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RADIATION THERAPY:

2 TYPES OF IONIZING RADIATION:



- ELECTROMAGNETIC (X-RAYS & GAMMA)
- PARTICULATE (ELECTRON, BETA PARTICLES,
PROTONS, NEUTRONS, ALPHA)
EFFECTS:
TISSUE DISRUPTION ALTERATION OF THE
DNA
BREAKS THE STRANDS OF THE DNA HELIX=
CELL DEATH OR
FORMATION OF FREE RADICALS=DNA
DAMAGE
USES:
1. PRIMARY only treatment used and
aims to achieve local cure of the cancer
2. ADJUVANT used either pre-or post-op
3. PALLIATIVE
HOW RADIATION THERAPY WORKS
Radiosensitivity RELATIVE
SUSCEPTIBILITY OF TISSUES TO RADIATION
High-energy ionizing radiation DESTROYS
A CELLS ABILITY TO REPRODUCE BY
DAMAGING ITS DNA, & FORMATION OF
FREE RADICALS
Normal cells have greater ability to repair
damaged DNA than Ca cells
RADIOSENSITIVE
Cells during the S, G2 & M phases
Cells that undergo frequent cell division
Tumors that are well oxygenated
Small size tumors & highly proliferative cells
RADIORESISTANT: slow growing & tissues at
rest (muscle, cartilage, connective tissue)

TYPES OF RADIATION
1. External beam ERBT (telegraphy)
radiation source is outside the body
THRU GAMMA-RAY MACHINES:
LINEAR ACCELERATOR, COBALT,
BETATRON
Client is NOT radioactive; not a hazard to
others; do not wash off markers
DURATION OF TX: CONVENTIONAL: 6-8 WKS
ENHANCED TREATMENTS:
INTENSITY MODULATED RADIATION
THERAPY (IMRT)
IMAGE GUIDED

APPROACHES OF EBRT
GAMMA RAYS (Ex: cobalt-60(
GammaKnife Stereotactic Radiosurgery
Unit
One time high dose delivery of ERBT
Stereotactic Body Radiotherapy
PROTON THERAPY
Utilizes high-linear energy transfer (LET) in
the form of charged protons generated by a
large magnetic unit cyclotron
BENEFITS:
Localized treatment
CLIENT EDUCATION:
WASH ARE WITH WATER ALONE OR MILD
SOAP & WATER
USE HAND RATHER THAN WASHCLOTTH
FOR WASHING
DO NOT REMOVE MARKINGS
DRY THE SKIN USING PATTING NOT
RUBBING MOTION
NO powder, lotions, ointment &creams to
affected area
Wear soft clothing over affected area
Avoid using anything that rubs on the
affected area
Avoid exposing irradiated area to the sun
Avoid heat exposure

2. Internal radiation therapy
(brachytherapy)
- Maybe delivered as a temporary or a
permanent implant.
Temporary Applications:
High-dose radiation (HDR) for short
duration
Advantage: treatment time is shorter-
reduced exposure to personnel
Low-dose radiation: longer treatment
INTRAVAITARY RADIOISOTOPES
- Uses: GYN cancers
- Maybe HDR or LDR
- LDR: hospitalized pt
- NC: bedrest for 72 hrs, log-rolling for
turning, low residue diet: IC to ensure
an empty bladder; personnel & visitor
precautions with TDS (Time, Distance,
Shielding)
INTERSTITIAL IMPLANTS
- Seeds, needles, wires or small catheters
- Used in breast (MammoSite device)
Sealed source: intracavitary/interstitial
Thru: needles, ribbons or catheters (temporary
implant) or beads (permanent) implanted
directly into the tumor
Exposure: direct contact with sealed
radioisotope NOT thru excretions
Client is radioactive ONLY when implant is
in place
Unsealed source: oral/injection/instillation into
body cavity for systemic treatment; direct
contact with body tissue.
*radioisotope circulates throughout the body.
Body fluid s are contaminatied
Clients urine, sweat, blood &vomitus contain
radioisotope
*eliminated from the body in 48 hrs.
Pts are isolated
Afterloading device: empty applicator is
implanted during surgery
SAFETY STANDARDS:
Private room & bath
Check all linens & materials removed from
the bed for any foreign body that could be
source of radioactive material.
Keep linens & trash in clients room until
they have been checked for radioactivity
Time-limit to 30 mins direct care/8hr shift
Distance: distance & radiation exposure
inversely related.
* Intensity of radiation decreases inversely
with the square of the distance from the
source Ex: 2m=1/4 exp; 4m-1/16 exp
*Visitors 6ft. from the source; off limits to
<16 y.o. & pregnant women
Shielding lead shields, lead container(pig)
& long-handled forceps are musts in pts
unit
Wear lead shield or apron for prolonged
care
Staff should wear films badges or
dosimeters
Precautionary measures for sealed &
unsealed

Treatment considerations:
Certain normal cells are more sensitive to
radiation & may incur permanent damage
SE related to total of radiation
*Gray (Gy) unit dose of radiation
Fractionation dosing:
To reduce SE
To allow normal cells to repair
themselves & increase susceptibility of
the cell to radiation
Vulnerable during late G2 and early M
phase of cell cycle
CHEMOTHERAPY
TYPES:
Adjuvant eliminates any remaining
submicroscopic cells after surgery and
RT
Neoadjuvant - pre-op use of CT to
reduce bulk & lower stage of tumor
making it amenable to surgery
Some Principles of Cancer Chemotherapy
1. Cure probably requires complete
eradication of tumor cells
2. Tumors usually detected clinical late in
course of disease
3. Adverse effect are decreased by giving
combinations of drugs with different
side-effects
4. Intermittent high doses are more
effective
5. Adjuvant therapy (chemotherapy after
surgery/radiation) is given to eliminate
metastases
6. Drugs have a narrow therapeutic index
*THERAPEUTIC RATION guiding principle
of chemotherapy
- Aim: To administer an antineoplastic dose
large enough to destroy cancer cells but
small enough to limit adverse effects to sage
& tolerable levels

VASCULAR ACCESS METHODS OF
ADMINSTRATION
Peripherally inserted central catheters
Implanted Venous Access Portq
Ommaya reservoirs