What is radiation therapy. How does radiation therapy work to treat cancer. What are the goals of radiation therapy. Which types of cancer can be treated with radiation therapy. What are the different types of external-beam radiation therapy. How is three-dimensional conformal radiation therapy (3D-CRT) performed. What are the benefits of intensity modulated radiation therapy (IMRT).

Understanding Radiation Therapy: A Powerful Cancer Treatment

Radiation therapy is a crucial component in the fight against cancer, utilizing high-energy x-rays or other particles to target and destroy cancer cells. This treatment is administered by a radiation oncologist, a medical professional specializing in using radiation to combat cancer. Typically, radiation therapy follows a specific regimen, consisting of a predetermined number of treatments over a set period.

Can radiation therapy be used for all types of cancer? While it is effective for many cancer types, its application depends on various factors. Radiation therapy can be used as a standalone treatment or in combination with other cancer-fighting methods such as chemotherapy and surgery.

The Science Behind Radiation Therapy’s Cancer-Fighting Abilities

To understand how radiation therapy works, we must first grasp the nature of cancer itself. Cancer occurs when healthy cells undergo abnormal changes, leading to uncontrolled growth and division. These cancer cells multiply at a much faster rate than normal cells.

How does radiation therapy combat this rapid cell growth? Radiation therapy targets the DNA of cancer cells, causing damage that prevents them from growing or ultimately leads to their destruction. Unlike some systemic treatments that affect the entire body, radiation therapy is typically a localized treatment, focusing on the specific area where cancer is present.

Is there a risk to healthy tissues during radiation therapy? While some healthy tissue near the cancer cells may be affected during treatment, it usually recovers once the therapy is completed. This targeted approach is one of the key advantages of radiation therapy in cancer treatment.

Goals and Applications of Radiation Therapy in Cancer Treatment

The objectives of radiation therapy can vary depending on the type of cancer, its stage, and its spread. Here are some of the primary goals:

• Primary Treatment: In many cases, radiation therapy aims to eliminate all cancer cells and prevent recurrence.
• Neoadjuvant Therapy: Radiation can be used before other treatments to shrink tumors, making subsequent interventions more effective.
• Adjuvant Therapy: After other treatments, radiation therapy can destroy any remaining cancer cells.
• Palliative Care: Radiation therapy can alleviate symptoms and improve quality of life for patients with advanced cancer.

How widely is radiation therapy used in cancer treatment? More than half of all cancer patients receive some form of radiation therapy during their treatment journey. Its versatility allows it to be effective for various cancer types, including recurrent and metastatic cancers.

External-Beam Radiation Therapy: The Most Common Approach

External-beam radiation therapy is the most frequently used form of radiation treatment. This method delivers radiation from a machine outside the body, allowing for the treatment of large areas if necessary.

What equipment is used in external-beam radiation therapy? The primary device used is a linear accelerator, or linac, which generates the radiation beam for x-ray or photon radiation therapy. Advanced computer software adjusts the beam’s size and shape, ensuring precise targeting of the tumor while minimizing damage to surrounding healthy tissue.

How often are radiation therapy treatments administered? Most radiation therapy regimens involve daily treatments on weekdays for several weeks. For treatments targeting the head, neck, or brain, custom-fitted supports or mesh masks may be used to ensure the patient remains still and the radiation beam consistently reaches the intended area.

Three-Dimensional Conformal Radiation Therapy (3D-CRT): Precision in Treatment

Three-dimensional conformal radiation therapy (3D-CRT) represents a significant advancement in radiation treatment technology. This method utilizes detailed 3D images of the cancer, created from CT or MRI scans, to precisely aim the radiation beam.

What are the advantages of 3D-CRT? By using these detailed images, the treatment team can administer higher doses of radiation therapy while reducing damage to healthy tissue. This increased precision leads to a lower risk of side effects, improving the overall treatment experience for patients.

The Process of 3D-CRT

1. Image Acquisition: Detailed CT or MRI scans are taken to create a 3D model of the tumor and surrounding tissues.
2. Treatment Planning: Radiation oncologists use these images to design a treatment plan that maximizes radiation delivery to the tumor while sparing healthy tissue.
3. Beam Shaping: The radiation beam is shaped to match the tumor’s contours, often using multi-leaf collimators.
4. Treatment Delivery: The shaped beam is delivered from multiple angles, concentrating the radiation dose on the tumor.

Intensity Modulated Radiation Therapy (IMRT): Advanced Precision in Cancer Treatment

Intensity modulated radiation therapy (IMRT) represents a more sophisticated form of radiation therapy compared to conventional 3D-CRT. The key difference lies in its ability to vary the intensity of the radiation beam.

How does IMRT improve upon conventional radiation therapy? By modulating the intensity of the radiation, IMRT can deliver a more precise dose to the tumor while further reducing exposure to healthy tissues. This enhanced targeting capability allows for potentially higher doses to be delivered to the tumor, potentially improving treatment outcomes.

