How Does External Beam Radiation Therapy Work
External beam radiation therapy, or EBRT, uses a machine to direct high-energy X-rays at the cancer in daily doses. The radiation beam is generated by a machine called a linear accelerator or LINAC. Using treatment planning computers and software, your treatment team controls the size and shape of the beam as well as how it is directed at your body to most effectively treat your tumor and minimize damage to surrounding normal tissue.
To minimize side effects, the treatments are typically given five days a week over a six-to-nine week period. The break in days allows the doctors to get enough radiation into the body to kill the cancer while giving healthy cells time to recover.
Watch our expert medical oncologist, Dr. Alicia Morgans from Vanderbilt-Ingram Cancer Center, discuss external beam radiation therapy:
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Preparing For Radiation Treatment
Radiation treatment requires preparation on the part of you and your medical team. Thats because radiation dosages must be precisely targeted to maximize their curative effect while minimizing damage to surrounding tissues. This is particularly critical with external-beam radiation. Planning may involve:
- Radiation simulation: During a simulation procedure, your physician will insert marker pellets into your prostate to help him or her locate it more precisely. Members of the medical team may also mark your body to improve positioning for the radiation session./
- Planning scans: Your physician will take CT scans of your lower abdomen and pelvic region.
This preparatory work enables your physician to select the type and dosage of radiation best suited to treating your cancer.
Who Should Consider External Beam Radiation Therapy
In most cases, external beam radiation therapy is used for men with localized prostate cancer . The intent of EBRT in this case is to kill the tumor while sparing as much healthy tissue as possible. Sometimes it is used in more advanced cases. For example, it can be used along with hormone therapy, or used to relieve pain from bone metastases.
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What Are The Side Effects Of Brachytherapy
- Frequent urination or urinary retention or burning with urination
- Erectile dysfunction
- Urethral stricture or narrowing of the urethra
- Diarrhea or blood in the stool
- Secondary cancers
For the short time that the seeds are giving off larger amounts of radiation, you should avoid close proximity to children or pregnant women. Make sure to talk with your radiation oncologist or oncology nurse for instruction about radiation safety and exposure for family members or pets.
If you are traveling through an airport following brachytherapy treatment, there is a chance that radiation detectors will be set off. Talk to your radiation oncologist and ask for a note to indicate youve just had radiation treatment.
Are There Side Effects Of The Combination Approach To Prostate Cancer Radiation Therapy
When it comes to early stages of disease, patients very frequently do well with either brachytherapy or external beam radiation. Success rates of around 90% or higher can be achieved with either approach. When the disease is somewhat more advanced based on the PSA level, Gleason score, extent of visible disease on magnetic resonance imaging we have learned over the years that higher doses of radiation are critical to achieving better results. Some evidence, including a large trial, suggests that for patients with intermediate- or high-risk prostate cancer, a combined approach using brachytherapy along with external beam radiation may be best compared to standard dose external beam radiation therapy alone.
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Radiation Therapy In Localized Disease:
For men that need treatment for localized prostate cancer, external radiation therapy and brachytherapy can be alternatives to surgery. Modern radiation therapy is as effective as surgery when used to cure prostate cancer.
At this stage of disease, radiation therapy is used to attempt to cure the disease. However, it is also sometimes used if surgery didnt completely remove the cancer, or it came back in the area of the prostate after surgery.
These treatment options may require multiple visits. As always, it is important to consider costs and potential side effects. Scroll down to learn more about the different types of external radiation therapy or brachytherapy.
What Does External Beam Radiotherapy Involve
You will have your treatment at a hospital radiotherapy department. Youll see a specialist doctor who treats cancer with radiotherapy, known as a clinical oncologist. You may also see a specialist nurse and a specialist radiographer. Theyll talk to you about your treatment plan and ways to manage any side effects.
Before your radiotherapy treatment
Radiotherapy planning session
A week or two before your treatment, youll have a planning session. This is to make sure the radiographers know the exact position, size and shape of your prostate. It will help them make sure the radiotherapy is aimed at your prostate and that the surrounding areas get as little radiation as possible.
During your radiotherapy treatment
You will have one treatment at the hospital five days a week, with a rest over the weekend. You can go home after each treatment.
If you have localised prostate cancer, the course of radiotherapy usually involves 20 treatment sessions over four weeks. You might hear this called hypo-fractionated radiotherapy.
