Radiation Therapy

What is radiation therapy?  

Radiation therapy is a common cancer treatment that uses radiation energy in high doses to kill cancer cells.  

Nearly 50% of cancer patients receive radiation therapy to cure cancer to relieve symptoms or alongside other treatments like chemotherapy.   

Radiation therapy also damages normal cells but these recover faster than cancerous cells. The process begins with an appointment with your consultant to discuss the extent of the disease and outlook.  

The consultant will explain the steps you will undergo during treatment and the side effects that accompany radiation therapy.  You will be advised on the radiation therapy that will work best for you.

The oncologist team will design a treatment plan that includes the right radiation dosage to destroy cancer cells while preserving normal healthy cells.  You will sign a consent form after the full explanation of the procedure. 

Goals of radiation therapy  

Radiation therapy can be used in different ways depending on the type of cancer and the extent of its spread.  Radiation therapy may be administered as the main treatment or in combination with other treatments.  

Radiation therapy may be used in the following ways: 

As the main treatment – The aim of radiation therapy is to kill all the cancer cells and ensure no recurrence. 

Neo-adjuvant therapy – Radiation therapy can be administered before you undergo other types of cancer treatment. For example, if you have a large tumor, your oncologist may suggest that you first have radiation therapy to shrink the tumor before surgery 

Adjuvant radiation therapy – Radiation therapy can also follow other forms of cancer treatment. The aim is to ensure that any cancer cells that may have survived an earlier treatment get destroyed completely.  

Palliative radiation therapy – You may also receive radiation therapy to relieve cancer symptoms.

Radiation therapy is highly effective in treating certain forms of cancer. For other forms of cancer, you are better off using radiation therapy alongside other treatments like surgery.  

Types of radiation therapy

Radiation therapy falls under two main categories – internal radiation therapy and external radiation therapy.

Both forms of radiation therapy interfere with the cell’s DNA instructions. That means cancer cells no longer receive instructions to grow and multiply. Eventually, the cells die and the tumor will shrink.

Internal radiation therapy

In this type of radiation treatment, the oncologist places an implant with radiation energy near or at the site of the cancer.

Internal radiation therapy treats small tumors found mainly in the cervix, prostrate, neck, and uterus. The source of internal radiation can be in liquid or solid form.

Brachytherapy is an example of internal radiation based on a solid source. Your oncologist implants a solid radioactive source next to or inside a tumor.

The implant releases low or high dosages of radiation that kills the cancer cells depending on the type of treatment plan you are on.

Some implants remain in your body for a long time while others are temporary. Ultimately, the source ceases to release radiation.

The liquid radioactive material is administered via systematic therapy. Either as an IV injection or orally.

An example of systematic therapy is radioimmunotherapy. In the procedure, a radioactive protein identifies particular cancer cells to which it will attach. It then releases radiation to kill the cancer cells.

External radiation therapy

This is the most popular form of radiotherapy.  A linear accelerator machine directs a photon or x-ray radiation beam toward a tumor at high levels of precision.

Your oncologists will first develop a treatment plan that directs the radiation to your tumor.  Examples of external radiation therapy include:

• Intensity-modulated radiation therapy – This form of radiation therapy radiation involves beams of different with a different dose intensity. A lower dose of radiation is directed at healthy tissues. A higher dose is directed at the tumor.
• 3D conformal radiation – In this type of radiation therapy, the radiation team creates a 3D model of a tumor using computer software and CT scans of the tumor.  The radiation beams are directed at cancer cells without harming the healthy cells.
• Image-guided radiotherapy – The radiation machine generates mini-CT scans and X-ray images in low doses prior to the commencement of treatment.
• Image-guided radiotherapy allows the oncologist’s team to align the site of treatment accordingly. It leads to high precision in the delivery of radiation.
• Gamma knife radiosurgery – the treatment is also known as stereotactic body radiation therapy. It involves directing high radiation doses at a tumor under high precision.
• Particle therapy – This type of radiation uses proton particles to kill cancer cells. Healthy tissues receive low radiation energy, and cancer cells receive high radiation energy.
• Intraoperative radiation – This procedure is administered following the surgical removal of a tumor. Intraoperative radiation aims to kill any cells that could have survived surgery.

External radiation treats the following cancers:

• Prostate cancer

• Breast cancer

• Cancers of the neck and head

• Lung cancer

Your oncologist can recommend brachytherapy if you have the following forms of cancer:

• Cancer of the esophagus

• Brain

• Bladder

• Eye

• Cancer of the rectum

• Vaginal cancer

• Skin

• Uterus

Preparing for radiation therapy 

Radiation therapy begins with consultation with your oncologist. He or she will examine you, assess your general health, and order diagnostic tests to determine the type of cancer.  

Your oncologist will discuss the plan of treatment that is most effective for you.  If you are to undergo external beam radiation, your oncologist team will arrange a simulation session.  

During a simulation session, your radiation therapist puts small marks on your skin to indicate the target of radiation beams.   

Your oncologist team may design a body mold to ensure you are positioned correctly while radiation therapy is ongoing. 

In case the site of radiation therapy is your neck or head, you will require a face mask.  The face mask ensures your head remains in place during radiation therapy. 

Your oncologist will request for MRI or CT scan to reveal the location of your tumor. Such images will assist the care team in developing X-rays that targets tumor only without affecting the healthy cells. 