Key Benefits of IMRT

• Improved Dose Distribution: IMRT can create complex dose distributions that conform more precisely to the tumor shape.
• Reduced Side Effects: By minimizing radiation exposure to healthy tissues, IMRT can lead to fewer and less severe side effects.
• Dose Escalation: The precision of IMRT may allow for higher doses to be delivered to the tumor, potentially increasing the likelihood of tumor control.
• Adaptability: IMRT can be adapted to treat complex tumor shapes and locations that may be challenging for conventional radiation therapy.

Proton Beam Therapy: Cutting-Edge Precision in Radiation Treatment

Proton beam therapy represents one of the most advanced forms of radiation therapy available today. Unlike traditional x-ray based treatments, proton beam therapy uses positively charged particles called protons to target and destroy cancer cells.

What makes proton beam therapy unique? The key advantage of proton therapy lies in its ability to deliver a specific dose of radiation to the targeted tumor with minimal radiation exposure beyond the tumor site. This characteristic is particularly beneficial when treating tumors near sensitive organs or in pediatric patients where minimizing radiation exposure is crucial.

The Proton Beam Therapy Process

1. Proton Acceleration: Protons are accelerated to high energies using a particle accelerator.
2. Beam Focusing: The proton beam is precisely focused on the tumor using powerful magnets.
3. Energy Modulation: The energy of the protons is adjusted to control how deep they penetrate into the body.
4. Treatment Delivery: The protons deposit most of their energy at a specific depth, known as the Bragg peak, which is aligned with the tumor location.

Are there specific types of cancer that benefit most from proton therapy? While proton therapy can be used for various cancer types, it is particularly advantageous for tumors in sensitive areas such as the brain, spine, or near the heart. It’s also often preferred for pediatric cancers to minimize long-term side effects from radiation exposure.

Emerging Trends and Future Directions in Radiation Therapy

The field of radiation therapy continues to evolve rapidly, with new technologies and techniques emerging to improve treatment efficacy and patient outcomes. Some of the exciting developments in radiation therapy include:

• Adaptive Radiation Therapy: This approach involves modifying the treatment plan based on changes in tumor size or patient anatomy during the course of treatment.
• Image-Guided Radiation Therapy (IGRT): IGRT uses frequent imaging during treatment to ensure precise targeting of the tumor, accounting for organ motion and setup variations.
• Stereotactic Body Radiation Therapy (SBRT): This technique delivers very high doses of radiation to small, well-defined tumors in a small number of treatment sessions.
• Combination Therapies: Research is ongoing into combining radiation therapy with immunotherapy or targeted drugs to enhance treatment effectiveness.

How might these advancements shape the future of cancer treatment? As these technologies continue to develop, we can expect to see more personalized and effective radiation treatments with fewer side effects. This could lead to improved cure rates and better quality of life for cancer patients undergoing treatment.

The Role of Artificial Intelligence in Radiation Therapy

Artificial intelligence (AI) is poised to play a significant role in the future of radiation therapy. AI algorithms can assist in treatment planning, image analysis, and predicting treatment outcomes. Some potential applications include:

• Automated Contouring: AI can help in accurately delineating tumor boundaries and organs at risk, saving time and improving consistency.
• Treatment Plan Optimization: AI algorithms can generate and evaluate multiple treatment plans to find the optimal approach for each patient.
• Predictive Models: AI can analyze vast amounts of patient data to predict treatment outcomes and potential side effects, helping in personalized treatment decisions.

Will AI replace radiation oncologists? While AI will certainly enhance the capabilities of radiation therapy, it is unlikely to replace the expertise and judgment of trained medical professionals. Instead, AI is expected to serve as a powerful tool to assist radiation oncologists in delivering more precise and effective treatments.

Patient Experience and Side Effect Management in Radiation Therapy

While radiation therapy is a powerful tool in cancer treatment, it’s important to consider the patient experience and potential side effects. Understanding these aspects can help patients and their caregivers better prepare for treatment.

Common Side Effects of Radiation Therapy

Side effects can vary depending on the treatment area and dose, but some common ones include:

• Fatigue: Many patients experience tiredness during and after treatment.
• Skin Changes: The treated area may become red, irritated, or dry.
• Hair Loss: This typically occurs only in the treatment area.
• Nausea: More common when treating areas near the stomach or abdomen.
• Changes in Appetite: Some patients may experience loss of appetite or changes in taste.

How can patients manage these side effects? Healthcare teams typically provide guidance on managing side effects, which may include medications, dietary changes, and self-care techniques. It’s crucial for patients to communicate any side effects they experience to their treatment team.

Quality of Life Considerations

Radiation therapy can impact a patient’s quality of life during treatment. Some considerations include:

• Treatment Schedule: Daily treatments can be time-consuming and may require adjustments to work or family schedules.
• Emotional Impact: Dealing with cancer and its treatment can be emotionally challenging. Many centers offer psychological support services.
• Long-term Effects: While most side effects resolve after treatment, some patients may experience long-term effects that require ongoing management.

How can patients maintain their quality of life during radiation therapy? Maintaining a healthy lifestyle, seeking support from family and friends, and utilizing available support services can help patients cope with the challenges of treatment. Many cancer centers also offer complementary therapies such as acupuncture or massage to help manage side effects and improve well-being.

