Radiation Therapy

Radiotherapy planning Process

1. 1. Initial Consultation and Consent
      In your first visit Radiation Oncologist will take history of your complaints and do the complete clinical examination of patient. He need to see all reports including CT scan, MRI, PET CT, Ultrasonography and Histopathology reports.
   2. Simulation
      In this process, Radiation Oncologist prepares a immobilization device for patient which may be a mask (Thermoplastic mask) or vacuum bag (vaclock). The purpose of preparing immobilization device is to maintain the same position of patient throughout imaging and treatment and to achieve high accuracy
      After process of immobilization patient will be shifted to CT scan. CT scan of the desired area will be done.
   3. Planning
      After CT scan the images of CT scan will be transferred to planning software. Radiation oncologist will mark the tumor area and plan the Radiation. Medical physicist will support them for planning.

Treatment
After planning the plan will be transferred to treatment machine software. Patient has to lie down on treatment couch in the same position as in CT scan. Treatment will be started after verification of position of patient. Treatment will take approximately 5 to 15 minutes daily depending on technique.
Radiation therapy is OPD basis treatment, it does not require admission in hospital. Generally, patient will be given specific appointment time daily. During treatment patient will not have any pain, burning or heat.

External beam Radiation therapy

1. Conventional Radiation
   This is simplest and oldest technique of Radiation therapy. In this technique possibility of adverse effects of Radiation is more compared to advanced techniques of Radiotherapy. This is cheapest technique of all.
2. 3DCRT (3-Dimensional Conformal Radiation Therapy)
   This is more advanced technique of Radiotherapy than conventional treatment. Possibility of adverse reactions is less compared conventional Radiation therapy. This technique is costlier than conventional Radiation Therapy.
3. IMRT (Intensity Modulated Radiation Therapy)
   This is advanced form of Radiation Therapy. Possibility of adverse reactions is less compared to conventional and 3-DCRT Radiotherapy. Radiation Oncologist needs more time for planning IMRT radiation therapy because process of planning is very much complex.
4. VMAT/Rapid Arc (Volumetric modulated arc Radiotherapy)
   This is specialized form of IMRT. In this technique, Machine rotates around the patient and is on position throughout the arc. The benefit of this treatment is time required for Radiotherapy is less so that patient has to lie down for less time on treatment machine. Also conformity or accuracy of treatment is more.
5. IGRT (Image Guided Radiation Therapy)
   IGRT is the use of imaging like CT scan or x-rays during Radiation Therapy. Modern Radiotherapy machines are equipped with inbuilt CT scanner within Radiation therapy machine. Benefit of IGRT is that Radiation Oncologist can confirm the position of patient and it increases the accuracy
   of treatment set up. IGRT includes benefits of IMRT and imaging.
6. Stereotactic Radiosurgery (SRS)
   Stereotactic Radiosurgery is highly conformal and accurate form of Radiation therapy in which single high dose of Radiation is given to tumor inside brain. It is especially useful in patients of brain metastasis, pituitary tumor, acoustic neuroma, meningioma and arteriovenous  alformations of brain.
7. Stereotactic Radiotherapy (SRT)
   This is giving very high dose of Radiation in 2 to 6 fractions in brain or other sites of body. This can be given in Cancer of Lung, Liver metastasis and vertebral bone (spine) metastasis.

• • • Central vaginal source (CVS) Brachytherapy
      This is given in case of cancer of Cervix and endometrium (Uterus). This is OPD basis
      procedure. In this type of radiation on cylindrical shaped applicator is placed in vagina and radiation is delivered through computerized system.
    • Intra-cavitatary brachytherapy (ICA)
      This treatment can be used for treatment of cancer of Uterine Cervix. This is integral part of treatment of ca cervix when treated with Radiation therapy. Most of the time it is done as day care admission or 1 day admission may be required. In this procedure under anesthesia or sedation procedure of applicator insertion is done. CT scan of patient will be taken and planning of treatment is done in software. After approval of Radiation oncologist treatment will be delivered.
    • Interstitial brachytherapy
      In this type of Radiation therapy, needles or plastic catheters are inserted in the tumor. CT scan of patient will be done and planning of treatment will be done in software.

• Intensity Modulated Radiation Therapy is highly conformal type Radiation treatment which concentrates high dose of Radiation in tumor area and very less dose in surrounding normal organs of body.
• Better preservation of normal structures.

Better clinical results

• Dr. Jagdish Shinde. MD, DMRT – Consultant Radiation Oncologist PuneWhat skin reaction to expect…
  Radiation therapy can cause skin reaction at the site of treatment. Severity of reaction increases as radiation progresses. During first two weeks patient won’t feel any skin reaction. Patient may feel slight redness of skin during first 24 to 48 hours of starting Radiotherapy. During 3rd week there is reddening of skin followed by blackish discoloration. If skin dose is more then patient may have ulceration of skin. Initially there is dryness of skin with hair loss in affected area. In severe cases the area may become wet called wet reaction. Patient may have more skin reaction in area of skin folds, area where loose skin is present and skin where more friction is present like armpit.Do’s and Don’ts during Radiation therapy
  1. Don’t apply hard soap on radiation area during bathing. Cleaning area with plain water or with small amount of mild soap can be done.
  2. Don’t do shaving of radiation area with blade. Shaving with electronic device is allowed.
  3. Don’t apply deodorant, perfume, talk or any other cosmetic material over radiation area.
  4. Don’t expose the radiation area to heat like direct sunlight.
  5. Wear loose and cotton cloths. Do not use tight and irritating cloths.
  6. Some medicines like alovera gel, low dose local steroids may reduce the skin toxicity. Please consult your physician before starting any medication.
  7. Use of higher end technology like IMRT may help to reduce skin toxicity.

