therapy painful?

“No” radiotherapy is not painful and it does not hurt during the treatment. But there are some side effects of radiation therapy which may be seen after 2-3 weeks of treatment. The side effects vary as per the site of radiation and they are usually managed comfortably with different medications.

Is radiation therapy treatment done alone or it is combined with other forms of treatment?

As I had mentioned earlier radiation therapy may be needed to be combined with other forms of treatment like surgery or chemotherapy.

• Radiation therapy and surgery: Radiation may be given before, during or after surgery. It may be used to shrink the tumor size before surgery (Rectal Cancer), or it may be used to kill remaining microscopic cancer cells after surgery (Head and Neck Cancers).
• Radiation therapy and Chemotherapy: Similar to surgery, Chemotherapy can be used before , during and after radiation therapy.

Who are the people involved in radiation therapy treatment?

Radiation Oncologist/Doctor: A doctor with specialized degree of treating cancer with radiation. The doctor is associated with the patient right from the time of diagnosis. He needs to plan the treatment along with medical and surgical oncologist. During radiation treatment the doctor does positioning, simulation and scanning of the patient. The radiation oncologist need to be very much well versed with CT / MRI scanning as he needs to draw individual organs, tumor etc on each and every slice of ct scan. He has to define the planning target volume depending on the tumor type, its mode of spread etc. Then the radiation oncologist has to prescribe the dose. After that the radiation physicist plans the treatment on the computer and finally the oncologist has to thoroughly study the plan and if it is good will approve it for treatment. During the treatment the doctor verifies the accuracy and monitors the treatment. During the total course of treatment the doctor looks after the side effects of treatment and gives medications for the same. After the treatment the oncologist evaluates the effect of treatment and decides any further treatment is required or only regular follow-up.

Radiation Physicist: Medical physics is a specialized branch with few institutes providing the course. The physicist has got a pivotal role in the planning of treatment especially in the present era of advanced technology.

Radiotherapy technologist: The technologist implements daily treatment. They position the patient and run the machine; they have got a pivotal role in ensuring the proper dose is delivered as advised by the oncologist.

What is the Role of a patient on radiotherapy?

• Come for treatment daily without fail. Patient should not interrupt between treatments unless advised by the doctor.
• Ask questions, concerns without any hesitation.
• See the doctor once a week personally and let the doctor know if he has any side effects.
• Follow the advice of doctor and nurse like care of skin, food, adequate liquid intake etc.
• Maintain proper nutrition during the radiation therapy.

Why is radiation Therapy so costly?

Radiation therapy uses a complex machine which is very costly. The radiation therapy cost is based on the technique of treatment that is used for the treatment. As the higher techniques are preferred the cost goes up especially because it uses complex techniques like better planning system and use of specialized health care providers. All insurance companies provide coverage for the radiation therapy.

Is Radiation therapy completely technology driven?

No, the technology plays a very important part of the treatment but it is always the “man behind the machine” which is important. The training and expertise of the people taking care of the treatment is most important or it can be detrimental in the hands of less trained people.

How many days the radiation therapy is given?

The standard protocol of radiation therapy is 5 days of treatment weekly. The total duration of treatment may vary from 5 weeks to 8 weeks depending on the type and site of cancer. Radiation therapy may be given twice a day (Hyper fractionated treatment). It is decided by the radiation oncologist based on the tumor site, type, patient general condition etc.

Do I need admission during radiation therapy?

“No” Admission is not always necessary during radiation therapy. It is usually done as outpatient basis. Many patients also go to work during the course of radiation therapy. Patients are likely to feel better on staring of treatment. As time goes on patient should not be surprised if he feels more tired and week. The weakness can be overcome by taking proper diet. Once radiation is over  all side effects will go away.

Does radiotherapy make me radioactive?

“No” radiotherapy does not make a patient radioactive. Patient can comfortably mix and live with family members. Infact the patient should not be ,made to feel that he has got a disease.

How can I cope with my feelings during radiation therapy?

• Relax and meditate: You might try thinking yourself in a favourite place, breathing slowly while paying attention to every breath.
• Listening to soothing music
• Yoga, Pranayama etc
• Talk with Others.
• Talk to your doctor whatever be the problem

What should I wear during radiation Therapy?

Patient should wear clothes that are comfortable and made of soft fabric. Don’t wear tight clothes, Do not wear ornaments which lie in the radiation field as it may cause unnecessary skin reactions. Do not use Band-aid, lotions, powder in the area of radiation treatment.

I hope this post might answer many of your queries about radiation therapy please feel free to post your views.