The Multidisciplinary Approach to Radiation Therapy

Effective radiation therapy often involves a team of healthcare professionals working together to provide comprehensive care. This multidisciplinary approach ensures that all aspects of a patient’s treatment and well-being are addressed.

Key Members of the Radiation Therapy Team

• Radiation Oncologist: The physician who oversees the radiation therapy treatment.
• Medical Physicist: Ensures the accurate delivery of radiation and maintains equipment.
• Dosimetrist: Calculates the precise radiation doses for treatment.
• Radiation Therapist: Operates the treatment machines and positions patients for treatment.
• Oncology Nurse: Provides patient care and education throughout the treatment process.
• Nutritionist: Helps manage dietary needs and concerns during treatment.
• Social Worker: Offers emotional support and helps with practical concerns.

How does this team approach benefit patients? By bringing together experts from various fields, the multidisciplinary approach ensures that all aspects of a patient’s care are coordinated and optimized. This can lead to better treatment outcomes and improved quality of life for patients undergoing radiation therapy.

The Role of Clinical Trials in Advancing Radiation Therapy

Clinical trials play a crucial role in advancing radiation therapy techniques and technologies. These research studies help to:

• Develop new treatment approaches
• Improve existing techniques
• Evaluate the effectiveness of combining radiation with other therapies
• Assess ways to reduce side effects and improve quality of life

Should patients consider participating in clinical trials? For some patients, participating in a clinical trial may provide access to cutting-edge treatments not yet widely available. However, the decision to participate should be made in consultation with the healthcare team, considering the potential benefits and risks.

What is Radiation Therapy? | Cancer.Net

Radiation therapy is a cancer treatment that uses high-energy x-ray or other particles to destroy cancer cells. A doctor who specializes in giving radiation therapy to treat cancer is called a radiation oncologist. A radiation therapy regimen, or schedule, usually consists of a specific number of treatments given over a set period.

Radiation therapy can treat many different types of cancer. It can also be used in combination with other cancer treatments, such as chemotherapy and/or surgery.

This article provides a general overview of radiation therapy, the different types of radiation therapy, and why it is used to treat cancer. Learn more about what to expect when having radiation therapy and the side effects of radiation therapy.

How does radiation therapy treat cancer?

Cancer begins when healthy cells change and grow out of control. All cells in the body go through a cycle to grow, divide, and multiply. Cancer cells go through this process faster than normal cells. Radiation therapy damages cell DNA so the cells stop growing or are destroyed.

Unlike other cancer treatments affect the whole body, such as chemotherapy, radiation therapy is usually a local treatment. This means it generally affects only the part of the body where the cancer is located. Some healthy tissue near the cancer cells may be damaged during the treatment, but it usually heals after treatment ends.

There are many different types of radiation therapy, and they all work a little bit differently to destroy cancer cells.

What are the goals of radiation therapy?

The goals of radiation therapy depend on your type of cancer and if and how far it has spread. Radiation therapy can be given alone or as a part of a treatment plan that includes different treatments. Some of the ways radiation therapy is used include:

As the primary treatment. Often, the goal of radiation therapy is to get rid of all the cancer and keep it from coming back.

Before other treatments. Radiation therapy can be given before other treatments, such as surgery, to shrink a large tumor. This is called “neoadjuvant radiation therapy.”

After other treatments. Radiation therapy can be given after other kinds of treatments to destroy any remaining cancer cells. This is called “adjuvant radiation therapy.”

To relieve symptoms. Radiation therapy can be used to relieve the signs and symptoms of cancer. This is called “palliative radiation therapy.”

Radiation therapy can be used to treat many different types of cancer. More than half of people with cancer will receive some type of radiation therapy. For some cancers, radiation therapy alone is an effective treatment. Other types of cancer respond best to a combination of treatments. Radiation therapy can also be used to treat recurrent cancer and metastatic cancer. Recurrent cancer is cancer that comes back after treatment. Metastatic cancer is cancer that has spread to other parts of the body.

What are the types of external-beam radiation therapy?

The most common type of radiation therapy is external-beam radiation therapy. It delivers radiation from a machine outside the body. It can be used to treat large areas of the body, if needed.

A machine called a linear accelerator, or linac, creates the radiation beam for x-ray or photon radiation therapy. Special computer software adjusts the beam’s size and shape. This helps target the tumor while avoiding healthy tissue nearby.

Most radiation therapy treatments are given every weekday for several weeks. Form-fitting supports or a plastic mesh mask are used for radiation therapy to the head, neck, or brain to help people stay still and make sure the beam reaches the same area each session.

The different types of external-beam radiation therapy are:

• Three-dimensional conformal radiation therapy (3D-CRT). During this type of radiation therapy, detailed 3-dimensional pictures of the cancer are created from computed tomography (CT) or magnetic resonance imaging (MRI) scans. The treatment team uses these images to aim the beam. With this technique, the treatment team can safely use higher doses of radiation therapy and reduce damage to healthy tissue. This lowers the risk of side effects.

