Radiation Therapy

Overview

Radiation therapy is a type of cancer treatment that uses beams of intense energy to kill cancer cells. Radiation therapy most often uses X-rays, but protons or other types of energy also can be used.

The term "radiation therapy" most often refers to external beam radiation therapy. During this type of radiation, the high-energy beams come from a machine outside of your body that aims the beams at a precise point on your body.

Radiation therapy damages cells by destroying the genetic material that controls how cells grow and divide. While both healthy and cancerous cells are damaged by radiation therapy, the goal of radiation therapy is to destroy as few normal, healthy cells as possible. Normal cells can often repair much of the damage caused by radiation.

Why it's done

More than half of all people with cancer receive radiation therapy as part of their cancer treatment. Doctors use radiation therapy to treat just about every type of cancer. Radiation therapy is also useful in treating some noncancerous (benign) tumors.

How radiation therapy is used in people with cancer

Your doctor may suggest radiation therapy as an option at different times during your cancer treatment and for different reasons, including:

• As the only (primary) treatment for cancer
• Before surgery, to shrink a cancerous tumor (neoadjuvant therapy)
• After surgery, to stop the growth of any remaining cancer cells (adjuvant therapy)
• In combination with other treatments, such as chemotherapy, to destroy cancer cells
• In advanced cancer to alleviate symptoms caused by the cancer

Risks

Radiation therapy side effects depend on which part of your body is being exposed to radiation and how much radiation is used. You may experience no side effects, or you may experience several. Most side effects are temporary, can be controlled and generally disappear over time once treatment has ended. Some side effects may develop later. For example, in rare circumstances a new cancer (second primary cancer) that's different from the first one treated with radiation may develop years later. Ask your doctor about potential side effects, both short and long term, which may occur after your treatment.

How you prepare

Before you undergo external beam radiation therapy, your health care team guides you through a planning process to ensure that radiation reaches the precise spot in your body where it's needed. Planning typically includes:

• Radiation simulation. During simulation, your radiation therapy team works with you to find a comfortable position for you during treatment. It's imperative that you lie still during treatment, so finding a comfortable position is vital. To do this, you'll lie on the same type of table that's used during radiation therapy. Cushions, restraints, and other devices to immobilize the body may be used to position you in the right way and to help you hold still. Your radiation therapy team will mark the area of your body that will receive the radiation. Depending on your situation, you may receive temporary marking with a marker or you may receive small permanent tattoos.
• Planning scans. Your radiation therapy team will have you undergo computerized tomography (CT) scans to determine the area of your body to be treated.
  After the planning process, your radiation therapy team decides what type of radiation and what dose you'll receive based on your type and stage of cancer, your general health, and the goals for your treatment.
  The precise dose and focus of radiation beams used in your treatment is carefully planned to maximize the radiation to your cancer cells and minimize the harm to surrounding healthy tissue.

What to expect

External beam radiation therapy

External beam radiation therapy is usually conducted using a linear accelerator — a machine that directs high-energy beams of radiation into your body. As you lie on a table, the linear accelerator moves around you to deliver radiation from several angles. The linear accelerator can be adjusted for your particular situation so that it delivers the precise dose of radiation your doctor has ordered.

You typically receive external beam radiation on an outpatient basis five days a week over a certain period of time. In most instances, treatments are usually spread out over several weeks to allow your healthy cells to recover in between radiation therapy sessions. Expect each treatment session to last approximately 5-30 minutes. In some cases, a single treatment may be used to help relieve pain or other symptoms associated with more-advanced cancers.

During a treatment session, you'll lie down in the position determined during your radiation simulation session. You might be positioned with molds to hold you in place. The linear accelerator machine may rotate around your body to reach the target from different directions. The machine makes a buzzing sound. You'll lie still and breathe normally during the treatment, which takes only a few minutes. For some patients with lung or breast cancer. Your radiation therapy team stays nearby in a room with video and audio connections so that you can talk to each other. You should speak up if you feel uncomfortable, but you shouldn't feel any pain during your radiation therapy session.

Results

If you're receiving radiation to a tumor, your doctor may have you undergo periodic scans after your treatment to see how your cancer has responded to radiation therapy. In some cases, your cancer may respond to treatment right away. In other cases, it may take weeks or months for your cancer to respond. Some people aren't helped by radiation therapy.

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Radiation Therapy treatments at Ellis include:
 

External Beam Radiation Therapy (EBRT)

This technique uses a large machine called a linear accelerator (LINAC) to create and deliver radiation beams to precisely targeted areas of the body. Ellis Medicine’s Radiation team offers the following external radiation therapies:

3-Dimensional Conformal Radiation Therapy (3D-CRT) 

Using the latest technologies available in linear accelerators with sophisticated computer software systems, 3D-CRT delivers accurate radiation to very precisely shaped target areas. 3D-CRT has become the new standard in radiation therapy, combining modern imaging such as computer tomography (CT) and magnetic resonance imaging (MRI) with the planning software.

Intensity Modulated Radiation Therapy (IMRT) 

An advanced form of 3D-CRT, this treatment uses hundreds of tiny radiation beam shaping devices (collimators) to deliver a single dose of radiation. The treatment team can move the collimators to sculpt the radiation beams to the shape of the tumor, and treat the tumor from various angles. As the collimators move and shape the beam, radiation intensity can vary or modulate, allowing different areas of the tumor or nearby tissues to receive different doses of radiation.

Image-Guided Radiation Therapy (IGRT) 

Uses repeating imaging scans (CT, MRI, or PET) taken during treatment to identify changes in the tumor’s size or location during treatment. Patient position and/or radiation dose can be recalculated as needed during treatment.

Stereotactic Body Radiation Therapy (SBRT) 

This radiation therapy uses special equipment to position the patient deliver a very high dose of radiation to tumors in the body (except the brain) over 1 to 3 treatment sessions. The equipment helps account for tumor movement with body movement, such as breathing. SBRT is used for some lung and liver tumors, even in patients who cannot undergo surgery.

Volumetric Modulated Arc Therapy (VMAT) 

A more precise form of external radiation than 3D-CRT, where the radiation dose and the field shape is changed or modulated as the treatment machine moves or arcs around the patient. This treatment helps spare more normal tissue.

For more information about cancer care at Ellis Medicine, please call 518.243.4317.