RADIATION THERAPY

Mr. Jils Suresh MSc (N)

• In radiation therapy, ionizing radiation is used to interrupt cellular growth. More than half of
patients with cancer receive a form of radiation therapy at some point during treatment.
 INDICATIONS
Radiation may be used to cure the cancer, as in
 Hodgkin’s disease which is (a cancer originating from white blood cells called lymphocytes)
 Testicular seminomas (germ cell(biological cell that gives rise to the gametes ) tumor of the
testis),
 Thyroid carcinomas, localized cancers of the head and neck, and cancers of the uterine cervix.
 Radiation therapy may also be used to control malignant disease when a tumor cannot be
removed surgically or when local nodal metastasis is present, or it can be used prophylactically
to prevent leukemic infiltration to the brain or spinal cord.
 Palliative radiation therapy is used to relieve the symptoms of metastatic disease, especially
when the cancer has spread to brain, bone, or soft tissue, or to treat oncologic emergencies,
such as superior vena cava syndrome or spinal cord compression.
 TYPES OF RADIATIONS USED

Two types of ionizing radiation—electromagnetic rays (x-rays and gamma rays) and

particles (electrons [beta particles], protons, neutrons, and alpha particles)—can

lead to tissue disruption.

 MECHANISM OF ACTION
The most harmful tissue disruption is the alteration of the DNA molecule within the cells of the tissue. Ionizing
radiation breaks the strands of the DNA helix, leading to cell death. Ionizing radiation can also ionize constituents of
body fluids, especially water, leading to the formation of free radicals and irreversibly damaging DNA. If the DNA is
incapable of repair, the cell may die immediately, or it may initiate cellular suicide (apoptosis), a genetically
programmed cell death.
Cells are most vulnerable to the disruptive effects of radiation during DNA synthesis and mitosis (early S, G2,
and M phases of the cell cycle). Therefore, those body tissues that undergo frequent cell division are most sensitive to
radiation therapy. These tissues include bone marrow, lymphatic tissue, epithelium of the gastrointestinal tract, hair
cells, and gonads.
Slower-growing tissues or tissues at rest are relatively radioresistant (less sensitive to the effects of radiation).
Such tissues include muscle, cartilage, and connective tissues.
Tumors that are well oxygenated also appear to be more sensitive to radiation. In theory, therefore, radiation
therapy may be enhanced if more oxygen can be delivered to tumors.
In addition, Certain chemicals, including chemotherapy agents, act as radiosensitizers and sensitize more
hypoxic (oxygen-poor) tumors to the effects of radiation therapy.
Radiation is delivered to tumor sites by external or internal means.
 EXTERNAL RADIATION
If external radiation therapy is used, one of several delivery methods may be chosen,
depending on the depth of the tumor. Depending on the amount of energy they contain, x-rays can
be used to destroy cancerous cells at the skin surface or deeper in the body. The higher the energy,
the deeper the penetration into the body.
1. Kilovoltage therapy devices deliver the maximal radiation dose to superficial lesions, such as
lesions of the skin and breast,
2. Linear accelerators and betatron machines produce higher-energy x-rays and deliver their
dosage to deeper structures with less harm to the skin and less scattering of radiation within the
body tissues.
3. Gamma rays are another form of energy used in radiation therapy. This energy is produced
from the spontaneous decay of naturally occurring radioactive elements such as cobalt 60.
4. The gamma rays also deliver this radiation dose beneath the skin surface, sparing skin tissue
from adverse effects.
 INTERNAL RADIATION
Internal radiation implantation, or brachytherapy, delivers a high dose of radiation to a localized area.
The specific radioisotope for implantation is selected on the basis of its half-life, which is the time it
takes for half of its radioactivity to decay.
This internal radiation can be implanted by means of needles, seeds, beads, or catheters into body
cavities (vagina, abdomen, pleura) or interstitial compartments (breast).
Brachytherapy may also be administered orally as with the isotope I 131, used to treat thyroid
carcinomas.
Intracavitary radioisotopes are frequently used to treat gynecologic cancers.
In these malignancies, the radioisotopes are inserted into specially positioned applicators after the
position is verified by x-ray.
These radioisotopes remain in place for a prescribed period and then are removed. Patients are
maintained on bed rest.
 RADIATION DOSAGE
The radiation dosage is dependent on the sensitivity of the target tissues to radiation and on
