1.

Radiation
Radiation describes the way energy moves from one place to another.
Sometimes this is in the form of particles such as protons, while other times it is in the
form of waves like x-rays or visible light. The various types of radiation are grouped
according to how much energy they contain. Low energy radiation, like radio waves and
heat, is known as non-ionizing radiation. High energy radiation, such as ultraviolet (UV)
light from the sun and x-rays, is known as ionizing radiation because it has enough
energy to break chemical bonds and knock electrons (negatively charged particles) out
of atoms. When these changes take place in cells, it can sometimes cause enough
damage to kill the cells. As a result, such high-energy x-rays or other particles can be
used to destroy cancer cells in a treatment called radiation therapy.
2. Radiation as therapy
Doctors known as radiation oncologists oversee radiation therapy, which usually
consists of a specific number of treatments given over a set period of time. The goal of
this treatment is to destroy cancer cells without harming nearby healthy tissue.
Radiation therapy may be used as the main treatment or as an adjuvant therapy
(treatment given after the main treatment to target any potential remaining cancer cells).
Radiation therapy can also be used to shrink tumors and reduce pressure, pain, and
other symptoms of cancer (called palliative radiation therapy) when it is not possible to
completely eliminate the disease.
More than half of all people with cancer receive some type of radiation therapy.
For some cancers, radiation therapy alone is an effective treatment; however, other
types of cancer respond best to combination treatment approaches that may include
radiation plus surgery, chemotherapy, or immunotherapy.
3.3 Types of radiation therapy
3.3.1 External-beam radiation therapy.
This is the most common type of radiation treatment, and it involves giving
radiation from a machine located outside the body. It can treat large areas of the body, if
necessary. The machine typically used to create the radiation beam is called a linear
accelerator or linac. Computers with special software are used to adjust the size and
shape of the beam and to direct it to target the tumor while avoiding the healthy tissue
that surrounds the cancer cells. External-beam radiation therapy does not make you
radioactive.
3.3.1.1 Types of external-beam radiation therapy include:

Three-dimensional conformal radiation therapy (3D-CRT): As part of this

treatment, special computers create detailed three-dimensional pictures of the
cancer. This allows the treatment team to aim the radiation more precisely, which
means they can use higher doses of radiation while reducing the risk of

damaging healthy tissue. Studies have shown that 3D-CRT can lower the risk of
complications and side effects, such as damage to the salivary glands (which can
cause dry mouth), when people with head and neck cancer are treated with
radiation therapy.

Intensity modulated radiation therapy (IMRT): This treatment better directs the
radiation dose at the tumor than 3D-CRT by precisely modulating (varying) the
intensity of the beam under strict computer guidance. (The positioning of the
beam occurs during a specialized planning process.) Because of the modulation
of the beam intensity and the special planning computers, IMRT protects healthy
tissues from radiation better than 3D-CRT.

Proton beam therapy: This treatment uses protons, rather than x-rays, to treat
some cancers. Protons are parts of atoms that at high energy can destroy cancer
cells. Researchers have found that directing protons at a tumor decreases the
amount of radiation delivered to surrounding healthy tissue, reducing the damage
to that tissue. Because this therapy is relatively new and requires highly
specialized equipment, it is not available at every medical center. The potential
benefits of proton therapy compared to IMRT have not been established for some
cancers, such as prostate cancer. Learn more about proton therapy

Stereotactic radiation therapy: This treatment delivers a large, precise

radiation dose to a small tumor area. Because of the precision involved in this
type of treatment, the patient must remain extremely still. Head frames or
individual body molds may be used to limit movement. Although stereotactic
radiation therapy is often performed as a single treatment, some patients may
need several radiation treatments, sometimes as many as five.

3.3.2 Internal radiation therapy.

This type of radiation treatment, also known as brachytherapy, involves placing
radioactive material into the cancer itself or into the tissue surrounding it. These
radioactive implants may be permanent or temporary and may require a hospital stay.
Permanent implants are tiny steel seeds (capsules) about the size of a grain of rice that
contain radioactive material and are placed inside the body at the tumor site. The seeds
deliver most of the radiation around the area of the implant; however, some radiation
can be emitted (released) from the patients body. This means the patient needs to take
special precautions to protect others from radiation exposure while the seeds are still
active. Over time, the implant loses its radioactivity, but the inactive seeds remain in the
body.
For temporary implants, the radiation is delivered through needles, catheters
(tubes that carry fluid in or out of the body), or specialized applicators and kept in the
body for a specific amount of time, from a few minutes to a few days. Most temporary
implant procedures deliver radiation for just a few minutes. If temporary implants are

