A person who has cancer may receive radiotherapy as a treatment. Radiotherapy is also known as radiation therapy or x-ray treatment, and is most often given at a cancer center.

Most people are familiar with x-rays being used to help diagnose disease – by taking pictures – but x-rays can also treat cancers.

What types of radiotherapy are there?

There are two main ways to give radiation treatment. Radiation options for you will be recommended by your Radiation Oncologist (a type of doctor who gives radiation treatments).

Radiation given from the outside

A person lies on a table, like having an x-ray taken, and a large machine moves around them without touching them. The radiation travels out of the machine to the patient, external to the patient. This is called ‘external beam radiation therapy.’ This is the type of radiation therapy used to treat most kinds of cancers. This is usually done as an outpatient day treatment, as long as you feel well enough.

Radiation given from the inside

Radioactive substances can be implanted, inserted, injected or ingested into the body, and give off their radiation internally. One type of ‘internal’ radiation is called ‘brachytherapy’. For more on ‘internal’ radiotherapy, see below.

How is radiotherapy used?

Radiotherapy is used with two main goals, depending on the type and stage of cancer.

Curative Treatment

• Radiotherapy can be used alone or in combination with other treatments (surgery, chemotherapy) to destroy cancer cells in the body with the intention of curing the cancer. This is sometimes called ‘radical radiotherapy’.
• Radiotherapy can be used to shrink a tumour before other treatments (‘neoadjuvant’) or can be used to reduce the chances of cancer returning after surgery (‘adjuvant’ treatment).
• Depending on the type and stage of cancer, this may take between three and seven weeks of daily treatments.

Palliative Treatment

• Radiotherapy can also help decrease symptoms related to cancer, such as pain or difficulty with swallowing.
• Palliative treatment is usually given over a shorter period of time, sometimes only one day, and to a lower total dose than curative radiotherapy.

 For more information go to:
www.palliative.org/PC/ClinicalInfo/PcareTips/PCareTipsIDX.html

What to expect from external radiation treatment and its planning

Radiation machines are generally located in larger hospitals and cancer centers since the equipment is complex, requires considerable space and needs specially trained staff.

Radiotherapy treatments, each known as a ‘fraction’, are usually given daily Monday to Friday, with breaks over weekends and holidays.

Each fraction takes 10-15 minutes or less, including the time taken to ensure you are in the right position. Plan to be in the cancer center for up to one hour on a typical day, to check in at reception and get changed.

The person having the treatment does not feel anything; it is like having a regular x-ray.

The number of treatments a patient has depends on several factors, including:

• General health
• Type of cancer
• Where the cancer is in the body
• Whether the person is going to have, or has already had, other treatments (like surgery, chemotherapy or hormone therapy)

For these reasons, treatment is ‘custom-made’ for each patient. Even people with the same type of cancer may have different types or lengths of radiation treatment. The radiation oncologist decides on the location to treat, how much radiation to prescribe and how long it will take.

Planning your treatments is a very important part of radiotherapy and it may take a few visits to get it exactly right. Careful planning ensures the radiotherapy is aimed precisely at the cancer, and causes the least possible damage to surrounding normal tissue.

Simulation

Before your radiation treatments can start, you will have a ‘planning’ or ‘simulation’ appointment. This is an appointment where your treatment will be simulated, and x-rays or a CT-scan will be taken by radiation therapists. This takes between 15-45 minutes. The information from these scans helps the radiation oncologist plan the treatment.

During the simulation session, you will be lying on a fairly hard table. Every effort will be made to ensure that you are comfortable, with pillows and foam pads.

You must be able to lie very still for a few minutes for accurate measurements to be taken and your position to be recorded because it must be reproduced each day you have treatment.

Once your final position has been determined, ink marks are made on your skin to pinpoint the exact place where radiation is to be directed. The therapists will explain how to look after these marks. If the marks begin to rub off, you must tell the therapists. Do not attempt to redraw them yourself! Since the marks can rub off onto clothing, some people choose to wear older clothes next to the skin during this time.

