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Radiation Therapy in India



What is Radiation Therapy?

Radiation is one of the most crucial treatments for cancer. This therapy uses high energy radio waves such as: gamma rays, electron beams or protons; to destroy cancerous cells and prevent them from growing.

Usually, normal cells divide to form new cells; where as cancerous cells grow and divide faster to form solid tumors.

It is here that the radiation comes into use. The function of radiation therapy is to shrink and break the DNA inside the cancer cells.

Due to this the cancerous cells stop growing and dividing and eventually leads to its death.

Malignant Conditions such as bone cancer, liver cancer, breast cancer, brain cancer, stomach cancer, skin cancer, etc. are a few of many where radiation therapy is proven to be an effective treatment.

Also Benign Conditions, where tumor growth is not cancerous such as Goitre, spurs, several painful and inflammatory diseases of the joints like bursitis and tendonitis, blood diseases, skin diseases, harmless brain tumors can be treated.

Radiation therapy is sometimes the only treatment provided but most often it is given alongside other cancer treatments such as chemotherapy and surgery.

While chemotherapy exposes the whole body to cancer fighting drugs, radiation therapy is normally a localized treatment.

Generally, it is used to treat a specific part of the body where the cancer cells are located.

Sometime harm may come to the nearby normal tissues but due to technological advancement it is now possible to minimize harm to those tissues.

But if they are harmed, most recover and go back to working the way they should.


When is Radiation Therapy used?


When is Radiation Therapy used?

1. Primary Mode of Treatment: In some cancers, radiation therapy might be effective independently as the first and the only mode of treatment.

2. Before Surgery: In case, the tumor is too big to be remove easily through surgery at that time radiation therapy is administered to shrink the size of tumor so it can be easily removed.

Further, this makes the cancer less likely to return.

3. During surgery: In this case the area of tumor is exposed during surgery and the radiation therapy is applied directly to the tumor bed. This technique is also called Intraoperative radiation therapy.

Generally, this is used when it is difficult to remove the cancer during surgery or when there is a risk of microscopic amounts of cancer remaining.

Intraoperative radiation therapy also helps the doctors protect the normal tissues from radiation.

4. After Surgery: If the surgery fails to properly remove all the cancerous tissues or it’s been observed that the cancer is still present in adjacent organs or lymph nodes then it becomes very important to treat them as there is a chance of relapse or metastasis.

In such cases, radiation therapy is administered to destroy any remnant cancer and prevent it from returning.

5. In Conjunction with Chemotherapy: During cancer treatment, there might a requirement of multiple treatments to ease the symptoms of cancer.

For this radiation therapy might be used alongside chemotherapy.

Some chemo drugs called radiosensitizers help radiotherapy work better by making cancerous cells more sensitive to radiation.

Generally, in such cases the chemotherapy is given before the radiation therapy.

This can also make the side effects of both of these treatments somewhat worse.

6. Palliative Treatment: Radiation therapy is also used to control symptoms of cancer or prevent symptoms from occurring.

The aim of this type of treatment is not to cure the cancer but to relive its symptoms and improve the quality of life of the patient.

So, the doses of radiation are lower and can be used without any major side effects.

Usually, palliative radiation will be given alongside surgery, chemotherapy, or hormone therapy which may be more beneficial.

7. In Non-cancerous Diseases: Radiation therapy can be used in benign or non-cancerous conditions independently as method of treatment or along with medicinal or surgical treatment.


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Why India for Radiation Therapy

India is one of the recognized and best cancer care facilitators across the world.

India today offers high quality treatments and cutting-edge technology to international patients at an affordable price.

International patients from countries like Bangladesh, Pakistan, Africa, Middle-East, Afghanistan, Sri Lanka, etc. come to India for radiation therapy.

It has a large number of multi-speciality hospitals which offer beneficial outcomes for various cancer treatments including radiation therapy.

Cost of radiation therapy in India is extremely reasonable as compared to other developed nations.

Mostly international patients prefer undergoing low cost radiation therapy in India as it helps them save thousands of dollars.

Indian hospitals charge only one-third of the total cost which other countries like the United States usually charge.

There are hospitals that are known for their consistency to deliver high-class medical care and services.

In addition, majority of Indian doctors follow international protocols to ensure patient’s good health.

Also, you will find some of the best radiation oncologist in India.

Therefore, you can count on such unmatched services and avail radiation therapy in India.


Radiation Oncology Hospitals in India



Radiation Oncology is a department which deals with the use of radiation to treat cancer.

And for cancer, accurate treatment is needed. Therefore, it is very important that you choose the right hospital for your cancer treatment.

There are many cancer hospitals which have world class Radiation Oncology department and are equipped with the latest and cutting-edge radiation technologies.

