Radiation therapy is a type of treatment that uses beams of intense energy to kill cancer cells. Radiation therapy most often uses X-rays, but protons or other types of energy also can be used.
Radiotherapy qualifies the use of radiation to destroy cancer cells locally. This technique thus makes it possible to treat tumors without affecting neighboring organs or tissues.
There are several types of radiotherapy, but the most frequently used is external radiotherapy, which uses a beam of radiation that passes through the skin to treat the area. During this type of radiation, the high-energy beams come from a machine outside of your body that aims the beams at a precise point on your body.
There is a different type of radiation treatment called brachytherapy (brak-e-THER-uh-pee), where radiation is placed inside your body.
Types Of Radiation Therapy
There are two main types of radiation therapy:
External Beam Radiation Therapy
External beam therapy (EBT) is a method for delivering high-energy x-ray or electron beams, targeted to destroy cancer cells while sparing surrounding normal tissues. External beam therapy (EBT) also may be used to relieve symptoms in patients with advanced cancer or cancer that has metastasized.
External beam therapy (external radiation therapy), is a method for delivering a beam or several beams of high-energy x-rays to a patient’s tumor.
Beams (high energy x-rays) are generated outside the patient and are targeted at the tumor site. They can deposit their dose to the area of the tumor to destroy the cancer cells. With careful treatment planning, the surrounding normal tissues will be spared, and no radioactive sources will be placed inside the patient’s body.
External beam therapy is most commonly used to treat cancer, with the goal of eliminating a tumor or preventing one from returning.
The procedure may also be performed before or after surgery for the following purpose:
- to remove a cancerous tumor,
- to reduce the tumor size before surgery,
- to prevent the tumor from coming back after surgery, or
- May also be used as a palliative treatment in patients with advanced-stage cancer or cancer that has metastasized (in this case, the goal of therapy is to reduce a patient’s symptoms rather than cure cancer).
External beam therapy is used to treat the following diseases as well as many others:
- Lung Cancer Treatment
- Breast Cancer Treatment
- Colorectal (Bowel) Cancer Treatment
- Brain Tumor Treatment
- Esophageal Cancer Treatment
- Head and Neck Cancer Treatment
- Prostate Cancer Treatment
- Types of Beams Used in Radiation Therapy
Radiation beams used in external radiation therapy come from the following types of particles: Photons, Protons, and Electrons
Most radiation therapy gear uses photon beams. Photons are also used in x-rays (x-rays use lower doses). Photon beams can reach tumors deep in the body, and as they travel through the body, they scatter little bits of radiation along their path. Photon beams do not stop once they reach the tumor but go into normal tissue past it.
Protons are positively charged particles, and its beams can also reach tumors deep in the body. On the other hand, proton beams do not scatter radiation on their path through the body and they stop once they reach the tumor.
Health experts think that proton beams might reduce the amount of normal tissue that is exposed to radiation, and clinical trials are underway to compare radiation therapy using proton beams with one, using photons beams.
Some cancer centers are using proton beams in radiation therapy, but the high cost and size of the machines are restraining their use.
Electrons are negatively charged particles, and cannot travel very far through body tissues. Therefore, their use is limited to tumors on the skin or near the surface of the body.
Internal Radiation Therapy
Internal radiation is when a radioactive implant is put inside the body in or near the tumor. It is also called brachytherapy or seed implantation.
With internal radiation therapy, the oncologist implants or inserts temporary or permanent radioactive materials at the site of your cancer.
This radioactive material, known as the seed will slowly release radiation over a few months, and within one year, their radiation completely decays. The seeds can remain safely in place permanently.
Internal radiation therapy uses a radiation source that’s usually sealed in a small holder called an implant and allows a higher dose of radiation in a smaller area that might not be possible with external radiation treatment.
The implants are placed very close to or inside the tumor, in your body. This way the radiation harms as few healthy cells as possible.
The implant procedure is usually done in a hospital operating room. This room is designed to keep the radiation inside the room.
You’ll get anesthesia, where drugs are used to put you into a deep sleep so that you don’t feel pain or where part of your body is numbed.
One or more implants are put into the body cavity or tissue with an applicator. The applicator is usually a metal tube or a plastic tube called a catheter.
