Overview of

Radiation Therapy

Ms. Mezie Laurence B. Ortiz, RRT

June 2015
Goal of Radiation Therapy

Aims of Radiation Therapy

Members of the Radiation Therapy team

Forms of Radiation Therapy

Dose of Radiation

Target Margins

Overview of Treatment Process

Side effects of Radiation Therapy

 Radiation Therapy
• It is the use of high level radiation
WHAT? (Megavoltage) to destroy cancer cells.

• Has its greatest effect on tissues that divide rapidly such

as cancer cells. It destroys the cell ability to divide or
WHY? multiply (LAW OF BERGONIE AND TRIBONDEAU)

• With each treatment more of the cancer cells die and the tumor
shrinks
• Damage to healthy cells are the reason for SIDE EFFECTS of
HOW? Radiotherapy
 GOAL OF
RADIOTHERAPY

CURATIVE also called RADICAL RADIOTHERAPY. In this treatment,

radiation dose is given so high that some side effects are unavoidable, but
theses are accepted as an inevitable part of attempted cure. Radiation can
be used as treatment alone or be given in combination with
CHEMOTHERAPY, SURGERY and other forms of treatment.
 GOAL OF
RADIOTHERAPY

CONSIDERED EMERGENCY CASES IN RADIOTHERAPY:

• BONE METASTASIS
•MASS OBSTRUCTING THE LUNGS
•BRAIN METASTASIS
AIM OF RADIOTHERAPY
The aim of radiotherapy is to deliver a
PRECISE measured dose of radiation to a
DEFINED tumor volume:

With minimal damage to surrounding tissue.

That results in eradication of tumor.
That results in a high quality of life for the patient.
For prolongation of life at competitive cost.
For effective palliation or prevention of symptoms of
cancer including pain.
For restoring luminal patency, skeletal integrity and organ
function with minimal morbidity.
MEMBERS OF RADIOTHERAPY
TEAM
Radiation Oncologist

Medical Physicist/
Dosimetrist

Radiotherapy
Technologist
RADIATION ONCOLOGIST
 RADIATION ONCOLOGIST

XRAY IMAGE OF PELVIS CT IMAGE PELVIS

MEDICAL PHYSICIST/DOSIMETRIST
RADIOTHERAPY TECHNOLOGIST
RADIOTHERAPY TECHNOLOGIST
RADIOTHERAPY TECHNOLOGIST
IMMOBILIZATION DEVICES (ALPHA CRADLE)
RADIOTHERAPY TECHNOLOGIST
IMMOBILIZATION DEVICE (THERMOPLASTIC MASK)
TWO FORMS OF
RADIOTHERAPY
 TWO FORMS OF RADIATION THERAPY
EXTERNAL RADIATION THERAPY (TELETHERAPY)
IN THIS TYPE OF TREATMENT, DOSES OF RADIATION ARE GIVEN TO A CAREFULLY
DEFINED AREA THROUGH A MACHINE THAT DIRECTS THE HIGH-ENERGY RAYS OR
PARTICLES FROM OUTSIDE THE BODY AT THE CANCER AND THE NORMAL TISSUES
SURROUNDING IT.

INTERNAL RADIATION THERAPY (BRACHYTHERAPY)

INTERNAL RADIATION THERAPY PLACES THE SOURCE OF THE HIGH-ENERGY RAYS
INSIDE THE BODY, AS CLOSE AS POSSIBLE TO THE CANCER CELLS. THIS DELIVERS
VERY INTENSE RADIATION TO A SMALL AREA OF THE BODY AND LIMITS THE
DOSE TO NORMAL TISSUE.

