Will I Need Radiotherapy After Chemo?

radioUCL

It depends. For example, in Breast Cancer, if you have breast conservatory surgery (lumpectomy), you will always receive radiotherapy in the breast, to reduce the risk of recurrence in the future. It does not matter if in your surgery, after pathology analysis, they did not see a single cancer cell. You will still get radio.

Sometimes, even if you have had a mastectomy, you still might need some radiotherapy in the whole breast and axila area (it depends on how advanced was your Cancer at the time of diagnosis).

For some lucky types of cancer, you won´t receive chemotherapy, but just radiotherapy.

Radiotherapy might sound scary, but compared to chemotherapy is like a walk in the park.

What is it?

Radiotherapy uses high-energy rays, such as x-rays, to treat cancer cells; it destroys them, in the area where it is given. Some normal cells in the area where it is given will also be damaged, which will cause side effects. But the normal cells will usually be able to repair themselves, whereas the cancer cells cannot.

What is Radiotherapy Used For?

-To cure cancer (sometimes it is given to destroy a tumour).

-To reduce the risk of cancer coming back (this is called adjuvant radiotherapy).

-Sometimes it is given prior to surgery to shrink a tumour, and make it easier to remove (this is called neo-adjuvant radiotherapy).

-To treat symptoms when the Cancer has spread, like coughing or pain (this is called palliative radiotherapy).

Ways of Giving Radiotherapy

-External beam radiotherapy (the most common type) is given externally by a radiotherapy machine.

-Internal radiotherapy is when a radioactive material is placed inside the body.

You will usually receive radiotherapy in a main hospital as an outpatient (this means that you will go home after).

Types of External Beam Radio:

-Conformal Radio: The beams are specially shaped to fit the treatment area.

-Intensity-Modulated Radio (IMRT): Allows different doses of radio to be given to different parts of the treatment area. This type is better, as this means lower doses of radio are given to healthy tissue. It is usually used when tumours are close to important organs.

-Volumetric-Modulated Arc Therapy (VMAT): It is even more accurate that IMRT, and shortens the treatment time.

-Image-Guided Radio (IGRT): It uses the pictures from scans taken before, and sometimes during each treatment. The pictures are compared to those taken during the planning scan to check everything is spot on. IGRT is useful to treat areas in the body that change position during the treatment session. For example, it is very useful to treat the prostate and cervix, as their positions can change depending on how full is the bladder or bowel on the day of the treatment. IGRT allows to be very precise just before each treatment.

-4D Radiotherapy: These machines can take pictures during the treatment that show any movement of the tumour. For example, if the tumour is in a lung, because this moves as you breath, this machine is able adjust the area during the treatment.

-Stereotactic radiotherapy: It uses many small beams of radiation to target the tumour. It makes it super precise, being able to give high doses of radio to very small areas of the body.

-Total Body Irradiation (TBI): This is when a large single dose of radiation or 6-8 lower doses are given to the whole body. It isn´t used very often; it is sometimes given to patients having a stem cell transplant.

-Proton Beam Therapy: It uses proton radiation rather than x-rays to kill Cancer cells. Proton beams can be made to stop once they reached the tumour, avoiding damaging healthy tissue. At University College Hospital, in London, it will be available from 2020. Up until now patients had to travel abroad to get this type of radio (to Germany or USA), but from now on English patients can benefit from this treatment in London and in Manchester.

Check this video out, and watch the delivery of this super heavy machine (it weights like 7 buses!) at UCL, in London! It is impressive!

-Intraoperative Radiotherapy: It is when a single dose of radiation is given during surgery to remove a Cancer.

People Involved

You will be seen by a consultant clinical oncologist specialised in radiotherapy, and they will decide how many sessions you will receive, and if you will need some booster sessions after.

The therapeutic radiographers are specially trained in giving you the treatment (helping you get into the right position and operating the machine). They will also give you advice and support while you receive the radiotherapy.

The radiologist is a specialist doctor who will look at your scans with your consultant and help plan your treatment.

Is There Something I Should Avoid During Radiotherapy?

Pregnancies (to become pregnant or to leave someone pregnant), as the external beam radiotherapy could harm the developing baby (you can, of course, have sex).

Planning Your Radiotherapy

Before starting your treatment, the people involved will plan everything very thoroughly, so the machine causes the least possible damage to the healthy tissue.

Your first visit might take up to an hour, as you will have a CT scan in the area that needs to be treated (you might have an injection of dye into a vein, depending on the area and the tumour). The CT scan will take lots of pictures from different angles to build up a 3D picture of your body, and will help identify the precise area to treat.

Sometimes you might need to have an MRI and a PET scan as well.

All this information will be sent to a planning computer, and the radiotherapy team will work out the precise dose and exact area of your treatment.

