1. i
RADIATION THERAPY
SEMINAR PAPER PRESENTED
BY
Odey Godwin Oko
TO
THE DEPARTMENT OF NURSING SCIENCES, FACULTY OF
HEALTH SCIENCES, U.N.E.C
IN PARTIAL FULFILLMENT OF THE COURSE
ONCOLOGY NURSING
(NSC 714)
LECTURER: PROF. ANARADO
DATE: OCTOBER 2017

2. ii
Table of content
Introduction …………………………………………………………………………1
Objective …………………………………………………………………………….2
The goals of radiation therapy ……………………………………………………….2
Mechanism of action of radiotherapy ………………………………………………..3
Types of radiation therapy ………………………………………………………..…4
Length of treatment ……………………………………………………………..…..6
Principle of radiation therapy …………………………………………………………..6
Types of cancer treated by radiation ………………………………………………..….9
Team of professionals involve in radiation treatment and their roles ……………………..10
Types of radiation therapy ……………………………………………………………11
Safety precautions to follow in systemic radiation therapy. ……………………………15
Side effects of radiation therapy ……………………………………………………..17
Advantages and disavantages of radiation thrapy …………………………………20
Patient education …………………………………………………………………..21
Patient monitoring …………………………………………………………………21
Nursing considerations for radiation safety ………………………………………26
Conclusion …………………………………………………………………………26
References …………………………………………………………………………27

3. 1
Introduction
Radiation therapy is one of the many tools used in treatment of cancer. It is one of the most
common treatments for cancer (American cancer society (ACS), 2017). According to
Radiological Society of North America (RSNA), about 60 percent of cancer patients are treated
with radiation at some time during their course of treatment. Radiation therapy can also be
referred to as radiotherapy, irradiation or x-ray therapy. Radiation therapy uses high-energy
particles or waves such as x-ray, gamma rays, electron beams, or protons to destroy or damage
cancer cells. Unlike chemotherapy, which exposes the whole body to cancer fighting drugs,
radiation therapy is usually a local treatment (ACS, 2017).
Radiation can be used alone or in combination with other forms of treatment (chemotherapy,
surgery) to cure or stabilize cancer. The choice to use radiation to treat a cancer depend on a
wide range factors which include, the type of cancer, the physical state of patient, the stage of
cancer and the location of the tumor. (Emory University, 2016). Radiation therapy is focused on
the tumor, and the normal tissues are avoided. Modern technology has combined the use of
three- dimension imaging technology, computerized treatment planning and high- energy x-ray
machines to make more precise treatment possible.
Oncology Nurse is one of the professional teams involved in management of patients undergoing
radiotherapy and their roles cannot be over emphasized. The Oncology nurse is the cornerstone
of patient advocacy, extensive symptom management, and patient education regarding
complicated treatment regimen. They can also help the patients navigate through the hospital and
medical system so that they can get efficient and streamlined care. (Oncology Nurse Advisor,
2017)
Hence, as cancer treatment becomes more complex and standard, the medical surgical nurse need
to have knowledge and skill to accurately assess, intervene and provide best possible care. All
patients with cancer deserve it.

4. 2
OBJECTIVE
The objective of this paper includes:
 Discuss the goals of radiation therapy
 Discuss the mechanism of action of radiotherapy
 Discuss the different type of radiation therapy
 Discuss the principle of radiation therapy
 List the type of cancer treated with radiation
 Identify the team of professionals involved in radiation therapy
 Discuss the different type of radiation therapy delivery
 Discuss the planning process involved in radiation therapy
 Identify the side effects of radiation treatment
 List the advantages and disadvantages of radiation therapy
 Discuss the role of a medical-surgical nurse in management of patient undergoing
radiation treatment.
THE GOALS OF RADIATION THERAPY
According to American cancer society (ACS, 2017), the goals of radiation therapy include the
following
To cure or shrink early-stage cancer
Some cancers are very sensitive to radiation, in this case radiation may be used alone to shrink or
completely cure the cancer. For other cancers, radiation may be used before surgery to cure or
shrink the tumor, this is called pre-operative therapy or neoadjuvant therapy or after surgery to
keep the cancer from recurring called adjuvant therapy.
For certain cancers that can be treated by either radiation or surgery, radiation may be the
preferred treatment. This is because radiation can cause less damage and the organ may be more
likely to work the way it should after treatment.
For some types of cancer, radiation and chemotherapy might be used together. Certain chemo
drugs called radio-sensitizers help radiation work better by making cancer cells more sensitive to
radiation, but the side effects are often worse.

5. 3
To prevent metastasis from occurring
It is often assumed that a few cancer cells might already have spread even when they are not
detected by imaging scan like computerized tomography (CT) and magnetic resonance imaging
(MRI). The area where the cancer most often spread to may be treated with radiation to kill any
cancer cells before it grows into tumor, for example, people with certain kinds of lung cancer
may get prophylactic radiation to the head to prevent spread to the brain.
To treat symptoms caused by advanced cancer
Radiation might help relieve problems like pain, trouble swallowing, difficulty in breathing or
intestinal obstruction that can be caused by advanced cancer. This is often called palliative
radiation.
Mechanism of action of radiotherapy
The exact mechanism of cell death due to radiation is still an area of active investigation. A large
body of evidence supports double-stranded breaks of nuclear DNA as the most important cellular
effect of radiation. This breakage leads to irreversible loss of the reproductive integrity of the cell
and eventual cell death (Schreiber, 2015). The death of the cells causes the tumor to shrink.
Radiotherapy is not specific to cancerous cells and may damage healthy cells as well. The
response of tumors and normal tissues to radiation depend on their growth pattern before therapy
starts and during treatment. Death is not instantaneous but occurs when the cells try to divide but
fail a process termed abortive mitosis. For this reason, radiation damage is manifest more quickly
in tissues containing cells that are dividing rapidly (Emory university 2016).
Normal tissue compensates for the cells lost during radiation treatment by accelerating the
division of the remaining cells. In contrast, tumor cells divide more slowly after radiation
treatment, and the tumor may decrease in size. The degree of tumor shrinkage depends on the
balance between cell production and cell death. Carcinomas are an example of a type of cancer
that often has high division rates. These types of cancer tend to respond well to radiation
treatment. Depend on the dose of radiation used and individual tumor, the tumor may start to
grow again after cessation of therapy, often slower than before (Emory University 2016).