Imaging tests like an x-ray, ultrasound, MRI, or CT scan are usually used during the procedure to find the exact place the implant needs to be placed.
There are three types of Internal Radiation Therapy (Brachytherapy):
Low-Dose Rate (LDR) Implants: The radiation source stays in place for 1 to 7 days, and you are likely to be in the hospital during this treatment time.
High-Dose Rate (Hdr) Implants: The radiation source is left in place for just 10 to 20 minutes at a time and then taken out. You may have treatment twice a day for a couple of days or once a week for 2 to 5 weeks.
You may be in the hospital during this time, or you may choose to make daily trips to the hospital to have the radiation source put in place.
Permanent Implants: In permanent implants, after the radiation source is put in place, the catheter is removed, and the implants remain in your body for the rest of your life. The radiation gets weaker each day though, and as time goes on, almost all the radiation will go away.
Some facts about radiation therapy include:
- Radiation therapy is a local treatment if it affects cancer cells only in the treated area. If the area treated is broader, then it becomes a regional treatment.
- The whole body can be given radiation therapy for a systemic or total-body effect, but that is extremely rare.
- Radiation can come from a machine (external radiation), or it can come from an implant (a small container of radioactive material) placed temporarily or permanently into or near the tumor (internal or interstitial radiation). Some patients may receive both kinds of radiation therapy.
- More than half of all people with cancer receive radiation therapy as part of their cancer treatment.
- Doctors use radiation therapy to treat just about every type of cancer and are also useful in treating some noncancerous (benign) tumors.
- Your doctor may suggest radiation therapy as an option at different times during your cancer treatment and for different reasons.
- Radiation therapy can be used as the only (primary) treatment for cancer
- It can also be used before surgery, to shrink a cancerous tumor (neoadjuvant therapy)
- Radiation therapy can be used after surgery, to stop the growth of any remaining cancer cells (adjuvant therapy)
- Radiation therapy can also be used in combination with other treatments, such as chemotherapy, to destroy cancer cells
- Finally, doctors can use Radiation therapy in advanced cancer to alleviate symptoms caused by the cancer
Side Effects Of Radiation Therapy
With radiation therapy, the side effects depend on the treatment dose and the part of the body that is being treated. The most common side effects include:
- Tiredness Or Fatigue
- Skin reactions such as skin changes, a rash or redness, permanent pigmentation, and scarring, in the treated area.
- Inflammation of tissues and organs in and around the body site radiated.
- Radiation can inflame skin to cause a burn or permanent pigmentation.
- Radiation therapy can also irritate the colon and cause diarrhea.
- It causes a decrease in the number of white blood cells, which help protect the body against infection.
- sore mouth, dry mouth, taste changes, and difficulty swallowing
In general, the side effects of radiation therapy will depend on:
- the type of radiation therapy (internal or external radiation therapy)
- the part of the body being treated
- the amount (dose) of radiation and treatment scheduled to receive, and
- your overall health
Although the side effects of radiation therapy can be distasteful, they can usually be controlled, and in most cases, they are not permanent.
Today radiation therapy using modern types of equipment can be better focused and thereby result in fewer side effects.
Again, the possible side effects of radiation therapy depend on the location and the amount of radiation.
Skin Reactions to Radiation Therapy
While undergoing radiation treatment, you will likely notice a change in the color of your skin. The skin also may be dry, sore, and more sensitive to touch, just as in the case of sunburn. The skin can sometimes start to peel in a dry way or in a wet way (like a blister).
Peeling will probably be limited to a few areas of the skin, and if the blister opens, the exposed raw area can be quite painful and weepy. Skin reaction can become more serious if the exposed area is not treated and infection can develop.
Toxicity related to radiation therapy occurs because of the effect of radiotherapy on normal tissue that divides rapidly, such as the skin and mucous membranes.
Acute toxicity mostly occurs during treatment and 2–3 weeks after completing radiotherapy. Late toxicity occurs from weeks to years after treatment.
Most patients have mild reactions with limited impact on their quality of life, while some patients experience more severe reactions that are associated with symptoms including pain, itching and infections, and in the worst cases, treatment interruptions.