• Intensity modulated radiation therapy (IMRT). This is a more complex form of radiation therapy. With IMRT, the intensity of the radiation is varied. This is different than conventional 3D-CRT, which uses the same intensity with each beam. IMRT targets the tumor and avoids healthy tissue better than conventional 3D-CRT.

• Proton beam therapy. This treatment uses protons rather than x-rays. A proton is a positively charged particle. At high energy, protons can destroy cancer cells. The protons go to the targeted tumor and deposit a specific dose of radiation therapy. Unlike x-ray beams, very little radiation dose goes beyond the tumor with proton therapy. This limits damage to nearby tissue. Proton therapy is a relatively new treatment that requires special equipment. It is currently only used to treat certain types of cancer. Learn more about proton therapy.

• Image-guided radiation therapy (IGRT). IGRT uses imaging during radiation treatment. Images are taken right before and during treatment and compared to imaging taken before treatment began. This helps doctors position the radiation as precisely as possible.

• Stereotactic radiation therapy (SRT). This treatment delivers a large, precise dose to a small tumor area. The patient must remain very still. A head frame or individual body molds help limit movement. SRT is often given as a single treatment or in fewer than 10 treatments. Some people may need more than one course of SRT.

What is internal radiation therapy?

Internal radiation therapy is also called brachytherapy. This type of radiation therapy is when radioactive material is placed into the cancer or surrounding tissue. Implants may be permanent or temporary. This treatment may require a hospital stay.

The different types of internal radiation therapy include:

• Permanent implants. These are tiny steel seeds that contain radioactive material. The capsules are about the size of a grain of rice. They deliver most of the radiation therapy around the implant area. However, some radiation may exit the patient’s body. This requires safety measures to protect others from radiation exposure. Over time, the implants lose radioactivity. The inactive seeds remain the body.

• Temporary internal radiation therapy. This type of radiation therapy can be given by needle, through a tube called a catheter, and through special applicators. The radiation stays in the body for anywhere from a few minutes to a few days. Most people receive internal radiation therapy for just a few minutes. Sometimes, internal radiation therapy can be given for more time. If so, they stay in a private room to limit other people’s exposure to radiation.

What are the other radiation therapy treatment options?

Other radiation therapy treatment options include:

• Intraoperative radiation therapy (IORT). This treatment delivers radiation therapy to the tumor during surgery using either external-beam or internal-beam radiation therapy. IORT allows surgeons to move healthy tissue out of the way so that it does not get damaged during the radiation therapy. This treatment is useful when vital organs are close to the tumor.

• Systemic radiation therapy. Patients swallow or receive an injection of radioactive material that targets cancer cells. The radioactive material leaves the body through urine, saliva, and sweat. These fluids are radioactive, and people in close contact with the patient should take the safety measures recommended by the health care team (see below). An example of systemic radiation therapy is radioactive iodine therapy (RAI; I-131) for thyroid cancer.

• Radioimmunotherapy. This is a type of systemic therapy. Specifically, it uses monoclonal antibodies, which are proteins that are attracted to very specific markers on the outside of cancer cells, to deliver radiation directly to the tumors. Because the treatment uses these special antibodies, there is less effect on the surrounding normal tissue. An example is ibritumomab (Zevalin), which is used in the treatment of some lymphomas.

• Radiosensitizers and radioprotectors. Researchers are studying radiosensitizers and radioprotectors. Radiosensitizers are substances that help radiation therapy better destroy tumors. Radioprotectors are substances that protect healthy tissues near the treatment area. Examples of radiosensitizers include fluorouracil (5-FU, Adrucil) and cisplatin (Platinol). Amifostine (Ethyol) is an example of a radioprotector.

Is radiation therapy safe for patients and their families?

Doctors have safely and effectively used radiation therapy to treat cancer for more than 100 years.

Like other cancer treatments, radiation therapy causes side effects. Talk with your health care team about what to expect and what you are experiencing during and after your treatment. While most people feel no pain when each treatment is being delivered, effects of treatment slowly build up over time and may include discomfort, skin changes, or other side effects, depending on where in the body treatment is being delivered.

Having radiation therapy slightly increases the risk of developing a second cancer later in life. But for many people, radiation therapy eliminates the existing cancer. This benefit is greater than the small risk that the treatment could cause a new cancer in the future.

During external-beam radiation therapy, the patient does not give off any radiation after treatment sessions. Any radiation remains in the the treatment room.

However, internal radiation therapy causes the patient to give off radiation. As a result, visitors should follow these safety measures, unless other directions are given by the patient’s doctor:

• Do not visit the patient if you are pregnant or younger than 18

• Stay at least 6 feet from the patient’s bed

• Limit your stay to 30 minutes or less each day

Permanent implants remain radioactive after the patient leaves the hospital. Because of this, for 2 months, the patient should not have more than 5 minutes of contact with children or pregnant people.

Similarly, people who are treated with systemic radiation therapy should follow safety precautions. Here are some common safety measures for the first few days after treatment. Be sure to talk with your health care team about specific instructions about your treatment.

