What is the radio therapy, to whom it is applied, what are the side effects?
Radiotherapy is a treatment method made with the aim to prevent the division and reproduction of the cancer cells by forming DNA breakage in the cores of cancer cells with ionizing X rays Cancer cells are more sensitive to radiotherapy than the other organs and tissues in the body. Radiotherapy can be applied to benign lesions except from cancer treatment. In order to remove microscopic remains after surgery, Radiotherapy can be applied with chemotherapy so as to minimize the tumor before operation or provide cure. Palliative operations can be applied in order to remove pain symptoms or the impression, and fracture risk findings.
Cancerous cells are more sensitive to radio therapy than other normal organs and tissues in the body. Among the normal organs and tissues, the ones covered with mucosa (respiratory system, digestive system, and urogenital system), skin, nervous system, bone marrow, reproduction organs, kidneys can be affected from radiation more easily.
Patient treatment is made with team work in Gayrettepe Florence Nightingale Hospital, in advanced Oncology Center, Radiation Oncology Department. The team consists of Radiation Oncologist, Radio Physics Experts, Medical Dosimetrists and Radiotherapy Technicians who are experts in their field. Our medical secretaries and assistant personal meet you and give response to your needs.
- - Radiation Oncology Expert is the doctor who is specialized in giving treatment with radiation and decide to in what way the patient will be treated and to which region of the body and with which dosage to give the treatment. She/he decides to the necessary treatment changes and the follow-up of the patient. Late side effects that may be occurred during the radiotherapy and may be seen in early or long period are followed and treated by Radiation Oncologist Expert.
- - Radio Physics Experts are the ones who maintain the installation and measurements of the devices and preparation and verification of the patient treatment plans. They ensure the continuity of the proper operating of the systems by controlling the systems used in treatment.
- - Dosimetrists help the Radio Physics Experts for the preparation of treatment plans and quality control measurements.
- - Radiotherapy Technicians are the staff who graduated from relevant academy and are responsible for application of the treatment to the patients every day. They are responsible for providing the position of the patient, taking the daily portal images with the intent of treatment field control. During the treatment, they follow the patient from the control room.
This staff work closely and move in cooperation at all the stages of the treatment series.
We do the Radiotherapy planning by using the PET-CT images besides Computed Tomography and Magnetic Resonance image fusions for the determination of target volumes. Positron Emission Tomography shows the tumoral forms whose metabolism is high with help of radionuclide specific marked FDG glucose given with vascular access.
Will help to shape the volume has to be treated by conformal radiotherapy beam with a multi-leaf collimator is carried out with the creation of the treatment area. Computed tomography of the sections of the body or organ to be treated, tumor volume, and treatment of solid organs at risk willbe drawn to the field. The patient is prepared by a three-dimensional treatment planning and scheduling is treated by linear accelerator devices. Adjacent to the target volume and organs at risk to be treated, the doses indicated by dose-volume histogram graphs called.
English IMRT (Intensity Modulated Radiotherapy), known as intensity modulated radiation therapy in the (IMRT) dose painting methods, while maintaining a solid organs and tissues better, higher doses are accessible by the targeted treatment area. Divided into small segments with wisps of radiation beams from outside is given a more sophisticated method of irradiation. With this method, to achieve better tumor control and can better protect intact organs and tissues.
IGRT is to apply image-guided radiotherapy. In order to minimize the differences between treatments per day (set-up, depending on the movements of patient and organ) during pre-treatment zone controls are done by taking daily films.
Arc therapy in the treatment of those who developed linear accelerators and daily treatments with faster and more homogeneous dose distribution has been able to give.
We have Multi-energy Varian 2300CD linear accelerator and Varian Unique RapidArc device in our clinic. With both devices and the help of Electronic Portal Imaging we make image-guided studies.
