What Is A Radiation Oncologist
If a patient is undergoing radiation, the cancer treatment plan may be managed by a radiation oncologist who carefully monitors the persons overall health and well-being through the process.
With advanced cancer, a patient may also be referred to a medical oncologist. This specialized doctor uses medicines such as chemotherapy and hormone therapy to treat cancers. Its common for several medical specialists to work together on a treatment plantheyre known as a cancer care team.
Prevention And Mitigation Of Radiation Enteropathy
Strategies or interventions for protecting normal tissues from radiation injury may be divided into two conceptual categories . The first approach is to directly protect against or mitigate the oxygen free radical injury that occurs during and after radiotherapy. Examples of mitigators of this type include antioxidants, free radical scavengers, and various cytoprotectors . The second approach is to target downstream tissue responses from radiation exposure. Examples include immune-modulators , enterotrophic drugs , compounds that regulate intraluminal contents , drugs that inhibit key signal transduction pathways , and alteration of fibroblast metabolic radiotherapy response . It is not possible to discuss all agents under development in this review. We summarize studies that provide quantitative data on extent of protection for preclinical and clinical studies .
Two important issues should be addressed when considering potential mitigators of radiotherapy damage. These two issues are relevant to all drugs: scheduling of mitigators with radiotherapy and verifying that mitigators do not protect tumor against radiotherapy damage. Examples of these considerations are shown below.
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What To Expect After Radiation Therapy For Prostate Cancer
Patients who receive radiation therapy for prostate cancer may experience a wide range of short-term and long-term side effects. And side effects may vary widely from patient to patient depending on a variety of factors, including the extent of the disease and the patients overall health. For instance, some patients may need a urinary catheter to help empty the bladder. Other patients may experience sexual side effects.
At CTCA, our trained supportive care providers work closely with you and your doctors to determine how best to address radiation therapy side effects. Services may include:
- Pelvic floor therapy
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Lifesaving Proton Therapy Close To Home
If you are receiving cancer treatment, you want the latest, most innovative therapies available.
The Proton Therapy Center at The University of Kansas Cancer Center offers the most advanced form of radiation therapy available for cancer today. Ours is the first proton center in Kansas and in the Kansas City region. If you or a loved one is facing cancer, you no longer need to travel out of the region to receive this innovative treatment.
Short Term Side Effects
Patients who receive any type of radiation therapy to treat their prostate cancer can have side effects. Short term side effects are ones that start during or shortly after your radiation treatment. Below is a list of possible short term side effects. Treatments can affect each patient differently, and you may not have these particular side effects. Talk with your care team about what you can expect from your treatment
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How Fertility Might Be Affected
For women: Talk to your cancer care team about how radiation might affect your fertility . Its best to do this before starting treatment so you are aware of possible risks to your fertility.
Depending on the radiation dose, women getting radiation therapy in the pelvic area sometimes stop having menstrual periods and have other symptoms of menopause. Report these symptoms to your cancer care and ask them how to relieve these side effects.Sometimes menstrual periods will return when radiation therapy is over, but sometimes they do not.
See Fertility and Women With Cancer to learn more.
For men: Radiation therapy to an area that includes the testicles can reduce both the number of sperm and their ability to function. If you want to father a child in the future and are concerned about reduced fertility, talk to your cancer care team before starting treatment. One option may be to bank your sperm ahead of time.
See Fertility and Men With Cancer to learn more.
Using Prophylactic Radiation To Decrease Skeletal Events In Asymptomatic Bone Metastases
One set of phase 2 data highlighted that prophylactic radiation therapy significantly reduced the occurrence of skeletal events in addition to subsequent pain and hospitalizations in patients with asymptomatic, high-risk bone metastases.1
Investigators reported that skeletal eventsdefined as pathologic fracture, cord compression, surgery for instability, or radiotherapy for painoccurred in 1.6% of patients who received radiation therapy vs 29.0% of patients who had no radiation therapy .
We know that metastases to the long bone are associated with impending fractures. Generally speaking, radiation is utilized when erosion of the long bone is significant or after a patient has had a fracture, Potters explained. This study was able to demonstrate an overall improvement following prophylactic treatment of these patients earlier upstream in their disease course, which not only impacted the risk of bony fracture, but an overall survival benefit as well.
After a median follow-up 2.41 years, the median OS was 0.99 years among patients who didnt receive radiotherapy vs 1.67 years among those who did . Moreover, there were 4 hospitalizations in the no radiotherapy arm vs 0 hospitalizations in the radiotherapy arm .
In the no radiotherapy arm, common grade 2 adverse effects included fatigue and diarrhea , and grade 3 AEs included nausea and emesis . In comparison, grade 2 AEs in the radiotherapy arm included nausea , emesis , erythema , fatigue , and diarrhea .
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Prostate Seed Brachytherapy Or High Dose Rate Radiation
SHORT TERM
Immediately after the procedure, patients may have some perineal discomfort and even some bruising for a few days. Patients often experience increased urinary frequency, urgency, weak stream and nighttime urination. These effects are at their greatest for 4-6 weeks after brachytherapy and will dissipate over the following 3-6 months.
