Radiotherapy Treatment

Radiotherapy is the use of ionising radiation, otherwise known as X rays for treatment of cancer. It is usually delivered using a machine known as a linear accelerator, which directs high energy radiation through the body to the target area.

The first visit to the radiotherapy department is for treatment planning on a machine called a CT simulator. The patient is positioned carefully on the couch by the radiographers (radiotherapy technicians) and a CT scan is taken through the region of the body to be treated. Several marks and permanent tattoos are placed on the skin in order for the same position to be reproduced on the linear accelerator for treatment.

The treatment area (target volume) is determined by the cancer specialist (clinical oncologist) and the optimal way of delivering the treatment is planned by the physicists.

Radiotherapy works by causing damage to the DNA (genetic code) of cancer cells but can also affect normal tissue cells. If higher doses of radiotherapy are to be used, this is usually divided into multiple smaller treatments (fractions) in order to minimize unwanted side-effects. A typical course of radiotherapy can take 4-6 weeks to deliver.

The radiotherapy treatment usually takes 10-15 minutes to deliver and during treatment the patient does not feel anything. Side-effects can be of acute or late onset and depend on the area which is treated as well as the dose delivered. Acute side-effects occur immediately or soon afterwards and commonly include tiredness, nausea, diarrhoea and sore skin. Late side-effects are less common and are usually not apparent for at least 6 months after completion of radiotherapy but tend to be permanent and often progressive.

Patients will be fully advised by the clinical oncologist what the risks and benefits of the radiotherapy are before a decision is made to proceed. When planning the radiotherapy treatment, the greatest care will be taken to balance achieving the most benefit against minimizing the risk of late side-effects.

When chemotherapy is given at the same time as radiotherapy (synchronous chemoradiotherapy) in many cancers, there is a radiosensitisation effect increasing the effectiveness of the treatment. Chemoradiotherapy is routinely used for cancers of the anus, rectum, oesophagus, pancreas, cervix, bladder, head and neck, brain and lung.

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