Here are the best hospitals for radiotherapy in India:




Best Radiation Oncologists in India



Along with choosing right hospital it is necessary that you choose the right doctor for your cancer treatment.

Today, India is growing much faster in the field of Radiation Oncology because of which we have nationally and internationally acclaimed Radiation Oncologists.

Let’s have a look at the best radiation oncologist in India




Radiation therapy is a one of the most important as well as effective treatment for various cases of cancer ranging from eye, prostate, breast to brain tumor.

It is understood that cancer treatments are very expensive. And further undergoing radiotherapy will add up to the cost but this is one of the crucial and many times the only segment of cancer treatment.


Types of Radiation Therapy


1. Internal Radiation Therapy

What is Internal Radiation Therapy?

Internal Radiation Therapy allows the radiation oncologist to provide a higher dose of radiation in a smaller area.

It uses radiation sources which are usually sealed in a small holder called implant.

There are many types of implants such as pellets, ribbons, tubes, seeds, wires, capsules, balloons, or needles.

Moreover, it doesn’t really matter which type of implant the doctor uses, it is safely placed in your body, close to or inside the tumour.

Due to internal radiation therapy, very less number of normal tissues are harmed.

A. Brachytherapy

Brachytherapy

Brachytherapy, also known as Internal Beam Therapy is a procedure in which the radioactive sources are left in place or near the tumour permanently or temporarily depending upon your Cancer.

There are two main forms of Brachytherapy – Intracavitary and Interstitial.

With Intracavitary treatment, the radioactive sources are placed where the tumour is located, such as the vagina, cervix or the windpipe.

With the Interstitial treatment, the radioactive sources are directly put into the tissues, such as in the prostate.

The radiation from the Brachytherapy kills the cancer cells by inflicting overwhelming damage to the DNA.

Soon the tumour shrinks as the cells stop dividing and die.

Brachytherapy treats many cancers like,

  1. Breast
  2. Oesophagus
  3. Bile Duct underneath the Liver
  4. Uterus
  5. Cervix
  6. Vagina
  7. Prostate
  8. Rectum
  9. Skin
  10. Head and Neck
  11. Lungs

Brachytherapy can also be used along with External Beam Radio Therapy (EBRT) and other cancer treatments.

Basically, there are two types of Brachytherapy –

  1. HDR (High Dose Rate)
  2. LDR (Low Dose Rate)

a. HDR (High Dose Rate)

HDR

HDR Brachytherapy is a powerful way of delivering radiation therapy internally by inserting a tube called Catheter directly targeting the tumour.

The radioactive sources pass through this tube and destroy the cancer cells.

This technique can be used to fight many types of cancers such as skin, cervical, breast and prostate.

HDR Brachytherapy can be used as a standalone treatment or after the tumour is removed surgically to eliminate other remaining cancerous cells.

In this process, the radiation dose deposits faster. The doctor and his team of radiation technicians will monitor you from a separate room.

Usually HDR Brachytherapy is given in multiple doses either once or twice daily or once or twice weekly.

You may go home after the treatment with few restrictions.

Benefits of HDR Brachytherapy :

✔ Precise radiation therapy delivered internally.

✔ Used alone or applied after surgery to prevent recurrence of cancer.

✔ Suitable treatment

✔ Usually pain free

✔ Minimizes the risk of short and long term side effects.

b. LDR (Low Dose Rate)

LDR

In LDR Brachytherapy, the radioactive sources/seeds which are size of a rice grain are positioned inside or immediately next to the tumour for several days but it might also be left in position permanently.

These seeds emit radiation resulting in shrinking the tumour.

LDR Brachytherapy is usually used to treat prostate cancer and brain tumour.

In prostate cancer, the urologist with the help of the radiation oncologist performs this implant by placing the radioactive seeds in the prostate tissue.

In case of brain tumour, the neurosurgeon along with the radiation oncologist will place the radioactive sources in position after the removal of the tumour.

During this process, nearly 50 to more than 100 radioactive seeds may be placed in a single session using 20 to 50 needles.

Generally in LDR Brachytherapy, the patient will have to stay in the hospital for a day or two so that the radiation delivery device stays in place and he can receive continuous radiation.

Benefits of LDR Brachytherapy :

✔ The radioactive seeds can be positioned next to the tumour with a high degree of accuracy.

✔ Each seed affects a small area so very little radiation reaches the near-by organs.

✔ As the recovery time is fast, the patient can return to work within a few days.

B. Radiation Iodine Therapy/ Radioiodine

Radioiodine

Radioactive Iodine Therapy is an internal radiation therapy used to treat Thyroid cancer.

In this treatment, iodine 131 (Radioiodine) which is a radioactive substance, is used.

Before the treatment you might be asked to eat a low iodine diet. Also, your doctor may advise you to change your thyroid medicines or other medicines for a while.