LONG TERM
Late effects are much less common than early effects, but can be more serious and long lasting. Urinary stricture or incontinence are rare, but can occur particularly in patients who have significant urinary problems prior to treatment. Loss of potency can occur and is directly related to the patients age and erectile function prior to treatment. Rectal inflammation, called proctitis, can occur, but infrequently becomes serious enough to require treatment.
If Youre Getting Radiation Therapy To The Head Or Neck
People who get radiation to the head and neck might have side effects such as:
- Soreness in the mouth or throat
How to care for your mouth during treatment
If you get radiation therapy to the head or neck, you need to take good care of your teeth, gums, mouth, and throat. Here are some tips that may help you manage mouth problems:
- Avoid spicy and rough foods, such as raw vegetables, dry crackers, and nuts.
- Dont eat or drink very hot or very cold foods or beverages.
- Dont smoke, chew tobacco, or drink alcohol these can make mouth sores worse.
- Stay away from sugary snacks.
- Ask your cancer care team to recommend a good mouthwash. The alcohol in some mouthwashes can dry and irritate mouth tissues.
- Rinse your mouth with warm salt and soda water every 1 to 2 hours as needed.
- Sip cool drinks often throughout the day.
- Eat sugar-free candy or chew gum to help keep your mouth moist.
- Moisten food with gravies and sauces to make it easier to eat.
- Ask your cancer care team about medicines to help treat mouth sores and control pain while eating.
If these measures are not enough, ask your cancer care team for advice. Mouth dryness may be a problem even after treatment is over. If so, talk to your team about what you can do.
How to care for your teeth during treatment
Radiation treatment to your head and neck can increase your chances of getting cavities. This is especially true if you have dry mouth as a result of treatment.
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What The Research Shows About Radiation Vs Surgery
The ProtecT trial was a 10-year, randomized clinical study designed to compare radical prostatectomy, external-beam radiotherapy and active surveillance for the treatment of localized prostate cancer.
The results, published in 2016, showed that the rate of disease progression among men assigned to radiotherapy or radical prostatectomy was less than half the rate among men assigned to active monitoring. However, there was no significant difference in survival at the median 10-year follow-up for radiation therapy, surgery or active surveillance.
If youre interested in directly comparing treatment outcomes by treatment method and risk group , the Prostate Cancer Free Foundation provides an interactive graph on its website with information from data obtained from over 129,000 prostate cancer patients over a 15-year period.
As discussed earlier in the sections on the side effects of radiation therapy and surgery, the researchers conducting the ProtecT trial also looked at side effects and quality-of-life issues and found that the three major side effects of these two treatment options that affect quality of life after prostate cancer treatment are urinary incontinence, sexual dysfunction and bowel health.
The trial found that urinary leakage and erectile dysfunction were more common after surgery than after radiation therapy. Gastrointestinal bowel problems were more common after radiation therapy.
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What Happens At A Follow
Discussion with your doctor or nurse
At each appointment, your doctor or nurse will ask how youve been since your last appointment.
Tell them about any symptoms or treatment side effects youve had, as well as any other problems or concerns. You can tell them how you are feeling emotionally as well as physically. You can also discuss any practical problems you might have, such as problems at work or with day-to-day activities. You may be given a questionnaire about your physical, social, emotional and practical needs. You might hear this called a holistic needs assessment form.
Your GP or hospital doctor or nurse can help you deal with side effects, or refer you to someone else who can. For example, if you have problems with leaking urine , they might refer you to a continence service. Or if you have problems getting or keeping erections , they can refer you to an erectile dysfunction service. They can also help you get support for emotional problems, such as feeling anxious or depressed, and practical problems, such as managing your finances.
You might feel embarrassed talking about some of the side effects of treatments, such as erection problems. But remember doctors and nurses see people with these problems every day, so be as open as you can. They are there to help.
PSA test
You may be asked to avoid any vigorous exercise or ejaculating in the 48 hours before a PSA test, as this could cause a temporary rise in your PSA level.
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Early And Late Effects Of Radiation Therapy
- Early side effects happen during or shortly after treatment. These side effects tend to be short-term, mild, and treatable. Theyre usually gone within a few weeks after treatment ends. The most common early side effects are fatigue and skin changes. Other early side effects usually are related to the area being treated, such as hair loss and mouth problems when radiation treatment is given to this area.
- Late side effects can take months or even years to develop. They can occur in any normal tissue in the body that has received radiation. The risk of late side effects depends on the area treated as well as the radiation dose that was used. Careful treatment planning can help avoid serious long-term side effects. Its always best to talk to your radiation oncologist about the risk of long-term side effects.
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Long Term Side Effects Of Brachytherapy For Prostate Cancer
Brachytherapy for prostate cancer can cause some long term side effects such as passing urine more often and difficulty getting an erection.