Sometimes permanent, pinpoint tattoo marks are made, with your permission. These are also a good way of making sure you are set up in the right way each time. These tattoo marks are also useful once treatment has finished to show where the radiotherapy was delivered.

Treatment

When you go to the radiation machine for each daily treatment, you will meet several more radiation therapists. The therapists leave the room during the treatment, but they will watch you on a TV monitor. There is also an intercom if you need to speak with someone. Over the duration of your treatment, you will be seen once per week by your radiation oncologist to monitor you for side effects and answer any questions you may have.

Mould room

Because radiotherapy is designed very precisely to treat exactly the right area, it is important to keep that part of the body as still as possible during treatment. With this goal in mind, a see-through plastic device called a ‘mould’ or ‘shell’ can be made for certain parts of the body, such as the arm or leg. When it is made for the head and neck, it may remind you of a goalie mask for a hockey player. Any necessary marks can then be made on the shell instead of on your skin. Any shell you need will be made before your simulation appointment.

In the mould room, a plaster cast is made of the body part. Some people may find this a little claustrophobic, particularly if the shell is for the head, but it takes only a short time. The plastic is moulded onto the cast to form a mask, with holes for the eyes, nose and mouth. This is designed to fit snugly and you need to wear it only for the brief minutes of each treatment.

 Watch a video of how the mould is made

How does radiotherapy work?

Radiation is directed at the specific area in the person’s body where the cancer cells are located. Radiation damages the DNA in cells, both in healthy and cancer cells. This damage makes it impossible for cells to grow and divide; however, most healthy cells can repair themselves more efficiently than most cancer cells. This leads to more damage to the cancer cells, which with time results in tumour shrinkage.

This also explains where radiation side effects come from: damage to healthy cells. This is eventually repaired by the body, though. In the planning phase of radiation treatments, normal tissue in surrounding areas is protected as much as possible.

The radiation is gone from a person’s body as soon as the treatment machine is turned off at the end of each treatment, unless radioactive implants have been inserted into the body.

With external radiation treatments, the patient is not dangerous to their family or friends. In the case of brachytherapy, you will be given specific instructions about protecting yourself and others.

Brachytherapy and systemic radiation therapy

In some types of brachytherapy, radioactive sources are planted in the patient’s body in or near the cancer. This usually occurs in a hospital operating room with local or general anesthetic.

Implants can be temporary or permanent.

Permament Implants

With a permanent implant, radiation is released over a period of time until the radioactivity disappears. The implants then lie dormant and are not removed from the body. Safety precautions are sometimes taken for a period of time but it is unlikely with this type of implant that other people could be affected.

Temporary Implants

With a temporary implant, the radioactive sources are inserted temporarily into the patient and removed after the radiation has been delivered.

Radiation from temporary implants can be given over different periods of time. Sometimes this requires patients to stay in hospital for a few days in a special room. Visitors will be limited during this time and other safety precautions will be followed.

Once treatment is over and the implants are removed, it is then safe for people to be around the patient.


Sometimes, patients receive this type of treatment as outpatients. Patients come to hospital, the source is inserted, the treatment takes place over a few minutes, and then the radioactive source is removed. The patient is then able to go home without any safety concerns.

‘Systemic radiation therapy’ is also known as unsealed source radiation therapy. The radiation in this case is given in liquid or capsule form, or can be injected. The radiation travels through the patient’s body, mostly leaving the body within a few days.

During this time, special precautions are followed while the levels of radioactivity are high. Sometimes this requires a stay in hospital for a few days in a special room but other times, this treatment can be given as an outpatient.

Possible pregnancy

Women of childbearing age will be asked whether they could be pregnant. X-rays given during pregnancy could harm a baby. A pregnancy test will be performed if it is possible that you are pregnant.