Furthermore, you undergo a scan before the treatment. This helps the doctor to have a clear picture of your thyroid.

During the treatment, you will be kept in an isolated room where you might have to stay for a few days.

Next, you will be given radioiodine as a drink or capsule. You won’t be able to eat or drink for a couple of hours so that your body absorbs the radioiodine.

Further, your body will absorb the radioiodine and this iodine will be picked up by the cancer cells. The radiation then destroys the cancer cells.

This is also a type of targeted therapy as the treatment straight-a-way affects the cancer and has very little effect on healthy cells in the body.

Difference between Brachytherapy and EBRT (External Beam Radiation Therapy)

2. External Beam Radiation Therapy (EBRT)

What is EBRT?

External Beam Radiation Therapy

External Beam Radiation Therapy is a type of radiation therapy that aims a beam of radiation from outside the body, towards the cancerous cells present inside the body.

It is a treatment which uses doses of radiation to destroy cancerous cells and shrink the tumour.

EBRT comes from a machine which targets radiation directly at your cancer.

It is a local treatment which treats a specific part of your body.


How EBRT works?

How EBRT works?

EBRT uses special X-ray machine which delivers high energy rays to tumours.

The machine shapes radiations beams to the outline of the tumours and allows an accurate delivery of radiation from any angle as the machine moves around the patient during the treatment.

All these treatments can be designed in such a way that they destroy cancer cells, sparing the surrounding/nearby tissues and organs. Also, patients don’t feel anything during the treatment.


How long does it take?

How long does it take?

EBRT is usually conducted daily over a period of 6 to 8 weeks.

Most people are treated once a day for five days each week.

EBRT treatment takes place from Monday to Friday, Saturday and Sunday being the rest days for the patient.

Moreover, patients might receive two treatments in the course of a single day depending upon the cancer stage and condition of the patient.

Each treatment takes a few minutes and is provided as an outpatient procedure.

Patient is allowed to go home after the Radiation Therapy.

Types of Machines used in EBRT

1) ARTISTE

ARTISTE

The ARTISTE from Siemens is a high-precision radiation therapy machine.

It is ideally suitable for IGRT, as it improves the targeting of the radiation beam and reduces risk to the tissue nearby.

The ARTISTE machine integrates imaging along with treatment delivery so as to provide fast and accurate radiation.

The machine is equipped with world’s most advanced megavoltage 3D imaging system which guides patient positioning in complex cases.

Further, ARTISTE also provides a precisely shaped 3D radiation dose for IMRT (Intensity Modulated Radiation Therapy).

2) TomoTherapy

TomoTherapy

TomoTherapy is a form of IMRT (Intensity Modulated Radiation Therapy) in which the radiation is transmitted slice by slice.

TomoTherapy is an advanced technology which continuously delivers powerful and precise radiation beams to effectively treat incurable tumours.

There is an inbuilt CT scan which helps in confirming the size and position of the tumour before the treatment.

TomoTherapy has unique 4D kV imaging feature which provides 4D images of the tumours that are moving.

Due to this precision, the radiologists are able to target the tumours without harming the healthy tissues.

3) TrueBeam Stx

TrueBeam

TrueBeam STx is a radiation therapy machine which treats cancer with speed and accuracy by delivering radiation to the tumour and not harming the nearby healthy tissues.

This machine is amongst the latest radiation machine in India.

This is a versatile and powerful machine which allows the radiation oncologists to treat complex cancers throughout the body, including brain, spine, liver, etc.

The TrueBeam STx machine treats the patient in a much lesser time period compared to other radiation machines.

Here, the patient lies down and within 15 minutes the machine gives radiation while moving 360 degree around the patient.

The radiation beam precisely targets only the tumour sparing the healthy tissue.

Within 15-20 minutes the patient is good to go back home and needs no hospitalization.

Moreover, this machine can be used to deliver many other forms of radiotherapy, such as:

  • IMRT (Intensity Modulated Radiation Therapy)
  • IGRT (Image- Guided Radiation Therapy)
  • SRS (Stereotactic Radio Surgery)
  • SBRT (Stereotactic Body Radiation Therapy)

Radiation is a very complex topic and you surely must be wondering about the techniques used in it.

So for your benefit, we have briefly discussed all the different Types of Techniques below:

A. IGRT (Intensity-Guided Radiation Therapy)
IGRT

Basically, Image Guided Radiation Therapy (IGRT) is the use of imaging while providing radiation therapy to improve the precision and accuracy of treatment delivery.

Before IGRT treatment, the patient undergoes simulation wherein, CT scan, Ultrasound and X-rays are taken just before the radiation treatment on daily basis.

The information from CT scan is then transmitted to a computer where the doctors compare the previous images with the present one.

This helps the doctor to compare the images to see if any adjustment is needed in the process of treatment without harming healthy tissues.

