RADIOTHERAPY

How does it work

Radiation therapy consists of "targeting radiation or particles ionizing towards the tumor mass, in order to kill the diseased cells that constitute it.
The radiation ionizing agents used in radiotherapy are X-ray And γ rays high energy. The former are produced by specific tools called linear accelerators for radiotherapy, while the latter are issued by radioactive isotopes.
THE particle beams they can be made up of protons, neutrons or positive ions.
These radiations or particles, when they hit the cell, interfere with both the genetic material, causing a direct damage, both with the "water within it, causing a indirect damage. In fact, following the interaction of the radiation with water, free radicals are generated capable of damaging the molecules that make up the DNA.
Healthy cells have defense mechanisms capable of repairing damage to their DNA, while, in cancer cells, these mechanisms are less efficient, so DNA damage is more easily lethal.
In addition to affecting the tumor mass, the lymph nodes can also be affected; this intervention is desirable when the lymph nodes are clinically involved in the disease, or if there is a fear of malignant spread of the tumor through the lymphatic circulation (metastasis).
Of course, only diseased cells are attempted, but unfortunately, portions of healthy cells can also be irradiated.

Types of radiation therapy

Radiotherapy can be used for different purposes, depending on the type of tumor to be treated, its location and the patient's condition:

Radiotherapy for curative purposes (radical radiotherapy): it aims to cure and completely eliminate the tumor.

Exclusive radiotherapy: Radiation therapy is the only treatment used. It is used only for certain types of tumors, with certain characteristics. For example, this treatment is used for some prostate cancers, gynecological cancers and non-aggressive lymphomas.

Preoperative radiotherapy (neoadjuvant radiotherapy): it is used before surgery to reduce the size of the tumor mass that must be removed. It can also be used to prevent the spread of malignant cells during the operation.

Postoperative radiotherapy (adjuvant radiotherapy): after the patient has undergone surgery, in some cases, this type of treatment is recommended in order to eliminate any residual traces of the tumor.

Intraoperative radiotherapy (Intraoperative radiotherapy or IORT): it is used during the operation to attack portions of the tumor that cannot be removed surgically, or to bomb the area where the tumor has developed in order to avoid possible recurrence.

Total body radiation therapy (total body irradiation or TBI): this type of treatment is carried out in patients suffering from particular types of lymphoma or leukemia, who must undergo a stem cell or bone marrow transplant. The aim is to destroy the diseased cells which will then be replaced by new lymphatic or blood cells following the transplant.

Palliative radiotherapy: This treatment aims to reduce the discomfort and pain caused by certain types of cancers. It is used, for example, in some types of bone metastases.

Side effects

Although technological innovations try to minimize the side effects caused by radiotherapy, unfortunately it has not yet been possible to completely eliminate them.
The side effects are due to the fact that ionizing radiation also affects healthy cells, as well as diseased ones. These effects are highly variable depending on the type of tumor and the type of treatment chosen. Furthermore - with the same pathology and treatment - there is also a great variability from person to person.
Most of the side effects occur in the area where the radiotherapy treatment was performed.

Short-term side effects

Short-term side effects occur a few hours to a few weeks after the end of treatment. Among these are:

Tiredness: this symptom can be very intense especially in the first periods of treatment.

Skin reactions: the skin in correspondence of the treated area can undergo redness, burns and irritation. Generally, skin reactions do not appear immediately, but after a few sessions.

Damage to the mucous membranes: as in the case of the skin, even the mucous membranes - when treated with radiotherapy - can undergo redness and irritation.

Nausea and vomit: these effects are caused by radiotherapy carried out in the abdomen or stomach. In some cases, radiotherapy used in the treatment of head and neck tumors can cause these reactions; this is due to the irradiation of areas in which they are located. the centers of regulation of vomiting.

Hair loss and skin hair: this happens only if the radiotherapy treatment takes place in areas where there is hair and hair. The untreated areas do not undergo alterations.

Mouth and throat problems: radiotherapy could cause small wounds and / or ulcerations in the mouth and throat. This type of lesion may disappear shortly after the end of the treatment.

Intestinal disorders: The lower intestine can be exposed to radiation during the treatment of rectal, bladder, prostate or gynecological cancers. Radiation thus absorbed can lead to ailments such as diarrhea and pain.

Swelling: The inflammation caused by radiotherapy can lead to swelling of the soft tissues (edema). This effect is of concern especially in the treatment of brain tumors and metastases, due to the intracranial pressure that can be generated and in the case of particular types of lung tumors that obstruct the bronchi.

Long-term side effects

Long-term side effects appear months or years after the end of radiotherapy treatment. Again, usually, they are limited to the treated area. Among these we find:

Fibrosis: Healthy cells can be damaged by radiation. When the damage is very deep, the damaged cells are replaced by connective tissue deposits. Deposition of connective tissue leads to fibrosis.

Lymphedema: radiotherapy can cause damage to the lymphatic system and as a result of this damage there may be an abnormal accumulation of lymphatic fluid. This side effect is typical of those patients who undergo radiotherapy following surgery for the removal of axillary nodules.

Infertility: when radiotherapy takes place in the pelvic area, patients can experience infertility.

Problems with the oral cavity: If the salivary glands are affected - which are very sensitive to radiation - it can lead to dry mouth or an increase in the viscosity of saliva. Radiation therapy can also cause damage to the tongue, gums and teeth, as well as lead to jaw stiffness.

Cognitive decline: it is a deficit of memory and learning that can occur following radiotherapy carried out at the level of the head. It is a side effect that is especially noticeable in children aged 5 to 11 years.

Cancer: ionizing radiation is one of the possible causes of the onset of cancer. It may happen that radiation therapy causes cancer or a secondary tumor in the area where it is administered. The appearance of the tumor can occur from twenty to thirty "years after the end of the radiotherapy treatment.

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