• Wash your hands thoroughly after using the toilet

• Use separate utensils and towels

• Drink plenty of fluids to flush the remaining radioactive material from the body

• Avoid sexual activity

• Try to avoid contact with infants, children, and pregnant people

Questions to ask the health care team

Consider asking your health care team these questions if radiation therapy is recommended as part of your cancer treatment plan:

• What type of radiation therapy is recommended for me? Why?

• What is the goal of having radiation therapy? Is it to eliminate the cancer, help me feel better, or both?

• How long will it take to have this treatment? How often will I have radiation therapy?

• Will I need to get a mesh mask or support made before my treatment begins? Can you describe this process?

• Where will I receive radiation therapy?

• What short-term side effects can I expect during radiation therapy?

• What can be done to relieve side effects I experience?

• Who should I talk with about any side effects I experience? How soon?

• How will this treatment affect my daily life? Will I be able to work, exercise, and perform my usual activities?

• What are the possible long-term side effects of this type of radiation therapy?

• Whom should I call with questions or problems?

• How can I reach them during regular office hours? After hours?

• If I’m very worried or anxious about having this treatment, what can I talk with?

• If I’m worried about managing the cost of this treatment, who can help me?

• Will special precautions be needed to protect my family and others from radiation therapy I receive?

• Will I receive other cancer treatments in addition to radiation therapy?

• When will we know if this treatment was successful? How?

Related Resources

What to Expect When Having Radiation Therapy

Side Effects of Radiation Therapy

Making Decisions About Cancer Treatment

More Information

National Cancer Institute (NCI): Brachytherapy to Treat Cancer

NCI: External Beam Radiation Therapy for Cancer

RadiologyInfo. org: Introduction to Cancer Therapy (Radiation Oncology)

RTAnswers.org: How Does Radiation Therapy Work

Radiation Therapy for Prostate Cancer

Radiation therapy uses high-energy rays or particles to kill cancer cells. Depending on the stage of the prostate cancer and other factors, radiation therapy might be used:

• As the first treatment for cancer that is still just in the prostate gland and is low grade. Cure rates for men with these types of cancers are about the same as those for men treated with radical prostatectomy.
• As part of the first treatment (along with hormone therapy) for cancers that have grown outside the prostate gland and into nearby tissues.
• If the cancer is not removed completely or comes back (recurs) in the area of the prostate after surgery.
• If the cancer is advanced, to help keep the cancer under control for as long as possible and to help prevent or relieve symptoms.

Types of radiation therapy

The main types of radiation therapy used for prostate cancer are:

• External beam radiation
• Brachytherapy (internal radiation)
• Radiopharmaceuticals (medicines containing radiation that are injected into the body)

External beam radiation therapy (EBRT)

In EBRT, beams of radiation are focused on the prostate gland from a machine outside the body. This type of radiation can be used to try to cure earlier stage cancers, or to help relieve symptoms such as bone pain if the cancer has spread to a specific area of bone.

You will usually go for treatment 5 days a week in an outpatient center for at least several weeks, depending on why the radiation is being given. Each treatment is much like getting an x-ray. The radiation is stronger than that used for an x-ray, but the procedure typically is painless. Each treatment lasts only a few minutes, although the setup time — getting you into place for treatment — takes longer.

Newer EBRT techniques focus the radiation more precisely on the tumor. This lets doctors give higher doses of radiation to the tumor while reducing the radiation exposure to nearby healthy tissues.

Three-dimensional conformal radiation therapy (3D-CRT)

3D-CRT uses special computers to precisely map the location of your prostate. Radiation beams are then shaped and aimed at the prostate from several directions, which makes it less likely to damage surrounding normal tissues and organs.

Intensity modulated radiation therapy (IMRT)

IMRT, an advanced form of 3D-CRT therapy, is the most common type of external beam radiation therapy for prostate cancer. It uses a computer-driven machine that moves around the patient as it delivers radiation. Along with shaping the beams and aiming them at the prostate from several angles, the intensity (strength) of the beams can be adjusted to limit the doses of radiation reaching nearby normal tissues. This lets doctors deliver an even higher radiation dose to the cancer.

Some newer radiation machines have imaging scanners built into them. This advance, known as image guided radiation therapy (IGRT), lets the doctor take pictures of the prostate just before giving the radiation to make minor adjustments in aiming. This appears to help deliver the radiation even more precisely and results in fewer side effects.

A variation of IMRT is called volumetric modulated arc therapy (VMAT). It uses a machine that delivers radiation quickly as it rotates once around the body. This allows each treatment to be given over just a few minutes. Although this can be more convenient for the patient, it hasn’t yet been shown to be more effective than regular IMRT.

Stereotactic body radiation therapy (SBRT)

This technique uses advanced image guided techniques to deliver large doses of radiation to a precise area, such as the prostate. Because there are large doses of radiation in each dose, the entire course of treatment is given over just a few days.

SBRT is often known by the names of the machines that deliver the radiation, such as Gamma Knife, X-Knife, CyberKnife, and Clinac.

