Five most commonly asked questions about radiation therapy answered

Radiation therapy is one of the most common treatment methods used to treat cancer, alongside surgery and chemotherapy. Read on as Icon Cancer Centre Radiation Oncologist Dr Francis Chin (Senior Consultant in Radiation Oncology, Palliative Medicine) answers some of your burning questions on radiation therapy treatment for cancer.

Radiation therapy, also known as radiotherapy, uses small doses of highly-targeted radiation to safely treat and manage cancer. It does this by delivering radiation over an extended period of time, typically days and weeks, to destroy cancer cells (which are more sensitive to radiation) while preserving normal healthy cells.

Radiation therapy treatment is typically delivered every day (Monday to Friday) across several weeks, which helps your healthy cells to recover while delivering enough radiation to target the cancer cells. The session generally lasts between five to 20 minutes and you generally will not need to stay in hospital following your radiation therapy treatment.

The duration of the treatment session is a guideline and the course of radiation therapy is unique for every individual, depending on the location and stage of the disease, type of cancer, age and general health.

There are some common short-term side effects that develop during radiation therapy treatment. These may include skin reactions such as redness, itchiness and irritation in the area that is being treated, which typically resolve four to six weeks after treatments. Your care team will show you how to care for your skin and manage any skin reactions.

Another common side effect from radiation therapy treatment is fatigue. You may feel tired or lack energy for daily activities during your treatment, which can worsen as you reach the end of your treatment. This is a common reaction to radiation therapy and each person is usually affected in varying degrees, which can also depend on whether you are also receiving other cancer treatments such as chemotherapy. Fatigue usually eases a few weeks after treatment finishes. Finding a balance between rest and activity will help you manage daily life.

If you have any concerns about the side effects, please discuss these with your radiation oncologist as they are the best person to provide more details.

Depending on the type of cancer you have and your unique needs, radiation therapy may be the only cancer treatment that is required. One of the benefits of radiation therapy is that it is usually given as outpatient treatment, so patients can still continue with their daily activities and lead a normal life.

Radiation therapy also works hand-in-hand with other treatments such as surgery, chemotherapy and immunotherapy. Radiation therapy can reduce the risk of cancer recurrence when delivered either before or after surgery for many types of cancer, such as breast cancer, uterine cancer, skin cancer and prostate cancer.

Other cancers such as head and neck cancer, bladder cancer, lung cancer and cervical cancer will typically have radiation therapy delivered as the main treatment to avoid the need to remove organs and/or avoid surgery.

Radiation therapy can also be used as palliative care for advanced cancers to effectively provide pain management.

When radiation therapy is delivered to the chest area for cancers such as lung cancer, oesophageal cancer or breast cancer, there is a small risk that certain heart issues can develop due to radiation being delivered to healthy tissue surrounding the cancer. Heart conditions that may develop include:

• Pericarditis – Inflammation of the tissue surrounding the heart
• Premature coronary artery disease and atherosclerosis
• Myocarditis – Inflammation of the heart muscle
• Congestive heart failure – Loss of heart pumping ability
• Heart valve disease
• Heart rhythm changes – Arrhythmia
• Cardiomyopathy – Enlarged heart

However, there are a number of techniques that are used to reduce damage to the heart and surrounding organs during radiation therapy such as Deep Inspiration Breath Hold (DIBH). The process involves holding a certain number of breaths for short bursts during treatment which allows the heart to move backwards into the chest while the breast is exposed to radiation.

Usually, your doctor will assess your personal health history before deciding on the best course of treatment for your cancer. Here are some of the factors that the doctor will look into:

• Heart disease risk factors – Such as obesity, cigarette smoking, diabetes and family history
• A personal history of heart disease

People who have been treated with radiation therapy for a previous cancer have a slightly higher risk of developing cancer again. The risk is different depending on where in the body you have been treated, the dose of radiation you received and your age when treated, with an average time of about 10 years between the radiation treatment and the diagnosis of a secondary cancer. If you are concerned about other cancers that may develop following radiation therapy treatment, please discuss this with your doctor.