IGRT is mostly suitable for Prostate cancer, Lung cancer, Gynaecological cancer and Urinary bladder cancer.

The main objective of IGRT is to achieve accurate targeting of tumour.

B. IMRT (Intensity Modulated Radiation Therapy)
IMRT

Intensity Modulated Radiation Therapy or IMRT allows the radiation beam to be shaped exactly to fit the tumour.

It is a specialized form of 3D-CRT.

During the process of IMRT, the radiation beams can be broken into “beamlets”, and the intensity of each beamlet can be managed individually.

Usually, Prostate cancer, Head and Neck cancer and Central Nervous System cancers are treated with IMRT.

Firstly, the patient needs to go through few scans like CT scan, PET scan and MRI scan which are used to scan the area of the body which needs to be treated.

Next, all the information from these scans is directly fed into the radiotherapy planning computer.

Using the scan images, the team plans the treatment carefully.

The radiation oncologist uses advanced computerised dose calculations to find the dose strength pattern which matches the best with the shape of the tumour.

Lastly, the doctor will ask the patient to lie down on a radiotherapy couch.

The radiographers take few x-rays to ensure that you are in the right position.

Later, the patient will be left alone in the room so that the doctors don’t get exposed to the radiation.

While going through the procedure the patient can’t feel the radiations and it won’t hurt.

Moreover, it takes 15 to 30 minutes or maybe more than that depending upon the stage and site of the tumour.

IMRT is usually given by machines like LINAC or TomoTherapy.

TomoTherapy has a CT scanner combined with IMRT.

C. IORT (Intra-Operative Radiation Therapy)
IORT

IORT or Intra-Operative Radiation Therapy is an advanced technique wherein a concentrated dose of radiation is delivered to the cancerous tumour during surgery.

It allows direct radiation to target the tumour while sparing normal nearby tissues.

IORT is mainly used to treat cancers which are difficult to get rid off during surgery.

Compared to conventional radiotherapy, IORT allows higher effective doses of radiotherapy.

With this treatment, you can avoid the removal of the organ and only remove the cancerous growth.

Usually, to ensure that all cancer cells are destroyed and chances of recurrence are minimized, the patient will have to go through 25 to 30 sessions of radiation therapy for over 5 to 6 weeks.

There are about three types of IORT:

Electron IORT: Electron IORT has the advantage to control the depth of the radiation penetration by providing a very uniform dose to the tumour.

It takes only 1 to 3 minutes to deliver the prescribed radiation dose.

Few hospitals have built a shielded operation room where a conventional linear accelerator is installed to deliver electron IORT radiation.

This eliminates the patient’s transportation from the operation room to the radiation room.

The doctor can simultaneously deliver electron IORT radiation treatment while performing surgery.

Mobetron is used to deliver electron IORT radiation.

But as it is costly only few hospitals are able to use this approach.

HDR-IORT: This technique was developed to combine the advantages of high dose rate brachytherapy and IORT for treating some complex cancers.

However, it costs lower than the electron IORT.

Many hospitals and centres have HDR system that can be transported to the operation room when HDR-IORT is needed.

However, it does require a shielded operation room to deliver HDR-IORT.

During this procedure, the penetration is limited, typically either ½ cm to 1 cm depth.

It sometimes requires extensive surgery because of the limited penetration of the radiation.

HDR-IORT takes around 40 minutes or longer, resulting in longer operation room duration, more anaesthesia and greater blood loss compared to electron IORT.

This treatment is mainly used to treat colorectal cancer, head and neck cancer and gynaecological cancers.

Low Energy IORT: This type of IORT uses low energy x-rays so as to deliver intraoperative radiation with a high dose, precisely to the tumour or directly to the tumour bed after the incision.

Low energy x-rays have relatively high biological effectiveness due to higher ionization density of radiation in tissue compared to megavolt X-rays.

Moreover, due to the steep dose, the tissue of concern is irradiated in a way which reduces damage to the other tissue.

This is a special characteristic of low-energy radiation.

Low energy IORT can be used majorly to treat breast cancer.

Immediately after tumour incision the tumour bed can be delivered IORT with low-distance X-rays by a single dose.

D. 3D-CRT (3 Dimensional Conformal Radiation Therapy)
3D-CRT

3D – CRT or 3 Dimensional Conformal Radiation Therapy is majorly used to deliver a conformal dose of radiation to the tumours, sparing the nearby healthy tissues.

The radiation oncologist prefers using 3D-CRT as it provides patient specific 3D images which are used in the treatment planning process.

This is what distinguishes 3D-CRT from conventional radiotherapy.

Generally, tumours don’t have regular shape and size.

3D-CRT uses specialized computers and imaging techniques such as CT, MRI and PET scans which show the accurate shape and size of the tumour as well as the surrounding organs.