6. 4
TYPES OF RADIATION THERAPY
According to Smith (2015), There are two main types of radiation therapy, namely:
Photon Radiation
This is the most common form of radiation used in the treatment of cancer and involves a beam
of high-energy photons. The radiation is produced from a radioactive source such as cobalt or
cesium, or with the use of a linear accelerator machine.
The photon beam is then directed towards the location of the tumor in the body. The high energy
of the photons that pass through the body allows them to break the DNA bonds and inhibit the
replication of cells.
Particle Radiation
Electron, proton and neutron particle beams can also be used to irradiate areas of the body and
damage the replication process of cancerous cells.
Electron beams produced by a linear accelerator can effectively treat tumors and lymph nodes
that are near the surface of the body, as their low energy level doesn’t allow them to penetrate
deep within the body.
Proton beams are believed to emit their energy to tissue at the end of their path, without causing
great damage to the tissues they previously travelled through.
Neutron beams can be a useful alternative when standard radiation therapy does not work
effectively. It is often used in cancer of the head, neck and prostate, however is not usually the
first line choice of therapy as it is difficult to target the beam and surrounding tissues can easily
be affected.
Additionally, alpha and beta particles can be used in the treatment of cancer, although they are
more commonly used in medical imaging. Radiation with carbon ions provides an option for
tumors that do not respond to conventional radiotherapy. This is a heavier particle and can,
therefore, do more damage than other radiation types, particularly on the cancer cell where it
finishes it path but also on the surrounding tissues.

7. 5
When radiation therapy is used to treat cancerous cells in the body, it is important to measure the
dose correctly to avoid unnecessary damage to normal cells in the body. Radiation is not
selective to tumor cells and targets any cells that are in the process of replication when the
therapy is applied, which accounts for the importance of the correct dose to ensure optimal
efficiency with minimal side effects.
Standard Dose
Gray (Gy) is the unit used to measure the total about of radiation the patient is exposed to. This
can also be recorded as centigray (cGy), which is 0.01 of a single gray unit. Adjuvant therapy
doses typically range from 45 to 60 Gy for cancer of the breast, head and neck, which is divided
into multiple smaller doses given over a period of one to two months. The specific dose for each
patient depends on the location and severity of the tumor and is at the discretion of the oncologist
responsible for therapeutic decisions (Smith, 2015).
Dose Fractioning
The total radiation dose is usually divided into several fractions. For most patients that require
radiation therapy, the total dose is broken up into daily doses five times a week for a total period
of five to eight weeks. Some cancers, however, require treatment more often than once per day.
Each fraction contains a small amount of radiation that gradually accumulates to form the total
dose. This technique allows the cancerous cells to be treated effectively, whilst leading to less
damage that affects normal tissues.
Dose Frequency
Hyperfractionated radiation divides the daily dose into two treatments each day, which means
that the patient is subjected to smaller but more frequent doses of radiation over the same period.
Conversely, hypofractionated radiation breaks the total dose into larger doses, often giving a
dose less that once each day. (Smith 2015)

8. 6
LENGTH OF TREATMENT
Standard treatment with radiation therapy lasts for five to eight weeks, depending on the specific
type of cancer being treated and is at the discretion of the oncologist supervising the therapy.
Accelerated radiation refers to when the total dose is administered over a shorter period than
usual. This involves more frequent doses, usually more often than once daily, to administer the
equivalent total dose over a shorter period. This can be useful in some types of cancer, when a
more aggressive treatment regimen is required. Changes in the dose frequency and treatment
length do not alter the total exposure to radiation and, as a result, the long-term effects remain
similar. However, different treatment fractioning and accelerated treatments are often associated
with a faster onset of effects, both on normal and cancerous cells (Smith, 2015)
PRINCIPLE OF RADIATION THERAPY
According to Breneman & Warnick (2003), all types of radiation therapy follow these general principles:
Precisely locate the target: Any tumor to be treatment with radiation is called a target. When
locating a target, its location, its size, shape, and closeness to an important organs and structures
must be known. Small targets are harder to locate than large ones. Diagnostics scans such as
computerized tomography (CT) and magnetic resonance imaging (MRI) are used to locate the
tumor earlier and even a smaller tumor while positron emission tomography(PET) and functional
MRI (fMRI) scans provide information about the function of critical areas next to the target.
Determining the exact location and border of a target within a normal tissue is not always clear
on diagnostic scans. A technique called stereotaxis which means to locate a structure, especially
deep ones using three dimensional coordinates (x, y and z axis). First, a stereotactic head or body
frame is attached over the target area. Next, a CT or MRI scan is taken and interpreted by computer
software. The stereotactic frame shows up on the scan and helps the doctor pinpoint the exact location of
the target. In some cases, stereotactic localization is performed using internal landmarks, such as bones,
and a frame is not necessary.
Hold the target still. Once the target is located, the body must be held as still as possible to accurately aim
the radiation only at the target and to avoid healthy tissue. This is especially difficult in areas that are
normally moving, such as the lungs and abdominal organs. Immobilization also is important for smaller
targets, because a slight shift in position can move the target out of the radiation beam’s path.

