RADIOTHERAPY

DEFINITION Radiotherapy or radiation treatment is the use of x-rays, electrons or gamma rays to treat cancer

SIMULATION
After a physical exam and a review of medical history, the doctor plans the treatment. In a process called simulation. 1. Patient will be asked to lie very still on an examining table while the radiation therapist uses a special x-ray machine to define the treatment field. Treatment field is the exact place on his/her body where the radiation will be aimed. Depending on the location of the cancer, patient may have more than one treatment field. Simulation may also involve Scans or other imaging studies to plan how to direct the radiation.

SIMULATION
2. Depending on the type of treatment patient will be receiving, body molds or other devices that keep patient from moving during treatment (immobilization devices) may be made at this time. Immobilization device will be used each time patient have treatment to be sure that patient are positioned correctly. 3. The radiation therapist often will mark the treatment field on the skin with tattoos or tiny dots of colored, permanent ink. It is important that the radiation be targeted at the same area each time. If the dots appear to be fading, tell the radiation therapist who will darken them so that they can be seen easily.

SIMULATION
4. Once simulation has been done, doctor will meet the radiation physicist and the dosimetrist. 5. Based on the results of medical history, lab tests, x-rays, other treatments patient may have had, and the location and kind of cancer patient have, they will decide how much radiation is needed, what kind of machine use to deliver it, and how many treatments patient should have.

TREATMENT
Usually, the treatment course lasts between two and five weeks. Patients are brought by the radiation therapist into the treatment room and positioned onto the treatment table. the treatment will then be set up by the radiation therapist, and the actual treatment itself will only last a couple of minutes. During the actual treatment, patients are alone in the room but the radiation therapist is outside and can hear patients through a close circuit television.

TREATMENT
The treatment is painless. Patients do not hear or feel anything during or after the treatment. Patients will then return on schedule to complete the treatment course. During the radiation course, patients are monitored by the radiation oncologist and his/her staff. These are called status checks.

TREATMENT
Patients should inform the radiation oncologist of any new symptoms. The side effects of the radiation depend on the exact type of tumor treated and the location of the radiation treatment. During the course of treatment, patients will undergo blood tests -- sometimes once a week -- and they will also have port films performed. These are x-ray pictures taken on the treatment machine which are used to ascertain the accuracy of the treatment plan.

TREATMENT
Radiation works best when it is given in small doses over several sessions. In this way, it can kill the tumour cells and yet allow sufficient time for the normal healthy cells around the tumour to repair any damage from the radiation.

BRACHYTHERAPY
Brachytherapy is radiation at short distances. The source of radiation is made in the form of wires, seeds or plaques and are inserted into the tumour for delivering high doses of radiation. These radioactive sources are Cessium, Iridium and Iodine. This type of treatment is very effective in certain types of cancer, such as cancer of the cervix, certain forms of head and neck cancer, and lung cancer.

BRACHYTHERAPY
Intra-cavity radiation. Here the radioactive sources are placed in a holder and inserted into the body organ, such as the uterus, or into the vagina. Interstitial therapy. Here rods, ribbons, or wires are directly inserted into the soft tissues of the body and placed right into the tumor.

BRACHYTHERAPY
With these two types of treatment, patients would most likely be admitted to the hospital and have the procedure done during an operation and under anesthesia. Patients would most likely remain in the hospital for several days while the radiation source is in place. In a few instances, the source will be left permanently inside the body. However, in the majority of cases, the radioactive sources will be removed after a few days. Patients will have restrictions in the number of people visiting and the time of visitation.

BRACHYTHERAPY
High dose rate brachytherapy.This is an outpatient form of radiation treatment. The high dose rate machine contains a very high activity radiation source and the source is then delivered through a catheter into a particular organ that is harboring the cancer. Usually the treatment itself lasts only a few minutes. Thereafter, the source is removed and stored within the machine, and the patients go home. Patients may require several sessions of high-dose rate brachytherapy in order to derive the most benefit. Many patients will experience side effects from radiation.

TREATMENT PLANNING
The time between simulation and when the patient start the course of treatment, is used to plan the treatment (treatment planning). Planning uses the data collected in the simulator (from the simulation process) and from the CT Scan, and is transferred to the planning computer where many calculations are performed. This ensures the cancer cells get the prescribed radiation dose whilst the dose to normal tissue is kept to a minimum.

TREATMENT PLANNING
The radiation therapist uses the information from the simulation and the CT Scan to work out exactly where x-rays should be directed (called treatment fields), and also calculates the amount of radiation dose given from each field. They use computers to plan the treatment. If necessary they will make special shields to protect delicate parts of the body and only treat the exact area.

LINAC with MLC: PRIMUS 1

LINAC: PRIMUS 2

LINAC: KD 2

HDR Brachytherapy in Cervix

HDR Brachytherapy in NPC

SIMULATION 3-DIMENSION CONFORMAL TREATMENT PLANNING 2-DIMENSIONAL

TREATMENT

PHOTON BEAM

HYPERTHERMIA

INTERNAL TREATMENT

EXTERNAL TREATMENT

ELECTRON BEAM IMRT

SUPERFICIAL X-RAY RADIOSURGERY

BRACHYTHERAPY

RADIOPHARMACEUTICAL