Depending upon the shape and size, the radiation oncologist can then precisely and accurately tailor the radiation beams to the tumour.

E. VMAT (Volumetric Modulated Arc Therapy)
VMAT

VMAT is considered as a next generation arc therapy.

With new established standards for radiation therapy, it reduces the treatment delivery time to few minutes.

Usually, during IMRT treatment the machine rotates several times around the patient or it repeatedly starts and stops to treat the tumour.

However, VMAT can deliver the radiation dose in an arc shape to the entire tumour by rotating 360-degree, typically in less than two minutes.

So, VMAT is considered as an advanced form of IMRT treatment.

Also, it reduces patient motion and ensures better comfort.

This technique is eight times faster than IMRT.

Benefits of VMAT:

✔ Personalized, safe, high quality radiation therapy.

✔ Higher tumour control

✔ Reduced treatment time to prevent inconvenience.

✔ Minimized side effects and complications.

F. SRS (Stereotactic Radio Surgery)
SRS

Stereotactic Radio Surgery (SRS) is a technique which involves the delivery of high dose of radiation, precisely focused on the tumour in the brain.

SRS is a non-surgical procedure with no involvement of an actual surgery; it is called radiosurgery due to its precision.

The Gamma Knife, a highly specialized machine used for SRS, gives out tightly focused gamma rays to the tumour by sparing the sensitive nearby organs and tissues.

It is a standard machine for SRS, with unparallel capabilities and supreme normal tissue protection compared to other techniques for brain radiosurgery.

Radiosurgery is often used for:

  • Small brain metastasis
  • Benign brain tumours
G. SBRT (Stereotactic Body Radiation Therapy)

Stereotactic Body Radiation Therapy (SBRT) is a similar treatment procedure like the SRS.

Just the difference is SRS treats tumours of the central nervous system and SBRT treats tumours outside the central nervous system.

SBRT gives radiation from many angles around the body. The beams meet exactly at the tumour.

This means the tumour receives a high dose of radiation and the organs or tissues near it receive much lower dose.

This minimizes the risk of side effects.

SBRT treatment can also treat areas which have already been treated with radiotherapy.

For example, if someone has earlier received radiotherapy in the pelvis region, he/she might not be able to get radiotherapy in that area again.

But because SBRT is a very precise treatment it can often mean that the treatment is possible in the same region.

This treatment involves a single high dose radiation treatment, or a few fractionated radiation treatments (usually up to 5 treatments).

SBRT is mainly used to treat patients with Lung, Spinal and Paraspinal tumours.

SBRT with LINAC

SBRT with LINAC

The radiographers will set you up in the right position on the radiation couch.

Once you are in the right position the doctor and radiographers will leave you alone in the room so that they are not exposed to the radiations.

However, you need not worry as the radiographers can speak to you through intercom and they can even see you and hear you the whole time from the other room from where they are monitoring you.

It is very important to lie still throughout the treatment which will take 15 minutes to 2 hours.

It might take even longer than this. You may receive the treatment in one go or into short breaks, depending upon your condition.

You won’t feel anything during the treatment as the machine doesn’t touch you.

The machine will beep time to time.

Once the treatment is over, the radiographers will come in and help you get down from the radiation couch comfortably.

SBRT with CyberKnife

SBRT with CyberKnife

The CyberKnife is a radiotherapy machine which also treats the patient with SBRT.

The machine has a robotic arm which moves around the treatment couch and provides doses of radiation from different angles.

The machine takes X-rays every 10-20 seconds.

Further, the robotic arm corrects its position with the help of these images.

Due to this the radiographers are able to target the radiation beams accurately at the tumour, even if the tumour is moving while you breathe.

This treatment might take 30 minutes to 4 hours depending upon the type of cancer and the position of the tumour.

A special thing about CyberKnife is that it can treat multiple tumours at the same time.

Moreover, it can be very useful to treat areas of cancer metastasis.

You might undergo the treatment in one go or it may be broken into short breaks.

H. Total Body Irradiation (TBI)

Radiation therapy given to the whole body is known as Total Body Irradiation or TBI.

You might be given TBI alongside high dose chemotherapy drugs for a stem cell or bone marrow transplant.

TBI is usually given to the patients with:

TBI given along with chemotherapy helps kill off leukaemia, lymphoma and myeloma cells in bone marrow.

While performing bone marrow transplant the doctor gives TBI to the patients using donor stem cells.

TBI suppresses the immune system which helps to prevent rejection of the donor stem cells.

Further, the treatment is planned and executed by the radiographers.

Usually, TBI is given twice a day for 3 or 4 days.

Or else just 1 or 2 radiotherapy treatment is given depending upon the patient’s condition.

There are two types of TBI:

1. TBI Treatment Lying Down

TBI Treatment Lying Down

In the lying down session of TBI, the radiographers measure the thickness of different parts of the body and place small radiation monitors known as diodes on your body.

