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Radiation Therapy

Oncology Consortium
by

Leah Shaw

on 6 August 2013

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Transcript of Radiation Therapy

Chest/Lung
CNS
Hair Loss and Itching associated
Neurological symptoms managed with steroids
Instruct to take on full stomach and with medication to protect stomach
Steroids always require a taper schedule
Brief History of RT
Radiation has been an effective tool for treating cancer for more than 100 years.
Radiation therapy works by damaging the DNA within cancer cells and destroying their ability to reproduce.
When the damaged cancer cells are destroyed by radiation, the body naturally eliminates them.
Normal cells can be affected by radiation but are able to repair themselves.
Radiation can be used alone or in conjunction with surgery and chemotherapy.
Introduction to Radiation Oncology
The first patient was treated with radiation in 1896, two months after the discovery of the x-ray.
Rapid technology advances began in the early 1950s with cobalt units followed by linear accelerators a few years later.
Recent technology advances have made radiation more effective and precise.
Radiation Therapy
How is Radiation Therapy Used?
2 different ways:
To cure cancer
-Destroy tumors that have not spread to other body parts.
-Reduce the risk that cancer will return after surgery or chemotherapy.
To reduce symptoms:
-Shrink tumors affecting quality of life, like a lung tumor that is causing shortness of breath.
-Alleviate pain by reducing the size of a tumor.
Meet the Radiation Oncology Team
Radiation Oncologist
-The doctor who oversees the radiation therapy treatments.
Medical Radiation Physicist
-Ensures that complex treatment plans are properly tailored for each patient.
Dosimetrist
-Works with the radiation oncologist and medical physicist to calculate the proper dose of radiation given to the tumor while minimizing the dose received by surrounding tissue.
Radiation Therapist
-Administers the daily radiation under the doctor's prescription and supervision.
Radiation Oncology Nurse
-Cares for the patient and family by providing education, emotional support and strategies for managing side effects.
Introduction to Radiation Oncology
Brief History of RT
Radiation Therapy Uses
Meet the Radiation Oncology Team
External beam
radiation therapy delivers radiation using a linear accelerator.
Radiation therapy can be delivered in 2 ways
Internal radiation therapy
(brachytherapy) involves placing radioactive sources inside the patient
HDR Cylinder
HDR Ring and Tandem
Seed implant for prostate cancer
Mammosite or Contura partial breast radiation
The type of tx used will depend on the location, size, and type of cancer.
Dx and stage of cancer
General condition of patient and comorbidities
Tumor size
Combination therapies
Availability of resources
Considerations for RT
RT Delivery
Considerations for RT
Planning Radiation Therapy
Simulation
Radiation therapy must be aimed at the same target every time patient is treated.

Doctors use several devices to do this:
Skin markings or tattoos
Immobilization devices such as casts, molds, headrests, masks
Each tx is mapped out in detail using tx planning software
Three-dimensional conformal RT (3D-CRT)
Uses CT or MRI scans to create a 3-D picture of the tumor.
Beams are precisely directed to avoid radiating normal tissue.
External Radiation Therapy
Intensity modulated radiation therapy (IMRT)
A specialized form of 3D-CRT
Radiation is broken into many "beamlets" and the intensity of each can be adjusted individually.
Proton Beam Therapy
Uses protons rather than x-rays to treat certain types of caner.
Allows MD to better focus the dose on the tumor with the potential to reduce the dose to nearby healthy tissue.
Neutron Beam Therapy
A specialized form of RT that can be used to treat certain tumors that are very difficult to kill using conventional RT.
Stereotactic Radiotherapy
Sometimes called stereotactic radiosurgery, this technique allows the radiation oncologist to precisely focus beams of radiation to destroy certain tumors, sometimes in only one treatment.
Also called brachytherapy as brachy is Greek for "short distance."
Internal Radiation Therapy
Radiation sources placed in close proximity of tumor bed or area of potential recurrence
Allows minimal radiation exposure to normal tissue.
Radioactive sources used are thin wires, ribbons, capsules, or seeds.
These can be either permanently or temporarily placed in the body.
Simulation Process
Side Effects
Symptom Management
Side Effects
Fatigue
Skin
Reaction
Side Effects and Mgt depend on area of body being tx
Head and Neck
Breast
Most common side effect to all treatment areas
Usually presents by 3rd week of treatment
Some physical activity is encouraged to combat fatigue.
Rest as needed.
Troubleshoot how to space out tasks and delegate to friends or family.
Chemotherapy used as a radiosensitzing agent
Dry or Moist Desquamations
R/t tx site, total dose, daily fx size, type of energy used
Management varies by facility
Minimal conclusive research
Keep skin moisturized if erethematous or dry desquamation is present (i.e. Aquaphor)
Promote epithelial recovery and prevent infection if moist desquamation present (i.e. Normal Saline soaks)
Pt comfort is high priority
Self care measure include decreasing friction, avoiding extreme temperatures, sun exposure, and irritants (i.e. chlorine, harsh soaps, scented lotions)
Upper Abdomen
Female Pelvis
Bone
Pain management and assessment prior to and during tx is important
Orthopaedics many times involved to assess risk for pathologic fracture, be sure to know mobility restrictions
Assess changes in nature of cough, pain, difficulty swallowing
Many times involves a skin rxn because of friction and skin folds present in treatment area.
Many times managed with HDR treatments such as ring and tandems and cylinder treatments.
Dilator teaching is required to prevent the vaginal stenosis and narrowing as a late effect of treatment
Assess for urinary symptoms, vaginal bleeding, and diarrhea.
Male Pelvis
May cause increase in frequency of urination, hematuria, or dysuria (managed with Aleve and Flomax; rule out infection prior to initiation)
May cause diarrhea (managed with Immodium)
May cause changes in sexual function
Nutrition consult at initiation of treatment, weekly weight checks
Many times patient has PEG tube placed prior to or early on in treatment
Pt requires dental evaluation prior to start of tx
Swallowing can become painful (BMX and Lortab elixir used for management)
Premedicate with compazine for nausea
Pt with prostate seeding or I-131 treatment are considered radioactive during treatment. Pt receiving external beam therapy do not need to take any precautions.
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