9. 7
Immobilization devices are used to prevent movement and secure the body area to the treatment table.
These devices include molds, masks and stereotactic head or body frames. Molds and masks are custom-
made from plastic to fit the area of the body exactly and are used during each treatment.
Accurately aim the radiation. Multiple radiation beams are aimed so that they all meet at a central point
within the target, where they add up to a very high dose of radiation. To accurately aim radiation, both the
patient and the machine must be correctly aligned with each other.
Patient alignment. Depending on the body area to be treated, different techniques may be used to
position the body, including: skin markers, laser lights, field lights, infrared cameras and x-ray
positioners. Laser lights are used to make sure the body are level and straight on the table. Field lights
correspond to the skin marks. Infrared cameras use body markers to detect position and match the
markers to the position in the treatment plan. X-ray positioners take stereoscopic x-rays of the patient’s
anatomy and match them to the position in the treatment plan images.
Machine alignment. Several types of machines used to create a radiation beam and aim it at the target.
Each machine offers a different level of accuracy and ability to deliver various radiation techniques to
treat the target.
A Linear Accelerator (LINAC), the most common type of radiation machine, uses electricity to form a
stream of fast-moving subatomic particles. The radiation beam produced by a LINAC can be shaped and
aimed at the target from a variety of directions by rotating the machine and moving the treatment table.
The advantage of LINAC-based systems is their versatility.
They:
 are used for both radiotherapy and radiosurgery treatments
 treat any area of the body
 treat large and small tumors
 use highly focused radiation sources
 produce high intensity radiation
 can use techniques such as Intensity Modulated Radiotherapy (IMRT)

10. 8
The Gamma Knife system uses 201 converging beams of gamma radiation (cobalt-60). All 201 beams
meet at a central point within the target, where they add up to a very high dose of radiation. In contrast to
LINAC, the Gamma Knife does not move around you. Rather, you are placed in a helmet unit that allows
the target to be placed exactly in the center of the converging beams. The features of Gamma Knife
systems include:
 used for radiosurgery only
 limited to treating head and neck lesions
4. Shape the radiation beam. It is crucial that the radiation dose is delivered only to the target. Shaping
the beam to match the target minimizes exposure to normal tissue. The problem is that most tumors are
irregularly shaped, and most radiation beams are round. Beams can be shaped using treatment planning
software and hardware.
Treatment planning software. High-end computers and software are used to plan the treatment so that
all beams meet at a central point within the target, where they add up to a very high dose of radiation. The
software uses CT or MRI images to form a 3D view of the body anatomy and the target. The radiation
oncologist uses different settings in the software to create a final radiation prescription specific for a
patient.
The prescription includes:
 correct radiation dose of each beam (measured in rads or Gy)
 correct size and shape of the beams
 number and angle of treatment arcs
 number of treatment sessions
Hardware. Radiation beams can be shaped by attaching blocks or collimators to the radiation machine to
block a portion of the beam (like placing your finger in the path of a flashlight to cast a shadow). The goal
is to shape the beam to the exact contour of the tumor and minimize exposure to normal tissue. Block
devices shape the beam in a linear fashion and are only able to squarely shape the beam. Collimator
devices can shape the beam into circular or elliptical shapes. Multileaf collimators can focus and shape
the beam in infinite ways and are the most precise method.

11. 9
5. Deliver an optimal dose. Radiation works best when given in high rather than low doses; however,
normal cells that border the target cannot repair themselves very well after a high-dose exposure.
Determining the best radiation dose is a balance between the maximum dose tolerated by normal cells
versus the minimum dose necessary to cause tumor cell death. Doctors can take advantage of the body’s
own healing process by delivering a fraction of the complete dose over multiple sessions. In this method,
called fractionated radiotherapy, normal cells are allowed time to repair between each radiation session
and are protected from permanent injury or death. The fewer the treatment fractions, the more the
radiation affects tumor and normal tissue equally. The greater the number of treatment fractions, the less
the risk of injury to normal cells and the fewer the side effects. During fractionated radiotherapy, patients
receive treatment daily for 3 to 6 weeks.
TYPES OF CANCER TREATED BY RADIATION
Radiation therapy is used against many types of cancer. About 60% of cancer require radiation therapy
(RSNA, 2017). Certain tumors respond to radiation treatment better than others. The amount of radiation
and type needed depends on each individual case, taking into consideration the tumor size, the stage of
the cancer, tumor location, health of the patient, method of radiation delivery, and total dose. Certain
types cancers are considered more responsive to radiation therapy. These cancers can be successfully
treated with radiation therapy alone without permanent damage to the normal tissue if treatment was
initiated before metastasis. The cure rate is high (RSNA, 2017). The cancer in this group include: skin and
lip, head and neck, breast, cervical and endometrium, prostate, Hodgkin’s disease, and extranodal
lymphoma, seminoma of testis and dysgerminoma of ovary, medullablastoma, pineal germinoma, and
ependymoma, Retinoblastoma, choroidal melanoma.
Other tumors with limited response to radiation that may be curable with combined therapies include:
wilms tumor, rhabdomyosarcoma, colo-rectal cancer, soft tissue carcinoma, embryonal carcinoma of
testis.
Tumors found especially sensitive tissue cannot be treated with large doses of radiation necessary to kill
cancer cells. Also, radiation alone is not usually successfully against highly metastatic tumors.

12. 10
TEAM OF PROFESSIONALS INVOLVE IN RADIATIONTREATMENT AND THEIR ROLES
Like all medical procedures, planning and delivering radiation treatment require team effort and each
member of the team have a specific role to play to achieve a positive outcome. The team of professionals
involve in radiation treatment include the following:(RSNA, 2017)
1. Radiation oncologists: they are doctors and heads the radiation therapy team. They have
extensive training in the safe use of radiation to treat diseases. Their roles include:
 They oversee the care of each patient undergoing radiation treatment.
 Develop and prescribe each patients treatment plan
 Monitor patients progress
 Adjust treatment to ensure quality care throughout treatment session
 Identify and treat any side effects of radiation therapy
 Work closely with all team members of the radiation oncology team
2.Radiation therapist: Specifically trained to operate sophisticated system and computers used for
radiation treatment. They are under the supervision of the oncologist (Imaginis, 2017). Their roles
include:
 Administer the daily radiation treatment under the onocologist’s prescription and
supervision
 Maintain daily records and regularly check the treatment machines to make sure it
functions effectively.
 Operates the radiation equipment a
 Positions patients for each treatment
3. Radiation oncology Nurses: They are advanced practice nurses in oncology, which include clinical
nurse specialist and nurse practitioners. They have master’s degree certificate (RSNA 2017) Their roles
include:
 Evaluation of the patient before commencement of treatment
 Health education of patient about their radiation treatment, the potential side effects and
their management
 Weekly or frequent evaluation of patient under therapy to assess problems and patients
concern
 Management of side effect (ACS, 2017)
4. Medical radiation physicists: Work directly with the oncologist in the treatment planning and
delivery. Oversees the dosimetrist and also ensure that complex treatments are properly tailored for each
patient.They are responsible for the following:

