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What is Radiotherapy?

 
What is B-Radiotherapy?
 
Radiotherapy is the application of the ionization radiation for the purpose of medical treatment. Radiotherapy means something radiating according to its word meaning and as a matter of fact all of visible lights, radio waves, radars, microwaves, telephone waves are radiation in general. Some waves give rise to changes by means of removing the constituents namely atoms of the human body. This change causes the atom to be instable and deformation in the structure of the substance. Radiation which is used in radiotherapy is this kind of ionization radiation. That is to say, it gives rise to stimulation in atoms whenever applied and they cause change in structure.
 
Radiation which is used in radiotherapy is two types.
 
1.    External (Outer) radiotherapy: It is applied to the patient from a certain distance (from 80-199 cm distance in general) by means of using equipment (Cobalt 60 equipment) coming from a radioactive resource or equipments which use beams which are obtained from electricity (Linear Accelerator or Linak in short name). The radiation applied does not cause any pain or ache. No radiation remains in the environment whenever the medical treatment is over. The patient does not become radioactive. There is no obstacle for approaching or embracing the patient as well.
 
2.     Brachytherapy (Inner-internal) radiotherapy: It is applied by means of placing the radioactive resources (consider it as a wire) on, inside or close to the ailing area. Either the applied radioactive resource is placed temporarily and then removed following the medical treatment or left in the body for a lifetime (just like applied with prostate cancer). The resources which are left in the body lose their influence nearly completely just after they perform their required effect.
 
Another medical treatment is Iod 131 treatment which is used in goiter or thyroid cancer which is applied by the Nuclear Medicine Department. In this medical treatment which is called atom treatment in public, the radioactive substance is inserted into the body from vein directly. Thus, the patient becomes radioactive at temporary basis. It is temporarily restricted to approach to the patient. Whenever the influence of the radioactive substance is over, it is allowed to approach to the patient.
 
C- Equipments which are used in radiotherapy:
 
Cobalt 60 equipment: Gamma rays which are radiated by a substance with the size of lentil radiating artificial radiation in a head which we call gantry are used. It is applied to the patient from a certain distance. The treatment technician could be exposed to a higher rate of radiation in comparison with the other equipments. That is to say, it is not possible to take under control the dosage which is applied to the patient. It could not make sure performing the medical treatment successfully in all of the cancer types. It has a minimal influence in the thick area of the body in particular. For instance, if you are a fat or large patient, then it is not recommended to apply medical treatment with such equipment on the abdomen and chest region. The quality of the medical treatments which are performed in the other regions is also not very good. It is not used in developed countries.
 
Linear accelerator or Linak: It is equipment which operates by means of obtaining x-rays from electricity in the head it has as differently from the cobalt equipment. It is used very effectively nearly in all of the cancer treatments. The data relating to the medical treatment is stored in computer and could be checked whenever considered necessary. The patient error is minimized. It is widely used in developed countries.
 
TomoTherapy: This equipment which is used for radiotherapy purposes in the world firstly in the year 2003 could perform the medical treatment from all points from the equipment producing X ray which is placed in the equipment at the same time by scanning the tumor area of the patient with 360 degrees by means of the tomography equipment system. In this manner, while the normal tissues are maintained, tumor tissue could take the maximum treatment dose. This system has the most developed technology which could perform IMRT and IGRT.
 
Classical radiotherapy: It is two-dimensional planning. Tumor should be radiated with the wide safety limit. Because of this reason, it has more side effects.
Conformal radiotherapy: Not only it is ensured to radiate the tumor in the best manner but also the surrounding healthy tissues could be protected because tumor and surrounding normal tissues could be specified by radiating with three dimensions.
 
Intensive adjusted radiotherapy(IMRT): Just like in conformal radiotherapy, the planning is performed particularly in computer programs. Differently, because the radiated area is radiated differently in terms of intensity, the required dose dispersion becomes further superior. It is useful in protecting the normal tissues and organs in a better way as well. Dose increasing possibility is higher in comparison with the conformal treatment. The preparation period for the medical treatment and its period could be longer than the conformal treatment.
 
Image guided radiotherapy (IGRT): The patient getting prepared for therapy is prepared in therapy position in a large room. Technicians and physicians get out of the room and irradiate the area without exactly seeing the area under therapy. In IGRT, therapy area is determined with port films, port films which take immediate images or special devices integrated in the machine which emit very low doses of radiation. Before therapy, the area under therapy is seen and then treated. This ensures a more reliable irradiation. Newly developed TomoTherapy device is one of those which can apply this method in the best style.
 
Stereotactic radiotherapy or Stereotactic radio-surgery: Its word meaning is irradiation by determining 3 dimensional coordinates. This method which was being used for small circular diseases in brain in early times used to be applied in one high dose. With subsequently developed devices, therapies began to be applied by dividing therapies into sessions. This therapy is called stereotactic radiosurgery if applied with single dose, and stereotactic radiotherapy if applied by dividing.
 