THE RADIOACTIVE SUBSTANCES USED TYPICALLY INCLUDE RADIUM, CESIUM,

IODINE, AND PHOSPHORUS, AND THEY MAY BE IMPLANTED FOR ONLY A SHORT
TIME OR LEFT IN PLACE PERMANENTLY. PATIENTS WITH RADIATION IMPLANTS
SOMETIMES NEED TO BE ISOLATED FROM VISITORS SO AS NOT TO EXPOSE THEM
TO RADIOACTIVITY
EXTERNAL BEAM RADIATION
THERAPY (PHOTON BEAM)

LINEAR ACCELERATOR MACHINE ( DIRECT LINAC)

EXTERNAL BEAM RADIATION
THERAPY (PHOTON BEAM)

LINEAR ACCELERATOR MACHINE ( HELICAL LINAC)

EXTERNAL BEAM RADIATION THERAPY
(PROTON BEAM)

LINEAR ACCELERATOR MACHINE (LINAC)

Mechanism of ACTION
PHOTON VS. PROTON

)
INTERNAL BEAM RADIATION
THERAPY
INTERNAL BEAM RADIATION
THERAPY
DOSE OF RADIATION
DOSE OF RADIATION determination
TOLERANCE DOSE

•is the largest amount of

dose that can be accepted
without the production of
injurious symptoms
Factors affecting TOLERANCE DOSE
Dose per fraction/ dose rate

Volume irradiated

Sensitivity of the tissues

Amount of recovery which can take place

between fractions
 Volume irradiated
The smaller the volume to be treated the higher
the total dose which may be tolerated.
EXAMPLE:
Patient and Biological Factors
The type of tissue treated, poor dietary or fluid intake or
concomitant drug treatment, may affect the level of dose
tolerated.

Oxygen Effect
Good oxygenation increases the chance of radiation
damage to cells.
Many of the cells within a large cell mass where there is no
organized blood supply is hypoxic.
Tumor cells are less oxygenated and therefore less
sensitive to radiation.
Cell Doubling Time
One division of all cells in the mass.
If the number of cells doubles within the time interval
between two fractions, treatment may fail.
 Fractionation
Fractionation is the administration
of a course of radiation treatment in
a planned series of fractions of total
dose.
This allows recovery of normal cells
while depleting the number of
surviving tumor cells.
Fractionation
 Dose per fraction/dose rate
BODY PART DOSE PRESCRIBED DOSE PER DAY TOTAL TREATMENT
FRACTIONS/DAYS

BREAST 6040 cGy 180 cGy for 29 33 days

days then
200 cGy for 5
days
GYNE (CERVIX, 5040 cGy 180 cGy per day 28 days
UTERUS, OVARY

WHOLE BRAIN 3000 cGy 300 cGy per day 10 days

BONE METS 3000 cGy 300 cGy per day 10 days

 Dose per fraction/dose rate
•The dose that can be tolerated by normal tissue in
the treatment zone varies with the total time over
which the dose is given.
•Dose that could be given in a longer period of
time is larger than could be given over a shorter
period.
•For a given volume, the size of each fraction dose
and the time interval between fractions alters the
biological effect.
•The higher the fraction dose (or dose rate) the
greater the late damage potential.
 Dose per fraction/dose rate
Missed treatments would lead to an overall
treatment period which is significantly longer
than intended.

Some patients (for head and neck) are at a

survival disadvantage if treatment duration is
lengthened.

Because once some cells are killed the cell

kinetics change and there is a potential for
very rapid repopulation.
 Fractionation Regimes
Conventional fractionated courses
consist of once-daily doses given 5 days per week,
usually Monday to Friday.
with recovery period at the weekend.

Less than 5 fractions per week

Once-, twice-, or three times weekly treatments
with higher dose of radiation.
Potential for late radiation damage increases with
high fraction doses.
Reason for lowered fractionation regimes
Fewer visits and less traveling time for patients
Shortage of treatment machine
Clinical indications (for very sensitive tumor –
skin lymphomas)
 Fractionation Regimes

Hyperfractionation
Shortening the treatment course duration but
giving a high number of small fractions.
Given to tumors with a fast cell-doubling time such
as 5 days.
May result in more acute injury but an unchanged
potential for late damage.
 Target Margins
ICRU Reports 50/62 recommendations for target
delineation in which the target volume is separated into
three distinct regions:
 Target Margins
ICRU Reports 50/62 recommendations for target
delineation in which the target volume is separated into
three distinct regions:
Gross tumor volume (GTV) denotes the
demonstrable tumor.

Clinical Target volume (CTV) denotes the GTV

and subclinical disease (region to account for
uncertainties in microscopic tumor spread).