used for more time, the patient remains in a private room while the implants are in place
to limit others exposure to the radiation.
3.3.3 Other treatment options
Intraoperative radiation therapy (IORT). Radiation therapy can be delivered
directly to the tumor during surgery, either as external-beam radiation therapy or as
internal radiation therapy. This technique allows the surgeon to move healthy tissue out
of the way before radiation therapy occurs, and it may be helpful when vital (lifesustaining) organs are located very close to the tumor.
Systemic radiation therapy. Systemic (whole body) radiation therapy uses
radioactive materials, such as iodine 131 or strontium 89, that can be taken by mouth or
injected into the body to target cancer cells. These radioactive materials leave the body
through saliva, sweat, and urine, making these fluids radioactive. Additional safety
measures must be taken to protect people who come in close contact with the patient.
For more information, see the Safety for the patient and family section below.
Radioimmunotherapy. A type of systemic therapy, this treatment uses
monoclonal antibodies to deliver radiation directly to cancer cells. Monoclonal
antibodies are laboratory-made proteins designed to attach to specific factors only
found in cancer cells. By attaching radioactive molecules to these antibodies in a
laboratory, they can deliver low doses of radiation directly to the tumor while leaving
noncancerous cells alone. Examples of these radioactive molecules include
ibritumomab (Zevalin) and tositumomab (Bexxar).
Radiosensitizers and radioprotectors. Researchers are studying substances
that help radiation better destroy tumors (radiosensitizers) and those that better protect
healthy tissues near the area being treated (radioprotectors). Examples of
radiosensitizers include fluorouracil (5-FU) and cisplatin (Platinol), while amifostine
(Ethyol) is a radioprotector.
Safety for the patient and family
During external-beam radiation therapy, the patient does not become radioactive;
the radiation remains in the treatment room. However, because internal radiation
therapy causes the patient to emit radiation, a number of safety measures are
necessary.
While the implant is in place, women who are pregnant and children younger
than 18 should not visit the person receiving treatment. Other visitors should sit at least
six feet from the patients bed and limit their stay to 30 minutes or less each day.
Permanent implants remain radioactive after the patient is discharged from the hospital,
so he or she should not have close (less than six feet) or lengthy (more than five
minutes) contact with women who are pregnant and children for two months.

With systemic radiation therapy, safety precautions must be followed for the first few
days after treatment. The risk of radiation exposure to family and friends can be
minimized using the following precautions:

Washing hands thoroughly after using the toilet

Using separate utensils and towels
Drinking plenty of fluids to flush the remaining radioactive material from the
body
Avoiding sexual contact
Minimizing contact with infants, children, and women who are pregnant

4.1 Before treatment

Consultation and informed consent.
Before treatment begins, you will meet with a radiation oncologist to decide
whether radiation therapy is a necessary part of your treatment plan. The doctor will
review your records and perform a physical examination before discussing the potential
risks and benefits of radiation therapy with you. This is also your opportunity to ask any
questions you may have.
If you choose to receive radiation therapy, you will be asked to give written
permission (informed consent) and undergo tests to plan your treatment. The informed
consent form confirms that you have received information about treatment options and
that you are willing to undergo radiation therapy. By signing the informed consent form,
you are also telling your health care team that you understand there is no guarantee the
treatment will achieve the intended results.
Simulation and treatment planning. Your first radiation therapy session is called a
simulation and does not involve an actual treatment. During this visit, your radiation
therapy team will position your body and use imaging scans, such as a computed
tomography (CT) scan, a magnetic resonance image (MRI), or an x-ray, to help direct
the radiation beam to target the tumor. The tumors location may be marked on your
skin with a very small, dot-like temporary or permanent tattoo to help the radiation
therapist precisely aim the radiation beam each time treatment is given. Depending on
where the tumor is located, the radiation therapist may recommend using an
immobilizer to ensure you will stay in exactly the same position throughout each
radiation treatment. This could include tape, foam sponges, specially designed
headrests, molds, or plaster casts. For people receiving radiation therapy to the head or
neck, a special mesh mask, known as a thermoplastic mask, may be molded to your
face and secured to the table to gently hold your head in place.
After the simulation, your radiation therapy team will review your information and
design a treatment plan. Frequently, sophisticated computer software helps the team
develop this plan. Your doctor will then write a prescription outlining the course of your
radiation treatment.

