PPT 9 – Radiation Therapy

RADIATION THERAPY
• Is a local treatment modality for cancer and it is the destruction of cancer cells by ionizing radiation
• Purpose: is to destroy malignant cells which are more sensitive to radiation than are normal cells without
permanent damage to adjacent body tissues
Discussions:
• A component of treatment for ½-2/3 of all patients with cancer

May be used as a Primary, Adjuvant, or a Palliative treatment modality - can be used to relieve pain caused by
obstruction, pathologic fractures, spinal cord compression and metastases.
Discussions:
• PRIMARY - (e.g., early-stage skin cancer, Hodgkin’s disease, carcinoma of the cervix.
• ADJUVANT - it can be used in conjunction with chemotherapy to enhance destruction of cancer cells.

Methods of Delivering Radiation Therapy

Radiation Therapy is used two different ways;
 To cure cancer:
• Destroy tumors that have not spread to other body parts.
• Reduce risk that cancer will return after surgery or chemotherapy
 To reduce symptoms;
• Shrink tumors affecting quality of life, like a lung tumor that is causing shortness of breath.
• Alleviate pain by reducing the size of tumor.
Types of Radiation Therapy
 Externally (Teletherapy, DXT) – external beam radiation
– Delivers radiation using a linear accelerator
– This is administered through a high – energy X-ray or gamma x-ray machine*
– The major advantage of high-energy radiation is its skin – sparing effect.
Discussions:
• * (e.g., linear accelerator, cobalt, betatron, or a machine containing radioisotope).
• * The maximum effect of radiation occurs at tumor deep in the body, not on the skin surface.
• * There is no need for isolation.
Specialized Types of External Beam Radiation Therapy
 Three-dimensional conformal radiation therapy (3D-CRT)
– Uses CT or MRI scans to create a 3-D picture of the tumor.
– Beams are precisely directed to avoid radiating normal tissue
 Intensity Modulated Radiation Therapy (IMRT)
– A specialized form of 3D-CRT
– Radiation is broken into many “beamlets” and the intensity of each can be adjusted individually
 Proton Beam Therapy
– Uses protons rather than x-rays to treat certain types of cancer.
– Allows doctors to better focus the dose on the tumor with the potential to reduce the dose to
nearby healthy tissue
 Neutron Beam Therapy
– A specialized form of radiation therapy that can be used to treat certain tumors that are very
difficult to kill using conventional radiation therapy
 Stereotactic Radiotherapy
– Sometimes called stereotactic radiosurgery
– This technique allows the radiation oncologist to precisely focus beams of radiation to destroy
certain tumors, sometimes in only one treatment
– Stereotactic radiosurgery (SRS) is a non-surgical radiation therapy used to treat functional
abnormalities and small tumors of the brain.
– It can deliver precisely targeted radiation in fewer high-dose treatments than
traditional therapy, which can help preserve healthy tissue.
 PPT 9 – Radiation Therapy

Systems which produce different types of radiation for external beam therapy include:
A) orthovoltage x-ray machines,
B) Cobalt-60 machines,
C) linear accelerators,
D) proton beam machines, and
E) neutron beam machines.

 Internally (Brachytherapy or Seed implants) – internal radiation therapy

– Involves placing radioactive sources inside the patient.
– Places radioactive material into tumor or surrounding tissue
– Also called Brachytherapy – brachy Greek for “short distance”
– Radiation sources placed close to the tumor so large doses can hit the cancer cells
– Allows minimal radiation exposure to normal tissue
– the radioisotope is placed in needles, beads, seeds, ribbons, or catheters, which are then implanted
directly into the tumor*
Discussions:
• This can be either permanently or temporarily placed in the body

THE MAJOR TYPES OF INTERNAL RADIATION THERAPY

A. SEALED SOURCE – (brachytherapy) the radioisotope is placed within or near the tumor.
• is used for both intracavitary and interstitial therapy
Discussions:
• The radioactive material is enclosed in a sealed container.
o INTRACAVITY RT is used to treat cancers of the uterus and cervix. The radioisotope is placed in the
body cavity, generally for 24 to 72 hrs.
o INTERSTITIAL THERAPY, the radioisotope is placed in needles, beads, seeds, ribbons, or catheters,
which are then implanted directly into the tumor
Discussions:
• In sealed sources of internal radiation, the radioisotope cannot circulate through the client’s body, nor can it
contaminate the client’s urine, sweat, blood or vomitus. *
• However, radiation exposure can result from direct contact with the sealed radioisotope, such as touching the
container with bare hands or from lengthy exposure to the sealed radioisotope.
• Therefore, the client’s excretions are not radioactive
B. UNSEALED SOURCE
– The radioisotopes may be administered intravenously, orally or by instillation directly into the body
cavity.
– the radioisotope circulates through the client’s body.
• Discussions:
• Therefore, the client’s urine, sweat, blood and vomitus contain the radioactive isotope.

PRINCIPLES OF RADIATION PROTECTION - DTS

D – istance
 The greater the distance from the radiation source, the less the exposure dose of ionizing rays.
 Maintain a distance of at least 3 feet when not performing nursing procedures.
 Performed in closed proximity such as checking placement of the implant & performing nursing procedures
T – ime
 Limit contact with the client for 5 minutes each time, a total of 30 minutes per 8-hour shift
 Organize care to limit the amount of time spent in direct contact with the patient
 Spend less time with the patient without sacrificing the quality of care given
S – hielding
 PPT 9 – Radiation Therapy
Use lead shield during contact with client
 Pregnant staff should not be assigned to clients receiving internal RT
 If available, & no care should be delivered without wearing a film badge.
 The film badge should not be shared, should not be worn other than at work, & should be returned according to
the agency’s protocol
Discussions:
• The badge (radiation dosimeter badge) will indicate cumulative radiation exposure.