Radiotherapy sessions, during intensity modulated radiation therapy, can take 15-20 minutes. Patient should lie still on the treathment table during the treatment. Despite the stabilization devices to remain still and thermoplastic masks, due to the extension of the duration of treatment; breathing, coughing, etc., may vary for reasons such as treatment position. With RapidArc device treatment can be given 2-8 times faster and intact tissues are protected. Treatment sessions are shortened to 2 minutes, and patient comfort is increased.
With the multi-leaf collimators at the Linear accelerators, the area is shaped as desired.
Nutrition during radiotherapy:
- - Vary according to:
- - The size of the treatment area,
- - Total and daily treatment doses,
- - How many weeks will the radiotherapy continue,
- - The patient's general performance status,
- - Patient's accompanied non-cancer diseases (eg, diabetes, ulcerative colitis, and so on.)
- - Radiation sensitivity of the patient.
Today, thanks to the development of modern radiotherapy techniques and devices, it is possible to reduce the side effects. Three-dimensional and intensity modulated radiotherapy, rising the dose in cancer tissues, lower doses can be given to the adjacent organs intact with painting techniques. Despite these technological advances, either sequentially or simultaneously with the addition of chemotherapy treatments can cause side effects, serious deterioration in the patient's quality of life.
Irradiation of organs such as head and neck, lung, esophagus, can cause such side effects like deterioration of the mucous membranes in the mouth and esophagus, difficulty swallowing, dry mouth, taste changes. With poor pretreatment oral hygiene and inattentive oral care patients during the treatment these side effects can be seen faster and more violent. In the abdomen and pelvis irradiation of the digestive system and genitourinary tract tumors; nausea, vomiting, diarrhea, cramping, abdominal pain, style, urine and excretional side effects come into prominence. Findings of sensitization at rectum as the last part of the small intestine and bladder, may require drug therapy. In this case, depending on the developing side effects, patient's nutrition is also impaired.
In clinical trials, the pre-radiotherapy, patients with better overall body weight and good performance status have better treatment compliance. During radiotherapy in patients with head and neck tumors, follow-up by dietitian for nutritional support has been significantly reduced side effects. Later in treatment, patients with locally advanced head and neck tumors will inevitably have difficulty in feeding, so enteral feeding tube insertion is recommended in these patients before treatment. Patients with insufficient oral feeding, should be applied nasogastric feeding tube or i.v. additional fluid and nutritional supplements shoud be done.
Head and neck, lung and esophagus irradiation:
- - Brushing teeth regularly during treatment, salt-carbonated mouthwash should be done regularly for oral care, if thrush develops it should be treated, fur should be cleaned
- - 8-10 glasses of water should be drunk or a day
- - Smoking and alcohol certainly should not be used
- - Normal diet should be continued until the side effects occur, but foods that will irritate mucous membranes in acidic and bitter-spicy, and so on, should be avoided
- - Watery soft foods should be preferred. Meat broth-chicken broth soups and puddings are rich in protein.
- - Each day it is recommended to consume at least one egg. Egg is a pure source of protein and even patients with high cholesterol can safely consume.
- - Foods should be at room temperature, too cold or boiling is not recommended.
- - At the supervision of a dietitian, weekly weight and body-mass index, body fat, protein and water rates should be monitored in order to support necessity of protein and calories in liquid or powder form, ready to be used in foods
- - Glutamine amino acid is proven in clinical trials for the use of difficulty in swallowing and reduce the contribution of mucosal injury can be used with your doctors advice.
Patients that will receive radiation therapy for head and neck region should go to dentist to treat diseases of the teeth and gums before radiotherapy.
With gold markers in prostate cancer radiotherapy image guidance:
Biopsy needles used in the prostate biopsy with the 24 carat gold-markers (batch the head size of the needle) 3 pcs are placed inside the prostate, by the rectal out way. Prostate is adjacent to the, bladder and the last part of the large intestine, that have changing fullness of the hollow organs day by day. Therefore, the verification of gold markers in the prostate each day is based on electronic portal films due to the exchange of organs is followed.
Respiratory control with RPM:
Far infrared camera mounted on the BT following the respiration