The main advantage of SBRT over IMRT is that the treatment takes less time (days instead of weeks). The side effects, though, are not better. In fact, some research has shown that some side effects might actually be worse with SBRT than with IMRT.

MRI-guided radiation therapy

This approach combines some features of IMRT, IGRT, and SBRT therapies into one. It is done with a machine known as an MRI-linac, which combines an MRI scanner with a linear accelerator (linac, the machine that delivers the radiation). 

As with other types of IGRT, MRI pictures can be taken before each treatment, so the aim of the radiation can be adjusted to account for any change in the position of the prostate (and the tumor) since the last treatment. 

MRI images can also be taken while the radiation is given. If body functions (like breathing or digestion) cause the tumor to move out of the path of the radiation, the radiation stops until it is aimed correctly again. This can help reduce the amount of radiation to healthy tissues and organs around the tumor.

Proton beam radiation therapy

Proton beam therapy focuses beams of protons instead of x-rays on the cancer. Unlike x-rays, which release energy both before and after they hit their target, protons cause little damage to tissues they pass through and release their energy only after traveling a certain distance. This means that proton beam radiation can, in theory, deliver more radiation to the prostate while doing less damage to nearby normal tissues. Proton beam radiation can be aimed with techniques similar to 3D-CRT and IMRT.

Although in theory proton beam therapy might be more effective than using x-rays, so far studies have not shown if this is true. Proton beam therapy isn’t available everywhere. The machines needed to make protons are very expensive, and they aren’t available in many centers in the United States. Proton beam radiation might not be covered by all insurance companies at this time.

Possible side effects of EBRT

Some of the side effects from EBRT are the same as those from surgery, while others are different.

Bowel problems: Radiation can irritate the rectum and cause a condition called radiation proctitis. This can lead to diarrhea, sometimes with blood in the stool, and rectal leakage. Most of these problems go away over time, but in rare cases normal bowel function does not return. To help lessen bowel problems, you may be told to follow a special diet during radiation therapy to help limit bowel movement during treatment. Sometimes a balloon-like device or gel is put between the rectum and the prostate before treatment to act like a spacer to lessen the amount of radiation that reaches the rectum.

Urinary problems: Radiation can irritate the bladder and lead to a condition called radiation cystitis. You might need to urinate more often, have a burning sensation while you urinate, and/or find blood in your urine. Urinary problems usually improve over time, but in some men they never go away.

Some men develop urinary incontinence after treatment, which means they can’t control their urine or have leakage or dribbling. As described in the surgery section, there are different levels and types of incontinence. Overall, this side effect occurs less often with radiation therapy than after surgery. The risk is low at first, but it goes up each year for several years after treatment.

Rarely, the tube that carries urine from the bladder out of the body (the urethra) may become very narrow or even close off, which is known as a urethral stricture. This might require further treatment to open it up again.

Erection problems, including impotence: After a few years, the impotence rate after radiation is about the same as that after surgery. Problems with erections usually do not occur right after radiation therapy but slowly develop over time. This is different from surgery, where impotence occurs immediately and may get better over time.

As with surgery, the older you are, the more likely it is you will have problems with erections. Erection problems can often be helped by treatments such as those listed in the surgery section, including medicines.

For more about coping with erection problems and other sexuality issues, see Sexuality for the Man With Cancer.

Feeling tired: Radiation therapy can cause fatigue that might not go away until a few weeks or months after treatment stops.

Lymphedema: Lymph nodes normally provide a way for fluid to return to the heart from all areas of the body. If the lymph nodes around the prostate are damaged by radiation, fluid can collect in the legs or genital region over time, causing swelling and pain. Lymphedema can usually be treated with physical therapy, although it may not go away completely. See lymphedema to learn more.

Brachytherapy (internal radiation therapy)

Brachytherapy (also called seed implantation or interstitial radiation therapy) uses small radioactive pellets, or “seeds,” each about the size of a grain of rice. These pellets are placed directly into your prostate.

• Brachytherapy alone is generally used only in men with early-stage prostate cancer that is relatively slow growing (low-grade).
• Brachytherapy combined with external radiation is sometimes an option for men who have a higher risk of the cancer growing outside the prostate.

The use of brachytherapy is also limited by some other factors. For men who have had a transurethral resection of the prostate (TURP) or for those who already have urinary problems, the risk of urinary side effects may be higher. Brachytherapy might not work as well in men with large prostate glands because it might not be possible to place the seeds into all of the correct locations. One way to get around this may be to get a few months of hormone therapy beforehand to shrink the prostate.

Imaging tests such as transrectal ultrasound, CT scans, or MRI are used to help guide the placement of the radioactive pellets. Special computer programs calculate the exact dose of radiation needed.

There are 2 types of prostate brachytherapy. Both are done in an operating room. You will get either spinal anesthesia (where the lower half of your body is numbed) or general anesthesia (where you are asleep), and you might need to stay in the hospital overnight. Either brachytherapy treatment can be used alone or combined with external beam radiation (given at a lower dose than if used by itself).