They might even use gel bags or padding materials between knee and over your neck and chest.

This is to ensure that you receive even dose of radiation throughout your body.

During the planning session, you receive a very small dose of radiotherapy from a radiotherapy machine.

The couch near the radiotherapy machine moves so that one half of your body can receive radiation.

Then the couch turns so the other part of the body can also get radiation treatment.

2. TBI Treatment Standing Up

TBI Treatment Standing Up

During a Standing up TBI treatment the radiographer will make you stand in a specially designed frame.

First, you stand facing the radiotherapy machine and later you turn around so that your back faces the machine and you receive the treatment.

I. Proton Beam Therapy
Proton Therapy

Proton therapy is also known as proton beam therapy.

It is a type of radiation therapy which uses protons instead of X-rays to treat cancer.

A proton is a highly charged particle used to kill cancer cells at high energy.

Doctors may recommend proton therapy alone or it can be combined with chemotherapy, surgery, x-ray radiation or Immunotherapy.

Just like x-ray radiation, proton therapy is a type of external-beam radiation therapy. It painlessly and precisely delivers radiation to the tumour through the skin from a machine outside the body without harming any other organ or nearby tissue.

How does Proton Therapy work?

How does Proton Therapy work?

Steps flowchart

What can you expect?

What can you expect?

People usually receive proton therapy in an outpatient block.

The number of sessions completely depends on the type and stage of cancer.

Generally the doctor uses large doses of radiation for a fewer number of treatments. However, sometimes they might also deliver 1 to 5 proton beam therapy.

Planning of treatment

Planning of treatment

Proton therapy demands a lot of planning. Before the treatment you will have to undergo few scans like CT, PET or MRI.

During these scans, you will be in the exact same position as during the treatment.

The doctor will make you lie on the radiation couch and figure out your position.

To limit your movement a device will be fitted which helps you stay still.

The type of device depends on the location/site of the tumour in your body.

It will assist the doctor in figuring out the exact places where the radiation therapy is to be given whether on your body or on the device.

This helps the doctor in ensuring your position during each proton therapy.

The radiographers will use the radiation treatment scans to mark the site of the tumour and also where the normal tissues are so they can avoid that area.

This process is similar to the planning of radiation treatment through x-rays.

Receiving treatment

Receiving treatment

Patients eligible for proton therapy are taken to a special treatment room.

For every treatment, one of the radiographers will place you into the device.

For some patients suffering from tumour in the head and neck such as eye, he/she will be positioned in a chair, instead of a table.

Before the treatment proceeds further, the team takes x-rays or CT scan pictures so as to position the patient in the exact same position for every treatment.

This preparation is done so that the proton beams hit the tumour and not the healthy tissues near the tumour.

Some proton therapy treatment rooms have machine called gantry.

It rotates around the patient to give out radiation to the tumour from the best angles.

The machine contains a nozzle from where the protons are emitted towards the tumour.

Protons travel through the machine and the magnets direct them to the tumour.

Once the patient is positioned properly the team will leave the room and go to the delivery control room.

From that room the team will control the delivery of proton treatment.

They will be able to see you and hear you and also talk to you through the video placed inside the treatment room.

Treatment Time

Treatment Time

Usually, a proton radiation treatment lasts up to 15 to 30 minutes, right from the time you enter the room.

Also, it depends on the location of the tumour and number of treatments.

Moreover, it will also depend on how easily the team locates the tumour with x-rays and scans.

Other factors which affect the time of treatment are, such as waiting for one patient’s treatment to be finished.

Most proton centre’s have only one machine.

Even if there are two proton machines, the protons are magnetically steered from one room to another.

There are times when both the rooms are ready to deliver the treatment at the same time. But it is not possible and one of the patients will have to wait till the other patient’s treatment is delivered.

Cancer treated with Proton Therapy

Proton therapy mainly treats tumours which have not metastasized and are near important parts of the body.

For example, cancers near the brain and the spinal cord.

The drawback of proton therapy is that it does not treat all types of cancers.

Further, the cost of radiation therapy in India for this type of treatment is quite high.

Few cancers which are treated by Proton Therapy:

  1. Central nervous system cancers
  2. Eye cancer
  3. Head and Neck cancer
  4. Lung cancer
  5. Liver cancer
  6. Prostate cancer
  7. Spinal and Pelvic sarcomas
  8. Non-cancerous brain tumours.



As we know, every treatment associated with cancer has their own set of side effects. In Radiotherapy, high doses of radiation beams are used to kill the cancerous cells in and around the tumour.

The side effects of radiotherapy emerge as they damage the healthy tissues around the treatment area.

As Radiotherapy has advanced by leaps and bounds in the last 20 years, the severity of side effects has reduced a lot. However, severity of the side effects also differ from patient to patient.