Simulation helps your radiation oncologist establish the correct dosage of radiation to administer.

During treatment  

If you are receiving internal radiation therapy, this is usually administered in a hospital or a specialized outpatient facility. Your oncologist uses a catheter to insert the radiation implant. 

The procedure is administered under general anesthesia. It eases discomfort and pain during treatment. 

In the case of systematic internal radiation therapy, your radiation oncologist administers radioactive fluid via an IV. 

If you are undergoing external radiation therapy, your radiation oncologist requests you to lie on a table. 

A radiation therapist operates the linear accelerator machine from a nearby control room. The radiation team is on standby and you may communicate with them if need be. 

The linear accelerator machine moves around you as it makes a buzzing sound. The machine does not come into contact with your skin and you won’t feel anything during the procedure. 

The linear accelerator delivers radiation energy with high precision from various angles, targeting cancer cells. Your care team will adjust this machine specifically for you. 

Most facilities offer external radiation as an outpatient service. That means you will go home after each treatment and only return to the hospital when the next treatment is due.  

Some external radiation treatment courses run from between 1 and 2 weeks. The reason for spreading this treatment is to permit the recovery of healthy cells between sessions. 

An individual session might last between 10 and 30 minutes. The radiation team may use props and molds to hold you in place.

After treatment  

If you undergo internal radiation therapy, your recovery period is shorter. Your radiation oncologist may discharge you on the same date. 

If you have received high doses of radiation, your radiation oncologist may recommend staying in the healthcare facility for some time to shed radiation. 

Some patients who have received systematic radiation therapy may secrete radiation in small quantities. 

Radiation is secreted in blood or body fluids. Permanent or IV internal radiation minimizes the risk of exposing others to such radiation. 

You will receive proper guidance from your radiation therapist on the extent of contact following radiotherapy. 

Most people can partake in regular daily activities before and after external radiation therapy. 

Benefits of radiation therapy

The benefits of radiation therapy are as follows:

• Radiation therapy has proven to be an effective and reliable treatment for cancerous cells

• It promotes the working of other cancer treatments like surgery by destroying diseased cells

• It eases pain

Side effects

Your radiation therapist will spread the treatment plan across various sessions.  You receive treatment in smaller doses over time.

Multiple treatment sessions give your healthy cells ample time to recover before the next treatment session. It minimizes the side effects.

Still, you are likely to present with the following side effects:

• Vomiting

• Headache

• Fatigue

• Hair loss

• Loss of appetite

• Diarrhea

• Mouth sores

• Abdominal cramps

• Dry, itchy scalp

Most of these side effects will stop as soon as you are off the treatment plan. Other side effects are manageable with medication.

Speak to your radiation oncologist about the side effects you are likely to experience and the remedies available to them.

Recovery

The recovery after radiation therapy depends on your age, the type of radiation treatment received, and overall health.

Some people resume their normal routine after radiation therapy while others need to take a rest because of the side effects of this treatment. For other people, it takes a few weeks before they can experience side effects.

In case of permanent implants, you are advised by your oncologist team to minimize contact with pregnant women and children to below 5 minutes.

In systemic radiation therapy, your healthcare team may ask you to follow the following safety precautions for the next few days after treatment:

• Do not engage in sexual activities

• Thoroughly wash your hands with soap and water after using the washroom

• Stay hydrated by drinking plenty of fluids to flush out any radioactive material in your body

• If you are sharing a house with a spouse or family, use separate towels and utensils

• Minimize contact with children, infants, and pregnant women

Cost of radiation therapy in India  

The cost of radiation therapy in India ranges between Rs. 4,75,000 and Rs. 22,00,000. The difference is influenced by the following factors: 

Stage of cancer – The stage of cancer will determine radiation cost. For instance, if the cancer is at an advanced stage, you need radiation in higher doses. You also need an elaborate treatment plan. This affects the cost of radiation.  

Duration of treatment – If the treatment period is short, the cost of radiation is lower than one that requires several months. 

Treatment method – The cost of internal radiation therapy differs from that of external radiation therapy. In internal radiation therapy, your radiation oncologist may have to incorporate a radioactive implant, and is hence a sensitive procedure.  

Number of sessions – If your cancer is at a more advanced stage, you will need multiple sessions of therapy. Also, some patients cannot withstand a high radiation dose, thus necessitating multiple sessions. 

Dose requirement – Certain types of cancer require a higher radiation dose than others. This translates to a higher cost. 

Anesthesia charges – The cost of radiotherapy also depends on the dosage and kind of anesthesia used. 

Medical facility – The cost of radiotherapy at a hospital can be more expensive compared to a visit to the doctor’s clinic. 

Secondary procedures – If the radiation team undertakes any secondary procedures as part of treatment, this will increase the overall cost of radiation.  

Length of admission – If radiotherapy is administered alongside other treatments like chemotherapy, it means a longer you will need to stay longer in the hospital. 

The table below summarizes the cost of radiation therapy in selected cities across India:

Facilities offered by Indian hospitals to international patients receiving radiation therapy:

• One-on-one consultation with oncologists

• Access to emergency ambulatory services

• Visa processing and other documentation

• Foreign exchange services

• Get highly experienced nurses

• Accommodation, including private suites

• State-of-the-art facilities and infrastructure

References

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