From Diagnosis to Recovery: Navigating Radiation Therapy

What is Radiation Therapy?

Everyone experienced radiation. Whether its from the sun or from an x-ray, we've all felt low levels of radiation. However, when those radiation wave levels are amped up, it can be used to treat tumors and kill cancer. Radiation therapy is a cancer treatment that utilizes everyday radiation waves to disrupt the growth and division (aka the spreading) of cancer cells by damaging their DNA. Every cell runs on the health of its DNA; DNA are vital to function, cell division, and the cell cycle. By damaging and sometimes destroying the DNA, radiation therapy removes replication of harmful cancer cells and slowly kills the cancer.

The most common applications of radiation therapy are for brain tumors, lung cancer, breast cancer, skin cancer, prostate cancer, lymphoma, sarcoma, and more. Within radiation therapy, there are multiple strategies to go about the treatment. It can be broadly split into two types of therapy: external beam and internal (brachytherapy).

External beam radiation therapy can consist of 3D imaging to precisely target the tumor (3D Conformal Radiation Therapy), proton therapy to minimize damage to nearby healthy tissues, electron therapy for superficial tumors, and total body irradiation (TBI) which exposes the entire body to radiation to treat advanced cancer all throughout the body or prepare the body for bone marrow transplants.

Example of External Therapy Using Radiation Beams

Internal radiation therapy, medically known as brachytherapy, is as the name suggests: an internal implantation of radioactive material or source. Doses and placement varies, creating different types of brachytherapy such as low dose rate, high dose rate, intracavity, interstitial, and interoperative. Once again, as the names suggests, the brachytherapy can either be low or high dose and can be placed within the body cavity the tumor is in, within the tumor tissue itself, or during surgery while the tumor is exposed.

It is also possible to use antibodies to deliver radioactive material to specific cancer cells or swallow/inject the material to be brought to the cancer via blood stream.

Treatment Process

The University of Florida lists the steps for treatment as so:

1. Consultation

2. Simulation

3. Treatment planning

4. Start of Treatment

Everything begins with a visit to a radiation oncologist. There, the oncologist will review patient records, pathology, x-rays, and will conduct a physical examination. Following, the doctor will provide his or her recommendations of treatment and how to proceed.

The second appointment will be to run a simulation. During this simulation, the patient will rest on an x-ray table in whatever way best exposes the area needing treatment. This is called treatment position. The doctor may use an immobilization device like a mold or mask to help the patient sit or lay in the exact same position in future appointments. Once in treatment position, the radiation oncologist will take x-rays or CT scans to plan the target region for radiation therapy. In some cases, the oncologist will use wires to highlight certain landmarks or regions that would otherwise not show up on x-rays. After imaging, the oncologist will leave small marks to identify the area that will be treated for future visits.

The next steps are to plan treatment. The radiation oncologist, physics staff, and dosimetrists will work together to plan the treatment. The oncologist will use x-rays to map out the treatment area, while the physics staff and dosimetrists create shields and computer plans to protect healthy tissue and deliver the right amount of radiation.

Some patients have come back for a second appointment to test the shields and take more x-rays to make sure everything lines up. During this visit, more lines may be drawn on the skin to guide treatment and help keep it accurate each day. However, it's not anything abnormal or worrying, it is only the team ensuring their treatment is best aligned with the patients health.

The last step is the start of treatment. The patient will start in the replication treatment position. The oncologist can use several techniques to accurately recreate the position such as laser lights (to make sure patient is level), field lights (correspond to skin marks), and SSD measurements (the number that represents the distance from the source of radiation to the skin). After everything is set up, the therapist will leave the room because nobody is allowed in during treatment. The treatment itself is quick, usually under 30 minutes, with most of the time spent on setup. X-ray films are taken regularly to make sure the treatment area stays accurate, and small tattoos may be placed on the skin to help guide future treatments. Radiation doesn’t hurt, but patients must stay very still, and for children, safety straps are gently used. Parents can talk to their child through an intercom, and kids are encouraged to bring a favorite tape to listen to during treatment.

In everyday treatment, when a patient shows up for their scheduled radiation treatment, they are escorted by a therapist to the treatment room, have any clothing covering the treatment area removed, are placed on a table with privacy measures in place, and receive radiation to each designated field while therapists adjust equipment and verify positioning. This process is repeated for each field until it is finished, at which point the patient gets dressed and leaves for home. The radiation oncologist meets with the patient once a week to discuss progress and answer questions, and additional support is available as needed during the week.

Side Effects and Risks

Like all medical treatments, radiation therapy isn't without its side effects and risks. While it varies based on the amount of radiation and the area exposed, fatigue and skin irritation remain consistent among majority of patients.

Fatigue begins several weeks of treatment and may not resolve for 2-3 months post-treatment. Skin irritation will occur on the area of treatment; the skin will become red, dry, and occasionally blister. The oncologist will give their recommendation or prescription on what to do. Other possible side effects are hair loss, sore mouth, dry mouth, difficulty swallowing, lung/esophagus irritation, nausea, vomiting, diarrhea, and rectal/bladder/vaginal irritation. However, all of the aforementioned side effects are conditional on the type of cancer being treated and should be discussed in depth with the patients oncologist. For example, sore and dry mouth occur when radiation therapy is targeting the throat, mouth, or neck. Similarly, vaginal/rectal/bladder irritation only occurs in treatment to the pelvis.

