Radiation therapy (also radiotherapy) uses precisely focused, high-energy beams to destroy cancer cells.
Radiation therapy for cancer
Controlled radiation can destroy tumors or affect their growth and spread. Radiation therapy can be used as a stand-alone cancer treatment or in combination with chemotherapy and/or surgery. The X-rays and sometimes protons or beams of other types of energy are usually used in it. They are given from a special machines, similar to those for CT or MRI ones, where a patient is placed, so one can often find this therapy is called external radiation therapy. Radiation therapy can also be delivered internally by placing the radioactive material in the body near the tumor. Such therapy is called brachytherapy.
As with chemotherapy, radiation can be used to shrink the tumor before surgery (neoadjuvant therapy) or after surgery to stop the growth of remaining cancer cells that cannot be removed surgically (adjuvant therapy). In the late stages of cancer, radiation therapy helps to relieve the suffering caused by the disease (for example, in cases where the tumor interferes with drinking and eating).
Medical devices that deliver radioactive rays to the area of the body affected by cancer are called linear accelerators (or linac). They have the built-in imaging equipment so doctors can monitor exactly where the tumor is in the body before and during treatment sessions.
Radiotherapy at the Cancer Center of «Manufactura Clinic» Medical Center
Here in the Cancer center of «Manufactura Clinic» we use the «Elekta Infinity» linear accelerator for IMRT and IGRT therapy by the Elekta company for modern radiation treatment. We've chosen this device for treatment due to its innovative advantages that allow:
- to perform the pre-radiation planning, settings and the irradiation of affected tissues as accurately as possible;
- perform an irradiation session much faster (more than 40% compared to other devices) and in a dynamic mode with the patient's breathing synchronization, applying high-power doses in one operating cycle;
- reduce the dose of non-therapeutic irradiation of the patient's body and ensure high accuracy and efficiency of radiation therapy thanks to the movement of the emitter and its control in real time;
- thanks to improved images from the monitor, a larger dynamic field and special functions, the doctor has the opportunity to see a larger anatomy area in good quality, cover complex and multiple targets, increase the dose and, at the same time, safely reduce the size of the target, for making important clinical decisions during the treatment;
- ensure the most effective therapy even in cases of the complex cases, using special methods of volumetric arc radiation therapy with intensity modulation (VMAT) and radiosurgery (SRS).
The advances of our linac help us to perform radiotherapy sessions in both simple and complex cases of the disease. Thanks to morden techniques of visual control (IGRT) and intensity modulation (IMRT) of irradiation, we provide with the most effective treatment regimens for most types of cancer.
Image-guided radiation therapy
Image-guided radiation therapy (IGRT) uses test images to check the position of the patient and the location of the tumor in the irradiation area before and during the radiation session. The resulting images ensure precise targeting of the radiation exactly on cancerous formations, avoiding exposure to the healthy cells and surrounding tissues during the therapy. This technique does not require anesthesia and has fewer side effects than traditional methods.
IGRT is applied for many types of cancer, including those that develop in the spinal cord, brain, lung, prostate, bladder, esophagus, liver, bone etc.
Intensity Modulated Radiation Therapy
Intensity Modulated Radiation Therapy (IMRT) uses a specialized computer program to calculate and deliver radiation directly to cancer cells at different angles. This is radiation therapy in which the beams are shaped to surround the treatment area. The IMRT delivers higher and more effective radiation doses directly to the tumor. This technology significantly increases the chances of successful treatment and significantly reduces the duration of radiation exposure, as well as the appearance of side effects.
After we get 3D image of the tumor, we perform a complex computer calculation of the amount and the intensity of radioactive doses for the most effective impact. IMRT also calculates the radiation angles and actually delivers these calculated rays during treatment.
The extraordinary advantage of IMRT is that the treating area is affected according to the pre-scanned three-dimensional shape of the tumor, while the radiation beam is changed into several smaller beams where necessary. In this way, the radiation dose is delivered to the tumor as precisely as possible, avoiding the impact on healthy cells, and as powerfully as possible reducing time of therapy sessions.
We use IMRT to treat prostate cancer, head and neck, lung, brain, liver and breast cancer, gastrointestinal cancer, as well as lymphoma, sarcoma, gynecological cancer and some childhood cancers.
