Radiation therapy techniques in cancer treatment
- Timur Mitin, MD, PhD
Timur Mitin, MD, PhD
- Assistant Professor
- Department of Radiation Medicine
- Oregon Health and Science University
Radiation therapy (RT) was first used to treat cancer over a century ago [1,2]. Since then, enormous progress has been made to improve the effectiveness of this modality and minimize side effects.
Increasingly, RT has been used with surgery and systemic therapies in combined modality approaches for a wide range of malignancies to maximize tumor control and quality of life while minimizing toxicity and preserving the organs. The best outcomes are achieved when each patient is evaluated in a multidisciplinary setting and the team of clinicians, including surgeons, medical oncologists, radiation oncologists, and other specialists, jointly determine the best treatment.
In various settings, RT may be the sole treatment, can be given concurrently with systemic agents, or may precede or follow surgery to minimize the chance of microscopic disease left after treatment. In addition, RT may be used palliatively when disease is incurable. The duration of treatment can range from a single treatment up to eight weeks of daily irradiation. In each clinical scenario, the technique, dose, expected outcomes, and related toxicities vary depending upon the diagnosis and treatment site.
Organ preservation has become a very important component of clinical oncology patient management over the past 40 years. Randomized clinical trials have established equivalent outcomes between radical surgery and organ-preservation treatment with an RT backbone for appropriately selected patients with breast cancer, laryngeal cancer, and extremity sarcoma. Smaller trials have shown the appropriateness of organ preservation for patients with bladder cancer and early stage lung cancer. Equivalent outcomes to surgery and better quality of life with organ preservation make definitive RT a very important option for managing carefully selected patients with potentially curable solid malignancies.
In this topic, the mechanism of action of radiation will be reviewed along with the key features of different RT modalities. The application of these treatment modalities in specific malignancies and its integration with other treatment modalities are discussed in the treatment topics for those diseases.
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- MECHANISM OF ACTION
- EXTERNAL BEAM RADIATION THERAPY
- Linear accelerators
- Photons versus electrons
- Treatment planning
- Conformal therapy
- - Intensity-modulated radiation therapy
- - Image-guided radiation therapy
- Particle therapy
- - Proton beam
- - Other heavy particles
- Stereotactic radiation therapy techniques
- Total body irradiation
- INTRAOPERATIVE RADIATION THERAPY
- TARGETED RADIONUCLIDE THERAPY
- RADIATION SIDE EFFECTS