(
Radioterapia
)
If you've seen a dentist or been treated for a broken bone,
you've experienced radiation firsthand. In everyday life,
radiation in the form of X-rays is used to create images of areas
of the body that doctors can't see, such as the inside of a
tooth or the interior of the chest cavity.
In much higher doses, radiation is used to treat cancer.
Radiation therapy (also called radiotherapy, irradiation, or X-ray
therapy) works by preventing cells from growing or reproducing, and
by destroying them. But parents whose kids need radiation therapy -
one of the most common treatments for
childhood cancer
- often have many questions and concerns about it.
About Radiation Therapy
In radiation therapy, high-energy radiation from X-rays, gamma
rays, or fast-moving subatomic particles (called particle or proton
beam therapy) is used to kill cancer cells and shrink tumors. Some
types of childhood cancer treated with radiation therapy include
brain tumors, Wilms tumor, and head and neck cancers.
Besides destroying cancer cells, radiation therapy can also harm
normal cells. Normal cells are more likely to recover from its
effects, though, and your child's health care team will take
extensive measures to carefully monitor radiation doses to protect
healthy tissue.
Because every case is different, each child's cancer
treatment will also be unique. Some kids receive radiation therapy
alone, while others need both radiation and
chemotherapy
(the use of medicines to destroy cancer cells). And some kids
require radiation therapy and surgery to remove tumors or cancerous
areas.
How Radiation Is Given
Radiation therapy is administered two ways: externally or
internally. Some kids may receive both external and internal
radiation, depending on their needs.
External radiation therapy uses a large machine and special
equipment that aims very specific amounts of radiation at cancerous
tumors or diseased areas of the body. With Internal radiation
therapy (also known as brachytherapy, interstitial therapy, or
implant therapy), a radioactive substance is injected or implanted
into the body at the site of the tumor or cancer cells. In some
cases, the material is swallowed.
Most kids receive only external radiation therapy, although
those with cancers of the head and neck, uterus, cervix, thyroid,
and testes may also undergo internal radiation therapy.
A radiation oncologist (a doctor who specializes in radiation
therapy) will work with other health care professionals to decide
on the type and dose of radiation therapy that's best for your
child.
What Happens During External Radiation Therapy
Receiving radiation therapy for cancer treatment isn't a
one-time deal: Kids who receive external radiation usually visit
the hospital or treatment center as outpatients 4 to 5 days a week
for several weeks, coming in just for the treatment and going home
right after. Receiving small daily doses of radiation helps to
protect the normal cells from damage, and weekend breaks help the
normal cells to recover from the trauma of radiation.
Before the first radiation treatment, a planning session called
simulation will help you prepare. Your child will lie on an X-ray
table while a radiation therapist uses an X-ray machine (called a
simulator) to define the treatment area. Some X-rays or CT scans
might be taken, and an area on the skin is marked with ink to
highlight the treatment area. This "tattoo" should not be
wiped off because it helps to position the radiation for each
treatment.
At each external radiation appointment, your child will wear a
hospital gown or robe and enter the radiation treatment room, where
the radiation therapist will settle your child into position. The
therapist will leave, and a large machine will then deliver the
exact amount of radiation necessary to kill the cells in the
cancerous area. Most of the time that your child spends on the
radiation treatment table involves proper positioning - the
treatment itself takes only minutes.
Younger kids may have trouble being still during treatment - in
these cases, kids may wear a custom body cast or be sedated to help
immobilize them. To prevent unnecessary radiation exposure, parents
aren't allowed in the treatment room, but you can still be
there for your child during therapy. Some hospitals have two-way
communication devices so you can talk with and reassure your child,
and some even use closed-circuit TVs that allow parents to watch
the procedure.
What Happens During Internal Radiation Therapy
Internal radiation treatment usually requires a child to stay in
the hospital for several days for careful monitoring. The
radioactive material may be placed in small tubes that are
implanted into the cancerous tumor or a body cavity, or swallowed
or injected into the bloodstream. This can entail a minor surgical
procedure requiring anesthesia (for example, when inserting
something into the uterus, esophagus, or airways).
You may wonder whether the radiation your child receives will
rub off on you or other family members - and whether you can touch,
hug, and care for your child during and after treatment. If the
treatment is external radiation therapy, there's no need to
worry. Kids getting external radiation are not radioactive after
treatment, so contact with family members does not need to be
restricted in any way.
For kids and teens receiving internal radiation therapy, there
may be some restrictions. The radiation in the implant may send
high-energy rays outside the child's body, so visitors will
need to be protected from exposure. The child will be in a private
room, and nurses and visitors can only enter for short periods of
time. Your child will have all the necessary care, but the nurses
will work quickly to reduce exposure.
Common Side Effects of Radiation
If your child has cancer, you're not only coming to terms
with that diagnosis, but probably also worrying about the physical
and emotional effects of radiation therapy.
Although the main purpose of radiation is to destroy cancer
cells, it can also damage healthy cells. It's this damage to
normal cells that results in radiation side effects, most of which
are related to the area being treated. The physical side effects of
radiation therapy depend on the dose of radiation, the location
where it was received, and whether the radiation was internal or
external.
Many patients have no side effects at all, but for those who do,
most will go away in time, generally aren't serious, and can be
controlled with proper treatment.