4.2 During treatment

4.2.1 External-beam radiation therapy.
Each session of external-beam radiation therapy, in which radiation is given from
a machine located outside the body, is quick and painless. Treatments are usually
scheduled five times per week, Monday through Friday, and continue for three to nine
weeks. The sessions typically last about 15 minutes. Although the radiation beam and
your body position are adjusted so the radiation only targets the tumor, the radiation will
affect some of the healthy tissue surrounding the tumor. The two-day pause in treatment
each week allows your body to repair this damage.
4.2.2 Internal radiation therapy (brachytherapy).
Both temporary and permanent placement of radioactive sources in the body
may require anesthesia (medication to block the awareness of pain) and a brief hospital
stay. These treatments may be repeated across a number of days or weeks. Most
patients feel little to no discomfort during the treatment, but some may experience
weakness or nausea from the anesthesia. If you receive a permanent implant, you will
need to take certain precautions to protect other people from radiation exposure until
the implant loses its radioactivity. These precautions are not necessary if a temporary
implant
has
been
removed.
4.2.3 Weekly progress reports.
Your radiation oncologist will evaluate your progress at least once a week (more
often if needed) and may adjust your treatment plan accordingly. In addition, your
treatment team will use special x-rays called portal images or special scans known as
cone-beam computed tomography to provide image guidance to ensure the radiation
beam
is
always
aimed
correctly.
4.2.4 Personal care.
Many people experience fatigue, skin sensitivity at the site of radiation exposure,
and emotional distress during radiation therapy. The best way to care for yourself during
this time is to plan for extra rest; eat a balanced, nutritious diet; treat your skin with
lotions approved by your health care team; minimize your exposure to the sun; and
seek
emotional
support.
Learn
more
about coping
during
treatment.
4.2.5 After treatment
Once treatment ends, the radiation oncologist will need to see you for follow-up
appointments to monitor your recovery and watch for any side effects of treatment,
which may not happen right away. You may want to ask your doctor for a written record

of your radiation treatment so that you can have it for future reference. As your body
heals, you will need fewer follow-up appointments.
5.1 Radioactive iodine (radioiodine) therapy for thyroid cancer
Your thyroid gland absorbs nearly all of the iodine in your body. When radioactive
iodine (RAI), also known as I-131, is taken into the body in liquid or capsule form, it
concentrates in thyroid cells. The radiation can destroy the thyroid gland and any other
thyroid cells (including cancer cells) that take up iodine, with little effect on the rest of
your body. (The radiation dose used here is much stronger than the one used in
radioiodine scans, which were described in How is thyroid cancer diagnosed?)
This treatment can be used to ablate (destroy) any thyroid tissue not removed by
surgery or to treat some types of thyroid cancer that have spread to lymph nodes and
other parts of the body.
Radioactive iodine therapy improves the survival rate of patients with papillary or
follicular thyroid cancer (differentiated thyroid cancer) that has spread to the neck or
other body parts, and this treatment is now standard practice in such cases. But the
benefits of RAI therapy are less clear for patients with small cancers of the thyroid gland
that do not seem to have spread, which can often be removed completely with surgery.
Discuss your risks and benefits of RAI therapy with your doctor. Radioactive iodine
therapy cannot be used to treat anaplastic (undifferentiated) and medullary thyroid
carcinomas because these types of cancer do not take up iodine.
For RAI therapy to be most effective, patients must have high levels of thyroidstimulating hormone (TSH or thyrotropin) in the blood. This substance stimulates thyroid
tissue (and cancer cells) to take up radioactive iodine. If the thyroid has been removed,
one way to raise TSH levels is to not take thyroid hormone pills for several weeks. This
causes very low thyroid hormone levels (a condition known as hypothyroidism), which in
turn causes the pituitary gland to release more TSH. This intentional hypothyroidism is
temporary, but it often causes symptoms like tiredness, depression, weight gain,
constipation, muscle aches, and reduced concentration. Another way to raise TSH
levels before RAI therapy is to give an injectable form of thyrotropin (Thyrogen), which
can make withholding thyroid hormone for a long period of time unnecessary. This drug
is given daily for 2 days, with the RAI on the 3rd day.
Most doctors also recommend that the patient follow a low iodine diet for 1 or 2
weeks before treatment. This means avoiding foods that contain iodized salt and red
dye #3, as well as dairy products, eggs, seafood, and soy.
References:
American Cancer Society, Inc. (2014, May 5). Understanding Radiation Therapy.
Retrieved from Cancer Org Website:
http://www.cancer.org/treatment/treatmentsandsideeffects/treatmenttypes/radiation/und
erstandingradiationtherapyaguideforpatientsandfamilies/understanding-radiationtherapy-what-is-radiation-therapy

Submitted by: Johnasse Sebastian C. Naval, RN, MANc