the tumor size. The lethal tumor dose is defined as that dose that will eradicate 95% of the tumor
yet preserve normal tissue.
The total radiation dose is delivered over several weeks to allow healthy tissue to repair and to
achieve greater cell kill by exposing more cells to the radiation as they begin active cell division.
 TOXICITY
Toxicity of radiation therapy is localized to the region being irradiated.
Acute local reactions occur when normal cells in the treatment area are also destroyed and cellular death exceeds
cellular regeneration.
Body tissues most affected are those that normally proliferate rapidly, such as the skin, the epithelial lining of
the gastrointestinal tract, including the oral cavity, and the bone marrow.
Altered skin integrity is a common effect and can include alopecia (hair loss), erythema, and shedding of skin
(desquamation).
After treatments have been completed, reepithelialization occurs.
Alterations in oral mucosa secondary to radiation therapy include stomatitis, xerostomia (dryness of the mouth),
change and loss of taste, and decreased salivation. The entire gastrointestinal mucosa may be involved, and
esophageal irritation with chest pain and dysphagia may result. Anorexia, nausea, vomiting, and diarrhea may occur
if the stomach or colon is in the irradiated field.
Bone marrow cells proliferate rapidly, and if bone marrow– producing sites are included in the radiation field
anemia, leucopenia (decreased white blood cells [WBCs]), and thrombocytopenia (a decrease in platelets) may
result.
 TOXICITY
Patients are then at increased risk for infection and bleeding until blood cell counts return to
normal. Chronic anemia may occur. Certain systemic side effects are also commonly experienced
by patients receiving radiation therapy. These manifestations, which are generalized, include
fatigue, malaise, and anorexia. This syndrome may be secondary to substances released when
tumor cells break down. The effects are temporary and subside with the cessation of treatment.
Late effects of radiation therapy may also occur in various body tissues. These effects are
chronic, usually produce fibrotic changes secondary to a decreased vascular supply, and are
irreversible. These late effects can be most severe when they involve vital organs such as the
lungs, heart, central nervous system, and bladder. Toxicities may intensify when radiation is
combined with other treatment modalities.
NURSING MANAGEMENT IN RADIATION THERAPY
The patient receiving radiation therapy and the family often have questions and
concerns about its safety. To answer questions and allay fears about the effects of
radiation on others, on the tumor, and on the patient’s normal tissues and organs, the
nurse can explain the procedure for delivering radiation and describe the equipment,
the duration of the procedure (often minutes only), the possible need for
immobilizing the patient during the procedure, and the absence of new sensations,
including pain, during the procedure. If a radioactive implant is used, the nurse
informs the patient and family about the restrictions placed on visitors and health
care personnel and other radiation precautions. Patients also need to understand
their own role before, during, and after the procedure.
NURSING MANAGEMENT IN RADIATION THERAPY
PROTECTING THE SKIN AND ORAL MUCOSA
 The nurse assesses the patient’s skin, nutritional status, and general feeling of well-being.
 The skin and oral mucosa are assessed frequently for changes (particularly if radiation therapy
is directed to these areas).
 The skin is protected from irritation, and the patient is instructed to avoid using ointments,
lotions, or powders on the area.
 Gentle oral hygiene is essential to remove debris, prevent irritation, and promote healing.
 If systemic symptoms, such as weakness and fatigue, occur, the patient may need assistance
with activities of daily living and personal hygiene. Additionally, the nurse offers reassurance
by explaining that these symptoms are a result of the treatment and do not represent
deterioration or progression of the disease.
NURSING MANAGEMENT IN RADIATION THERAPY
PROTECTING THE CAREGIVERS
 When a patient has a radioactive implant in place, nurses and other health care providers need
to protect themselves as well as the patient from the effects of radiation.
 Specific instructions are usually provided by the radiation safety officer from the x-ray
department.
 The instructions identify the maximum time that can be spent safely in the patient’s room, the
shielding equipment to be used, and special precautions and actions to be taken if the implant
is dislodged.
 The nurse should explain the rationale for these precautions to keep the patient from feeling
unduly isolated.