Devices which perform this therapy are as follows:
 
Linac systems: Performed with some special apparatuses connected to Linac device.
Gammaknife: Only used for lesions aligned with the earlobe in brain.
Cyberknife: It is made from a small Linac installed on robots. Point irradiation is used on body in addition to brain.
 
General Information:
Radiotherapy means therapy with radioactive rays. Cancerous cells are prevented from growing, reproducing and spreading to normal tissues by using radiation.

Also normal cells falling within the therapy area can be adversely affected by these rays but repair themselves. Thus radiation associated normal tissue damage is often temporary.

In order to avoid possible side effects, total dosage is generally applied by dividing to one session a day, five days a week.

Radiotherapy shall jot make you radioactive. There is no disadvantage for those around you during or after your therapy.

Decision for and form of therapy is determined by examining many factors such as the patient’s age, general health status, type, stage, location of cancer and as the result of evaluation of the patient by physicians specialized in different majors seeing the patient together.

Therapy

Therapy Team:
It comprises Radiation Oncologist, Medical Physician and Radiotherapy Technicias.

Your physician decides how much therapy will be applied on which area of your body and apply necessary treatments by determining the side effects you encounter during therapy and your associated complaints. He/She will make changes in your therapy depending on the developments in your disease when necessary.

 Medical Physician will collaborate with your physician in planning and applying radiotherapy and prepares the suitable therapy plan.
Technicians arrange your therapy position, operate the device and oserve you during the time you are in the therapy room.

Therapy Informed Consent Form:
This form informs you in detail about any side effects you may encounter during radiotherapy.

Therapy Process:  

Evaluation and Decision for radiotherapy:
After examination and evaluation of your file in detail, if your physician decides to apply radiotherapy on you, you are given an appointment for planning. You are told about the side effects of the radiotherapy to be applied to you, your consent is obtained and the therapy is planned.

Appointments:
Appointment is made by your physician after decision is made for therapy. It is important for you to keep up with your appointment in order to avoid Tinterruption of therapy planning stages.

Therapy Planning and Simulation:

Areas to be treated are determined on Computerized Tomographt device for the purpose of planning a therapy specific to your disease. Meanwhile, no therapy purpose radiation is given. Then the planned therapy area is marked on the skin of the patient. Tattoos in form of points are applied on several locations of the area on your skin and these points are permanent. All these processes last averagely 15 – 45 minutes. Marks may be erased by way of perspiration or contact with your clothes. In such case notify the relevant staff and never try to redraw on your own.

During simulation, various special tools may be used in order to ensure that your body stays still during the therapy and you receive radiation in the same position and precision everyday. If therapy will be applied on head-neck area, a msk is created with which a mould of that area specific to you is obtained. This mask will be placed before each therapy and ensure your stillness. At first, the mask cause difficulty in breathing but it will be easy to get used to it for you.

Therapy:
We will try to apply your therapy at the same hour every day. It is very normal for you to feel obsessed on the first day of therapy. Radiation therapy is performed within periods only from a few seconds to a few minutes.

You will spend nearly 1—15 minutes in the therapy room during each therapy session.

This therapy is absolutely and completely painless.

The therapy technician will let you lie on the therapy table and tries to give you the correctest position with the help of the marks on your skin. After the technician makes you ready for the therapy, he/she leaves the room but will monitor you with the help of the camera and speaker systems in the therapy room during the therapy. The therapy device is controlled with the help of the computer from out of the room and the device is rotated with the predetermined angle.

You don’t have to hold your breath during therapy and it will be sufficient for you to breath in a calmly manner. You mustn’t move during therapy. This is important for the correct area to receive the correct dose in every session.

Your complaints, blood results, concurrent medication you receive and new examinations will be evaluated on a weekly basis by your physician during the course of your therapy. These examinations gives you the chance of asking questions to your physician.

Possible side effects of radiotherapy

Also the healthy cells falling within the therapy area will affects during radiotherapy. Side effects which may occur in this way are often moderate and temporary, although they may be severe in some patients. In order to reduce such side effects, radiotherapy is applied 5 days during week and 2 weekend days are allocated for resting. In addition, planning is made in such a way to protect the healthy tissues within the therapy area against radiation to maximum extent. Side effects generally start as the dose is increased in the following days. Some disappear after the therapy days and some in weeks. It is possible to mitigate such side effects by drugs or pausing the therapy.

Side effects seen of skin:

They are seen on the therapy area mostly in therapies which last 5-6 weeks and during the late periods of the therapy. The risk is higher for areas such as armpit, neck and groin. They start complaints like sunburn and can lead to wet, open wounds. In such cases, it may be necessary to pause your therapy for a while or for you to use drugs. But nec-ver use creams or dressing unless your physician advises yo to do so. Most of such reactions will disappear 2-4 weeks after the completion of the therapy. In long term after therapy, permanent dark spots may remain on your skin of therapy area, that area may remain with darker colour and tougher or hair on that area may be lost. This returns to normal status 2-3 months after the completion of the therapy.