13. 11
 Developing and directing quality control programs for equipment and procedures
 Ensure that equipments are functioning properly
 Take precise measurement of radiation beam characteristics and do other safety tests on
reguraly basis.
5. Dosimetrist: They work with the oncologist and the medical physicist to choose the treatment plan
that is just right for each patient. Their roles include:
 Calculation of dose of radiation to ensure the tumor gets a lethal dose
 Develop treatment plan that can best destroy the tumor while sparing the normal tissue
6. Social workers: their roles include:
 They may be available to provide practical help and counseling to patient and their family to
enable them to cope with demand of treatment.
 Arrange for home health care and other services
7. Dietitians: Their functions include:
 Work with patients to help maintain nutrition
 Monitor patients’ weight and nutritional problems.
 Educate patients’ and may provide them with recipes and nutritional supplements to improve
their nutritional status pre, during and post treatment
TYPES OF RADIATION THERAPY
There are three types of radiation therapy, according to ACS (2017) namely:
1. External radiation therapy:
External radiation (or external beam radiation) is the most common type of radiation therapy used for
cancer treatment. A machine is used to aim high-energy rays (or beams) from outside the body into the
tumor. The machine most commonly used is called a linear accelerator or “linac.” Radiation technology
allows the precise delivery of external beam radiation therapy. Modern machines better focus the
radiation and do less damage to normal tissues, so higher doses of radiation can be used. External
radiation is usually done during outpatient visits to a hospital or treatment center. Most people get
external radiation therapy in multiple sessions over many weeks.

14. 12
Types of external radiation therapy
Three-dimensional conformal radiation therapy (3D-CRT) delivers radiation beams from different
directions designed to match the shape of the tumor. This helps to reduce radiation damage to
normal tissues and better kill the cancer by focusing the radiation dose on the tumor.
Image guided radiation therapy (IGRT) is a form of 3D-CRT where imaging scans (like a CT scan) are
done before each treatment. This allows the radiation oncologist to adjust the position of the patient or re-
focus the radiation as needed to hit the tumor and limit normal tissue damage.
Intensity modulated radiation therapy (IMRT) is like 3D-CRT, but it also changes the strength of
some of the beams in certain areas. This gets stronger doses to certain parts of the tumor and helps lessen
damage to nearby normal body tissues.
Helical-tomotherapy a form of IMRT delivers radiation inside a large “donut.” For this treatment, the
patient lies on a table that slowly slides through the donut as the machine spirals around the patient. It
delivers many small beams of radiation at the tumor from different angles around the body. This may
allow for even more precisely focused radiation.
Proton beam radiation therapy uses proton beams instead of electrons or x-rays. Protons are parts of
atoms that cause little damage to tissues they pass through but are very good at killing cells at the end of
their path. This means that proton beam radiation may be able to deliver more radiation to the tumor
while reducing side effects on normal tissues. Protons can only be produced by a special machine called a
cyclotron or synchrotron.
Stereotactic radiosurgery: This is not surgery, but a type of radiation treatment that gives a large dose of
radiation to a small tumor area, usually in one session. It’s used for brain tumors and other tumors inside
the head. In some cases, a head frame or shell may be used to help keep the patient’s head still. Once the
exact location of the tumor is known from brain scans, radiation is sent to the area from many different
angles. The radiation is very precisely aimed to affect nearby tissues as little as possible. Treatment
outside the brain is called stereotactic body radiation therapy (SBRT). SBRT may be used for certain
lung, spine, and liver tumors. In many radiation therapy clinics, this technology is called by the name of
the vendor that makes the machine.

15. 13
There are 3 main ways stereotactic radiosurgery can be given:
 The most common type uses a movable linac that’s controlled by a computer. The machine
moves around to target the tumor from many different angles. X-Knife™
, CyberKnife®
, and
Clinac®
all work this way.
 The Gamma Knife®
uses about 200 small beams aimed at the tumor from different angles for a
short period to deliver a large dose of radiation. It’s usually given in one treatment session.
Again, this is a type of radiation therapy and no surgery is involved
 Another type aims heavy charged particle beams (like proton or helium ion beams) at the tumor
from different angles. These particles release most of the radiation’s energy at the end of their
paths, at more precise depths. This limits damage to nearby healthy tissues or organs.
Although most patients will be given the full radiation dose in one session with stereotactic radiosurgery,
it may be repeated if needed. Sometimes doctors give the radiation in several smaller treatments to deliver
the same or slightly higher dose. This may be called fractionated radiosurgery or fractionated
stereotactic radiotherapy.
Intraoperative radiation therapy (IORT) is external radiation given directly to the tumor or tumors
during surgery. It may be used if the tumors can’t be removed completely or if there’s a high risk the
cancer will come back in the same area. Under a general anaesthesia, the surgeon moves normal tissues
away from the tumor and protects them with special shields. A large dose of radiationis given to the
cancer and limit the effects on nearby tissues. IORT is given in a special operating room that has
radiation-shielding walls.
2. Internal Radiation Therapy (Brachytherapy)
Internal radiation is also called brachytherapy. A radioactive implant is put inside the body in or near the
tumor. The procedure is usually done under anaesthesia. Depending on type of cancer and treatment plan,
it may be temporary or a permanent implant.
Internal radiation therapy (brachytherapy) allows a higher dose of radiation in a smaller area than might
be possible with external radiation treatment. It uses a radiation source that’s usually sealed in a small
holder called an implant. Different types of implants may be called pellets, seeds, ribbons, wires,
needles, capsules, balloons, or tubes. No matter which type of implant is used, it is placed in the body,
very close to or inside the tumor. This way the radiation harms as few normal cells as possible.

