Radiation Therapy in Delhi, India

Radiation therapy, also known as radiotherapy, is a type of cancer treatment that uses high energy X rays to kill cancer cells. It works by damaging the DNA of cancer cells, preventing them from dividing and growing. It may be used as a standalone treatment for certain types of cancer, or be combined with other treatments such as chemotherapy or surgery, depending on the specific circumstances of the cancer and the patient's health. The decision on the treatment approach is typically made by a multidisciplinary team of healthcare professionals based on the type and stage of cancer, as well as the overall health of the patient.

There are two main types of radiation therapy:

1. External beam radiation therapy (EBRT)
2. Internal radiation therapy (brachytherapy)

External Beam Radiation Therapy (EBRT)

This is the most common type of radiation therapy. In EBRT, high-energy radiation is delivered to the tumour from a machine outside the body. The machine helps in shaping the radiation beam to direct it precisely at the tumour while minimising exposure to healthy tissues. Subtypes of EBRT:

• 3D Conformal Radiation Therapy (3D-CRT): Uses 3D images of the tumour to shape the radiation beam.
• Intensity-modulated Radiation Therapy (IMRT): Uses multiple beams of radiation with varying intensities to conform more closely to the shape of the tumour.
• Image Guided Radiation Therapy (IGRT): The therapy involves taking images during radiation treatment. Doctors use these images, taken right before and during treatment, to position the radiation as accurately as possible by comparing them to pre-treatment images.
• Respiratory Gating or Deep Inspiration Breath Hold: These are specialised techniques where radiation is delivered only at certain specified points during a patient breathing cycle to spare the underlying lung and heart. It is specially used in left sided breast cancer, lung cancer etc.
• Stereotactic Body Radiation Therapy (SBRT): Delivers high doses of radiation in a few, precisely targeted treatments.
• Proton Beam Therapy: Uses protons instead of X-rays to deliver radiation, which can reduce the dose to healthy tissues surrounding the tumour.

Internal Radiation Therapy

In internal radiation therapy, also known as brachytherapy, a radioactive material is placed inside the body, either directly in the tumour or in nearby tissues. This allows for a very high dose of radiation to be delivered to the tumour while minimising exposure to healthy tissues.

There are three main types of internal radiation therapy:

1. Permanent Implants: In this type of internal radiation therapy, tiny steel seeds containing radioactive material, about the size of a grain of rice, are implanted near the tumour. They deliver the majority of their radiation to the surrounding area, with minimum radiation to the surrounding healthy tissues. The implants gradually lose their radioactivity over time and remain inert within the body.
2. Temporary Internal Radiation: This type of radiation therapy can be administered via needles or tubes like specialised applicators called catheters placed near the tumour. These catheters are then connected to the radiation machine from which the radiation sources then pass through these catheters inside the patients’ body, deliver the prescribed dose of radiation and are then retracted back into the machine after which the catheters are also removed. While most patients receive temporary internal radiation for only a few minutes, in certain circumstances, the duration may be extended.
3. Intraoperative radiation therapy (IORT): IORT delivers a concentrated dose of radiation directly to a tumour site during surgery, minimising exposure to surrounding healthy tissues and enhancing the effectiveness of treatment. The specific type of radiation therapy that is best for a patient will depend on the type of cancer they have, the size and location of the tumour, and their overall health.

The goals of radiation therapy, also known as radiotherapy, can vary depending on the specific circumstances of the patient and the type of cancer being treated. The specific goals are determined by factors such as the type and stage of cancer, the overall health of the patient, and the treatment plan developed by a multidisciplinary team of healthcare professionals. The ultimate aim is to tailor the treatment to the individual patient's needs with the best possible outcome in terms of cancer control and overall well-being. However, common goals include:

