Radiation Therapy Overview

What is Radiation? “energy in motion” waves or streams of particles Can’t see it or feel it different forms of radiation

Types of Radiation At one end of the spectrum….. visible light ultraviolet light radio sound “non-ionizing”

At the other end….. High Energy “ionizing” produces ions (charged atoms) eg. photons, protons, electrons, neutrons

Ionizing Radiation Used in treatment of disease (malignant and benign) Linear accelerators X-rays Electrons Radioactive isotopes (HDR)

How does RT work? = Cell Death Damage to Parts of the cell DNA water proteins cell membrane DNA = Cell Death

Goal of Radiation Therapy Maximize dose to tumour & Minimize dose to normal tissue / critical structures

Radical Treatment (aim to cure) Combined with: Chemotherapy (before, after, during) Surgery (before, after) Hormones (before, after, during)

Palliative Treatment Quality of life Relief of symptoms pain bleeding Obstruction Spinal Cord Compression eg. metastatic cancer to bone, brain, lung

Radiation Therapy Department Main floor of TBRHSC (2nd level) Separate reception and waiting area Chemotherapy / medical oncologists are upstairs on 3rd level

2nd Floor Radiation Therapy Dept.

Treatment Units Linear Accelerators x 2 Photons (deep seated tumours eg. pelvis) Electrons (superficial eg. skin)

Entrance to Rx room

Entrance to treatment machine (Linac 3)

Linear Accelerator (Siemens ONCOR)

External Beam RT The process begins…..

CT-Simulation a.k.a. “Planning Scan” 1 hour appointment May require cast (done 2 hours before CT) Patient education (30 minutes) Consent CT-Simulation (15-30 minutes)

CT Simulation Treatment position Important to maintain position / keep still Positioning devices (standard or custom Reference marks placed on patient

Head & Neck Shell

Head Shell

Hip Fix (prostate)

Positioning Devices Prone pillow Wingboard

Positioning Devices (cont’d) Knee rest Foot rest Breast Board

After CT Scan Patient is finished & can go…… Tattoos / marks will receive a phone call with next appointment Approximately 1-2 weeks for radical tmt Couple of days or same day for palliative patients

Preparation for Planning All further work done on computer Critical structures outlined (by therapist) Spinal cord, rectum, bladder, eyes, kidney, etc. Tumour is outlined (by Rad. Onc)

Virtual Simulation

Next step…. Treatment Planning / Dosimetry Shows the doses of radiation within the treatment area and to critical structures near by May take up to 2 weeks to complete this step Approval by Oncologist

Radiation Dose Distribution

Comparison of Process Radical Palliative CT-Simulation 1 hour Planning Complex (up to 2 weeks) Simple (same or next day) # of treatments 15-40 Mon to Fri 1-10 Emergency (weekends/evenings) Sites Prostate, breast, brain, H & N Metastatic disease (eg. Bone mets)

1st Day on Treatment Unit “Dry run” Review treatment with patient Process Side effects Questions

Day 1 cont’d Electronic images done (like an x-ray) Measurements Review images Treatment begins!!! Final approval by Oncologist

While on treatment….. Assessed daily by Radiation Therapists Weekly assessment by Radiation Oncologist and Nurse (or as necessary) CBC Weeks 1 and 4 As necessary

Side Effects of RT Localized depends on area being treated size of area treated Severity depends on dose of radiation Adjuvant treatment (eg. Chemo) Condition of the patient

General Acute Side Effects Can occur for any site treated with radiation 1. Skin Reaction (erythema, pruritis, dry & moist desquamation) 2. Fatigue

Skin Reaction Why? Damages the cells within the basal layer of the skin When? Erythema / dry desquamation – usually 1-2 weeks into Rx Peak may occur at the end of the Rx or about 1 week post Rx Healing will occur 2-4 weeks after RT complete

Skin Reaction Erythema Dry Desquamation Moist Desquamation

Skin – Ways to help Keep area clean (gentle washing with mild soap, pat dry) Allow air to get at the area Apply Lubriderm (non-scented, non-greasy) Protect from sun & wind Reduce mechanical irritation (i.e. loose clothing, don’t scratch) No heating pads/ice packs Prescription cream – Hydrocortisone 1%, Flamazine after tmt complete

Fatigue Why? Cell damage/repair; cachexia; nausea; disease processes; pain; adjuvant Rx; medications May occur 1-2 weeks into Rx May increase after Rx finished, but will resolve with time

Ways to help…. Rest, nap, sleep Light exercise (brisk walk) Delegating tasks, setting priorities Dietary counselling Stress management techniques Fatigue booklet & video available

Other Important Points Clinical Trials Department – research to improve standards of treatment and patient outcomes Radiation Therapy In-Patient Form - in hospital chart

Questions?