16. 14
The implant procedure is usually done in a hospital operating room designed to keep the radiation inside
the room. The procedure is done under anesthesia, which may be either general or local. One or more
implants is put into the body cavity or tissue with an applicator, usually a metal tube or a plastic tube
called a catheter. Imaging tests (an x-ray, ultrasound, MRI, or CT scan) are usually used during the
procedure to locate the exact place the implant needs to go. Before being placed, implants are kept in
containers that hold the radiation inside so it can’t affect others. The health professionals handling the
implants may wear special gear that protects them from exposure once the implants are taken out of the
container.
The length of time an implant is left in place depends on the type of brachytherapy. Some implants are
permanent, while others are taken out after a few minutes or days. The type of implant chosen depend on
the kind of cancer, the location, general health status of the patient, and other treatments the patient had
previously.
Types of Brachytherapy
High-dose rate brachytherapy (Temporary brachytherapy)
High-dose-rate (HDR) brachytherapy allows a person to be treated for only a few minutes at a time with a
powerful radioactive source that’s put in the applicator. The source is removed after several minutes. This
may be repeated over the course of a few days to weeks. The radioactive material is not left in the body.
The applicator might be left in place between treatments, or it might be put in before each treatment. This
can be done as an outpatient procedure. The two main methods of HDR brachytherapy delivery are
 Interstitial treatment: Here, the implants are placed in or near the tumor, but not in a body cavity
by means of applicators such as needles or catheters.
 Intracavitary treatment: During intracavitary radiation, the radioactive source is placed in a
body cavity (space), such as the rectum or uterus.
The oncologist is responsible for the placement of the applicator or applicators at a target site.
Imaging procedures like computed tomography(CT) ultrasound (us) or magnetic resonance imaging
(MRI) are used to ensure the correct placement of these devices.

17. 15
Low-dose-rate brachytherapy (LDR) also called permanent brachytherapy.
In this approach, the implant gives off lower doses of radiation over a longer period. Some implants are
left in from 1 to a few days and then removed. The patient must stay in the hospital, in a special room,
during treatment. For larger implants, patient might have to stay in bed and lie still to keep it from
moving. Some smaller implants (such as the seeds or pellets) are left in place – they’re never taken out.
Over the course of several weeks they stop giving off radiation. The seeds are about the size of rice grains
and rarely cause problems.
3. Systemic Radiation Therapy
Radioactive drugs (called radiopharmaceuticals) are used to treat certain types of cancer systemically.
These drugs can be given orally or intravenously. The patient must be in the hospital for 1 or 2 days while
getting this treatment. Certain cancers, such as thyroid, bone, and prostate are treated with
radiopharmaceuticals (radioactive drugs). A radiopharmaceutical is a liquid drug made up of a radioactive
substance. It is bound to a special antibody (called a monoclonal antibody) that attaches to the cancer cells
then give off their radiation and kill the cancer cells. Examples of radiopharmaceuticals used for systemic
radiation include radioactive iodine, strontium, samarium, and radium. To protect others from radiation,
the drugs are kept in special containers that hold the radiation inside, and the patient will be treated in a
shielded room that also keeps the radiation inside. The health providers handling the drugs might wear
safety gear that protects them from exposure while administering the radioactive drug.
SAFETY PRECAUTIONS TO FOLLOW IN SYSTEMIC RADIATION THERAPY.
The body fluids (saliva, blood, urine and sweat) of the patient undergoing systemic radiation therapy are
radioactive, therefore the following precautions should be taken to protect the patient and other people
(ACS, 2017). The patient should be educated on the following:
 The toilet should be flushed twice after each use, and hands washed well after using the toilet.
 To separate utensils and towels (laundry may need to be washed separately).
 Drink extra fluids to flush the radioactive material out of the body
 No kissing or sexual contact (often for at least a week).
 To keep one arm’s length from anyone who spend more than 2 hours with the patient in any 24-
hour period. (the patient must sleep alone for a week or so.)
 To limit contact with infants, children, and women who are pregnant.
 To limit contact with pets.

18. 16
Treatment planning and preparation
Treatment planning is essential to ensure accuracy and reproducibility of the radiotherapy. This procedure
determines the dimensions, shape, and appropriate number of radiation beams (or treatment fields)
required to treat the tumour while limiting the dose to the surrounding normal tissues. Through this
process, radiotherapy treatments are tailored to meet specific need of an individual (National education
framework cancer nursing EdCaN, 2017).
Positioning and stabilisation
The chosen treatment position depends on the site of the person's tumour. Individuals are positioned to
avoid unnecessary radiation of normal tissues. The position needs to be easily reproducible each day.
Stabilisation devices include face masks and custom-made positioning supports for different areas of the
body (e.g. neck, arms, pelvis, and knees). Such devices help the person maintain the required position
during treatment (EdCaN, 2017).
Simulation
A simulator 'simulates' the movement and set-up parameters of the linear accelerator involved in
radiotherapy treatment delivery. Virtual simulation may be completed using results from imaging
procedures imported into a 3D treatment planning computer. Virtual representation of the person may be
generated through, computed tomography image (CT), magnetic resonance imaging (MRI) or positron
emission tomography (PET) scans (provides enhanced anatomical or metabolic tumour information,
supplementing the planning CT scan through the process of image fusion), 4D or respiratory-gated
planning CT scans (tracks the movement of a lung or abdominal tumour during breathing to ensure the
tumour is always in the path of the treatment fields).
The simulation process determines placement of external marks on a person that are used to accurately
direct the treatment fields of the person's daily treatment. External treatment marks are often small tattoos,
usually the size of a small freckle. Some stabilisation devices (such as face masks) also allow for the
treatment marks to be placed on the device rather than the person's skin to avoid embarrassing marks on
the face (EdCaN, 2017).
Once the simulation process is complete, dose calculations determine the amount of radiation to be
delivered each day. The isodose curve is the basis of all calculations and is used to: determine the daily

