Radiation Therapy (Ionizing Radiation, Radiotherapy, Brachytherapy)

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 scan—a 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 Radiation

You 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.

External Radiation

Jewelry may need to be removed, and you may be asked to change into a hospital gown.

Internal Radiation

In 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.

External Radiation

None

Internal Radiation

Local or general anesthesia

External Radiation

The 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 radiation—Rods, ribbons, or wires are placed inside the affected tissue on a temporary or permanent basis.
• Intracavitary radiation—A container of radioactive material is placed inside a body cavity, such as the uterus, vagina, or windpipe. This is always temporary.

External Radiation

You 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 visitation—Many 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 staff—Although 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.

External Radiation

The 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 Radiation

This depends on the type of cancer treated and the method of internal radiation used.

External Radiation

No

Internal Radiation

Anesthesia prevents pain during the procedure.

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:

General

• Fatigue
• Skin changes (redness, irritation)
• Reduced white blood cell count
• Hair loss

Breast

• Dryness or itchiness of the breasts
• Breast or nipple soreness
• Fluid build-up
• Tanning in irradiated area

Pelvic Region

• Bladder irritation
• Vaginal itching, burning, dryness, or menstrual cessation
• Reduced sexual desire
• Possible loss of fertility

Mouth, Stomach, or Intestine

• Appetite loss
• Nausea, vomiting, or diarrhea
• Mouth ulcers
• Difficulty swallowing

External Radiation

None—External radiation is typically done on an outpatient basis.

Internal Radiation

You 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.

External Radiation and Internal Radiation

During 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.