Some patients experienced more side effects and on the other hand some patients experienced few or none of the side effects.

Your radiation oncologist will weigh the benefits of any treatment option against the side effects and determine what is best for you.

It is important to make sure that you inform your radiation oncologist about any side effects you are experiencing, be it minor or major.

This is because he/she will help you cope with it and make things easier for you by adjusting the doses of radiation.

Some of the Side Effects of Radiotherapy are: Anemia, Depression, Fatigue, Hair Loss, Skin Problems and so on.

To Know More about the side effects associated with Radiotherapy Click Here..



You have many questions that pop up in your head regarding Radiotherapy as it looks confusing on the surface. Below we have answered some of the most Frequently Asked Questions:

Radiotherapy is neither a primary nor a secondary option treatment. All the treatment options available for cancer treatment like – chemotherapy, immunotherapy, targeted therapy, surgery, radiation therapy and so on are used in accordance to international guidelines. Most of the types of cancer have a preset series of treatments according to those guidelines. These guidelines even dictate the order of the treatment and the choices of treatment options available to the patient.

The benefits of Radiotherapy are as follows:

  1. In case of breast, bowel, prostate, bladder, lung, cervix, skin and head & neck cancers, radiation therapy is highly effective in reducing the risk of cancer recurrence post-surgery or aids to help the execution of the surgery.
  2. The cancers mentioned in the 1st point have both surgery and radiation therapy for treatment options. In Surgery, the organ affected by cancer is either partially or completely removed which hampers the functionality of it. Sometimes Radiotherapy and Chemotherapy are used in combination to eliminate the cancer cells thereby saving the functionality of the organs.
  3. You won’t lose hair from your head like you do in chemotherapy. However, you only lose hair at the site of irradiation and nowhere else.

External beam radiation treatments are painless, like getting an X – ray taken. But, the skin in the irradiated area will lose hair and become sore and will look like sunburned skin.

The people involved in the Multi-Disciplinary Team who will perform radiotherapy on you are:

  1. Radiation Oncologist who will decide the course of treatment and the doses of radiation to be given.
  2. Medical Oncologist who will be prescribing the anti-cancer drugs for your treatment.
  3. Medical Physicists will focus on prevention, diagnosis, and treatment, as well as ensuring quality services and prevention of risks during the radiotherapy treatment.
  4. Dosimetrist who works closely with the radiation oncologist and medical physicist to develop the treatment plan.
  5. Radiotherapists operate the machines that give you your radiotherapy treatment.
  6. Nursing staff or a team of nurses will look after your general needs like dressings, medicines and information about coping with side effects.
  7. Social worker who addresses any social or psychological needs that may arise prior to, during or after treatment.

If you are going to undergo external radiation, then you will go through a radiotherapy treatment simulation to determine exactly where to aim the radiation. The simulation takes 1 – 3 hours. The radiation therapist will position you on the table and take X-rays, CT scans and other images to confirm the treatment area. Once the images are approved by the radiation oncologist, the radiation therapist will mark reference points on your skin with a permanent marker. Body molds and shields dimensions are taken and made to protect the other body parts from the radiation or to prevent you from moving during the treatment.

If you are going to undergo external radiation, then you will go through a radiotherapy treatment simulation to determine exactly where to aim the radiation. The simulation takes 1 – 3 hours. The radiation therapist will position you on the table and take X-rays, CT scans and other images to confirm the treatment area. Once the images are approved by the radiation oncologist, the radiation therapist will mark reference points on your skin with a permanent marker. Body molds and shields dimensions are taken and made to protect the other body parts from the radiation or to prevent you from moving during the treatment.

External beam radiation is delivered in daily treatments over a period of 5 to 7 weeks. The patient will generally receive these treatments on weekdays, and then have the weekend off. The irradiation will take only a few minutes and in total would take about 30 - 45 minutes in the treatment room.

The two types of radiotherapy are:

  1. External Beam Radiation Therapy -
    In External Beam Radiation Therapy or EBRT the beams are delivered from outside the body. The different ways EBRT is used are :
    1. Image Modulated Radiation Therapy or IMRT
    2. Image Guided Radiation Therapy or IGRT
    3. Stereotactic Radiosurgery or SRS
    4. Stereotactic Body Radiation Therapy or SBRT
    5. Volumetric Modulated Arc Therapy or VMAT
    6. 3-Dimensional Conformal Radiation Therapy or 3D - CRT
    7. Proton therapy
  2. Internal Radiotherapy/ Brachytherapy –
    Brachytherapy is a form of radiotherapy where a sealed radiation source is placed inside or next to the tumour. Brachytherapy is commonly used for treatment of cervical, prostate, breast, esophageal and skin cancer. The two types of brachytherapy are :
    1. High Dose Rate Brachytherapy ( HDR Brachytherapy )
    2. Low Dose Rate Brachytherapy ( LDR Brachytherapy )
    For further reference regarding the types of radiotherapy, Click Here..

