Radiation therapy - questions and answers

 

Do I always have to be treated at the hospital?

Most radiotherapy does not require a stay in the inpatient department of the Clinic. The patient can spend the night at home and come to the clinic on an outpatient basis, solely for carrying out the treatment itself. Exceptions are those types of radiation therapy that require so much preparation that going home just does not make sense. The same applies to treatment, which requires surgical intervention, for example, brachytherapy, which is used to irradiate from the inside.

With some complex combined chemoradiotherapy, it is also advisable to stay in the clinic.

In addition, there may be exceptions to the decision on possible outpatient treatment if the general condition of the patient does not allow for outpatient treatment or if the doctors believe that regular observation will be safer for the patient.

What load can I tolerate during radiation therapy?

Whether treatment changes the maximum allowable load depends on the type of treatment. The likelihood of developing side effects with head irradiation or volumetric irradiation of extensive tumors is greater than in the case of targeted irradiation of a small tumor. An important role is played by the underlying disease and general condition. If the condition of patients as a whole is severely limited due to the underlying disease, if they have symptoms, such as pain, or if they lose weight - then exposure is an additional burden.

Ultimately, the mental situation also exerts its influence. Treatment for several weeks abruptly breaks the habitual rhythm of life, repeats itself again and again, and is already tedious and burdensome in and of itself.

In general, even in patients with the same disease, doctors observe great differences - some do not experience any problems, others clearly feel sick, their condition is limited by such side effects as fatigue, headaches or lack of appetite, they need more rest. Many patients in general feel at least so good that during outpatient treatment they are limited when doing simple things only to a moderate degree, or they do not feel any restrictions at all.

Whether higher physical exertion is permitted, for example, sports or small trips during breaks between treatment courses, the attending physician should decide. Anyone who wants to return to his workplace during the period of irradiation also must necessarily discuss this matter with doctors and the health insurance fund.

What should I look for in nutrition?

The effect of irradiation or radionuclide therapy on nutrition is difficult to describe as a whole. Patients who receive high doses of radiation in the mouth, larynx or throat area are in absolutely different situation than, for example, patients with breast cancer, in which the gastrointestinal tract does not fall completely into the radial field and in the case with which treatment, mainly , is conducted with a view to consolidating the success of the operation.

Patients, whose gastrointestinal tract is not affected during treatment, usually cannot be afraid of any consequences from nutrition and digestion.

They can eat normally, while they need to pay attention to consuming enough calories and a balanced mix of foods.

How to eat when irradiating the head or gastrointestinal tract?

Patients in whom the oral cavity, larynx or gastrointestinal tract are the target of irradiation, or cannot avoid incidental exposure, need to be monitored by a nutritionist, in accordance with the recommendations of the German and European Dietetics Society (www.dgem.de). In their case, you can expect problems with eating. The mucous membrane can be damaged, and this leads to pain and the risk of developing infections. In the most unfavorable case, swallowing problems and other functional disorders are also possible. It is necessary to avoid inadequate provision of energy and nutrients that may arise due to such problems, which under certain circumstances may even lead to interruption of treatment, this is the opinion of professional communities.

In supervision and support, especially those patients who before the beginning of irradiation could not eat normally, lost weight and / or found certain deficiencies, are in need of supervision and support. The question of whether the patient needs a supporting diet (“Nutrition for astronauts”) or the introduction of a nutritional probe, is decided according to the individual situation, best before the start of treatment.

Patients who develop nausea or vomiting associated with exposure to irradiation should always talk to their doctors about medications that suppress nausea.

Do complementary or alternative drugs, vitamins and minerals help cope with the effects of irradiation?

Because of the fear of side effects, many patients turn to funds, which are said to allegedly protect from radiation damage and the occurrence of side effects. As for the products that patients are asked about in the cancer information service, here we give the so-called “list of the most popular drugs”, which includes complementary and alternative methods, vitamins, minerals and other biologically active additives.

However, the vast majority of these proposals are not at all medicines and they do not play any role in the treatment of cancer. In particular, some vitamins are debated whether they can even have a negative effect on the effect of irradiation:

Presumed protection against the side effects offered by so-called radical scavengers or antioxidants such as vitamin A, C or E, at least theoretically, could neutralize the necessary effect of ionizing radiation in tumors. That is, not only healthy tissue, but also cancer cells would be protected.

The first clinical trials on patients with head and neck tumors, apparently, confirm this fear.

Can I prevent skin and mucous membrane damage with proper care?

Irradiated skin requires careful care. Washing is not taboo in most cases, however, it should be carried out, if possible, without using soap, shower gel, etc. - so recommends the working group on side effects of the German Society for Radiation Oncology. The use of perfume or deodorant is also not advisable. With regard to powder, creams or ointments, in this case, you can only use what the doctor has authorized. If the radiotherapist has applied the skin to the skin, then it can not be washed. Linen should not be pressed or rubbed, when wiping with a towel, you can not rub the skin.

The first symptoms of a reaction are often similar to a light sunburn. If more intense redness or even blisters are formed, then patients should consult a doctor even if the doctor's appointment has not been prescribed. In the long term irradiated skin can change pigmentation, that is, become either slightly darker or lighter. Sweat glands can be destroyed. However, to date, severe damage has become very rare.

What should dentistry look like?

For patients who need to be exposed to the head and / or neck, dental care is a particular problem. The mucous membrane refers to tissues, the cells of which divide very quickly, and it suffers from treatment more than, for example, the skin. Small painful wounds are frequent enough. The risk of developing infections is increasing.

If this is possible, before starting the irradiation it is necessary to consult a dentist, perhaps even in a dental clinic, which has experience in preparing patients for radiation therapy. Dental defects, if any, should be eliminated before treatment, however, often this cannot be done on time for practical reasons.

