Radiotherapy

What is it?
Radiation therapy is a cancer treatment where high-energy x-ray or other particles are used to destroy cancer cells. This is a complicated procedure and hence doctors have to take a specialisation course to perform it. The doctors who give radiation therapy to treat cancer are referred to as radiation oncologist.

Radiation therapy in itself is a long procedure. There are multiple treatments required over a set period of time to complete the procedure.

Radiation therapy is one of the most effective treatments available for cancer, this one therapy can be used to treat many different types of cancer. Not only this, it can be used combined with other treatments.

How does it work?
Cancer is a condition where a healthy cell begins to grow differently and deviates from its natural cycle. Usually, a cancer cells undergoes its natural cycle very fast as compared to a healthy cell.
Radiation therapy kills cancer cells or slows their growth by damaging their DNA. However it is not as easy as it sounds, it may take weeks of therapy before the radiation actually starts causing damage to the cancer cells. Cancer cells whose DNA is damaged beyond repair stop dividing hence stopping the further spread or die causing the tumour to become smaller. When the damaged cells die, they are broken down and removed by the body.
Radiation therapy is usually a targeted therapy for the body part which is affected unlike other cancer treatments like chemo therapy or surgery. This automatically renders it to be a safer option.
Radiation therapy can also be used to treat recurrent cancer and metastatic cancer. Recurrent cancer is cancer that comes back after treatment whereas Metastatic cancer is cancer that has spread to other parts of the body.

What are the different treatment goals of radiation therapy?
Most of the people who have cancer receive some type of radiation therapy during their treatment. For some cancers, radiation therapy alone is an effective treatment. Other types of cancer respond best to a combination of treatments. Based on this concept these are some ways in which radiation therapy is used:
1. Radiation therapy gets rid of cancer and keep it from coming back.
2. Radiation therapy shrinks a large tumour before surgery. Also known as neoadjuvant radiation therapy.
3. Radiation therapy destroys the remaining cancer cells after one has undergone a surgery or chemotherapy. Also known as adjuvant radiation therapy.
4. Radiation therapy gets rid of the symptoms of cancer. Also known as palliative radiation therapy.

What are the types of radiation therapy?
• External Beam Radiation Therapy
• Internal Radiation Therapy
External Beam Therapy
It delivers radiation from a machine outside the body. It can be used to treat large areas of the body. It is the most common type of radiotherapy. External beam radiation therapy comes from a machine that aims radiation at your cancer. The machine is large and may be noisy. It does not touch you, but can move around you, sending radiation to a part of your body from many directions.

What are the different types of external-beam radiation therapy:
(3D-CRT) Three-dimensional conformal radiation therapy: In this type of therapy a detailed 3D model of the tumour is made using CT scan or MRI scan. Using this model, the beam is aimed at the tumour. This method can use high levels of beam as the model helps in bringing precision leaving lower risk of side effects.
(IMRT) Intensity modulated radiation therapy: This type of therapy uses different intensity of radiation. This a complex type of radiation therapy.
Proton beam therapy: Also known as particle therapy this form of therapy uses protons instead of X-rays (photons). Protons are positively charged particles which have the potential to destroy cancer cells when used at high energy. As opposed to x-ray beams, very little radiation dose goes beyond the tumour with proton therapy. This limits damage to surrounding tissue. Proton therapy is a relatively modern technique that requires special equipment.
(IGRT) Image-guided radiation therapy: In this type of therapy, images of the tumour are taken right before the treatment and then during the treatment to ensure the precision of treatment.
(SRT) Stereotactic radiation therapy: Alternatively called Gamma Knife radiosurgery, uses high doses of focused radiation to destroy small brain tumours with surgical precision. Unlike surgery, there is no cutting required.
Internal Radiation Therapy
It is also called brachytherapy. Here radioactive material is placed into the cancer or surrounding tissue. Internal radiation therapy places radiation inside of your body, close to cancer cells. It treats smaller tumours in your head, neck, breast, cervix, uterus or prostate.

What are the different types of INTERNAL-beam radiation therapy:
• Permanent implants: Brachytherapy implants a solid radioactive source, or “seed,” inside or beside a tumour. The source releases radiation to a small area to kill cancer cells. Some implants release low doses for longer periods (weeks). Others may release high doses for shorter periods (minutes).
• Temporary internal radiation therapy: Systemic therapy sends liquid radioactive material through your blood to find and destroy cancer cells. Some forms are swallowed. For others, you’ll receive an injection through a vein (IV).
• Other radiation therapy treatment options:
• Intraoperative radiation therapy (IORT): In this therapy internal or externa radio therapy is delivered to the tumour during surgery.
• Radioimmunotherapy: this therapy uses monoclonal antibodies, (proteins that are attracted to very specific markers on the outside of cancer cells) to deliver radiation directly to the tumours. There is less effect on the surrounding normal tissue.

What are the side effects of radiation therapy?
Radiation therapy treatment is spread across multiple sessions which are time spaced. This time duration between multiple sessions is enough to healthy tissue for healing. This recovery time itself reduces the side effects.
Still there may be little unpleasant side effects that can be dealt with easily.

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