• Cure: In some cases, especially for early-stage cancers, the goal of radiation therapy is to cure the patient by eradicating the cancer completely. This is often achieved through a combination of treatments, including surgery, chemotherapy, and radiation therapy.
• Tumour Control: The primary objective is to target and destroy cancer cells or shrink tumours. Radiation therapy aims to reduce or eliminate cancerous cells, preventing their ability to grow and divide.
• Neoadjuvant Therapy: In some cases, radiation therapy is administered before surgery to shrink tumours, making them more manageable for surgical removal.
• Adjuvant Therapy: Radiation therapy is often used as adjuvant therapy following surgery to eliminate any remaining cancer cells and reduce the risk of recurrence.
• Preservation of Organ Function: In cases where the cancer is located near critical organs, radiation therapy may be used to preserve the function of those organs while treating the cancer.
• Palliation: In advanced stages of cancer or cases where a cure may not be possible, radiation therapy is used to alleviate symptoms and improve the patient's quality of life. This is known as palliative care.

Radiation therapy is a common treatment for cancer, but it does have some potential side effects, which can be divided into two categories: Early side effects and Late side effects.

Early side effects are those that occur during or shortly after treatment. They are typically caused by damage to healthy cells in the area being treated. However, these are temporary and will last only a few days or weeks before getting back to normal again.

The most common early side effects Include:

• Fatigue: This is the most common side effect of radiation therapy and can range from mild to severe. It is usually worse during the first few weeks of treatment and improves gradually afterwards.
• Skin Changes: The skin in the area being treated may become red, dry, itchy, or sore. It may also blister or peel.
• Nausea, Vomiting and Loose Motions: These side effects are more common with radiation therapy to the abdomen or pelvis. They can be managed with medication.
• Mouth and Throat Problems: Radiation therapy to the head and neck can cause mouth sores, dry mouth, and difficulty swallowing. These side effects can be managed with medication and special mouth rinses.
• Hair Loss: Hair loss can occur in the area being treated, but it usually grows back after treatment is finished.

Late side effects are those that occur months or even years after treatment. They are caused by long-term damage to healthy cells. The risk of late side effects depends on the dose of radiation received and the area being treated.

Some of the possible late side effects include:

• Cardiovascular Problems: Radiation therapy to the chest can increase the risk of heart disease, stroke, and other cardiovascular problems.
• Lung Problems: Radiation therapy to the chest can also increase the risk of lung problems, such as pneumonia and fibrosis.
• Secondary Cancers: Radiation therapy can increase the risk of developing a new cancer later in life.
• Infertility: Radiation therapy to the reproductive organs can cause infertility.

The risks of radiation therapy should be weighed against the potential benefits of treatment and can be considerably reduced with planning using newer radiation techniques. It is important to talk to your doctor about the specific risks and benefits of radiation therapy for your individual case.

The radiation therapy procedure involves a thorough planning process before the actual treatment begins.

Before Radiation Therapy

During treatment planning, the patient undergoes immobilisation process where a mask/mould is made customised to the patient's body shape and size. With this mask/mould on, then a CT scan with or without contrast is then taken in the treatment position. This scan is then transferred to the treatment planning system and fused with the previous diagnostic scans with the help of which the doctor then draws the tumour and areas to the treated as well as the areas or organs to be spared. According to the prescribed doses, the medical physicists then plan and place the radiation beam and multiple individualised plans are made. They are then evaluated by the doctor and the best one is finalised and transferred to the machine for delivery. Every radiation plan then undergoes quality assurance testing before final delivery on patients.

During Radiation Therapy

During radiation therapy sessions, patients lie on a treatment table with the mask /mould on and is set in position according to the plan finalised. An image either X ray or CT scan is then taken to verify that the plan is accurate and precise before delivering radiation to the predetermined target areas. The actual treatment is painless, and the radiation therapist closely monitors the process from an adjacent room. At least once every week the patient will review with the doctor in OPD to monitor clinical side effects if any and supportive care is provided to manage those symptoms.

After Radiation Therapy

After completing the prescribed course of radiation therapy, patients will have follow-up appointments to monitor their recovery and assess treatment effectiveness. Regular check-ups and imaging studies are conducted to track the progress and address any potential concerns. Patients are encouraged to communicate openly with their healthcare team to address any post treatment questions or issues.