19. 17
dose, show the total distributed radiation dose in an individual for the intended course of treatment and act
as a record of the treatment delivered.
Planning and preparation can be a lengthy process that adds to the anxiety and concerns for the person
undergoing radiotherapy. Providing an orientation to the treatment area, information and education, and
assessment of levels of anxiety and depression before radiotherapy can reduce anxieties and enhance
compliance with therapy.
SIDE EFFECTS OF RADIATION THERAPY
Radiotherapy effects can have a debilitating impact on an individual's quality of life, and the severity and
frequency of adverse effects can affect treatment delivery. The effect of radiation is a complex series of
interactions that can occur within a fraction of a second or several years after treatment. While
radiotherapy affects all body tissues in the path of the radiation treatment beam, every person will react
differently to the radiotherapy due to a range of treatment factors and individual characteristics. Factors
influencing responses to ionising radiation include:
 body site
 treatment intent (curative/palliative)
 dose
 treatment volume
 machine energy
 neoadjuvant therapy.
The individual's emotional responses to radiotherapy are influenced by:
 the severity of symptoms and specific side effects of treatment
 the need to be accommodated away from home for the duration of the radiation treatment
 difficulties managing in an unfamiliar environment away from usual support system
 long distance travel for treatment each day
 limited knowledge or resources to manage these problems.
Radiation treatment effects can be divided into acute and late reactions. Acute radiotherapy
reactions occur within days to weeks after commencing treatment, whereas late effects occur
weeks to years after completing treatment. Healthy tissue responds to radiotherapy with an
inflammatory response. The greatest adverse effects occur in tissues that are radiosensitive such

20. 18
as the skin and mucous membranes. The severity of effects is related to the cumulative radiation
dose over time.
There is a lack of standardised assessment of radiation side-effects and cancer treatment toxicity.
Symptoms develop in several stages, further compromising effective assessment and monitoring
of toxicities associated with radiotherapy (EdCaN, 2016).
Acute effects
The following list are the common acute radiation toxicities associated with specific treatment
sites:
Brain
 alopecia and scalp erythema
 ear and external auditory canal
 cerebral oedema
 nausea and vomiting
 somnolence syndrome
Eye: conjunctival oedema and tearing.
Head and neck
 oral mucositis
 oral candidiasis

 oesophagitis and pharyngitis
 taste changes (dysguesia, ageusia)
 laryngitis
 dental caries.
Breast
 skin reactions
 oesophagitis.
 Chest and lung

21. 19
 oesophagitis and pharyngitis
 taste changes
 pneumonitis.
Abdomen and pelvis
 nausea and vomiting
 diarrohea and proctitis
 cystitis
 vaginal dryness.
Late effects
Late or delayed effects of radiotherapy can become apparent months to years after radiation
treatment and are related mainly to vascular and connective tissue changes as a result of chronic
inflammatory effects. (EdCaN 2016)
Skin and mucous membranes changes
Normal skin functions such as elasticity, flexibility, and protection against physical trauma may
be impaired because of radiation damage to the skin and its appendages. Late skin effects include:
 fibrosis
 atrophy
 altered pigmentation
 slow healing of trauma
 telangectasia (dilated vascular channels which may be seen within one to two years after
completion of treatment).
With high doses of radiation there may be:
 loss of sebaceous and sweat gland activity
 hyperpigmentation
 fibrosis of the subcutaneous tissues
 impairment of lymphatic drainage.

22. 20
Late effects of radiation to the oral cavity may result in tooth decay and changes in the structure
of the gums. Trismus is the reduced capacity to open the mouth due to scar formation following
surgery which leads to contraction of the muscles of mastication.
Tooth decay and caries may occur because of the decreased saliva and from radiation damage.
The ultimate radiation insult to the structure of the mouth is osteoradionecrosis.
Bowel dysfunction
Late effects of radiation enteritis occur from 6 to 18 months following treatment. Symptoms may
be insidious in onset and include colicky abdominal pain, weight loss, or bleeding from the
rectum, or diarrhoea. Late effects include proctitis, colitis, enteritis, ulceration, fistular formation,
and obstruction.
Genitourinary dysfunction
Radiation to the female pelvis may result in: (EdCaN, 2016)
 inflammation
 mucosal atrophy
 lack of elasticity
 ulceration of the vaginal tissue
 vaginal stenosis.
Vaginal stenosis is a late effect following externalbeam and/or brachytherapy and occurs because
of the formation of adhesions and fibrosis of upper vaginal tissues, which in turn leads to
contraction of the vaginal vault, and finally to a shortened vagina. This may result in discomfort
and difficulty with penetration in sexual intercourse and can hinder medical examination of this
area of the body during routine follow up. (EdCaN, 2016)
ADVANTAGES AND DISAVANTAGES OF RADIATION THRAPY
The following are the advantages and disadvantages of radiation therapy according to Rodriguez (2017)
and Emory University (2016).

