• Clinical science

Radiation therapy (Radiotherapy)

Summary

Radiation therapy is a nuclear medical treatment that employs ionizing radiation to kill abnormal cells or control their growth. It is one of the three main approaches to the treatment of malignant tumors alongside chemotherapy and surgery, but can also be used to treat noncancerous diseases such as benign hyperthyroidism, Cushing disease, Dupuytren contracture, and plantar fibromatosis. Radiation therapy is typically employed as a supplement to other treatments and rarely represents the sole approach. There are three forms of radiation therapy: external beam radiation therapy (teletherapy), which involves irradiation from an external source; unsealed source radiotherapy (systemic radioisotope therapy), which involves the administration of radiopharmaceuticals that accumulate in target tissues and irradiate these internally; and sealed source radiotherapy (brachytherapy), which involves the implantation of radioactive material beside or within the tissue to be irradiated. The type of radiation therapy employed depends on the disease and the specific type of cancer being treated. Radiation therapy can be employed curatively (i.e., to kill the diseased tissue completely) or palliatively (e.g., to shrink a tumor, control its growth, or relieve symptoms caused by a tumor). Palliative indications include bone pain, spinal cord and nerve compression, and hemostasis. As with all medical use of ionizing radiation, the radiation dose should be maintained as low as reasonably possible (ALARA principle) and appropriate safety measures should be observed to minimize carcinogenic effects.

Dose fractionation

Description: the division of the total dose of radiation into smaller doses administered over the course of several days or weeks; total dose and duration of treatment depends on tumor type

  • Conventional fractionation (conventional radiation therapy): standard radiation dose per fraction (1.5–2 Gy) of a standard total radiation dose (45–70 Gy) over the standard duration of treatment (5–7 weeks).
  • Hypofractionation: reduced fractionation; i.e., higher radiation dose per fraction (> 2 Gy/1 × per day) of a reduced total radiation dose (< 45 Gy) over a shorter duration of treatment (3–5 weeks)
    • Indications include patient wish in palliative setting to reduce hospitalization time
  • Hyperfractionation: increased fractionation; i.e., lower radiation dose per fraction (1.15 Gy/2 × per day) of increased total radiation dose (> 70 Gy) over a prolonged duration of treatment (7 weeks); allows for application of higher total doses of radiation
    • Indications include tumors with high cell division rate
  • Acceleration: increase of fractionation rate at the same total radiation dose; allows for reduction of duration of treatment and increased effect at a higher risk of side effects.
    • Indication: tumors that quickly develop resistance to radiation

Types

By objective

  • Curative: applying radiotherapy with the intent of curing a patient (e.g., completely removing a malignancy)
  • Palliative: applying radiotherapy with the intent of prolonging life and/or alleviating symptoms. Examples include:

By timing

Type Timing Goal
Neoadjuvant radiotherapy
  • Applied before the main treatment, typically preoperatively
  • Reduce tumor size to help facilitate resection, possibly increasing the chances of curative resection
Intraoperative radiotherapy
  • Deliver a high dose of radiation to the targeted area more precisely than external beam radiation therapy, which minimizes:
    • Radiation exposure to surrounding tissue
    • Delays between surgery and EBRT → reduces the chance of tumor cell repopulation
Adjuvant radiotherapy
  • Destroy malignant cells still present after surgery
Radiation boost
  • Destruction of residual tumor cells and reducing the chance of local tumor recurrence
Chemoradiotherapy
  • Chemotherapy may increase a tumor's sensitivity to radiation and vice-versa
  • Support successful surgical resection

By technology

  • External beam radiotherapy (EBRT; teletherapy): radiation therapy using a source of radiation outside the body
  • Brachytherapy (sealed source radiation therapy): radiation therapy involving the implantation of radioactive seeds (approx. the size of a grain of rice) within or next to the target tissue
    • Low-dose radiation possible
  • Unsealed source radiotherapy (systemic radioisotope therapy): radiation therapy involving the administration of radiopharmaceuticals that accumulate in target tissues and irradiate these internally

Complications

We list the most important complications. The selection is not exhaustive.

last updated 07/01/2020
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