Staff members caring for the client with internal RT should wear radiation dosimeter badge while in the client’s room.
Discussions:
• measures the radiation dose that the individual has received through exposure to the source

If the client with cancer of the cervix has radioisotope implant into the uterus, the following nursing interventions should
be implemented.
1. Client’s back is turned towards the door.
- To minimize exposure of healthcare staff to radioisotope entering the client’s room.
2. Encourage the client to turn to sides at regular intervals
3. The client should be on complete bed rest.
- to prevent dislodgement of the radioisotope.
4. The client should be given enema before the procedure.
- Bowel movement during the procedure may cause dislodgement of the radioisotope.
5. The client should be given low fiber diet to inhibit defecation during the procedure until the device is removed in 2-3
days.
- to prevent dislodgement of the radioisotope
6. The client should have a Foley catheter in place during the procedure.
- to prevent bladder distention and subsequently prevent irradiation of the bladder.
7. Have long forceps and lead container readily available. Use long forceps to pick up dislodged radioisotope and place it
in the lead container.
– The client receiving an unsealed source of RT: should have a private room and bath.
– All surfaces, including the floor area the client will be walking on, are covered with Chux or paper.

 Foods are served on disposable plates and utensils.

 Trash and linens are kept in the client’s room and are not removed until the client is ready for discharge.
- This is to minimize radiation exposure of caregivers.
 The client is also instructed to rinse the sink with copious amount of water after tooth brushing and to flush the
toilet several times after each use.
- To prevent radiation contamination of other people and the environment.
 Anyone entering the room wears a new pair of booties each time to prevent tracking the radioisotope out into
the hallway.
 Caregivers should wear gloves when handling body fluids
 Any emesis (vomiting), especially that occurs shortly after ingestion of oral radioisotope, should be covered with
absorbent pads, and the radiation safety officer should be called immediately.

TEACHING GUIDELINES REGARDING EXTERNAL RADIATION THERAPY

1. It is painless
2. Lie very still on a special table while the intervention is being given and you may be placed in a special position
to maximize tumor irradiation.
3. Each treatment usually lasts for few minutes. You may hear sounds of the machine being operated, and the
machine may move during the therapy.
4. As a safety precaution for the therapy personnel, you will remain alone in the treatment room while the
machine is in operation.
 PPT 9 – Radiation Therapy
5. The technologist will be right outside your room observing you through a window or by a closed – circuit TV.
You may communicate.
6. There is no residual radioactivity after radiation therapy. Safety precautions are necessary only during the time
you are receiving irradiation. You may resume normal activities of daily living.

CLIENT EDUCATION ON SKIN CARE IN EXTERNAL RADIATION THERAPY

Skin Care within The Treatment Area includes the following:
 Keep your skin dry.
 Do not wash the treatment area until you are instructed to do so. When permitted, wash the treated skin gently
with mild soap, rinse well, and pat dry. Use warm water or cool water, not hot water.
 Do not remove the lines or ink marks (markings) placed on your skin
 Avoid using powders, lotions, creams, alcohol and deodorants on the treated skin.
 Wear loose – fitting clothing to avoid friction over the treatment area.
 Do not apply tape to the treatment area if dressings are applied.
 Shave with an electric razor. Do not use pre-shave or after-shave lotions.
 Protect your skin from exposure to direct sunlight, chlorinated swimming pools, and temperature extremes*
 Consult your radiation therapist or nurse about specific measures for individual skin reactions.

INTERVENTIONS FOR SIDE EFFECTS OF RADIATION THERAPY

1. SKIN REACTIONS
erythema, dry/moist desquamation
atrophy, telangiectasia, depigmentation, necrotic/ulcerative lesions.
 NURSING INTERVENTIONS:
 Observe for early signs of skin reaction and report to the physician.
 Keep area dry.
 Depigmentation telangiectasia
 Washing area with water, no soap and pat dry (do not rub). Mild soap is permitted.
 Do not apply ointments, powders or lotion to the area. Cornstarch may be used.
 Do not apply heat; avoid direct sunshine or cold on the area.
 Use soft cotton fabrics for clothing. To prevent skin irritation.
 Do not erase markings on the skin. These serve as guide for areas of irradiation.
2. INFECTION
– this is due to bone marrow suppression
 NURSING INTERVENTIONS:
 Monitor blood counts weekly, especially WBC
 Good personal hygiene, nutrition, adequate rest
 Teach the client signs of infection to report to physician
3. HEMORRHAGE
 Platelets are vulnerable to radiation.
 NURSING INTERVENTIONS:
 Monitor platelet count
 Avoid physical trauma or use of aspirin(ASA)
 Teach signs of hemorrhage to report (e.g., gum bleeding, nose bleeding, black stools)
 Monitor stool and skin for signs of hemorrhage
 Use direct pressure over injection sites until bleeding stops.
4. FATIGUE
 result of high metabolic demands for tissue repair and toxic waste removal
 plenty of rest and good nutrition
5. WEIGHT LOSS
 anorexia, pain, and effect of cancer
6. STOMATITIS AND XEROSTOMIA (DRY MOUTH)
- Ulceration of oral mucous membrane occurs
 PPT 9 – Radiation Therapy
 NURSING INTERVENTIONS:
 Administers analgesics before meals, as prescribed
 Bland diet, avoid smoking and alcohol
 Good oral hygiene with saline rinses every 2 hours
 Sugarless lemon drops or mint to increase salivation
7. Diarrhea, nausea and vomiting, headache, alopecia (hair loss) and cystitis, may also occur.
8. Social isolation is also experienced by the client due to fear of contaminating others with radiation.