Clinical Practice 4: Radiotherapy
Clinical Practice 4: Radiotherapy
Clinical Practice 4: Radiotherapy
RADIOTHERAPY
LECTURE 4
MODERN RADIATION THERAPY
TECHNIQUES
Shortcomings of Traditional Radiation Therapy
Until the 1980s, radiation oncologists devised treatment plans using plain
radiography, which rarely visualized a tumor directly.
This treatment approach was associated with uncertainties, inconveniences, and
toxicities.
Because only an approximate location of the cancer could be determined, the
radiation field needed to include a generous margin. For example, in prostate
cancer therapy, the treatment volume usually included portions of the
gastrointestinal and genitourinary tracts.
This led to radiation proctitis (characterized by fecal urgency and rectal pain
and bleeding) in up to 40 percent of patients; sexual dysfunction in up to 50
percent of patients; and urinary complications (e.g., incontinence, hematuria,
strictures) in up to 10 percent of patients.
Because radiation was typically administered over 30 or more daily fractions
(fractional doses), the location of the target tumor varied throughout treatment.
Slight changes in patient position were inevitable, and shifting rectal contents
altered the prostate's anatomic position. In some patients, such organ movement
led to underdosing of the target tumor and increased relapse rates.
EXTERNAL BEAM RADIATION THERAPY