  Skin Care Guide During Radiation Therapy – https://youtu.be/QSRglXb3QTA

• 1. One of the most common concern of patients getting radiation therapy to head and neck region is how to take care of oral cavity during radiation therapy. Radiation therapy causes thickening and increased stickiness of saliva. Generally it starts two weeks after starting treatment. There is increased level of acidity in oral cavity which promotes infection. During second week of radiation therapy there is reddening of oral cavity mucosa. Third week onwards you may experience ulceration in oral cavity. Patient may feel difficulty in swallowing.Do’s and Don’ts during Radiation Therapy
     1. Keep mouth clean by doing regular gargling. For gargling you may use water prepared by mixing one liter water with one teaspoon of salt and one teaspoon of baking powder. Gargle with this water every 3 to 4 hours. You can use non alcoholic mouth wash.
     2. Do gargling after taking food and remove remaining food particles from mouth
     3. Do not eat spicy, hot and hard food. You may have difficulty in swallowing
     4. Do have soft and bland diet. Take lots of water as there is increased chance of dehydration during Radiation therapy
     5. For brushing teeth use soft tooth brush. Do brushing gently.
     6. Sodium fluoride gel application over teeth may help to reduce dental caries.
     7. Dental check up is recommended before starting Radiation therapy
     8. Consult your doctor regularly during Radiation Therapy

     Author – Dr. Jagdish Shinde – Radiation oncologist in pune

     Mouth Care Guide During Radiation Therapy – https://youtu.be/xGTbNyt2M8s

• 1. 1. Initial Consultation and Consent –

     In your first visit Radiation Oncologist will take history of your complaints and do the complete clinical examination of patient. He need to see all reports including CT scan, MRI, PET CT, Ultrasonography and Histopathology reports.

     2. Simulation

     In this process, Radiation Oncologist prepares a immobilization device for patient which may be a mask (Thermoplastic mask) or vacuum bag (vaclock). The purpose of preparing immobilization device is to maintain the same position of patient throughout imaging and treatment and to achieve high accuracy.
     
     After process of immobilization patient will be shifted to CT scan. CT scan of the desired area will be done.

     

     3. Planning

     After CT scan the images of CT scan will be transferred to treatment planning software. Radiation oncologist will mark the tumor area and plan the Radiation. Medical physicist will support them for planning.

     

     4. Treatment

     After planning the plan will be transferred to treatment machine software. Patient has to lie down on treatment couch in the same position as in CT scan. Treatment will be started after verification of position of patient. Treatment will take approximately 5 to 15 minutes daily depending on technique.

      

     

     Radiation therapy is OPD basis treatment, it does not require admission in hospital. In most of patients it is given 5 days a week from Monday to Friday. Generally, patient will be given specific appointment time daily.

     During treatment delivery patient will not have any pain, burning or heat during delivery of Radiation.

Radiation therapy (Radiotherapy) –

External beam Radiation Therapy

1. Conventional Radiation

This is simplest and oldest technique of Radiation therapy. In this technique possibility of adverse effects of Radiation is more compared to advanced techniques of Radiotherapy. This is cheapest technique of all.

2. 3DCRT (3-Dimensional Conformal Radiation Therapy)

This is more advanced technique of Radiotherapy than conventional treatment. Possibility of adverse reactions is less compared conventional Radiation therapy. This technique is costlier than conventional Radiation Therapy.

3. IMRT (Intensity Modulated Radiation Therapy)

This is advanced form of Radiation Therapy. Possibility of adverse reactions is less compared to conventional and 3-DCRT Radiotherapy. Radiation Oncologist needs more time for planning IMRT radiation therapy because process of planning is very much complex.

4. VMAT/Rapid Arc (Volumetric modulated arc Radiotherapy)

This is specialized form of IMRT. In this technique, Machine rotates around the patient and is on position throughout the arc. The benefit of this treatment is time required for Radiotherapy is less so that patient has to lie down for less time on treatment machine. Also conformity or accuracy of treatment is more.

5. IGRT (Image Guided Radiation Therapy)

IGRT is the use of imaging like CT scan or x-rays during Radiation Therapy. Modern Radiotherapy machines are equipped with inbuilt CT scanner within Radiation therapy machine. Benefit of IGRT is that Radiation Oncologist can confirm the position of patient and it increases the accuracy of treatment set up. IGRT includes benefits of IMRT and imaging.