Possible side effects during radiotherapy on head and neck area:

Radiotherapy on this area may decaying tendency of your teeth. Your physician will request a detailed tooth check before starting therapy since no surgical therapies may be applied on your teeth for a period of one year during and after the therapy. Intraoral sores may occur during the therapy. Therefore, you may be required to use regular antiseptic gargling and other drugs during the therapy. Since salivary glands are affected, desert mouth ansd associated difficulty in swallowing and difficulty in chewing may also be seen. If your throat is severely irritated and your eating and drinking is painful, the therapy may have to be paused for a while. In addition fungus infection may develop intraorally and your taste may be spoilt. All these may result in loss of appetite and weight. Such side effects may continue for a few weeks after the completion of the therapy. Aphonia may be seen but returns to normal status maximum a few weeks after the completion of the therapy.

Possible side effects during radiotherapy on chest region:

You may fel difficulty in breathing for a while during and after radiotherapy and it may be difficult to eat solid food. It is possible to mitigate this pain which is felt during eating with some special painkillers and drugs of gargling type.

These symptoms will gradually decrease after the therapy and completely disappear generally in 5-8 weeks. Dry cough, difficulty in breathing may develop. But complaints of coughing or difficulty in breathing which develop a few months after the completion of the therapy are important since they may reveal radiotherapy associated AC damage.

Possible side effects in abdominal region during radiotherapy:

Nausea, sometimes vomiting may occur during the therapy even starting from the first days. Associated eating problem and rapid loss of weight starts. Medication will be given in order to prevent your complaints. Your complaints will end at the completion of radiotherapy. In addition, diarrhea, stomach cramps and swelling may be possible complaints. In case of diarrhea, therapy is paused if necessary and medication starts. Diarrhea will completely finish after therapy. In addition, thamuria, burning during urination may be seen because of the effect on bladder. Drinking plenty of water will mitigate all these symptoms.

Side effects associated with affected blood cells:

Radiotherapy may affect cells produced by blood producing system. In addition, side effects related with blood are more frequently seen in radiotherapies which are concuurently performed with chemotherapy or start immediately after chemotherapy. Each patient under therapy undergoes a blood count in order to detect such effects in a timely manner.

Suggestions

If your general status at the time you start radiotherapy is suitable for you to continue your daily life, no change will occur during radiotherapy. But in case of prolonged therapies, some side effects which may make your daily life difficult can develop. You can feel tired and exhausted during your therapy. This fatigue results from your therapy, doesn’t indicate that your diseare worsened and generally disappear after the therapy.

Nutrition:

You must make sure to have a healthy diet and drink plenty of water during the therapy. Food with high protein content such as meat, yogurt, pulses, egg, milk, fish are particularly required to be included in your diet suring this period. It will be beneficial to stay away from food which is oily or fried. Severe pain or sores may develop in your mouth, so you must stay away from very cold, very hot, hot and spicy food. When necessary, supplements may be added to your diet with special solutions with high calory until your intraoral problems are eliminated. If radiotherapy is applied on your abdminal region, it will be useful to consume limited beans, chick peas and food with cumin which cause gas formation. Since diarrhea may develop because of the effect on intestines, food such as skim cheese, white bread, potato, rice, lean boiled meat must be consumed during the course of the therapy. Make sure not to use alcohol or smoke during your therapy.

Exercise

Exercises which don’t tire your body, for example walks will contribute in physical strength. Therefore regular exercises may be useful during therapy.

Resting

You must continue your normal life as far as possible during radiation therapy but pay attention to resting.

Skin care:

Skin reactions may be seen frequently. The therapy area may be washed with warm water and you can bath. There may be itching on therapy area but never rub, scratch, because the skin in that area has become sensitive and can be easily irritated. It is unfavourable for you to use perfumed soaps, powders, deodorants, lotions, creams durin the therapy. If you receive radiotherapy from your head or neck area, don’t shave using foam, cream or razor during therapy. If necessary, a shaver can be used in the beginning period of the therapy.

Protection against sunlight:

The area under therapy must not be exposed to strong sunlight in summer and cold wind in winter. The area treated must be protected against strong sunlight for minimum 1 year following the completion of the therapy.

Wearing

Wool, nylon clothes may be irritationg. It will be right for women who receive therapy on their breasts not to use bra during therapy. If radiotherapy is applied on neck area, clothes with narrow collars must be avoided. Silk or cotton scarf for neck will be suitable choices in order to protect against from strong sunlight and cold wind.

Follow-up

After your therapy is completed, you will be called by your physician for controls with certain intervals in order to evaluate the recovery from your disease and your general status. Even if you feel good, you must carefully keep up with these control appointments for your therapy. Control intervals will prolong gradually and consequently last for lifetime even if once a year.

During controls, you will be examined and certain examinations will be requested. The opportunity of evaluating therapy-associated possible late side effects will be acquired during controls. Controls must never be a cause of stress for you, but they are a very good opportunity to speak about your any possible concern or problem to the contrary. Appointments will be made for you on certain dates for your controls. But in case of any complaint or any symptom you are obsessed by at any time, please do not hesitate to immediately contact to your physician without waiting for your appointment date.