The word "radiation" probably makes you a little scared. Especially when it comes to cancer treatment, that fear can be even greater. But technology has advanced a lot these days. Unlike in the past, these treatments can now be done very precisely and carefully. So today we're talking about the most common radiation treatment for cancer, External Beam Radiation Therapy, or EBRT for short.
Simply put, what is EBRT?
Imagine you're lying comfortably on a bed. Without touching your body, a large machine at a distance is firing very precisely designed radiation beams, aimed only at the tumor in your body. That's what we simply call EBRT.
This involves using high-energy rays to destroy cancer cells. The main goal is to minimize damage to the healthy cells around them while destroying the cancer cells. This is an external treatment, so nothing is put inside your body.
In this treatment, the radiation machine never touches your body. Instead, the medical team programs the machine to target only the cancer cells from a distance, destroying them.
What is the difference between external and internal radiation therapy?
Radiation therapy can be divided into two main types.
1. External Beam Radiation Therapy (EBRT): This is the method we are talking about. It involves delivering radiation from a machine outside the body.
2. Internal Radiation Therapy: This involves surgically placing a small radioactive device inside or near the tumor.
Although both of these methods destroy cancer cells, the way they do it is different.
What types of energy rays are used for this treatment?
Radiation is a beam of energy containing supercharged particles. These particles have the power to destroy cancer cells. The main challenge of this treatment is to destroy only the cancer cells without harming healthy cells. Different types of particles are used for this.
- Photons (X-rays and gamma rays): These are the most commonly used in EBRT treatment. They are like high-energy X-rays. They can penetrate deep into your tissue and kill cancer cells.
- Protons: These are particles that have a positive charge. The treatment using these is called ``Proton Therapy''. This is a relatively new technology. The specialty of this is that after the proton beam hits the tumor, it stops without going beyond it. Therefore, the damage to healthy tissue located next to the tumor is very minimal. However, this treatment method is still not very common in the world.
- Electrons: These are negatively charged particles. They cannot travel as deep as photons or protons. Therefore, they are mostly used to treat tumors on the surface of the body, such as skin cancer.
Most EBRT treatments use a machine called a ``Linear Accelerator`` or ``LINAC`` to accelerate these particles and deliver them to the cancer cells.
Are there different types of EBRT treatment?
Yes, with the advancement of technology, there are now several different strategies and types of EBRT treatment. Depending on the nature and location of your cancer, your doctor will choose the method that is most suitable for you.
| Therapy Type | Simply put... (Simple Explanation) |
|---|---|
| 3D Conformal Radiation Therapy | Using things like CT scans, a three-dimensional (3D) model of the cancer is created and radiation beams are aimed at it from different angles to match it. |
| Intensity-Modulated Radiation Therapy (IMRT) | This is an advanced opportunity in the 3D method. Here, not only the shape of the tumor can be targeted, but also the areas with more cancer cells can be treated with more power , and areas with less power can be treated with less power . |
| Image-Guided Radiation Therapy (IGRT) | Before each treatment, an imaging scan (like a CT scan) is taken to accurately determine the location of the cancer and then the radiation is delivered. This makes the accuracy very high. |
| Stereotactic Radiosurgery (eg Gamma Knife) | This is not surgery, even though it's called "surgery." It's a method of delivering very high doses of radiation to small tumors in the brain, either in one shot or in multiple shots, in a very precise manner. |
| Stereotactic Body Radiation Therapy (SBRT) | This is the same method as above, but is used for cancers located outside the brain, especially in places like the lungs, liver, and spine. |
| Intraoperative Radiation (IORT) | This is done during the surgery to remove the cancer. Radiation is given at the same time to the parts of the cancer that could not be completely removed by surgery. |
What types of cases is EBRT treatment used for?
This treatment is used for several main purposes.
- To destroy cancer cells: EBRT is used as the primary treatment for many types of cancer.
- To support other treatments: It is used to shrink the tumor before surgery (neo-adjuvant therapy) or to destroy any cancer cells that are suspected to be left after surgery and prevent the cancer from coming back (adjuvant therapy).
- To relieve symptoms: Although in some cases the cancer cannot be completely cured, this treatment helps to control symptoms such as pain caused by cancerous tumors and maintain the patient's quality of life.
Types of cancers treated with EBRT
EBRT is a major treatment for many types of localized cancer, such as:
- Breast cancer
- Colon cancer
- Lung cancer
- Prostate cancer
- Uterine cancer
- Head and neck cancer
- Blood cancers such as leukemia and lymphoma
What happens before treatment? (Planning phase)
This planning phase, also known as ``simulation'', is a crucial part of the success of EBRT treatment. It involves getting everything ready for your first treatment.
1. Positioning: You will be positioned on the bed on this planning day, just as you were during the treatment.
2. Scans: Then, a CT, MRI, or PET scan is done to get accurate pictures of your cancer and surrounding healthy organs. This is what helps determine the exact size, shape, and location of the cancer.
3. Marking: Next, a few very small, dot-like marks will be made on your skin with a pen to identify the area to be treated. These should be kept in place until the end of the treatment period.
4. Making Molds/Masks: To help you stay still during treatment, a special mold or mask may be made to fit your body part.
Using this information, your medical team will spend several days creating a treatment plan that is specific to you.
What happens during treatment?
You will not feel any pain during the treatment.
You will be positioned in the same position as you were during the simulation. If necessary, you will be given a special mask or splint. Then the radiation therapist will leave the room and turn on the machine. However , they may watch you on a monitor and talk to you over an intercom .
The machine rotates around you, makes different sounds, and focuses radiation on specific areas. All you have to do is remain calm, still, and breathe normally. The entire treatment can take about 15-30 minutes. However, the radiation is actually only applied for a few minutes.
What are the common side effects?
Even if we try to minimize the damage to healthy cells as much as possible, it is difficult to prevent some damage. It is the damage to these healthy cells that causes side effects.
Importantly, these side effects are not the same for everyone . They also depend on the part of the body being treated with radiation. For example, someone receiving treatment to the head may experience hair loss, but someone receiving treatment to the abdomen may not.
Some of the common side effects that can be seen are:
- Feeling very tired (Fatigue): This is the most common side effect.
- Nausea and vomiting
- Appetite
- Redness, dryness, or itching of the skin in the treatment area
- Hair loss in the treated area
- Difficulty swallowing if treating the mouth and throat
- Headache
Most of these side effects gradually subside within a few weeks after treatment ends. Talk openly with your doctor about the specific side effects you may experience and how to manage them . If any side effects are severe or you feel anything unusual, inform your doctor or the treatment center immediately. In severe cases, it is important to go to the hospital's Emergency Department (ETU).
Take-Home Message
- EBRT is a very common, painless, and highly targeted treatment method used for cancer today.
- This is performed by a team of specialist doctors. Its primary goal is to destroy only cancer cells while protecting healthy cells.
- Side effects are common, but they are usually temporary. The type of side effects that occur depends on the area of the body being treated.
- It is very important to talk openly and honestly with your doctor about the treatment, side effects, or any fears or concerns you may have.
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