Most side effects resolve between 4-6 weeks post-treatment but long-term effects may occur. Radiation therapy can cause permanent changes to skin elasticity and color. Similar to short-term side effects, long-term side effects are situational to the treatment and should be discussed in depth with the patients doctor prior to committing to radiation therapy.

Some accompanying risks of radiation therapy include damage of surrounding healthy tissue, lower effectiveness in larger tumors, lower effectiveness in areas with less blood supply, and the inability of patients to undergo radiation therapy if they've already had previous radiation or certain disorders. However, there are counteractions to these risks such as using extremely precise imaging tools and shields to prevent as much damage to healthy tissue as physically possible.

Post-Treatment

The cancer experiences doesn't end after treatment. Radiation therapy doesn't usually have an immediate effect, the cancer cells can die for weeks or months following the end of treatment and it may be quite some time before the cancer has been officially eradicated.

After therapy ends, the treatment team and doctors will prescribe a plan on how to care for the treatment area and how to manage long term side effects. There will also be follow-up appointments and check-ups to watch how the cancer is responding to treatment. These appointments will lessen over time.

Going through cancer treatment, especially radiation therapy, can be emotionally exhausting. Even after treatment, many patients experience sadness, anxiety, or depression as they readjust to life. It’s normal to feel overwhelmed or uncertain and disconnected. If a patient finds themselves struggling emotionally after radiation therapy, it can help to know that they aren't alone and that support is available. This is where the patients surrounding community can offer a shoulder of support. However, there are additionally groups of cancer survivors and patients who understand the experience and are able to support one another. Hospitals and local community organizations (American Cancer Society, Cancer Lifeline, etc.) run and facilitate support groups for cancer, typically run by trained professionals such as social workers. There are also online communities and organizations available such as Cancer Council (https://www.cancercouncil.com.au/cancer-information/living-well/after-cancer-treatment/can) help access resources like counseling, peer support groups, and mental health professionals who understand what the patient is going through.

Effectivity and Success

Radiation therapy, either alone or in combination with other treatments, is a very successful cancer treatment that has resulted in healthy lives for thousands of patients. When administered before or after surgery for common malignancies such breast, colon, uterine, prostate, and skin cancer, it kills cancer and lowers chances of recurrence. It can be used to treat almost all types of cancer. Radiation therapy can be used as the main treatment in some cases, such as prostate, head and neck, bladder, lung, cervical, and various skin cancers, frequently obviating the need for surgery.

Even in advanced stages of cancer, radiation therapy reduces pain, bleeding, and discomfort, helping patients live happy and fulfilling lives. For example, bone pain resulting from cancer can be alleviated and sometimes completely removed in in around 75% of radiation therapy cases. Advancements in radiation therapy technology have significantly enhanced the accuracy and efficiency of treatment, leading to greater effectiveness in targeting tumors while minimizing damage to healthy tissue and reducing side effects.

Conclusion

To conclude, radiation therapy remains an effective and monumental technological advancement, offering hope, symptom relief, and improved quality of life. It's a precise, efficient, and safer treatment that minimizes side effects while maximizing therapeutic benefits. The journey of radiation therapy is a physical and mental challenge, proving the strength of its patients. It's important to remember to reach out for help when necessary because there are thousands of others who understand the experience and are willing to offer support or educate. By understanding the treatment process, its benefits, and potential challenges, patients and their families can feel more empowered and supported throughout their cancer journey.

Work Cited

1. “Life after Radiation Therapy.” Cancer Council NSW, www.cancercouncil.com.au/cancer-information/cancer-treatment/radiation-therapy/life-after-cancer-treatment/.

2. “Living Well after Cancer.” Cancer Council NSW, www.cancercouncil.com.au/cancer-information/living-well/after-cancer-treatment/.

3. Radiation Oncology. “Benefits and Effectiveness.” Radiation Oncology Targeting Center, 2024, www.targetingcancer.com.au/radiation-therapy/benefits-and-effectiveness/.

4. Radiation Therapy: What to Consider» Radiation Oncology» College of Medicine» University of Florida. radonc.med.ufl.edu/patient-care/information-for-patients/radiation-therapy-what-to-consider/.

5. Vollmering, Karen. “What Are the Types of Radiation Therapy Used for Cancer Treatment?” MD Anderson Cancer Center, 10 June 2021, www.mdanderson.org/cancerwise/what-are-the-types-of-radiation-therapy-used-for-cancer-treatment.h00-159461634.html.

6. Willamette Valley Cancer Institute and Research Center. “Pros and Cons of Treating Cancer with Radiation Therapy.” Www.oregoncancer.com, 20 Feb. 2023, www.oregoncancer.com/blog/pros-and-cons-of-treating-cancer-with-radiation-therapy.

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