Permanent (low dose rate, or LDR) brachytherapy

In this approach, pellets (seeds) of radioactive material (such as iodine-125 or palladium-103) are placed inside thin needles, which are inserted through the skin in the area between the scrotum and anus and into the prostate. The pellets are left in place as the needles are removed and give off low doses of radiation for weeks or months. Radiation from the seeds travels a very short distance, so the seeds can give off a large amount of radiation in a very small area. This limits the amount of damage to nearby healthy tissues.

Usually, around 100 seeds are placed, but this depends on the size of the prostate. Because the seeds are so small, they seldom cause discomfort, and are simply left in place after their radioactive material is used up.

You may also get external beam radiation along with brachytherapy, especially if there is a higher risk that your cancer has spread outside the prostate (for example, if you have a higher Gleason score).

Temporary (high dose rate, or HDR) brachytherapy

This technique is done less often. It leaves higher doses of radiation in place for a short time. Hollow needles are placed through the skin between the scrotum and anus and into the prostate. Soft nylon tubes (catheters) are placed in these needles. The needles are then removed but the catheters stay in place. Radioactive iridium-192 or cesium-137 is then placed in the catheters, usually for 5 to 15 minutes. Generally, about 1 to 4 brief treatments are given over 2 days, and the radioactive substance is removed each time. After the last treatment the catheters are removed. For about a week after treatment, you may have some pain or swelling in the area between your scrotum and rectum, and your urine may be reddish-brown.

Possible risks and side effects of brachytherapy

Radiation precautions: If you get permanent (LDR) brachytherapy, the seeds will give off small amounts of radiation for several weeks or months. Even though the radiation doesn’t travel far, your doctor may advise you to stay away from pregnant women and small children during this time. If you plan on traveling, you might want to get a doctor’s note regarding your treatment, as low levels of radiation can sometimes be picked up by detection systems at airports.

There’s also a small risk that some of the seeds might move (migrate). You may be asked to strain your urine for the first week or so to catch any seeds that might come out. You may be asked to take other precautions as well, such as wearing a condom during sex. Be sure to follow any instructions your doctor gives you. There have also been reports of the seeds moving through the bloodstream to other parts of the body, such as the lungs. As far as doctors can tell, this is uncommon and doesn’t seem to cause any ill effects.

These precautions aren’t needed after HDR brachytherapy, because the radiation doesn’t stay in the body after treatment.

Bowel problems: Brachytherapy can sometimes irritate the rectum and cause a condition called radiation proctitis. Bowel problems such as rectal pain, burning, and/or diarrhea (sometimes with bleeding) can occur, but serious long-term problems are uncommon.

Urinary problems: Severe urinary incontinence (trouble controlling urine) is not a common side effect. But some men have problems with frequent urination or other symptoms due to irritation of the urethra, the tube that drains urine from the bladder. This tends to be worse in the weeks after treatment and gets better over time. Rarely, the urethra may actually close off (known as a urethral stricture) and need to be opened with a catheter or surgery.

Erection problems: Some studies have found rates of erection problems to be lower after brachytherapy, but other studies have found that the rates were no different than with external beam radiation or surgery. The younger you are and the better your sexual function before treatment, the more likely you will be to regain function after treatment.

Erection problems can often be helped by treatments such as those listed in the surgery section, including medicines. For more about coping with erection problems and other sexuality issues, see Sexuality for the Man With Cancer.

Radiopharmaceuticals

Radiopharmaceuticals are drugs that contain radioactive elements. They are injected into a vein and travel through the blood to reach cancer cells that have spread to other parts of the body. These drugs then give off radiation that kills the cancer cells. (The type of radiation they use travels only a short distance, which helps limit side effects.) Unlike other types of radiation, these drugs can reach cancer anywhere in the body.

Radiopharmaceuticals that target PSMA

Prostate-specific membrane antigen (PSMA) is a protein that is often found in large amounts on prostate cancer cells.

Lutetium Lu 177 vipivotide tetraxetan (also known as ¹⁷⁷Lu-PSMA-617 or Pluvicto) is a radiopharmaceutical that attaches to PSMA, bringing radiation directly to the prostate cancer cells.

This drug can be used to treat prostate cancer that has spread and that has already been treated with hormone therapy and chemotherapy. The cancer cells must also have the PSMA protein. Your doctor will order a PSMA PET scan before you get this drug to make sure the cancer cells have PSMA. 

This drug is given as an injection or infusion into a vein (IV), typically once every 6 weeks for up to 6 doses.

Possible side effects

Some of the more common side effects of this drug include:

• Feeling tired
• Dry mouth
• Nausea
• Loss of appetite
• Constipation

This drug can lower blood cell counts:

• A low red blood cell count can cause tiredness, weakness, pale skin, or shortness of breath.
• A low blood platelet count can lead to bleeding or bruising more easily than normal, or bleeding that is hard to stop.
• A low white blood cell count can lead to an increased risk of infections, which might show as a fever, chills, sore throat, or mouth sores.