In the same planning visit, before starting your radio, you will have some permanent markings (tattoos, like dots) made to your skin. This is to help radiographers position you precisely in the machine.

They are small, but they are actually really annoying, as they are not brown, but of a dark blue instead, so anyone who is familiar with radiotherapy will know what these dots mean. If this bothers you much, you can do brown dot tattoos on top of them, to pretend they are freckles.

Moulds and Masks

They are made of plastic, and they are used for people having radiotherapy to their brain, head or neck.

You might feel claustrophobic if you have to wear one, but you must know that the treatment is really short.

The Treatment Itself

External beam radio will be given daily in a machine that looks like a large x-ray machine or CT scanner.

Usually each treatment session will take about 10 to 30 minutes, but the treatment itself only take a few minutes. Mine was aimed at the breast, and it took 25 seconds (13 seconds from the right, and 12 from the left).

Positioning for your treatment takes a bit of time. You will be in a hospital gown and the room will be a bit dark, so the radiographers can easily see the laser lights from the machine, and match them with the tattoos in your skin.

It is not pleasant to be half naked with two people of very cold hands touching you, like if you were a dead cow (that is how it made me feel), but it is what it is, and by the end of your treatment you probably won’t care at all to have been seen naked by the whole Radiotherapy department.

The radiographers will say a thousand numbers, and when they make sure you are in the perfect position, then they will run away of the room, making you understand how bad is radiotherapy really.

The treatment itself is painless. You will hear a buzzing noise when the machine is working. Most radio involves having treatment from several directions, so the machine will move around you into different positions. You will need to stay lying still, in the position the radiographers left you.

After a minute, they will come back to help you out of the bed.

Side Effects

Skin Reaction

One of the most common side effects of radiotherapy is dermatitis, and reports indicate that nearly 85% of all patients undergoing radiotherapy experience a moderate to severe skin reaction.  Generally, dermatitis start within a few days after the start of radiation therapy, with toxicity increasing after 2 to 3 weeks. The symptoms may include skin dryness, itching, discomfort, pain, warmth and burning, which may persist up to 4 weeks after the end of the treatment.

Radiotherapy will almost always make your skin turn red or darker in the area that is being treated. I started to notice the redness from day 5, but this will vary from person to person.

One girl on Facebook reported that taking curcumin during radio helped her a lot with the skin reaction. I did take pills, but who knows if it helped me? I didn´t find any scientific proof of such claim. On the other hand, I did use creams and I do not know how much they helped me, because I cannot obviously compare with how would my skin looked had I not used them.

How to Improve the Redness in your Skin

As I said, I cannot know to what extent my creams helped me, but I did everything I read or heard that it helps. Here it is:

From day 1 of your radiotherapy, apply these ingredients in the treated area, 2 or even 3 times per day:

-A mixture of salt and water.

-100% pure organic Aloe Vera (perhaps you can storage it in the fridge, so it helps calm down the area treated, as this can get itchy as the weeks pass by).

-Organic raw shea butter (you can melt it and mix it with almond oil and collagen).

-Organic extra virgin raw coconut oil.

-Zerobase cream (or similar) after about three hours of putting all the above ingredients. This is basically liquid paraffin, which moisturises and protects red, inflamed and dry skin. You can apply this cream every hour for up to 28 days.

Important!

You should keep away from fire when using this product (the zerobase cream), as it can be very dangerous; basically the area where you applied the cream would burn in seconds.

Apply these creams ALWAYS, twice or three times per day, with no exception, as if not, you might have a burn-like skin for life.

https://www.drugs.com/uk/zerobase-cream-leaflet.html

-If your skin becomes really red and sore, Bethametasone cream works really well. Ask your doctor to prescribe it.

How to Care For Your Skin During these Weeks

-Wear soft cotton bras, and do not put deodorant in the side treated (if you are being treated for Breast cancer).

-Wash your skin with mild, and free-of-chemicals soap and water.

-Avoid the sun!

-If you are at home on your own or with your partner, go naked! The oils and creams will be absorbed by the skin and not by your clothes, and you will feel much more comfy.

Tiredness

Who knows why, but many patients report that radiotherapy makes them tired. After having chemotherapy, radiotherapy is really a walk in the park, so I cannot comment on this. Besides that, during my first two weeks of radio I had pneumonia, with high temperature, a horrendous cough, a pain in my lung and the effect of the antibiotics on me, so when the pneumonia was gone, in my last week of radio (4thweek), I felt more energetic that ever in the last 10 months!

To avoid tiredness, try to do some gentle exercise, like increasing your daily walks. I felt energised by my hula-hoop, my daily walks to the hospital, and sometimes my bicycle rides around my area.

Drink plenty of water!

There are long term side effects to Radio, like the possibility of getting a second cancer, but I don’t want to think about them, thank you very much. And you should not either!

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