1. Radiation Therapy Overview

2. What is Radiation? “energy in motion” waves or streams of particles
Can’t see it or feel it
different forms of radiation

3. Types of Radiation At one end of the spectrum….. visible light
ultraviolet light
radio
sound
“non-ionizing”

4. At the other end….. High Energy “ionizing”
produces ions (charged atoms)
eg. photons, protons, electrons, neutrons

5. Ionizing Radiation Used in treatment of disease (malignant and benign)
Linear accelerators
X-rays
Electrons
Radioactive isotopes (HDR)

6. How does RT work? = Cell Death Damage to Parts of the cell DNA water
proteins
cell membrane
DNA
= Cell Death

7. Goal of Radiation Therapy
Maximize dose to tumour
&
Minimize dose to normal tissue / critical structures

8. Radical Treatment (aim to cure)
Combined with:
Chemotherapy (before, after, during)
Surgery (before, after)
Hormones (before, after, during)

9. Palliative Treatment Quality of life Relief of symptoms
pain
bleeding
Obstruction
Spinal Cord Compression
eg. metastatic cancer to bone, brain, lung

10. Radiation Therapy Department
Main floor of TBRHSC (2nd level)
Separate reception and waiting area
Chemotherapy / medical oncologists are upstairs on 3rd level

11. 2nd Floor
Radiation Therapy Dept.

12. Treatment Units Linear Accelerators x 2
Photons (deep seated tumours eg. pelvis)
Electrons (superficial eg. skin)

13. Entrance to Rx room

14. Entrance to treatment machine (Linac 3)

16. Linear
Accelerator
(Siemens ONCOR)

20. External Beam RT The process begins…..

21. CT-Simulation a.k.a. “Planning Scan”
1 hour appointment
May require cast (done 2 hours before CT)
Patient education (30 minutes)
Consent
CT-Simulation (15-30 minutes)

22. CT Simulation Treatment position
Important to maintain position / keep still
Positioning devices (standard or custom
Reference marks placed on patient

23. Head & Neck Shell

24. Head Shell

25. Hip Fix (prostate)

26. Positioning Devices
Prone pillow
Wingboard

27. Positioning Devices (cont’d)
Knee rest
Foot rest
Breast Board

28. After CT Scan Patient is finished & can go…… Tattoos / marks
will receive a phone call with next appointment
Approximately 1-2 weeks for radical tmt
Couple of days or same day for palliative patients

29. Preparation for Planning
All further work done on computer
Critical structures outlined (by therapist)
Spinal cord, rectum, bladder, eyes, kidney, etc.
Tumour is outlined (by Rad. Onc)

30. Virtual Simulation

31. Next step…. Treatment Planning / Dosimetry
Shows the doses of radiation within the treatment area and to critical structures near by
May take up to 2 weeks to complete this step
Approval by Oncologist

32. Radiation Dose Distribution

33. Comparison of Process Radical Palliative CT-Simulation 1 hour Planning
Complex (up to 2 weeks)
Simple (same or next day)
# of treatments
15-40
Mon to Fri
1-10
Emergency (weekends/evenings)
Sites
Prostate, breast, brain, H & N
Metastatic disease (eg. Bone mets)

34. 1st Day on Treatment Unit
“Dry run”
Review treatment with patient
Process
Side effects
Questions

35. Day 1 cont’d Electronic images done (like an x-ray) Measurements
Review images
Treatment begins!!!
Final approval by Oncologist

36. While on treatment….. Assessed daily by Radiation Therapists
Weekly assessment by Radiation Oncologist and Nurse (or as necessary)
CBC
Weeks 1 and 4
As necessary

37. Side Effects of RT Localized depends on area being treated
size of area treated
Severity
depends on dose of radiation
Adjuvant treatment (eg. Chemo)
Condition of the patient

38. General Acute Side Effects
Can occur for any site treated with radiation
1. Skin Reaction (erythema, pruritis, dry & moist desquamation)
2. Fatigue

39. Skin Reaction
Why?
Damages the cells within the basal layer of the skin
When?
Erythema / dry desquamation – usually 1-2 weeks into Rx
Peak may occur at the end of the Rx or about 1 week post Rx
Healing will occur 2-4 weeks after RT complete

40. Skin Reaction
Erythema
Dry Desquamation
Moist Desquamation

41. Skin – Ways to help
Keep area clean (gentle washing with mild soap, pat dry)
Allow air to get at the area
Apply Lubriderm (non-scented, non-greasy)
Protect from sun & wind
Reduce mechanical irritation (i.e. loose clothing, don’t scratch)
No heating pads/ice packs
Prescription cream – Hydrocortisone 1%, Flamazine after tmt complete

42. Fatigue
Why?
Cell damage/repair; cachexia; nausea; disease processes; pain; adjuvant Rx; medications
May occur 1-2 weeks into Rx
May increase after Rx finished, but will resolve with time

43. Ways to help…. Rest, nap, sleep Light exercise (brisk walk)
Delegating tasks, setting priorities
Dietary counselling
Stress management techniques
Fatigue booklet & video available

44. Other Important Points
Clinical Trials Department – research to improve standards of treatment and patient outcomes
Radiation Therapy In-Patient Form - in hospital chart

45. Questions?