Planning Target Volume (PTV) denotes the CTV

and includes margins for geometric / position
uncertainties. Usually 1.5 cm physical margin
are set around the CTV.
 Target Margins
Treated volume
is the volume of tissue enclosed by an isodose
surface, selected and specified by the radiation
oncologists as being appropriate to achieve the
purpose of treatment. The treated volume is always
larger than the PTV and usually has a simpler
shape.

Irradiated volume
is the volume of tissue that receives a dose
considered significant in relation to tissue
tolerance.
Overview of Treatment Process
EXTERNAL BEAM RADIATION
THERAPY
 Overview of Treatment Process
1. INITIAL CONSULTATION WITH RAD ONCO
 Overview of Treatment Process
2. INFORMED CONSENT PROCESS (RAD ONCO)
 Overview of Treatment Process
3. SIMULATION STAGE (RADIOTHERAPY TECHNOLOGIST)

3.1 DETERMINE PATIENT POSITION 3.1 ACQUIRE X-RAY OR CT SCAN

WITH APPROPRIATE IMAGE OF THE PART TO BE
IMMOBILIZATION DEVICE TREATED AS DETERMINED BY
RAD ONCO.
 Overview of Treatment Process
3. SIMULATION STAGE (RADIOTHERAPY TECHNOLOGIST)

3.3 Tatto Process

It is necessary to make the marks permanent
since this will be the basis for body alignment
during the radiation therapy treatment
 Overview of Treatment Process
3. SIMULATION STAGE (RADIOTHERAPY TECHNOLOGIST)

3.4 Documentation
At the end of simulation stage a form called simulation worksheet or
simulation form must be filled out by the Radiation Therapist since
the data would be needed by the Medical Physicist for the Planning
Stage.
 Overview of Treatment Process
3. SIMULATION STAGE (RADIOTHERAPY TECHNOLOGIST)

Example Simulation Worksheet or Simulation Form

 MEDICAL PHYSICIST/DOSIMETRIST
Overview of Treatment Process
4. PLANNING STAGE (RAD ONCO & MED PHY)

(On this stage the Radiation Oncologist will draw / contour the
treatment fields on the acquired images as well as dose
prescription. After everything has been drawn the Medical
Physicist would do a lot of calculations considering the tolerance
dose of the part to be treated as well as its surrounding tissues).
Overview of Treatment Process

After the simulation stage and

planning stage, the Medical Physicist
usually have 3-5 working days to
complete everything for the patient to
start the treatment
 Overview of Treatment Process
.

BEAM VIEW
BEAM VIEW

PLANNED IMAGE PORTAL IMAGE

Overview of Treatment Process
Daily Treatments (Radiation Therapist)

SCHEDULE: Monday-Friday

FRACTION PER WEEK: usually ( 5 days a week)

FRACTION PER DAY: usually Once a day or it can be

given b.i.d if preferred by the RAD ONCO.

CONSULTATION: once a week the patient is seen by the

Radiation Oncologist in order to monitor patient’s
condition and answer the patient’s question regarding
the treatment.
 Overview of Treatment Process
End Of Treatment Visit

Once radiation treatment had been completed, patient

will have final visit with his attending Physician. The
doctor will make an evaluation examination and follow-
up care.
 Side Effects
The high doses of radiation that damage or
destroy cancer cells also can hurt normal cells,
causing side effects.

These will vary depending on the area treated

and the dose received.

Factors to Consider
Total dose delivered
Time over which the dose was delivered
Volume irradiated
 Side Effects
The risk of side effects is usually less than the
benefits of killing cancer cells.

It is usually temporary and will disappear gradually

when therapy is complete.

Side effects are generally limited to the region of the

body being treated.
 Side Effects on SKIN
Radiation Dermatitis is a
skin condition that is a
common side effect of
radiation therapy. The
affected skin becomes
painful, red, itchy, and
blistered.
 Side Effects
Nutritional problems
Radiation can affect the
membranes of the mouth
and/or gastrointestinal
tract, causing discomfort
while swallowing, nausea,
altered taste of foods, and
diarrhea.
 Side Effects

Fatigue or weakness is one of the most common side

effects of radiation therapy. Patients are not restricted
from their normal activity like going to work. However,
they should balance normal activity with period of
rest.
THANK YOU