Both IMRT and IGRT are powerful tools in the fight against cancer. Our radiation therapists, medical physicists and nurses are trained to treat cancer with the modern IMRT and IGRT technologies of "Synergy Platform" linear accelerator used in our clinic. Our radiation therapists are experts in imaging technologies and ensure precise and safe targeting of the cancerous tumor and avoiding damage to healthy tissue. The radiation therapist works with the medical physicist behind the machine to develop and fine-tune each patient's exposure map. The targeted treatment provided by our linac configuration increases our power of controlling or curing a patient's disease.
How radiation treatment is going on?
Pre-radiation preparation. Radiation therapy courses are designed according to the specific needs of the patient. Before every course, the pre-radiation preparation is needed to be held: with the help of MRI/CT simulators, the part of the body with the diseased organ is scanned. We map the irradiation area, with marks. If it is needed a specialized fixation, a thermoplastic mould will be made for the patient. It is a mesh anatomically repeating the area of the body and fixing it in the desired position. In case of using the moulds, marking of irradiation map is applied to it, and not to the skin.
According to organ contours and tissue structures, the radiation therapist creates the task of a radiation session, and with the help of the linac program, calculates doses and their distribution during the procedure.
Treatment session of radiotherapy. In most cases, radiation therapy sessions are performed in an outpatient settings. The duration can vary from 5 to 30 minutes. The therapy targets the tumor and a small area around it. Radiation can affect nearby healthy tissue, although modern techniques minimize exposure as much as possible.
A linear accelerator, a machine that performs radiotherapy, is similar to an MRI or CT machine, it does not touch the patient. The treatment is completely painless, and the radiation cannot be seen or felt during the procedure. The patient is placed on the couch of the linac and fixed to avoid accidental movements. The medical physicist calibrates the machine in accordance with the radiation map and with the session task compiled by the radiation therapist. Then the scan is done, there may be several, to make sure the patient is correctly positioned on the couch. The doctor is not in the room of treatment during the session, but contact with the patient is maintained through the intercom system and the medical staff of the radiation department is looking after the patient during all the session.
Rehabilitation after radiation therapy. High doses of radiation disrupt the structure and ability of the cell to recover, and in cancer cells after radiotherapy, this recovery process becomes impossible. Doctors carefully dose the intensity of irradiation and try to avoid irradiation of healthy tissues and organs. Thus, cancer cells are affected much more than healthy tissue, and the actual treatment is considered local. This means that any side effects will depend on the treated body's part (mainly manifested in functional disorders of the irradiated organ), the amount of radiation and the individual response. However, there are typical side effect syptoms, common for all patients, that should be known:
- general fatigue;
- short-term blunt, aching or shooting pains at the treatment part;
The process of restoring healthy cells normalizes over time and side effects disappear. Nevertheless, after each session the patient needs rehabilitation.
- Drink plenty of fluids every day during treatment, preferably with reduced sugar content.
- Eat regularly and try to follow a balanced diet. In the event of side effects that affect digestion or appetite, the treating oncologist prescribes a specialized diet, and in certain cases, additional medications.
- During radiation treatment, there is often a lack of calcium in the body and it is prescribed to be consumed additionally.
- The treating oncologist assesses any blood disorders based on blood tests and, if necessary, prescribes additional medications or infusion therapy.
- The area of skin exposed during radiotherapy sessions becomes inflamed and irritated. To reduce inflammination corticosteroids may be prescribed during and/or immediately after treatment. We advise to avoid excessive mechanical rubbing and exposing to the sun the treated spot of skin. If the side effects last a long time, there is a change in color, expansion of blood vessels, dryness and peeling of the skin, it is necessary to undergo an dermatology examination and apply the appropriate treatment.
Does radiation therapy work?
Radiation therapy is usually given in daily intervals called "fractions." This time between procedures is necessary for the recovery of healthy cells and the death of cancer cells. The death of cancer cells does not happen at once. It lasts for several days or weeks after each session and continues even months after the course of therapy. In the initial stages of an oncological disease, the use of radiation therapy allows to achieve a full recovery, and in the later stages, it helps to improve the quality of life and prolong it.
Control of the effectiveness of the therapy session takes place seven to ten days after the session, and the effectiveness of the course can be evaluated four to six weeks later at a consultation with an oncologist.
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I'd like to share my impressions about radiation therapy, I underwent in the clinic on the recommendation of my clinical oncologist S.P. Odarchenko. and by the decision of the medical council. Nice new machine, the radiation therapist explained everything very clearly, as well as the effects that could be during the treatment. Very friendly administrators in the radiation therapy building. Thanks to the entire team of specialists!