Radiotherapy is a cancer treatment technique where a high-intensity radiation dose is used to shrink or kill the cancer cells.
The high-intensity radiations are released from the machine, aiming at the exact location where the cancer cells are present. Mostly X-Rays are used; however, in some cases, protons may also be used.
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How Does Radiation Therapy Kill the Cancer Cells?
Radiation therapy, also called as radiotherapy, kills the cells by damaging its genetic material responsible for the growth and further division of cells1Baskar, R., Dai, J., Wenlong, N., Yeo, R., & Yeoh, K. (2014, November 17) 'Biological response of cancer cells to radiation treatment' Source
Does Radiation Therapy Kill the Normal Cells Too?
Yes, the normal cells may also get killed as the radiations cannot differentiate between the cancerous cell and the normal cell. However, normal cells can regenerate itself2Maani, E. V. (2020, August 29) 'Radiation Therapy' Source
At what Stage of Cancer Treatment do Oncologists prefer radiotherapy?
Your oncologist, depending upon the type of cancer, its spread, stage of cancer etc., shall decide to go with radiotherapy as follows3Rolf D;Elsayad K;Meheissen MAM;Elkerm Y;Opitz C;Radke I;Bremer A;Hülskamp A;Elsaka R;Ismail HM;Elfaham E;Ismail AA;Elmansy H;Wardelmann E;Elsaid AA;Krause-Bergmann B;Tio J;Eich HT;Micke O;. (2020, February) 'Impact of Adjuvant Radiation Therapy in Patients With Male Breast Cancer: A Multicenter International Analysis' Source:-
What to Expect During Radiation Therapy (Explained with an Example of Breast Cancer Case)
In the following case, radiation therapy is performed after the surgery (mastectomy - removal of breast). This type of radiation therapy is known as adjuvant therapy.
The standard radiation therapy for breast cancer involves three weeks of radiation for the patient with mastectomy and one week of radiation boost for breast conservation surgery patients. The technique is called external beam radiotherapy.
Following are the steps followed for radiotherapy4Morrow M and Harris JR. Chapter 35: Breast-Conserving Therapy. In: Harris JR, Lippman ME, Morrow M, Osborne CK, eds. Diseases of the Breast. 5th ed. Philadelphia: Wolters Kluwer Health; 2014,5National Comprehensive Cancer Network (NCCN). Practice Guidelines in Oncology: Breast Cancer. Version 3.2017:-
The first step involves radiotherapy planning, which is called “CT simulation,” where the patient’s body is simulated on the treatment couch to attain CT data set so that radiotherapy planning can be done. It helps in bringing accuracy in the treatment with radiotherapy.
Tumor Mapping and Dose Calculation
The next step involves tumor mapping, beam orientation, planning, and dose calculation for the radiotherapy.
Delivery of Radiotherapy
The next and final step is treatment delivery. The treatment usually lasts for 10-20 minutes and is delivered five days a week (i.e. from Monday to Friday ) for 3-4 consecutive weeks. This is a standard protocol for radiation therapy followed worldwide; however, minor modifications can occur on a case-to-case basis.
Myths About Radiation Therapy or Radiotherapy
Many people are scared of radiation therapy because of the prevalent myths and misconceptions in society. However, most of them are false and irrelevant.
Few myths about radiation therapy for breast cancer and their logical explanations are discussed below:-
Myth 1 - Radiation is a painful procedure
No, radiation treatment delivery is a completely painless procedure. It is a non-invasive technique which delivers high dose x-ray beams without touching the body or causing any trauma. It does not require any sedation
Myth 2 - Longer the duration of radiation more advanced is cancer
No, the duration of radiation has nothing to do with the severity of cancer. Different dose-fractionation schedules are followed for different types of cancer.
Further, based on current evidence for the practice, radiation therapy’s time duration shall differ for various cancer types. For example, the standard duration of radiation for head and neck cancer is 6-7 weeks and for breast cancer, it was 5 weeks earlier but 3 weeks now based on current evidence of hypofractionation trials6'Are Three Weeks of Whole-Breast Radiotherapy as Good as Five Weeks in Early Breast Cancer? - 10 Year Follow-Up in the Canadian Trial of Hypofractionated Radiation Therapy'. (2010, August). Source
Myth 3 - Radiation involves the entire body
No radiation therapy is a local treatment. It does not involve the entire body. It is only limited to the area being treated, e.g., in the case of breast cancer, it is limited to the thorax, specifically the unilateral breast or chest wall along with neck and axilla.
Myth 4 - Radiation Cause Burn or Shock
No radiation does not cause any burn or shock. However, one of the side effects of radiation is radiation dermatitis, which mimics burns, but this is seen in only 30 percent of patients receiving radiation, and moreover, it does not feel warm.
It is just a skin reaction in which the skin turns dark, dry, and desquamated. Symptomatic medications can very well manage it.
Also Read: - Breast Cancer in Men (Is it Possible?)
Myth 5 - Radiation decreases immunity
No, radiation is a local treatment. It does not decrease immunity until a large field’s radiation involves a significant portion of bone marrow. Its effects and side effects are only limited to the area being treated.
For example, radiation therapy for breast cancer involves a minimal field covering ipsilateral breast or chest wall, axilla, and lower neck. Therefore, no bone marrow suppression or a decrease in immunity occurs in radiation treatment of breast cancer.
