Radiation Therapy

Radiation therapy is used to treat many kinds of cancers. Radiation therapy is the use of high-energy x-rays to kill cancer cells and shrink tumors. It is a localized treatment which affects cancer cells in a specific region of the body; and may begin either before or after surgery. Radiation administered before surgery is generally done in an effort to shrink the tumor so that it can later be removed surgically. Radiotherapy given after surgery is done to destroy any cancer cells that remain, or to minimize a recurrence.

Radiation therapy may be either external or internal. External radiation therapy is administered from outside of the body by a machine and is performed on an outpatient basis at a hospital or cancer center. The benefit of internal radiation is that high doses of radiation can be administered to a cancer site for a shorter period of time. Internal or high dose radiation (also known as brachytherapy), is the administration of radioisotopes (radiation producing materials) through thin plastic tubes (called implants) which are inserted directly into the tumor or source of the cancer. For some sites, the use of both external and interstitial radiation may be considered to achieve therapeutic results; particularly in cases where the primary tumor is very large and bulky nodal metastases are present.

External radiation is generally administered once a day for five days with a two-day rest period between sessions, for a five- to six-week period. However, recent studies are being conducted to examine the efficacy of twice daily treatments. The administration of internal radiation requires that the patient be hospitalized for several days. General or local anesthetic is given depending on the source of the implant. Because these implants are capable of generating high energy x-rays outside of your body, throughout the duration of this treatment, you will have limited time with visitors and medical staff to minimize radiotherapy exposure to others. This will not compromise your care. Medical staff will still attend to your required needs. Visitors may be required to speak to you behind a protective barrier, or at a safely designated distance from your bed. The implants are removed before patients are discharged. Once the implants are removed, there is no radioactivity in the body.

Before beginning radiotherapy, your doctor may recommend that you receive a pretreatment evaluation from a prosthodontist (a dentist who is familiar with the oral changes that radiotherapy may cause). This is necessary, because pretreatment will minimize the risk and severity of complications that may arise later and improve the chances of the patient's ability to tolerate the recommended doses of treatment.

During the examination, the dentist will identify or treat any current infections. He may remove or repair teeth that may be problematic, or likely to become problematic in the future. Dentures will be examined for comfort and fit, or the need to acquire dentures following radiation treatment will be discussed. Finally, the patient will be counseled on the importance of maintaining excellent oral care and appropriate nutrition, to minimize infections, complications and side effects (pain, soreness and irritations), that could arise during treatment.

Whatever treatment your doctor recommends will be planned to minimize side effects. Patients are monitored very closely during treatment for any changes. Side effects may include physical discomfort or a decrease in physical activity. It is important to maintain some level of activity during treatment. Remember, one's activity level should coincide with one's energy level. Other physical changes that may occur are site tenderness, redness, dryness and itchiness. Exposure to sunlight should be minimized by wearing appropriate clothing. The application of sunscreens, creams, or lotions to affected areas should be done so on the advice of your physician.

For patients choosing radiation therapy treatments, below are some important questions to consider:

• When will I begin and complete treatment?
  
• How can I expect to feel during treatment?
  
• How will treatment affect my routine activities?
  
• What are the physical side effects of treatment?
  
• What can I do at home to make myself comfortable during treatment?
  
• Will there be any long term or permanent side effects of my treatment?