Radiation Therapy (Ionizing Radiation, Radiotherapy, Brachytherapy)

Localized solid tumors (eg, cancers of the skin, neck, tongue, larynx, esophagus, brain, breast, prostate, lung, anus, rectum, bone, bladder, ovary, uterus, or cervix)Lymphoma Risk Factors for Complications During the ProcedurePrevious radiation therapy A personal history of systemic lupus, scleroderma, or dermatomyositisA woman who is pregnant or could possibly be pregnant should avoid exposure to radiation to prevent harm to the developing fetus. What to Expect Prior to Procedure External Radiation You will go through a process called simulation. This process takes between 30 minutes and two hours. During simulation, you will: Lie on an exam table while a radiation therapist uses an x-ray machine to define the exact place(s) where radiation will be directed. The therapist may mark the exact radiation area with colored ink. You will probably also have a small tattoo (or several) placed on your skin as a permanent mark to help aim the radiation beam. Depending on the type of treatment required, you may also undergo: CT scana type of x-ray that uses a computer to make pictures of the inside of the body Measurement with immobilization devices to help you stay still during treatment Internal RadiationYou will be given general or local anesthesia so that you will not feel any pain when the doctor places the holder for the radioactive material in your body.

Tell your doctor if you experience these side effects. Steps can be taken to reduce your discomfort. Many side effects can be controlled with medication or diet. If the side effects are dramatic, your doctor may change or delay the course of your treatment. After treatment, most side effects will gradually go away. During Procedure External RadiationJewelry may need to be removed, and you may be asked to change into a hospital gown. Internal RadiationIn many hospitals, the radioactive material is placed in its holder or applicator after you return to your room so that other patients, staff, and visitors are not exposed to radiation.Implants may be removed after a short time or left in place permanently. If they are left in place, the radioactive substance used will lose radiation quickly and become non-radioactive in a short time. Anesthesia External RadiationNone Internal Radiation Local or general anesthesia Description of the Procedure External RadiationThe radiation therapist positions you on the treatment table or chair. Then the therapist leaves the room and enters a control room, where he controls the movements of the radiation machine (called a linear accelerator) to deliver radiation to the predetermined areas on your body. The most common sources of the radiation are x-rays, electron beams, and cobalt-60 gamma rays.

You will need to remain extremely still during the treatment. The therapist can see you on a television screen. You can talk with the therapist if you feel uncomfortable or sick. Internal Radiation The radiation source is placed inside the body directly on or near the affected area. This method provides higher doses of radiation in a shorter time than external radiation. The radioactive sources (such as cesium, iridium, palladium, or iodine) are usually in the form of wires, seeds, or rods. This type of treatment is most commonly used for cancers of the head and neck, breast, uterus, thyroid, cervix, and prostate. The two main types of internal radiation are: Interstitial radiationRods, ribbons, or wires are placed inside the affected tissue on a temporary or permanent basis.Intracavitary radiationA container of radioactive material is placed inside a body cavity, such as the uterus, vagina, or windpipe. This is always temporary. After Procedure External RadiationYou are free to leave and resume your normal activities. You are not radioactive after your treatment and you are not a threat to anyone else around you, in terms of radiation exposure. Internal Radiation You will return to a hospital room while the implant is in place. While the radiation is implanted, you will need to follow these precautions to prevent transmitting radiation to others:

Limited visitationMany hospitals do not allow children under 18 years old or pregnant women to visit a patient undergoing implant radiation until the implant is removed. If visitors are allowed, they will need to sit at least six feet from the bed. Their visits will be limited to a short time (10-30 minutes). A shield may be placed beside the bed to protect visitors and staff from radiation exposure.Limited contact with the staffAlthough the staff will be available to you at all times, be aware that they may speak to you from the doorway. They may also come and go very quickly to avoid excessive radiation exposure. How Long Will it Take? External RadiationThe actual treatment takes 1-5 minutes, but you should allow at least 30 minutes for each session. Most treatments last from 2-8 weeks, and are given once a day, five days per week. In some cases you may be treated twice daily or only three times a week. Treatment schedule will depend on various factors. Talk to your radiation oncologist about the schedule planned for you. Internal RadiationThis depends on the type of cancer treated and the method of internal radiation used. Will it Hurt? External RadiationNo Internal RadiationAnesthesia prevents pain during the procedure. Possible Complications External radiation does not cause your body to become radioactive.

However, external and internal can both cause side effects. These effects will vary depending on the type and location of cancer treatment. Common side effects of radiation include, but are not limited, to: GeneralFatigueSkin changes (redness, irritation)Reduced white blood cell countHair lossBreastDryness or itchiness of the breastsBreast or nipple sorenessFluid build-upTanning in irradiated areaPelvic RegionBladder irritationVaginal itching, burning, dryness, or menstrual cessationReduced sexual desirePossible loss of fertilityMouth, Stomach, or IntestineAppetite loss Nausea, vomiting, or diarrheaMouth ulcersDifficulty swallowing Average Hospital Stay External RadiationNoneExternal radiation is typically done on an outpatient basis. Internal RadiationYou will stay in the hospital until the implant is removed, or in the case of a permanent implant, when the radioactivity has decreased. High-dosage implants are usually removed within a matter of minutes. Low-dosage implants may remain in for a few days. Permanent implants lose their radioactivity within a few days. Postoperative Care External Radiation and Internal RadiationDuring treatment, your doctor will want to see you at least once a week. You may have routine blood tests to check the effect of radiation on your blood cells. After treatment is completed, you will have regular visits to monitor healing, and check for signs of recurrent disease. Follow-up care will vary for each patient, and may include further testing, medication, or rehabilitative treatment.

OutcomeIdeally, radiation therapy will shrink or eliminate the cancerous or diseased area. Call Your Doctor If Any of the Following OccursSigns of infection, including fever and chillsCough, shortness of breath, or chest painPain that doesn't go away, especially if it's always in the same placeNew or unusual lumps, bumps, or swelling Nausea, vomiting, diarrhea, or loss of appetite Unexplained weight lossUnusual rashes, bruises, or bleedingAny symptoms that you are concerned aboutAny other warning signs mentioned by your doctor or nurse RESOURCES: National Cancer Institutewww.cancer.gov/ Oncolink, Abramson Cancer Center, University of Pennsylvaniahttp://www.oncolink.upenn.edu/ CANADIAN RESOURCES: Canadian Cancer Societyhttp://www.cancer.ca/ Cancer Care Ontariohttp://www.cancercare.on.ca/ References: Definition of radiation therapy. National Cancer Institute website. Available at: http://www.cancer.gov/Templates/db_alpha.aspx?CdrID=44971. Accessed June 17, 2008. Cancer treatment information. Oncolink, University of Pennsylvania Cancer Center website. Available at: http://www.oncolink.upenn.edu/treatment/. Accessed June 17, 2008. Radiation therapy fact sheets. CancerNet, National Cancer Institute website. Available at: http://cancernet.nci.nih.gov/cancertopics/wtk/index. Accessed June 17, 2008. Last reviewed March 2008 by Igor Puzanov, MDPlease be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.