6. Stereotactic Radiosurgery (SRS)

Stereotactic Radiosurgery is highly conformal and accurate form of Radiation therapy in which single high dose of Radiation is given to tumor inside brain. It is especially useful in patients of brain metastasis, pituitary tumor, acoustic neuroma, meningioma and arteriovenous malformations of brain.

7. Stereotactic Radiotherapy (SRT)

This is giving very high dose of Radiation in 2 to 6 fractions in brain or other sites of body. This can be given in Cancer of Lung, Liver metastasis and vertebral bone (spine) metastasis.

1. Central vaginal source (CVS) Brachytherapy

This is given in case of cancer of Cervix and endometrium (Uterus). This is OPD basis procedure. In this type of radiation on cylindrical shaped applicator is placed in vagina and radiation is delivered through computerized system.

2. Intra-cavitatary brachytherapy (ICA)

This treatment can be used for treatment of cancer of Uterine Cervix. This is integral part of treatment of ca cervix when treated with Radiation therapy. Most of the time it is done as day care admission or 1 day admission may be required. In this procedure under anesthesia or sedation procedure of applicator insertion is done.  CT scan of patient will be taken and planning of treatment is done in software. After approval of Radiation oncologist treatment will be delivered.

3. Interstitial brachytherapy

In this type of Radiation therapy, needles or plastic catheters are inserted in the tumor. CT scan of patient will be done and planning of treatment will be done in software.

What is Cost of Radiation Therapy?

Cost of Radiation Therapy depends on the technique of Radiation Therapy. As technique of radiation advances the cost increases. To know the cost of Radiation therapy for your patient please call Dr. Shinde. Mob 9890233887

What are the side effects of Radiation therapy?

During treatment delivery patient will not have any pain, burning, heat sensation; just like doing CT scan patient will not understand that radiation is being done. Side effects of Radiation therapy will start from end of second week. The side effects of Radiation depends on area to be treated. The side effects of Radiation Therapy are mostly local. If patient is having Radiation therapy to face and neck area then patient will have ulcers in mouth and throat and difficulty in swallowing. If such side effect occurs then consult your doctor. The area where Radiation Therapy is given will initially become reddish and in later part it will become black. The skin colour will eventually become normal after completing Radiation Therapy. If Radiation Therapy is given to abdomen or pelvis area then patient may have diarrhea, nausea, vomiting and pain in abdomen. With advancement of technique the side effects of Radiation therapy have decreased.

Is chemotherapy given along with Radiation Therapy?

In some patients, we need to give chemotherapy along with Radiation Therapy. It depends on site and stage of disease.

Does Radiation therapy harm people around patient?

Radiation therapy does not harm people around patient. You can share food, cloths with patient.

What skin reaction to expect…

Radiation therapy can cause skin reaction at the site of treatment. Severity of reaction increases as radiation progresses.  During first two weeks patient won’t feel any skin reaction. Patient may feel slight redness of skin during first 24 to 48 hours of starting Radiotherapy. During 3^rd week there is reddening of skin followed by blackish discoloration. If skin dose is more then patient may have ulceration of skin. Initially there is dryness of skin with hair loss in affected area. In severe cases the area may become wet called wet reaction. Patient may have more skin reaction in area of skin folds, area where loose skin is present and skin where more friction is present like armpit.

Do’s and Don’ts during Radiation therapy

1. Don’t apply hard soap on radiation area during bathing. Cleaning area with plain water or with small amount of mild soap can be done.
2. Don’t do shaving of radiation area with blade. Shaving with electronic device is allowed.
3. Don’t apply deodorant, perfume, talk or any other cosmetic material over radiation area.
4. Don’t expose the radiation area to heat like direct sunlight.
5. Wear loose and cotton cloths. Do not use tight and irritating cloths.
6. Some medicines like alovera gel, low dose local steroids may reduce the skin toxicity. Please consult your physician before starting any medication.
7. Use of higher end technology like IMRT may help to reduce skin toxicity.

Blog Article 2

Mouth care during Radiation Therapy

One of the most common concern of patients getting radiation therapy to head and neck region is how to take care of oral cavity during radiation therapy. Radiation therapy causes thickening and increased stickiness of saliva. Generally, it starts two weeks after starting treatment. There is increased level of acidity in oral cavity which promotes infection. During second week of radiation therapy there is reddening of oral cavity mucosa. Third week onwards you may experience ulceration in oral cavity. Patient may feel difficulty in swallowing.

Do’s and Don’ts during Radiation Therapy

1. Keep mouth clean by doing regular gargling. For gargling you may use water prepared by mixing one liter water with one teaspoon of salt and one teaspoon of baking powder. Gargle with this water every 3 to 4 hours. You can use non-alcoholic mouth wash.
2. Do gargling after taking food and remove remaining food particles from mouth
3. Do not eat spicy, hot and hard food. You may have difficulty in swallowing
4. Do have soft and bland diet. Take lots of water as there is increased chance of dehydration during Radiation therapy
5. For brushing teeth use soft tooth brush. Do brushing gently.
6. Sodium fluoride gel application over teeth may help to reduce dental caries.
7. Dental check-up is recommended before starting Radiation therapy
8. Consult your doctor regularly during Radiation Therapy

Author – Dr. Jagdish Shinde – Radiation oncologist in Pune