At some hospitals, youll have 37 sessions over seven or eight weeks instead. If you have 37 sessions, youll receive a slightly larger overall dose of radiotherapy but the dose you receive at each session will be lower than if you have 20 sessions.
Its safe for you to be around other people, including children and pregnant women, during your course of radiotherapy. The radiation doesnt stay in your body so you wont give off any radiation.
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Brachytherapy: A Highly Targeted And Effective Option For Treating Prostate Cancer
Prostate cancer is the second most common cancer in American men, with about 250,000 new cases diagnosed each year. It starts when cells inside the prostate gland, which is located below the bladder and in front of the rectum, begin to grow out of control.
While prostate cancer affects around 1 in 8 men during their lifetime, the good news is that there are effective treatment options, including a treatment called brachytherapy.
Side Effects Of Prostate Cancer Radiotherapy
Radiotherapy to the prostate can cause some side effects, such as loose or watery poo and passing urine more often.
Side effects tend to start a week or 2 after the radiotherapy begins. They gradually get worse during the treatment and for a couple of weeks after the treatment ends. But they usually begin to improve after around 2 weeks or so after treatment finishes
Everyone is different and the side effects vary from person to person. You may not have all of the effects mentioned.
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What Happens On Treatment Days
If you get external radiation therapy, youâll need to get regular sessions during a period of about 5 to 8 weeks.
For each treatment, the radiation therapist will help you onto the treatment table and into the correct position. Once the therapist is sure youâre positioned well, theyâll leave the room and start the radiation treatment.
Theyâll watch you closely during the treatment. Cameras and an intercom are in the treatment room, so the therapist can always see and hear you. Try to stay still and relaxed during treatment. Let the therapist know if you have any problems or you feel uncomfortable.
Theyâll be in and out of the room to reposition the machine and change your position. The treatment machine wonât touch you, and youâll feel nothing during the treatment. Once the treatment is done, the therapist will help you off the treatment table.
The radiation therapist will take a port film, also known as an X-ray, on the first day of treatment and about every week thereafter. Port films verify that youâre being positioned accurately during your treatments.
Port films donât provide diagnostic information, so radiation therapists canât learn about your progress from them. But these films do help the therapists make sure theyâre delivering radiation to the precise area that needs treatment.
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What Should I Expect From Radiation Treatment For Prostate Cancer
External-beam radiation is delivered to the body from a large machine known as a linear accelerator. You will lie down to receive treatment. The machine will pass over you several times. The process is painless and should last less than an hour. You will undergo treatment five days a week for a period of seven to nine weeks.
Prostate brachytherapy requires surgery. You will be given an anesthetic so you sleep during the operation. Your surgeon will implant either low-dosage radioactive pellets or tubes for high-dosage wires inside your prostate. In the latter case, you may receive several treatments before going home. Expect to spend time recuperating in the hospital. You may experience some pain in the days following the procedure.
Youll see your physician regularly after completing radiation therapy for prostate cancer. He or she will evaluate the effectiveness of your treatment. This process will continue indefinitely, to ensure that you remain cancer-free. If the treatment is unsuccessful or your cancer returns, your physician will devise a new plan for addressing it.
Who Might Benefit From Radiation Therapy
Your doctor might recommend radiation therapy in several situations.
It can be the first treatment for cancer that hasnât spread outside your prostate gland and is âlow grade.â The grade is a number that tells you how abnormal your cancer cells look under a microscope. The lower the grade, the more normal-looking your cancer cells are â and, in general, the more likely your cancer is slow-growing.
Radiation, along with hormone therapy, might also be part of your first cancer treatment if the disease has spread beyond your prostate into nearby tissues.
If you get surgery for prostate cancer, your doctor might recommend you get radiation therapy afterward, too. It can be helpful if the surgeon couldnât remove all of the cancer or if the cancer comes back in the area of your prostate.
If you have advanced prostate cancer, radiation could help keep the disease under control for as long as possible. It can also help prevent or ease symptoms that the cancer might cause.
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Possible Side Effects Of Radiation Treatment For Prostate Cancer
The radiation used to destroy cancer cells can also hurt normal cells in the nearby area. Side effects from radiation treatment are related to the area of the body being treated. Patients start to have side effects a few weeks into their treatment. While side effects may be unpleasant, there are treatments to help deal with them. Most side effects are temporary and slowly start to go away once treatment is done.
You will be seen by your radiation oncology providers often during treatment. These visits are a chance to ask questions and to talk about any side effects and how to best manage them. You can also call your providers to speak about any side effects.