During the irradiation, experts recommend brushing your teeth carefully, but very carefully, to reduce the number of bacteria in the mouth, despite the possible damage to the mucous membrane. To protect the teeth, many radiologists, together with treating dentists, perform fluorine prophylaxis with the use of gels that are used as toothpaste or for some time directly affect the teeth through the kappa.

Will my hair fall out?

Hair loss during irradiation can occur only if the hair-covered part of the head is in the radiation field, and the radiation dose is relatively high. This applies to the hair on the body, which falls into the radial field. Thus, adjuvant breast irradiation with breast cancer, for example, does not affect the hair of the head, eyelashes or eyebrows. Only the growth of hair in the axillary region from the affected side, which falls into the radiation field, can become scarcer. Nevertheless, if the hair follicles are actually damaged, then until the visible growth of hair appears again, it may take six months or more. How should hair care at this time should look like, it is necessary to discuss with the doctor. Important is a good sun protection for the scalp.

Some patients after irradiation of the head are forced to reckon with the fact that for some time the growth of hair directly in the place of hit by the rays will be meager. At doses above 50, specialists in the field of radiation therapy proceed from the premise that not all hair follicles can recover again. To date, there are no effective means to combat or prevent this problem.

Will I be “radioactive”? Should I stay away from other people?

This need to be clarified

Ask your doctors about it! They will explain to you whether you will ever contact radioactive substances. This is not the case with normal irradiation. If you do contact such substances, you and your family will receive several radiation protection recommendations from the doctors.

This issue worries many patients, as well as their loved ones, especially if the family has small children or pregnant women.

With “normal” transdermal radiotherapy, the patient is still not radioactive! The rays penetrate his body and there give up their energy, which swallows up the tumor. Radioactive material is not used. Even close physical contact is completely safe for relatives and friends.

With brachytherapy, the radioactive material can remain in the patient's body for a short time. While the patient “emits rays,” he usually remains in the hospital. When doctors give a “green light” for discharge, there is no danger for the family and visitors anymore.

Are there long-term consequences that I should take into account even after a few years?

Radiation therapy: many patients after irradiation do not have any visible changes on the skin or internal organs. Nevertheless, they need to know that irradiated tissue is for a long time more susceptible, even if it is not very noticeable in everyday life. However, if you take into account the increased sensitivity of the skin with body care, in the treatment of possible irritations caused by exposure to sunlight, as well as with mechanical loads on tissue, there is usually very little that can happen.

When carrying out medical measures in the field of the former radiation field, blood sampling, physiotherapy, etc., the responsible specialist should indicate that he should be cautious. Otherwise, even with minor injuries, there is a danger that in the absence of professional treatment, the healing process will go wrong and a chronic wound is formed.

Damage of organs

Not only the skin, but also every organ that received too much radiation dose, can react to irradiation by changing tissues.

This includes cicatrical changes in which healthy tissue is replaced by a less elastic connective tissue (atrophy, sclerosing), and the function of the tissue or organ itself is lost.

It also affects the blood supply. It is either insufficient, since the connective tissue is worse supplied with blood through the veins, or multiple small and enlarged wreaths (telangiectasia) are formed. The glands and tissues of the mucous membranes become very sensitive after irradiation and, due to cicatrical restructuring, react to minute changes by sticking. 

Which organs are affected?

As a rule, only those regions that are really in the radiation field are affected. If the organ is affected, the scarring, for example, in the salivary glands, oral cavity and other parts of the gastrointestinal tract, in the vagina or in the genitourinary tract, under certain circumstances, actually leads to loss of function or to the formation of obstructive constrictions.

The brain and nerves can be affected by high radiation doses. If the uterus, ovaries, testicles or prostate were in the trajectory of the rays, then the ability to conceive children may be lost.

It is also possible to damage the heart, for example, in patients with cancer, in the case of which, when irradiating the chest, there was no way to get around the heart.

From clinical and preclinical studies, radiologists are aware of specific tissue-specific radiation doses, which can be expected to produce similar or other severe injuries. Therefore, they try, as far as possible, to avoid such loads. New techniques of targeted radiation have facilitated this task.

If you cannot reach the tumor without exposing the sensory system in passing, the patients, together with their doctors, must jointly consider the relationship between benefit and risk.

Secondary cancer diseases

In the most unfavorable case, the delayed effects in healthy cells also lead to the emergence of secondary tumors provoked by irradiation (secondary carcinomas). They are explained by persistent changes in the genetic material. A healthy cell can eliminate such damage, but only to a certain extent. Under certain conditions, nevertheless, they are transferred to the daughter cells. There is a growing risk that with further cell division, more damage will appear and eventually a tumor will develop. In general, the risk after exposure is small. Often, it may take several decades before such an “error” actually arises. However, most of the irradiated patients with cancer are already ill in the second half of their life. This should be taken into account when comparing possible risks and benefits of treatment.

In addition, the load with the new methods of irradiation is much less than with the methods that were applied a couple of decades ago. For example, in young women who, due to lymphoma, received extensive chest irradiation, that is, so-called irradiation through the magnetic field around the shell, as a rule, the risk of developing breast cancer is usually slightly increased. For this reason, as part of the treatment for lymphoma, doctors are trying to apply extensive irradiation as rarely as possible. Among patients with prostate cancer who underwent radiation therapy before the end of the 1980s using conventional methods at that time, the risk of developing bowel cancer is higher compared to healthy men. An up-to-date study by American scientists shows that approximately since 1990, the risk has significantly decreased – the use of newer and much more targeted radiation techniques today leads to the fact that in most men the intestine no longer reaches the radial field at all.

Source: https://www.krebsinformationsdienst.de/behandlung/strahlentherapie.php

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