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What is Radiotherapy?

Radiotherapy is the medical specialty that uses controlled high-energy ionizing radiation, and is especially focused on the treatment of oncological diseases. This medical specialty, is together with surgery and chemotherapy, one of the main approaches in cancer treatment and it is assumed that approximately half of cancer patients at some stage of their disease, shall be subjected to radiotherapy treatment

Radiotherapy can also be used to treat other conditions such as benign lesions (AVM - arteriovenous malformations) and other conditions such as thyroid disorders and blood diseases.

The aim of radiotherapy is the destruction of tumor cells, which must be combined with the need to minimize radiation exposure to healthy surrounding tissues.

 

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What is Radiotherapy?

Radiotherapy Treatment Steps

  • Decision

In a multidisciplinar process it is decided the need of carrying out radiotherapy, with or without conjunction with other therapeutic modalities;

 

  • Planning

Treatment position definition and immobilization systems to be used;

Acquisition of anatomical data of the region of interest (usually computed tomography (CT)), which can be combined with other imaging or functional studies, such as Magnetic Resonance Imaging (MRI) or positron emission tomography (PET) for the preparation of treatment plans;

Dose calculation and technical parameters definition such as the number and type of radiation incidence (arcs or fields of treatment), dose fractionation schemes, protocols and therapeutic criteria to be implemented;

 

  • Quality assurance tests

Performance of verification procedures depending on the technique of treatment to be administered and the policy implemented in each Radiotherapy Centre;

 

  • Treatment

Can be administered in a single session or spread over several sessions. The individual plan of treatment for each patient can be composed of only one or several steps.

<b>Radiotherapy Treatment Steps</b>

Radiotherapy Modalities

Radiation therapy can be divided into two large areas and its clinical application depends primarily on the pathology and therapeutic target.

 

  • External Radiotherapy

Set of treatment techniques using an external to the patient source of radiation, obtained from the use of dedicated equipment.

 

The administration of such treatments is most commonly performed with Linear Accelerators. These equipments use radio frequency particles acceleration interacting with a target and producing high energy X-radiation.

 

  • Brachytherapy

Treatment techniques where sources of radiation of radioactive material are used within the human body, directly or very close to the volumes that are intended to irradiate.

 

These treatment techniques can be administered within few minutes by using a high energy radioactive source (HDR brachytherapy) or several hours by implantation of low dose rate (brachytherapy seeds) materials. Both modalities require a process of implant location with the execution of a more or less invasive procedure, depending on the location of the volume to be irradiated, as well as the treatment technique to be performed.

<b>Radiotherapy Modalities</b>

Treatment Techniques

Currently, Radiotherapy has the possibility to be administered in various ways, according to clinical criteria, targets and therapeutic equipment available.

 

  • 3D Conformal Radiotherapy (3DCRT)

Conventional treatment technique that allows the development of individualized treatment plans, using multiple static beams irradiation (treatment fields), where the projection of each of these treatment fields gets the form of the volume to be irradiated, by the use of advanced protection devices called Multileaf Colimators (MLC).

The aim of such systems is to guarantee the irradiation of target volumes and the protection of adjacent healthy tissues: the MLC is a device integrated in radiation equipments, consisting of several pairs of leafs that moves by electronic monitoring, and is usually used to protect the tissues adjacent to the volumes of interest, making irregulars shapes for each field in order to be adjusted to the irregular form of the volume to be irradiated.

 

  • Intensity Modulated Radiotherapy (IMRT)

Complex case of 3D Conformal Radiotherapy where the fluence of each beam of treatment is adjusted (modulated) in order to achieve, within the same incidence of irradiation, variations in the intensity of the beam. It allows a more adequate irradiation of the target volume, preserving the adjacent tissues. This method of treatment can be administered by the use of static treatment fields, or arcs of treatment, assuming in this case the name of IMAT - Intensity-Modulated Arc Therapy. To achieve this modulation, the MLC moves simultaneously as the irradiation takes place either in the situation where the equipment is static, or when it rotates around the patient.

 

  • Stereotactic Radiosurgery (SRS)

Very complex treatment technique, commonly used in intracranial lesions, performed in a single treatment session with high dose administration. It uses, for the localization of the target volume, a system of stereotactic coordinates, typically external to the patient, or alternatively/simultaneously to this, robust imaging systems.

 

  • Stereotactic Body Radiation Therapy (SBRT)

Similar to Stereotactic Radiosurgery treatment directed to the irradiation of extra cranial lesions. Uses an external system of coordinates for the location of the target volumes. It is complemented by very specific and rigorous immobilization systems and complex methods of image acquisition for treatment planning and control. It is usually given as a single fraction or a small number of high dose fractions.

Multidisciplinary Team

A Radiotherapy team is composed by physicians, physicists, radiotherapy technologists, operational assistants, administrative assistants and eventually nurses.

Radiological Protection and Safety

Protection and radiation safety are mandatory in Radiotherapy. Professionals should be closely monitored with individual dosimetry. It is also the duty of the owner of the Radiotherapy Unit to ensure that the building has the appropriate shielding construction in order to protect from the radiation levels established, so as not to expose the public inadvertently.

Radiological protection of patients is also a key factor, guaranteed by the application of the ALARA principle (As Low As Reasonably Achievable).

Training

Radiation therapy is an evolving area, so a structured training program for professionals is essential.

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