Myth 6 - Radiation causes hair loss
No, radiotherapy does not cause hair loss. Radiation can cause hair loss only when cancer has spread to the brain in the form of metastasis, and brain radiotherapy is given, which may result in scalp hair loss.
Myth 7 - After radiation patient become radioactive
No radiation therapy is an external beam therapy. The high energy x-ray beam enters the body at the site of the tumor and instantaneously leaves the patient’s body after the therapy. The treated patient does not emit radiation. He can live with his family and dear ones throughout treatment.
Myth 8 - Radiation causes cancer
Yes, radiation is one of the causes of cancer. But the incidence of radiation-induced cancer is very low, i.e., less than 5 %, and it occurs in patients who have radiation exposure at a younger age. Male breast cancer is usually diagnosed at an advanced stage, so radiation-induced second malignancy is very low7R;, D. C. (2018, June 29). 'Radiation induced secondary malignancies: A review article' Source
Myth 9 - Radiation makes the patient bedridden
No radiation therapy for breast cancer is an outpatient department procedure. Most of the patients are active enough to perform their daily routine work, mild exercises, and light office work during treatment without much trouble.
Side effects of radiation therapy
The side effects of radiation therapy are divided into acute side effects and long term side effects8MC;, W. J. (2006) 'Toxicity from radiation in breast cancer' Source,9Dilalla, V., Chaput, G., Williams, T., & Sultanem, K. (2020, April). 'Radiotherapy side effects: Integrating a survivorship clinical lens to better serve patients' Source:-
Acute Side Effects
- Changes in the Skin
Changes in the skin like reddening, irritation, itching, and skin darkening over the treated area are some of the common side effects of radiation therapy.
Swelling is observed due to the damage of lymph nodes. This condition is called as lymphoedema. In breast cancer radiotherapy, swelling may be observed in the breast or chest wall. Further, occasionally mild swelling occurs in the treated breast chest wall or arm as it consists of lymph nodes, which is transient and recovers well with arm & shoulder exercises.
- Pain and Stiffness in Joints
Patient might experience occasional aches and stiffness in the joints
- Loss of Appetite, Weight Loss and Sore Mouth
Radiation therapy done in head and neck can cause sore mouth, discomfort in swallowing, loss of appetite, along with weight loss
Radiotherapy of the stomach region can cause diarrhea.
The patient need not be bedridden however he/she might feel tired while doing day to day tasks.
- Dental infection
Patient may suffer from dental infections such as poor oral health and dental caries post radiotherapy sessions.
Reduction in the efficiency of the salivary glands leading to less secretion of saliva. This leads to difficulty in swallowing and speech.
- Stress, Anxiety and Depression
The patient might fell stress, anxiety and depression. A cancer patient needs unconditional moral support, especially during the treatment.
Long Term Side Effects
- Changes in Skin Color
Skin looks like that of an aged individual. Thinning of the skin dilated capillaries, minor scaring may occur because of radiation therapy.
Risk of pneumonitis may occur due to scattered dose of radiation in the lungs.
- Heart Failure
An additional risk of heart failure arises post radiotherapy sessions, because of the scattered radiation dose in heart. It is most common side effect in left-sided male breast cancer cases.
- Fertility Issues
Fertility issues may occur in both male and female post radiotherapy sessions
- 1Baskar, R., Dai, J., Wenlong, N., Yeo, R., & Yeoh, K. (2014, November 17).
Biological response of cancer cells to radiation treatment.
Retrieved November 3, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4429645/
- 2Maani, E. V. (2020, August 29).
Retrieved November 3, 2020, from https://www.ncbi.nlm.nih.gov/books/NBK537036
- 3Morrow M and Harris JR. Chapter 35:
In: Harris JR, Lippman ME, Morrow M, Osborne CK, eds. Diseases of the Breast. 5th ed. Philadelphia: Wolters Kluwer Health; 2014.
- 4National Comprehensive Cancer Network (NCCN). Practice Guidelines in Oncology:
Version 3.2017. Accessed www.nccn.org on January 18, 2018.
- 5Rolf D;Elsayad K;Meheissen MAM;Elkerm Y;Opitz C;Radke I;Bremer A;Hülskamp A;Elsaka R;Ismail HM;Elfaham E;Ismail AA;Elmansy H;Wardelmann E;Elsaid AA;Krause-Bergmann B;Tio J;Eich HT;Micke O;. (2020, February). Impact of Adjuvant Radiation Therapy in Patients With Male Breast Cancer: A Multicenter International Analysis.
Retrieved November 3, 2020, from https://pubmed.ncbi.nlm.nih.gov/32529127/
- 6(2010, August)
Are Three Weeks of Whole-Breast Radiotherapy as Good as Five Weeks in Early Breast Cancer? - 10 Year Follow-Up in the Canadian Trial of Hypofractionated Radiation Therapy.
Retrieved November 3, 2020, from https://pubmed.ncbi.nlm.nih.gov/22590449/
- 7R;, D. C. (2018, June 29).
Radiation induced secondary malignancies: A review article.
Retrieved November 3, 2020, from https://pubmed.ncbi.nlm.nih.gov/29983028/
- 8MC;, W. J. (2006).
Toxicity from radiation in breast cancer.
Retrieved November 3, 2020, from https://pubmed.ncbi.nlm.nih.gov/16335014/
- 9Dilalla, V., Chaput, G., Williams, T., & Sultanem, K. (2020, April).
Radiotherapy side effects: Integrating a survivorship clinical lens to better serve patients.
Retrieved November 3, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7253739/