A child who receives radiation therapy may experience side
effects shortly after beginning treatment (called early side
effects), such as:
Fatigue
One of the most common side effects of radiation treatment, both
during treatment and after, fatigue often begins within a few weeks
of the start of treatment and commonly lasts for 4 to 6 weeks after
it's completed. Encourage your child to rest and sleep as often
as possible, even if resting or sleeping doesn't immediately
result in more energy. In the long run, rest helps the body recover
from radiation treatment.
Skin Damage or Changes
Skin damage is another very common side effect of radiation
treatment, but only in the area receiving the radiation dose. This
area may be red, sensitive, or easily irritated in the days, weeks,
and months during and after treatment. The skin may swell or droop
or the texture may change. The doctor may prescribe ointments or
cream to speed healing and reduce irritation, which should go away
within 2 to 3 weeks after the end of treatment.
Also, this skin may be more sensitive to sun exposure for months
after treatment. There may also be some permanent changes to the
color and elasticity of the skin.
How can you help? Dress your child in loose-fitting, soft
clothes (such as cotton fabrics) to avoid skin irritation in the
treatment area. It's also important to protect the delicate
skin from sunlight. During the course of treatment, the irradiated
skin should not be exposed to sunlight. After treatment, you should
always apply a sunblock with a sun protection factor (SPF) of at
least 30 on the affected area.
When it comes to skin care, gentleness is key. Be careful not to
irritate the treated skin, and wash it gently with only lukewarm
water and mild soap. Avoid rubbing and scrubbing; simply pat the
skin dry after bathing. Discourage your child from scratching the
area. You should also avoid applying any powders, creams, or
lotions to the treated area.
Hair Loss
Radiation therapy to the head and neck may cause hair thinning
or hair loss shortly after treatment begins. It's important to
remember, though, that radiation anywhere else but the head and
neck will not cause the hair on the head to fall out. Losing hair
can be scary for kids, especially if they're at an age where
it's hard to be different. Getting a shorter haircut may make
it less traumatic for your child once hair loss starts. Your child
also may feel more comfortable wearing hats, bandannas, baseball
caps, scarves, or wigs until the hair grows back - which may happen
within 3 months after treatment ends. Although hair loss usually is
temporary, it can be permanent.
Sore Mouth and Tooth Decay
The tissues of the mouth may be sore and sensitive and there may
be an increased risk of tooth decay if your child received
radiation therapy to the head and neck. These side effects usually
occur during the second or third week after therapy begins and
disappear within a month or so after it ends. The doctor may
prescribe a mouth rinse to reduce pain and irritation. Be sure to
take your child for regular dental checkups and follow the
dentist's advice during radiation therapy.
Gastrointestinal Problems
In the hours following treatment, kids may experience
gastrointestinal problems (such as loss of appetite, diarrhea,
nausea, and vomiting) if they received radiation treatment to the
pelvis or abdomen. Some who receive radiation therapy to the head
and neck may have nausea and vomiting.
Even if your child doesn't feel like eating, it's still
important to try to make sure he or she gets good nutrition. Offer
foods high in nutrients and talk to your doctor about medicines or
dietary changes that may alleviate stomach upset and prevent weight
loss. Several small meals may be easier for your child to consume
than fewer larger ones, and bland foods, such as crackers, broth,
and rice, may be easier to digest.
Blood Changes
Radiation therapy may cause low levels of platelets and white
blood cells (the cells that prevent bleeding and help the body
fight infection) and red blood cells. The doctor will monitor your
child's blood counts regularly and prescribe medication or
transfusions if necessary.
Some kids who have radiation therapy in the head and neck region
also experience long-term or chronic side effects that can occur
months to years after the treatment. These long-term effects -
which can be temporary but usually are permanent - can include
problems with bone growth, fertility, skin changes, and new tumor
development, depending on where the radiation was received, the age
of the child, and the dose given. Radiation on the brain may affect
learning and memory.
Your doctor can offer advice and may prescribe medications to
make your child more comfortable during radiation treatment. Make
sure you avoid giving your child any medications, including herbal
medicines or over-the-counter drugs, without the doctor's
OK.
Caring for Your Child
Its side effects can be unpleasant, but radiation therapy itself
is painless and causes no discomfort. To alleviate your child's
fears before treatment, it may help to have a tour of the radiation
department to see the radiation technologists and equipment.
When your child asks questions about cancer or treatment, be
honest. Use age-appropriate terms and encourage your child to share
his or her feelings. And remember that you're not alone:
Doctors, nurses, psychiatrists, psychologists, social workers,
child-life therapists, and other members of the cancer treatment
team are there to reassure you and your child before, during, and
after radiation therapy.
Once radiation treatment is done, it's still important for
the doctor to monitor your child's health and progress in
follow-up appointments. During these checkups, the doctor will ask
if there are continuing side effects or any signs of the cancer
recurring.
Coping with childhood cancer can be frightening for kids and
parents alike, but remember that many kids treated with radiation
therapy go on to live healthy, full lives.
Don't hesitate to discuss your questions and concerns with
the doctor. The more you know about how radiation therapy will
affect and help your child, the better prepared you'll be.
Reviewed by:
Donna Patton, MD
Date reviewed: February 2007
Note: All information is for educational purposes only. For specific medical advice,
diagnoses, and treatment, consult your doctor.
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