This drug might damage the kidneys. Your doctor or nurse will likely advise you to drink plenty of fluids and to urinate often before and after getting this drug, to help protect the kidneys. Tell your doctor or nurse if you start to pass less urine than is normal for you.

This drug contains radiation that might stay in your body for several days after treatment, so your health care team will advise you on ways to protect yourself and others. You will likely be advised to drink plenty of fluids and to urinate often to help flush any excess drug from your body and help protect the bladder. You might also be advised to avoid close contact with other people, especially children and pregnant women, for at least a few days after each treatment.

Radiopharmaceuticals that target the bones

Some radiopharmaceuticals are designed to settle in the bones, where they can help treat prostate cancer that has spread there. Radiopharmaceuticals that treat prostate cancer spread to the bones include:

• Strontium-89 (Metastron)
• Samarium-153 (Quadramet)
• Radium-223 (Xofigo)

These drugs are discussed in more detail in Treatments for Prostate Cancer Spread to Bones.

Contagious dead: is it possible to get a dose of radiation from a dead man

https://tj.sputniknews.ru/20190729/radiatsia-mertvets-1029525353.html

Infectious dead: is it possible to get a dose of radiation from a dead man

For different dead: you can Is it possible to get a dose of radiation from a dead person

Doctors from America raise the issue of the need to monitor patients after radiotherapy, because after death they can “irradiate” 29.07.2019, Sputnik Tajikistan

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DUSHANBE, July 29 – Sputnik. American doctors in a research essay drew attention to the problem of radiation exposure from the dead, publishing an article in the Journal of American Medical Association.

The doctors report refers to a case that occurred in 2017. The man, who died two days after being injected with cancer, was cremated.

But the radioactive elements were still in his remains.

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When the staff of the mortuary where the man was cremated learned about his radiotherapy (a method of treatment that uses radiation exposure or drugs containing isotopes), they decided to test the morgue for radiation. And not in vain.

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Experts began to study the building of the morgue with a Geiger counter. And indeed they found a small radiation background.

It seems to be not scary. But there was only one “radioactive dead man”. And if we assume that there were several such “patients” in the morgue?

Further – more interesting. The mortuary worker who sent the corpse to the oven was tested for exposure to radiation. And they also found traces of radioactive elements in his body. Fortunately, no one was hurt.

And this, doctors remind, is only one recorded case.

Life after death: it became known what happens in the afterlife

There is only one conclusion. In all countries, patients undergoing radiotherapy are tightly controlled.

But as soon as the patient dies, all responsibility is shifted to relatives and friends.

With regard to the dead, which contain radiation isotopes in the body, there are simply no clear measures.

Radionuclide therapy and how it works

Nuclear medicine therapy uses radiopharmaceuticals that target specific tumors such as thyroid cancer, lymphomas, or bone metastases. Radiation is delivered to tumor lesions and is part of a therapeutic strategy aimed at curing, alleviating the condition or suppressing tumor growth. Radiopharmaceuticals can be used both for individual targets and for the whole organism.

Tumor as a target

Advances in medical technology have led to a surge in the development and availability of new cancer treatments. Cancer treatment includes various strategies such as chemotherapy, surgery, radiation therapy and more recently targeted therapies such as the use of radionuclide techniques used in nuclear medicine. External radiation therapy using ionizing radiation is the most commonly used type of radiation therapy for cancer patients. In this approach, the primary tumor and a limited area around it are irradiated with high-energy X-rays.

Another treatment option offered for certain types of cancer is the use of targeted radionuclide therapy, based on the administration of radioactive substances to patients. Like chemotherapy, this type of therapy is a systemic treatment that travels through the bloodstream to cells throughout the body. However, unlike chemotherapy, these radioactive substances specifically target diseased cells, thus reducing potential side effects.

Radiopharmaceuticals

Radiopharmaceuticals that form a strong bond with the tumor, also known as carriers with high tumor affinity, are suitable for therapeutic purposes. They can deliver targeted doses of radiation directly to tumors and their metastases, sparing normal healthy tissue. The choice of a molecule that delivers radiation to a tumor is determined by its affinity – or binding ability – for tumor target structures such as antigens or receptors. The ionizing radiation produced by the radionuclides that are bound to the carrier kills the cancer cells by damaging their DNA, which causes the tumors to shrink.

An ideal radiopharmaceutical for therapeutic purposes should:

• act exclusively in malignant tumor cells;
• to reach all cells of malignant tumors in all places of their localization;
• to leave intact healthy tissues and organs, while simultaneously delivering the maximum doses of radiation to the tumor; and
• eliminate cancer cells with great efficiency.

How radionuclide therapy works

The biological effect of a radiopharmaceutical is determined by the type of ionizing radiation produced by the radionuclide. While nuclear medicine imaging procedures require radionuclides that produce γ-radiation (gamma) that can penetrate the human body, radionuclide therapy requires a different class of radionuclides, those that have optimal relative biological effectiveness. For antitumor therapy, radionuclides that produce ionizing radiation with a shallow penetration depth into body tissue, such as α-emitters (alpha) or β-emitters (beta), which release energy near targets, are best suited.