Everyone is different and the side effects vary from person to person. You may not have all of the effects mentioned. Tell your doctor or nurse if you have any of these problems. They can help you to find ways of controlling the effects.
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Negative Effects Of The Treatments
The negative effects by treatment are shown in . Patients treated with prostatectomy and radiotherapies commonly reported urinary and sexual difficulties, and those with external radiotherapy reported also bowel dysfunction. Depending on the treatment, 3348% reported at least one current negative effect after 5 years, and this was more common after prostatectomy and external radiotherapy but less common after brachytherapy .
Table 2 Negative effects in different treatments
Risk Of Neurological Deficits
As a matter of fact, both current neurological function and potential neurological compromise based on the amount of epidural disease or cord compression must be considered. A disease limited to bone, actually, poses relatively little immediate risk for the patient neurological status, and the treatment for this as compared to spinal cord compression is clearly different.
Assessment of the degree of epidural disease is crucial to determine the most suitable treatment. Bilsky et al. proposed a systematic grading of the degree of epidural spinal cord compression , which is now widely used amongst spinal oncologists.
The ESCC scale consists of six grades: grade 0, bone involvement alone grade 1, epidural impingement grade 2, the retention of cerebrospinal fluid is visible despite spinal cord compression and grade 3, cerebrospinal fluid is not visible due to marked spinal cord compression. Grade 1 is classified into three subgroups: grade 1a, epidural impingement without deformation of the thecal sac grade 1b, compression of the thecal sac without spinal cord abutment and grade 1c, deformation of the thecal sac with spinal cord abutment in the absence of spinal cord compression .
Figure 1. Bilski classification of epidural spinal cord compression .
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How Does Radiotherapy Treatment Work
Radiation therapy works by use of high doses of radiation to kill or slow down its growth rate. In prostate cancer treatment it is used to kill the cancerous cells or slow the growth rate. It also kills the nearby healthy cells as it kills the cancerous cells.
Where curing the cancer is impossible, radiotherapy is used to reduce the symptoms such as pain caused by cancer tumor. It can also be used to prevent the problems that result from cancer tumor such as loss of bowel and bladder control, blindness etc.
*All individuals are unique. Your results can and will vary.
Here are different types of radiations and how they work:
Worsening Of Your Brain Tumour Symptoms
Radiotherapy for brain tumours can sometimes make symptoms worse before they get better. This is because the treatment can cause swelling in the brain. The swelling increases the pressure in the head and makes the symptoms worse.
This can be frightening because you might think the radiotherapy isnt working. Increased pressure in the brain might cause:
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Prostate Cancer Treatments Have Serious Long
New research strongly reinforces the notion that prostate cancer is vastly overtreated with often dire results.
A study out Wednesday in the New England Journal of Medicine focused on treatment side effects, following a group of 3,533 men for 15 years after they got either surgery or radiation for cancer that had not spread beyond the prostate. Radiation produced fewer side effects — especially in the first years after treatments– but both groups experienced huge impacts.
This paper tells you that if you get treatment there are a lot of side effects regardless of the therapy you chose, the senior author Dr. David Penson, professor of urologic surgery at Vanderbilt University Medical Center, said in an interview.
Most men were in their sixties when they were first treated. Two years after treatment 60.8 percent of the men who had undergone radiation had erectile dysfunction, compared to 78.8 percent of those who chose surgery. By 15 years, the numbers became 87 percent and 93.9 percent. Many men also suffered urinary and bowel problems and those, too, grew worse with time.
A rational argument is that such side effects are acceptable if the treatment is saving lives. But the paper raises serious doubts.
So many of these men have low-risk disease that probably doesn’t need to be treated, Penson said.
Learning that lesson could spare an enormous amount of misery and money.
Related:
Coping And Support For You And Your Family
Coping with the side effects of prostate cancer radiotherapy can be difficult. There are things you can do, and people who can help you and your family to cope.
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Prostate cancer: diagnosis and managementNational Institute for Health and Care Excellence , 2019. Last updated December 2021
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Long-term urinary adverse effects of pelvic radiotherapy.P Elliott, B Malaeb.World Journal of Urology, 2011. Volume 29, Pages 35-41
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Secondary malignancies following radiotherapy for prostate cancerPetros and others
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Staging Of Prostate Cancer
Doctors will use the results of your prostate examination, biopsy and scans to identify the stage of your prostate cancer .
The stage of the cancer will determine which types of treatments will be necessary.
If prostate cancer is diagnosed at an early stage, the chances of survival are generally good.
Treatment Areas And Possible Side Effects
| Part of the Body Being Treated | Possible Side Effects |
|---|---|
Healthy cells that are damaged during radiation treatment usually recover within a few months after treatment is over. But sometimes people may have side effects that do not improve. Other side effects may show up months or years after radiation therapy is over. These are called late effects. Whether you might have late effects, and what they might be, depends on the part of your body that was treated, other cancer treatments youve had, genetics, and other factors, such as smoking.Ask your doctor or nurse which late effects you should watch for. See the section on Late Effects to learn more.
- Posted:May 1, 2018
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