23. 21
Advantages
 Death of a large proportion of cancer cells
 Ability to shrink tumors thereby relieving pressure symptoms and also converting patients from
unresectabe to resectable
 Synergy with systemic therapy
 Organ preservation: Not removing an organ can have a positive impact on the patient
 Possible stimulation of an immune response against the tumor
Disadvantages
 Limited effectiveness against metastasized cancers
 Long term side effect
 Damage to surrounding tissue
 Inconvenience of therapy example Treatment can be delivered daily for 5 days per week for 1-2
months.
The nurse being the cornerstone of patient care, play a vital role in management of patient undergoing
radiotherapy. They perform the following intervention according to Ruppert (2011)
CLIENT EDUCATION
The primary role of the nurse in relation with radiation therapy is client teaching. Patients and families
must know what to expect, get a chance to ask questions, and have those questions answered to
their satisfaction. Whenever possible. patients and families can tour the radiation department on
designated days to become familiar with the facility and learn about the treatment process.
PATIENT MONITORING
Monitor and assess the patient’s pain level using a standard 0-to-10 pain scale. Note what pain
medications the patient takes and whether these are effective. If the patient is taking prescription
analgesics, ask about constipation; as needed, use an effective bowel-care protocol. Know that
patients shouldn’t go more than 3 days without a substantial bowel movement. Monitor for side
effect, assess the vital signs and assess the lungs for rales. Monitor the white blood cell counts
and platelet count for significant decrease. Obtain a complete list of the patient’s medications
and monitor for drug interactions. Stress the importance of informing all healthcare providers of
medication changes

24. 22
Skin care
Radiation can cause skin irritation resembling a sunburn on a cold day. The skin may redden or
darken and blisters may develop. Recommend the use of skin-care products that hydrate the
entire treatment area but instruct patients to avoid applying them within 2 hours before treatment
because they may exacerbate skin irritation caused by radiation. Hydrogel pads also are effective
in reducing heat and improving comfort. If more severe skin irritation occurs, the radiation
oncologist may order prescription medication, such as Silvadene Cream. Teach the patient to
keep prescription medications out of the treatment field to avoid a radiation bolus (concentrated
dose). Advise patients who experience more intense skin irritation they should be seen by a
radiation-care nurse more frequently (daily or weekly) after treatment ends to monitor skin
healing and the skin regimen. Radiation to the head may cause hair loss and irritate the tops of
the ears. Applying mineral oil to the affected areas reduces irritation (Ruppert, 2011)
Dressings are required once the skin has broken. Exposure of superficial nerves can cause
moderate to severe pain. Sera may be released from damaged cells, and dressings need to be
moist and non-adherent so that new epithelial cells are not separated from the vascular bed. A
wound with serous loss is a potential site for infection, and the dressing needs to maintain
cleanliness and prohibit the growth of damaging microorganisms (EdCaN, 2016)
Dressings to broken skin areas also need to protect against friction from clothes and other
irritants. Hydrogel and hydrocolloid wound dressings can provide protection, and maintain a
moist, healing environment (EdCaN, 2016).
Nutrition and hydration
Patients should be weighed weekly on the same scale. If appropriate, refer them to a dietitian.
Patients who have difficulty swallowing and maintaining adequate nutrition and hydration may
need a percutaneous endoscopic gastrostomy tube.
A dehydrated patient may require I.V. fluids. Teach the patient to report dehydration signs and
symptoms, such as weakness, dizziness, and decreased urine output. If the patient reports
diarrhea or vomiting, assess for volume depletion and check orthostatic vital signs and weight.

25. 23
Document the color of the patient’s urine. Patients who complain of dysuria may require a
urinalysis to rule out infection (Ruppert, 2011).
Radiation enteritis is a common effect of radiotherapy with fields that involve the pelvis or
abdomen. Symptoms include nausea, diarrhoea, abdominal cramps and proctitis.
Diarrhoea is the most common acute side effect of radiation to the abdomen and pelvis and may
vary from mild to severe. Diarrhoea may be a treatment-limiting side effect and requires careful
monitoring and swift treatment. The individual may also experience abdominal cramping,
tenesmus, and proctalgia.
These effects may be severe and impact on wellbeing (both physically and emotionally) as pain
and discomfort and frequent trips to the toilet can interfere with sleep and rest patterns, and may
limit normal activities. Education, reassurance, a low residue diet and anti-diarrhoeals are
beneficial in managing this symptom and antiemetic is required in cases of prolonged nausea and
vomiting to prevent dehydration. (EdCaN, 2016 & Ruppert, 2011).
Emotional support
A cancer diagnosis affects not just the patient but the entire family. Remember that in their view,
there’s no such thing as a “minor” cancer. A cancer diagnosis causes fear, uncertainty, and
anxiety; many patients and families feel powerless and even hopeless. They may experience grief
over life plans altered or eliminated by the disease. They may have financial concerns, too. And
once treatment ends, they may wonder if the cancer will return.
Patients need guidance, education, and support from nurses to navigate the healthcare system and
the cancer-care continuum. Provide education encouragement, problem-solving help, and
resource assistance to them and their families. Listen empathetically as they express their
concerns and provide support to help them cope with the emotional highs and lows of cancer
diagnosis and treatment. As appropriate, work in collaboration with pastoral staff, social services
staff, and counselors. Suggest to the patient to use stress-relieving techniques, such as keeping
a journal or meditating. At some cancer treatment facilities, nurses highly trained in the care of

26. 24
radiation patients meet with each patient at least weekly. The patient also meets weekly with the
radiation oncologist. Such meetings help patients feel more comfortable with their treatment.
Some cancer treatment programs also offer peer navigators—cancer survivors trained to work
with newly diagnosed patients. Navigators mentor the patient and provide ongoing emotional
support. They’ve “walked the walk” and can relate to patients on a deeper level.
Reentering life after cancer treatment can be challenging. Families may expect the patient to “get
over it” and “get on with life.” To help patients and families manage posttreatment expectations,
point them toward local support groups as appropriate. Although support groups aren’t for
everyone, many patients benefit from meeting with others who have a similar diagnosis. Inform
them about credible cancer websites, such as those of the American Cancer Society, National
Institute for Cancer, and Susan G. Komen Foundation. Caution them that some websites offer
questionable information that only serves to promote false hope or false claims and generate fear.
(Ruppert, 2011)
Oral care
Clean teeth with soft brush and tooth paste that contain no abrasives. Remove denture if there is
sore to prevent infection
Admission
Patient on internal radiation will be admitted in a private room with radiation shield. Visitor to
the patient should limited and sit at least6 feet
Navigator
The Nurse act as a navigator to help the patient navigate through the hospital and medical
systems to receive efficient and streamlined care.