What Side Effects May I Have During Or After My Imrt Treatments
There are several side effects that you may have during or after your IMRT treatments. They are urinary problems, bowel problems, erectile dysfunction or impotence , skin problems, loss of appetite and tiredness. Remember, that IMRT treatments are focused on your prostate cancer. This protects the healthy cells around your prostate, which means you may have fewer side effects and that the side effects you do have wont be as bad.
The urinary problems you may have are:
The bowel problems you may have are:
- Soreness in your rectal areaYou may have soreness in your rectal area. This usually goes away by itself. If you are very sore, let you doctor or health care team know. There are medicines and things that you can do to be more comfortable.
The erectile dysfunction problem you may have is:
- Fewer erectionsMost men do not have problems with erections or intercourse during or right after IMRT. Over time, you may find that you are not having as many erections as you used to. This is because the radiation can harm the nerves near your prostate that help you have erections. Talk to your doctor or health care team if you have a problem like this.
The skin problems you may have are:
Another problem you may have is:
If you have trouble figuring out how to make changes to deal with your tiredness, you may want to talk with your doctor or health care team.
Another problem you may have is:
Managing your side effects.
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What Are The Advantages And Disadvantages
What may be important to one man might be less important to someone else. Your doctor, nurse or radiographer can help you choose the right treatment for you. Theres usually no rush to make a decision, so give yourself time to think about things.
Advantages
- Recovery is quick, so most men can return to their normal activities one or two days after treatment.
- It delivers radiation directly into the prostate, so there may be less damage to surrounding healthy tissue, and a lower risk of some side effects.
- You will only be in hospital for one or two days.
- If your cancer comes back, you may be able to have further treatment.
Disadvantages
- It can cause side effects such as urinary and erection problems.
- You will usually need a general or spinal anaesthetic, which can have side effects.
- It may be some time before you know whether the treatment has been successful.
- You will need to avoid sitting close to pregnant women or children during the first two months after treatment.
If you are having external beam radiotherapy or hormone therapy as well as permanent seed brachytherapy, think about the advantages and disadvantages of those treatments as well.
Will My Diet Affect My Treatment
Yes. Good nutrition is an important part of recovering from the side effects of radiation therapy.
When you eat well, you have the energy to do the activities you want to do, and your body is able to heal and fight infection. Most importantly, good nutrition can give you a sense of well-being.
Since eating when you don’t feel well can be hard, let your treatment team know if youâre having trouble. You could also consider working with a dietitian. They can help make sure that youâre getting enough nutrition during your radiation therapy.
These tips might help while youâre going through treatment:
Try new foods. Things that you havenât liked in the past may taste better to you during treatment.
Power up with plant-based foods. They can be healthy and tasty substitutes for meat. So for instance, swap out a burger or chicken for beans and peas at a few meals each week.
Eat a rainbow of fruit and vegetables. Get your fill of these healthy powerhouses every day. Good options include spinach, raspberries, yellow peppers, carrots, and cauliflower.
Limit or avoid unhealthy choices. That includes red or processed meats, sugary foods and drinks, and processed foods.
Aim to stay at a healthy weight during treatment. You can ask your doctor what your ideal range on the scale should be. Itâs normal to have small weight changes while you go through treatment.
Try to stay physically active. If youâre not active now, you can ask your doctor how to move more and exercise safely.
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What Should Patients Know About Msks Approach To Treating Prostate Cancer
At MSK, we manage prostate cancer in a very comprehensive way, tailored to each patients disease. There is no one specific therapy that is best for everyone.
Our initial assessment includes a carefully evaluated biopsy and a very detailed MRI to show the location of the disease, the integrity or soundness of the capsule surrounding the prostate, and the amount of disease. We will often obtain next-generation imaging and do genomic testing. Then, based on that information and with input from the urologist, the radiation oncologist, and the medical oncologist we can provide a comprehensive recommendation.
The radiotherapy we do here at MSK is state-of-the-art and unparalleled. We are one of the few centers in the world to do MRI-based treatment planning and one of the few centers in the US to offer MRI-guided treatment. When we give brachytherapy, we use computer software that provides us with real-time information about the quality and accuracy of the seed implant during the procedure. It requires a great deal of collaboration with our medical physics team to try to get the most accurate positioning of the prostate during the actual three or four minutes of the treatment.
We make adjustments while the patient is still under anesthesia, so that when the procedure is completed, we have been able to achieve ideal placement of the radiation seeds. This translates into improved outcomes.