At four to five weeks into radiation therapy, the production of new cells is reduced, and it stops altogether if treatment continues. Skin cells keep peeling off from the surface, with no new cells produced.
This results in the whole of the epidermis being lost, and moist desquamation occurs, with the basal layer and dermis exposed. It takes a few weeks after treatment ends before the process of skin cell growth returns to normal and the skin can heal.
Studies for the past 10 to 15 years has shown that few, or even no, skin care products are effective in preventing or reducing acute radiotherapy skin reactions.
There are lots of skin products that are used and have not been evaluated, and there is a wide variation in practice, with many treatment centers using local remedies that have not been tested.
Basic strategies, such as keeping the skin clean seem to be more helpful than particular creams. The goal here is to keep the skin clean, control pain, provide comfort, avoid friction and trauma from clothes, weather, and prevent infections.
Other measures that can help with skin care include pain management and good nutrition to support wound healing.
Smoking cessation is also, an important measure a patient can take to reduce their risk of severe skin reactions. Furthermore, be careful with sun exposure, to maintain good hygiene and to avoid skin care products just before treatment.
Skin Care Tips Include:
- Don’t rub the area too hard to avoid soreness.
- Don’t use perfume or perfumed soaps, talcs or lotions on the affected areas.
- Use a deodorant that is free of any metal.
- Don’t shave the area being treated (you can use an electric trimmer instead of shaving).
- Wear loose-fitting clothes, and use clothes made of natural fibers.
- Avoid tight collars and ties if you’ve had radiotherapy to your neck, and avoid shoulder and bra straps.
- As always, when exposed to the sun you should use a high factor sunscreen, and wear a hat.
How To Deal With Fatigue During Radiation Therapy
While nausea, diarrhea, and hair loss, are side effects that can be difficult to tolerate, it is actually fatigue that affects people the most. Lack of energy and excessive tiredness seem to afflict all cancer patients, but those going through radiation therapy do experience it more frequently and often persistently.
Fatigue occurs during radiation therapy because the body is working hard to repair damage to healthy cells incurred during radiation treatment. The degree of fatigue generally varies depending on the location of radiation and amount of tissue irradiated.
Radiation therapy may not be the sole culprit of fatigue, as it can be a result of cancer itself or the mental stress associated with being a cancer patient.
Fatigue can be extremely frustrating because you aren’t quite sleepy, but you just don’t have enough energy to do much, and you find it difficult to accomplish physical tasks.
There are many things you can do to help cope with cancer fatigue. Ask for help and accept it when it is offered. Pushing yourself to accomplish everyday chores can leave you even more worn out.
Get enough sleep, and if you have trouble sleeping at night, try to limit how often or how long you are napping during the day.
Ensure you are properly hydrated since dehydration is a common cause of fatigue. Avoid caffeinated drinks like an energy drink that act as a diuretic, the energy boost is short-lived. They are also loaded with sugar and caffeine, which may give you a boost, but may increase fatigue after you come down from the caffeine/sugar rush.
Exercise when you can, as studies have shown that exercise can increase energy in people with cancer. Exercise does not have to be extreme. It can be a short walk (Find out more on Tips to Help Cope with Fatigue).
The Radiation Therapy Team
A professional medical team usually works together to provide cancer patients with the best possible care. This team may include these members:
Radiation oncologist: This doctor specializes in giving radiation therapy to treat cancer, and oversees radiation therapy treatments. He or she works closely with others in the team to develop the treatment plan.
Radiation oncology nurse: This nurse specializes in caring for patients receiving radiation therapy, and plays many roles, like answering questions about treatments, monitoring your health during treatment, and helping you manage potential side effects
Radiation physicists: these are professionals who have expertise in radiation equipment. They help design treatment plans.
Dosimetrist: the dosimetrist is a professional who helps the radiation oncologist calculate the right dose of radiation.
Other health care professionals: These professionals include social workers, Nutritionists or dietitians, Physical therapists, and Dentists. They will help care for additional physical, emotional, and social needs during treatment.
Radiation therapy is one of the most common treatments for cancer patients and it may be used to cure or shrink early-stage cancer, stop cancer from coming back, or to treat symptoms when cancer has spread.