27. 25
INTERVENTIONS BY CANCER TYPE OR RADIATION SITE (Ruppert, 2011)
Breast radiation: Advise the patient to avoid bras with underwires, nylon, or lace. Instead,
recommend a breathable cotton bra or camisole. Tell patients they may use deodorant but should
avoid shaving the armpits to avoid skin irritation.
Head or neck: If the patient complains of dry mouth, suggest an oral mouthwash, such as a
solution of 1 qt of water, 1 tsp of salt, and 1 tsp of baking soda. Instruct the patient to swish it in
the mouth and spit it out, repeating several times a day. Some patients may need a prescription
mouthwash. If appropriate, advise patients to see a dentist before radiation treatment starts to
check for severely decayed teeth or an oral infection, as these could be a source of infection
during treatment.
Brain tumor: Assess the patient for neurologic impairment, such as a change in level of
consciousness, speech, vision, balance, or strength. Check for numbness, tingling, and seizures.
Recognize that any change from baseline assessment findings requires intervention.
Bone involvement: Assess the patient’s pain level; effectiveness of pain management
interventions; and extremity strength, numbness, tingling, and range of motion. Caution patients
that a bone tumor impairs bone integrity, setting the stage for fractures.
Pelvic cancer: For younger patients with pelvic cancers (both male and female), provide
information about sexuality and possible infertility before radiation treatment begins. As
appropriate, teach them about banking sperm or egg-harvesting options.
Radiation side effects: Helping patients and families manage side effects is a key nursing
responsibility. Unlike the systemic side effects of chemotherapy, radiation side effects are
specific to the treatment site. Make sure your patient receives an explanation of the treatment and
its potential side effects. Keep in mind that not all patients experience the same side effects.
Every patient is unique and may have comorbidities that can complicate the treatment picture.

28. 26
NURSING CONSIDERATIONS FOR RADIATION SAFETY
The nursing staff must minmise radiation exposure to themselves as much as possible by
applying the principle of time, distance and shielding as follows:
 Minimize the amount of time near a radiative source
 Maximize distance from radioactive source
 Use required shielding to minimize exposure (Smeltzer & Bare, 2004)
Pregnant nursing staff should not be involved in immediate care during radiation therapy.
Nursing visit should be planned and co-ordinated to minimize contact time with the patient.
Furthermore, the nurse should be far away from the radiation source as possible. However, the
nurse should make effort to discuss the patients’ anxieties and fears.
Other safety considerations include the following:
 Always wear film badge or pocket ion chamber to monitor exposure
 Wear rubber gloves to dispose of any soiled matter that are contaminated
 Provide specific laundry and housekeeping direction
 Keep patient restricted in her room and allow no visitors who are or may be pregnant
or who are younger than 18 years of age (Smeltzer & Bare, 2004)
CONCLUSION
Advancement in radiation therapy may continue to evolve in future. It is therefore imperative
that the medical-surgical / oncology radiation nurse must be proactive in developing the
knowledge and skill needed to meet the challenges of the future and also to provide care in line
with the best practice.

29. 27
REFERENCE
American cancer society( 2017) Radiation Therapy Basics accessed from
www.cancer.org/treatment/treatment -and-side-effects/treatment-types/radiation/basic.html
Emory university (2016) Radiation Therapy Retrieved from
www.cancerquest.org/patients/treatments/radiation-therapy?gclid=EAIaIChMIq-izpf-
R1gIVBLXtCh0WJgu6EAAYAiAAEgLUO-D-BwE
Radiological society of North America, (2017) Introduction to cancer therapy(Radiation
Oncology) Retrieved from www.radiologyinfo.org/en/info.cfm?pg=intro_onco
Oncology Nurse Advisor (2017) The role of the radiation oncology nurse: Being the best
that you can be retrieved from www.oncologynurseadvisor.com/the-role-of-the-radiation-
oncology-nurse-being-the-best-that-you-be/article/169325/2
Breneman J & Warnick R (2013) Introduction to Radiation Therapy
www.precisionradiotherapy.com/RadiationTherapy.html
Schreiber G. J (2015) General Principles of Radiation Therapy retrieved from
www.emedicine.medscape.com/article/846797-overview#a2
MacGill ,M.(2016) Radiation therapy (Radiotherapy):Uses, side effects. Online article of
Medical News Today. Retrieved from
www.medicalnewstoday.com/articles/158513.php#radiation_treatment_planning
American society of clinical oncology (2017). Side effects of radiation therapy. Retrieved
from www.cancer.net/navigating-cancer-care/how-cancer-treated/radiation-therapy/side-effects-
radiation-therapy
Smith, Y. (2015). Side effects of radiation therapy. Retrieved from www.news-
medical.net/health/side-Effect-of-Radiation-Therapy.aspx
Rodriguez, D. (2017) Advantages and Disadvantages of Radiation Therapy. Retrieved
from https://livestrong.com/article/513783-advantages-disadvantages-of-radiation-therapy

30. 28
Smith, Y. (2015). Radiation therapy dosage. Retrieved from https://www.news-
medical.net/health/Radiation-Therapy-Dosage.aspx
Ruppert, R. (2011) .Radiation Therapy 101. Online article of American Nurse Today. Vol
6. No 1. Retrieved from https://www.americannursetoday.com/radiation-therapy.101/
National Education Framework Cancer Nursing EdCaN (2016) Providing care for the
persons having radiotherapy for cancer. Retrieved from
https://www.D:/Downloads/oncology%20care.pdf
Smeltzer, C. & Bare, B. (2004). Brunner & Suddarth’s textbook of medical-surgical
nursing (Edition 10).Philadelphia: Lippincott &Wilkins.