Q. Is Radiation therapy a painful procedure?

No, radiation therapy is a completely painless and non-invasive procedure per se , however one may experience some discomfort due to some side effects during the later weeks of treatment. Fortunately, these side effects are typically mild and can be managed effectively with medication.

Q. How safe is Radiation therapy?

Radiation therapy is a safe and effective treatment for many types of cancer. It is carefully controlled by radiation oncologists and medical physicists to ensure that you receive the correct dose of radiation to the target area while minimising the risk of side effects.

Q. Is Radiation therapy more harmful than Chemotherapy? 

Both radiation therapy and chemotherapy can have side effects, but they are different types of treatments with different risks and benefits. Radiation therapy is more likely to cause localised side effects, such as skin irritation or fatigue, while chemotherapy is more likely to cause systemic side effects, such as nausea, vomiting, and hair loss. The best treatment for you will depend on your individual type and stage of cancer.

Q. What are the pros and cons of Radiation therapy?

Pros:

• Effective treatment for many types of cancer.
• Can be used to cure cancer, shrink tumours, or relieve symptoms.
• Non-invasive treatment.
• Delivers targeted radiation precisely to specific areas.
• Can be combined with other treatments, such as surgery or chemotherapy.

Cons:

• Can cause side effects, such as fatigue, skin irritation, nausea, and hair loss.
• Not suitable for all types of cancer.
• Usually requires multiple sessions with an overall prolonged treatment course.

Q. What’s the chance of cancer coming back after Radiation therapy?

The chance of cancer coming back after radiation therapy depends on several factors, including the type and stage of cancer, the dose of radiation received, and other treatments received. Your doctor can give you a more accurate estimate of your individual risk.

Q. What type of Radiation therapy is best for cancer treatment?

The best type of radiation therapy for you will depend on your individual type and stage of cancer, as well as your overall health. There are several types of radiation therapy available, each with its own advantages and disadvantages. Your doctor will discuss the different options with you and help you choose the best one for your needs.

Q. How long does a session of Radiation therapy take?

A session of radiation therapy typically lasts 15 to 30 minutes which includes patient set up imaging, radiation delivery etc., however the actual radiation delivery takes just a few minutes. The overall treatment course may span several weeks, depending on the specific treatment plan.

Q. What types of cancer does Radiation therapy treat?

Radiation therapy has a role in treatment of most of the cancers with different aims at different stages. The most common one are :

• Breast cancer
• Prostate cancer
• Lung cancer
• Brain cancer
• Head and neck cancer
• Rectal and anal cancers
• Skin cancer
• Cervical and uterine cancer
• Lymphoma
• Liver cancers

Q. How often will I get radiation treatments?

The number of radiation treatments you will receive depends on your individual type and stage of cancer, as well as the type of radiation therapy you are receiving. Some people receive treatment every day for several weeks, while others receive treatment less frequently. Your doctor will develop a treatment plan that is right for you.

Q. Who gives Radiation therapy treatments?

Radiation therapy treatments are given by a team of healthcare professionals, including:

• Radiation Oncologists: These are doctors who specialise in using radiation to treat cancer. They will develop your treatment plan and oversee your care.
• Medical Physicists: These are scientists who help in treatment planning, ensure that the radiation therapy machine is working properly and that you are receiving the correct dose of radiation.
• Radiation Therapists: These are healthcare professionals who operate the radiation therapy machine and deliver the treatment to you.

Q. How safe is Radiation therapy for patients and their families?

Radiation therapy treatments generally pose no risk to family members as there is no residual radiation in the patient's body once the patient is out of the machine room.

Reviewed by Dr. Priyanka Singh, Senior Consultant - Radiation Oncology, Cancer Care / Oncology, Gastrointestinal & Hepatobiliary Oncology, Uro-Oncology, Paediatric (Ped) Oncology on 19 Jan 24.