In Brachytherapy, they do implant radioactive seeds that emit therapeutic levels of radiation for a certain period. These radiations are limited to the target site and don’t emit outside your body. If you are having prostate brachytherapy, your doctor may advise you to stay away from pregnant women and children and to wear a protection if you are sexually active. The same is with External Beam Radiation Therapy, it won’t make you radioactive.

The seeds implanted in you are of low energy and will pose very little risk to your partner. The semen will not be radioactive, and you can resume sexual activity after the procedure. But there will be occasional blood in the semen and slight pain at climax.

Just like any other cancer treatment, the usage of either External Beam Radiotherapy or Internal Beam Radiotherapy depends on the international guidelines around the treatment of a cancer. But in a general sense, Internal Beam Radiotherapy/ Brachytherapy is used in earlier stages of cancer where the tumour is small. External Beam Radiotherapy can be used for both earlier stages of cancer as well as its advanced stages.

Now for advanced stages of cancer a palliative team is dedicated to treat that cancer. The team will consist of a Surgical Oncologist, Radiation Oncologist and a Medical Oncologist who will give the necessary treatment for your type of cancer. But the administration of Chemotherapy or the performing of surgery depends on the treatment plan decided. It is not fixed that you will have to do either.

In the Conditioning stage, the patient might be given Total Body Irradiation to destroy all the stem cells, so it can be replaced with healthy new cells by Bone Marrow Transplant. Apart from the necessity in Bone Marrow Transplant, no other blood cancer treatment requires radiotherapy.

The side effects of radiotherapy are dependent on the site of radiation on the patients. But there are common side effects which are listed below:

  1. Anemia
  2. Depression
  3. Fatigue
  4. Hair Loss and Redness and Skin Problems at the site of radiation
  5. Infection/Fever
  6. Low Blood Counts
  7. Mouth Sores
  8. Nausea and Vomiting
  9. Neutropenia
  10. Pain
  11. Low Sex drive
  12. Thrombocytopenia

To know more about the side effects of radiotherapy, Click Here..

Talking about secondary cancers, Radiation therapy was recognized as a potential cause of cancer many years ago. But with the advancement of radiotherapy machines and the treatment method, the chances of secondary cancer dwindled over time. Secondary cancers develop when the radiation doses are above the target tolerance limit. It is always made sure that your target area is irradiated within the tolerance limit. So secondary cancers have a very small chance of occurring.

Yes, you will lose hair due to radiotherapy but only in the target area. Radiation therapy not only destroys cancerous cells but also the healthy cells around the tumour. The healthy cells that are most at risk for being damaged by radiation therapy are those that tend to grow at a fast rate, including hair cells. So hair begins to thin in the area, but sometimes results in total hair loss depending on the extent of damage to the hair roots.

A pregnant woman cannot undergo radiation therapy as there is a high chance of harming the baby. Just like radiation therapy, even hormone therapy and targeted therapy are avoided due to the same reason.

Radiotherapy is a very safe and carefully planned procedure in which the radiation is delivered to the area in calculated doses. These doses are in controlled amounts overlooked by a radiation oncologist and are not fatal to the patient. Each target areas doses are calculated according to many factors. Although, there is a very small chance of radiotherapy being fatal as it is with every other cancer treatment method. This happens only when the basic health of the patient is bad.

Clinical Trials are studies that are conducted by cancer specialists to test out new treatments. These trials are available almost everywhere and you need to ask your doctor about it. Participating in a Clinical Trial is totally up to the patient and is voluntary. Patients who are participating in the clinical trial can also leave it at any point of time. Before making the decision to participate, it is very important to learn as much as possible about your cancer and the ongoing clinical trials for your type of cancer.

While and after undergoing radiotherapy, you can get back to your regular routine and exercising. During Radiation Therapy you should make sure about taking care of yourself in the following ways:

  1. Fatigue is a side effect commonly experienced by patients. So, you need to make sure that you are getting plenty of rest.
  2. If you develop a fever of 101° or higher, please get it touch with your doctor immediately and follow his instructions.
  3. You should make sure that you are eating a well balanced and healthy diet. Having a healthy diet may help minimize side effects.
  4. ) The skin in the area which is receiving radiation may become red and photosensitive. You should clean your skin with warm water and a mild soap daily. You should also avoid lotions, perfumes and deodorants in the area. Avoid putting heating pads or cold packs over the area and stay out of the sun. Protect your skin by using sunscreen and covering yourself with proper clothing and a hat.
  5. Join cancer groups for emotional support as it is natural to feel anxious, depressed or afraid while undergoing the treatment.

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