- ELECTROMAGNETIC (X-RAYS & GAMMA) - PARTICULATE (ELECTRON, BETA PARTICLES, PROTONS, NEUTRONS, ALPHA) EFFECTS: TISSUE DISRUPTION ALTERATION OF THE DNA BREAKS THE STRANDS OF THE DNA HELIX= CELL DEATH OR FORMATION OF FREE RADICALS=DNA DAMAGE USES: 1. PRIMARY only treatment used and aims to achieve local cure of the cancer 2. ADJUVANT used either pre-or post-op 3. PALLIATIVE HOW RADIATION THERAPY WORKS Radiosensitivity RELATIVE SUSCEPTIBILITY OF TISSUES TO RADIATION High-energy ionizing radiation DESTROYS A CELLS ABILITY TO REPRODUCE BY DAMAGING ITS DNA, & FORMATION OF FREE RADICALS Normal cells have greater ability to repair damaged DNA than Ca cells RADIOSENSITIVE Cells during the S, G2 & M phases Cells that undergo frequent cell division Tumors that are well oxygenated Small size tumors & highly proliferative cells RADIORESISTANT: slow growing & tissues at rest (muscle, cartilage, connective tissue)
TYPES OF RADIATION 1. External beam ERBT (telegraphy) radiation source is outside the body THRU GAMMA-RAY MACHINES: LINEAR ACCELERATOR, COBALT, BETATRON Client is NOT radioactive; not a hazard to others; do not wash off markers DURATION OF TX: CONVENTIONAL: 6-8 WKS ENHANCED TREATMENTS: INTENSITY MODULATED RADIATION THERAPY (IMRT) IMAGE GUIDED
APPROACHES OF EBRT GAMMA RAYS (Ex: cobalt-60( GammaKnife Stereotactic Radiosurgery Unit One time high dose delivery of ERBT Stereotactic Body Radiotherapy PROTON THERAPY Utilizes high-linear energy transfer (LET) in the form of charged protons generated by a large magnetic unit cyclotron BENEFITS: Localized treatment CLIENT EDUCATION: WASH ARE WITH WATER ALONE OR MILD SOAP & WATER USE HAND RATHER THAN WASHCLOTTH FOR WASHING DO NOT REMOVE MARKINGS DRY THE SKIN USING PATTING NOT RUBBING MOTION NO powder, lotions, ointment &creams to affected area Wear soft clothing over affected area Avoid using anything that rubs on the affected area Avoid exposing irradiated area to the sun Avoid heat exposure
2. Internal radiation therapy (brachytherapy) - Maybe delivered as a temporary or a permanent implant. Temporary Applications: High-dose radiation (HDR) for short duration Advantage: treatment time is shorter- reduced exposure to personnel Low-dose radiation: longer treatment INTRAVAITARY RADIOISOTOPES - Uses: GYN cancers - Maybe HDR or LDR - LDR: hospitalized pt - NC: bedrest for 72 hrs, log-rolling for turning, low residue diet: IC to ensure an empty bladder; personnel & visitor precautions with TDS (Time, Distance, Shielding) INTERSTITIAL IMPLANTS - Seeds, needles, wires or small catheters - Used in breast (MammoSite device) Sealed source: intracavitary/interstitial Thru: needles, ribbons or catheters (temporary implant) or beads (permanent) implanted directly into the tumor Exposure: direct contact with sealed radioisotope NOT thru excretions Client is radioactive ONLY when implant is in place Unsealed source: oral/injection/instillation into body cavity for systemic treatment; direct contact with body tissue. *radioisotope circulates throughout the body. Body fluid s are contaminatied Clients urine, sweat, blood &vomitus contain radioisotope *eliminated from the body in 48 hrs. Pts are isolated Afterloading device: empty applicator is implanted during surgery SAFETY STANDARDS: Private room & bath Check all linens & materials removed from the bed for any foreign body that could be source of radioactive material. Keep linens & trash in clients room until they have been checked for radioactivity Time-limit to 30 mins direct care/8hr shift Distance: distance & radiation exposure inversely related. * Intensity of radiation decreases inversely with the square of the distance from the source Ex: 2m=1/4 exp; 4m-1/16 exp *Visitors 6ft. from the source; off limits to <16 y.o. & pregnant women Shielding lead shields, lead container(pig) & long-handled forceps are musts in pts unit Wear lead shield or apron for prolonged care Staff should wear films badges or dosimeters Precautionary measures for sealed & unsealed
Treatment considerations: Certain normal cells are more sensitive to radiation & may incur permanent damage SE related to total of radiation *Gray (Gy) unit dose of radiation Fractionation dosing: To reduce SE To allow normal cells to repair themselves & increase susceptibility of the cell to radiation Vulnerable during late G2 and early M phase of cell cycle CHEMOTHERAPY TYPES: Adjuvant eliminates any remaining submicroscopic cells after surgery and RT Neoadjuvant - pre-op use of CT to reduce bulk & lower stage of tumor making it amenable to surgery Some Principles of Cancer Chemotherapy 1. Cure probably requires complete eradication of tumor cells 2. Tumors usually detected clinical late in course of disease 3. Adverse effect are decreased by giving combinations of drugs with different side-effects 4. Intermittent high doses are more effective 5. Adjuvant therapy (chemotherapy after surgery/radiation) is given to eliminate metastases 6. Drugs have a narrow therapeutic index *THERAPEUTIC RATION guiding principle of chemotherapy - Aim: To administer an antineoplastic dose large enough to destroy cancer cells but small enough to limit adverse effects to sage & tolerable levels
VASCULAR ACCESS METHODS OF ADMINSTRATION Peripherally inserted central catheters Implanted Venous Access Portq Ommaya reservoirs