Radiotherapy

Introduction

Patient education on cancer is a must & involves dissemination of information and knowledge about oncology support systems.  The treatment of cancer is  multidisciplinary  and involves surgery, chemotherapy, radiation, rehabilitation & psychosocial support. A multidimensional approach is the best way to deal with this disease.

Our endeavour is to provide you the best available information regarding cancer of various sites, with special emphasis on radiation therapy.  Radiation is used in a definitive, adjuvant or palliative setting,  depending on the type & stage of cancer. In this section, we are attempt to  demystify radiation therapy and  to provide you  information regarding  the latest developments in the field of radiation therapy.

• Introduction to radiation therapy
• Side effects
• Precautions
• Frequently asked questions regarding radiotherapy.
• New developments in the field of radiotherapy.

Introduction to Radiotherapy. Cancer management mandates a  multimodality approach and radiotherapy plays a major role in the management of cancer. Radiation is the main treatment for most head neck cancers and cervix cancers. It is used as an adjuvant treatment (treatment after definitive treatment,  to prevent reccurence) for breast cancer, gastrointestinal cancers, head neck cancer, soft tissue sarcomas and many more.
What is radiotherapy and how does it work?
Radiation is broadly divided into X rays (Photons) and particulate radiation. Diagnostic radiology uses low energy X rays for imaging while in radiotherapy high energy X rays are used to treat tumor. Particulate radiation includes radiation by electrons, protons or neutrons. The following details pertain to  X ray based radiation since this is the form used most often.
The photons present in the radiation admenisterd  ionizes the water in the cell and induces formation of  free radicals which can  damage of genetic material (DNA). This  damage may be  lethal and can cause death of the tumour cell.  However,  often the damage is not enough to cause cell death i.e. it is  is sublethal. This may be converted to lethal damage by repeated exposure to radiation; radiation is therefore fractionated and given over multiple sittings.  Normal cells are also affected adversely by radiation but  have the capacity of repair. Within their tolerance limits, the cells reapair themselves and the damage is transient and reversible.

Radiation side effects -- General

Before starting any radiation treatment, check with your doctor about the side effects of radiation. Some patients may have severe side effects while others have only mild symptoms. It is difficult to predict that how your body will react to radiation.

	SIDE EFFECTS	TREATMENT OF SIDE EFFECTS (please consult your doctor before using any of the advised medicine).
1	Tiredness. This  can occue because of radiation or anemia	Try mild exercise.  Engage in  your hobbies and activities like reading, gardening, playing cards etc. .  Patients diagnosed with anemia may require blood transfusion.
2	Sore skin in an area where radiation is being given.	This side effect is a function of dose. If you are getting radiation which will exceed more than 4 weeks probably you will have this radiation reaction. Avoid any cream, lotion oil soap over the skin. Wear loose cotton  clothing. Review with your radiation oncology team every week.
3	Hair fall in the area where radiation is being given. Hair fall can be permanent or temporary depending on the dose of radiation.	Consult your doctor regarding the nature of hair fall. Whether permanent or temporary. Now a day's natural looking wigs are available in market.
4	Nausea & Vomiting. Usually mild in nature but in some patient it can be severe.	Drugs to control vomiting will be usually started by your doctor. If nausea and vomiting is still bothering you please consult your doctor.
5	Bone marrow suppression.	It presents as fall in your hemoglobin or WBC count or Platelet count or combination of these or all of these. If you have received chemotherapy earlier then chances of developing these side effects are more. You will be required to undergo weekly blood checks. If your hemoglobin is low you will require blood transfusion and for low platelet, platelet transfusion. For low WBC you will be given GCSF injections which enhances the capacity of bone marrow to produce WBC.

Radiation side effects -- Head Neck Cancer

Before starting any radiation treatment, check with your doctor about the side effect of radiation. Some patients may have severe side effects while others have only mild symptoms. It is difficult to predict that how your body will react to radiation.

	SIDE EFFECTS	TREATMENT OF SIDE EFFECTS. (please consult your doctor before using any of the advised medicine)
1	Mucositis: You can have ulcer in oral cavity and throat. While on radiation this usually occurs third week onward.	Oral hygiene is must and require betadine gargles. If mucositis is very painful then painkiller are required ranging from non-opioids to opioids. Mouth dissolving antifungals. Syrup containing local anesthesia. Avoid hot food and beverages. Suck ice chips 5 to 6 times daily.
2	Dysphagia: difficulty in swallowing.	If dysphagia is mild then syrup containing local anesthesia will help. Take 2 TSF in 1/4th glass of water and dissolve 1/2 tablet of dispirin. Gargle with this solution and swallow slowly. Take feeds after 15 minutes. If dysphagia is severe then feeding tube may be required which is placed via nose in the stomach.
3	Salivary gland toxicity: In the initial few week excessive salivation occurs followed by thick sticky saliva in later part of the treatment.	Syrups containing mucolytics can help. Drink plenty of water. Oral artificial saliva can be of help.
4	Laryngeal toxicity: hoarseness of voice can occur in later part of the treatment.	Voice rest is advised. If there is breathing difficulty and you hear strange sound while breathing please immediately consult your doctor.

Radiation side effects -- Pelvic Malignancies.

Before starting any radiation treatment, check with your doctor about the side effect of radiation. Some patients may have severe side effects while others have only mild symptoms. It is difficult to predict that how your body will react to radiation.

	SIDE EFFECTS	TREATMENT OF SIDE EFFECTS. (please consult your doctor before using any of the advised medicine)
1	Diarrhea: Loose motions	Drink plenty of fluids. Anti diarrheal medication as prescribed by your doctor. Avoid milk in diet and oily and spicy food. Pain killer and antispasmodic medications as prescribed by your doctor. You may require hospital admission for intravenous fluid administration -- if your loose motions are not responding to medications.
2	Genitourinary complications: you can have burning micturation or increase frequency of micturation.	Urinary antispasmodics and analgesics as prescribed by your doctor. If your urine culture sensitivity reveal infection then your doctor will prescribe antibiotics accordingly. Urine becomes acidic and causes burning. Urine alkalinizing agents will help.
3	Radiation proctitis: presents as pain while deification.	Local anesthetic for local application. Syrup containing sucralfate. Sucralfate retention enema. Steroid retention enema. Non - Opioids or opioids for pain management.