Thanks to modern technologies, radiotherapy is becoming more precise, i.e. more effective and more gentle. Radiotherapy is a collective term for a host of different irradiation methods. Thus, percutaneous radiotherapy, intraoperative radiotherapy, brachytherapy or Cyberknife can be used, for example.

The importance of x-rays in the treatment of tumours and other skin conditions was established just one year after this technology was discovered by Wilhelm Conrad Röntgen. Ionising radiation was first used to treat a human in 1896 in Vienna. Since then, radiotherapy – in addition to surgery and chemotherapy – has become one of the three cornerstones in the treatment of tumours.

Also known as radio-oncology, it is one of the most important methods in the treatment of cancer. It makes use of certain types of radiation to destroy tumours or diseased cells which could develop into tumours.

Each cancer is assessed individually and treated with the appropriate equipment. Thanks to the ultra-modern infrastructure at the Institutes for Radiotherapy in Aarau, Lausanne, Männedorf and Zurich, our doctors and physicists are able to develop a tailor-made course of treatment for each patient.

Radiotherapy is an important treatment method for cancer. Cancer cells and malignant tumours can be specifically targeted and killed off by administering localised x-ray radiotherapy, gamma radiotherapy or partial radiotherapy (electrons, protons, neutrons). The principle of the different types of radiotherapy is the same: the atoms and molecules in the tumour cells are changed (ionised) by the radiotherapy.  This is designed to kill off the cells. Radiotherapy is used on half of all cancers. Radiotherapy is often combined with other treatment methods such as chemotherapy and immunotherapy.

What preparations are carried out before the procedure?

Firstly, evaluations are made to determine which radiation method is the most suitable form of treatment. The stage of the cancer is also recorded and the cancer cells are examined to determine whether they are sensitive to radiation. These evaluations are undertaken by an interdisciplinary team consisting of oncologists and radiologists.

The dosage of the radiotherapy is precisely calculated before the actual radiotherapy takes place. The trick is to find the minimum dose which conclusively destroys the tumour cells but is as gentle as possible on the healthy tissue. The correct position for the radiotherapy is determined with the help of x-ray images. A support mattress is often used so that the patient can undergo every radiotherapy session in exactly the same position. It is a mattress which adjusts itself to the person's body position. When the correct position is found, the mattress is fixed with the body imprint. Thus, the patient can always put him or herself into the absolutely correct position.

Once the patient has decided to go ahead with radiotherapy, they must be prepared for the treatment. The institute’s modern radiotherapy equipment ensures treatment with millimetre accuracy. What’s more, the amount of radiation applied to the designated body part can also be exactly calculated to within 1-2%. The art of radiotherapy lies in providing the necessary dose exactly where the tumour cells are (still) present and to avoid damaging those areas which are not affected by the cancer. It is also vital that each radiotherapy treatment be carried out under exactly the same conditions. 

First contact

Once the patient is registered for radiotherapy by the attending doctor, they will receive an appointment for an initial consultation (either by post or telephone). On the day of the appointment, the patient must register at reception and will then be personally collected from the Hirslanden clinic waiting room by the attending doctor. It is advisable to bring along a family member, partner or friend to the initial consultation if possible.

Preparation

During each radiotherapy session, the patient must assume the same position on the radiotherapy table to ensure the radiation is always applied under exactly the same conditions.

Assessing the present situation

In order to provide the correct treatment, the radio-oncologist must first precisely assess the current situation. Additional examinations may be required before the commencement of the radiotherapy treatment. It is also important to know whether the patient suffers from other illnesses which may influence the radiotherapy. In any case, the examining doctor will discuss all the details with the patient and explain any additional procedures that might be necessary. The examining doctor should also be informed of any medication currently being taken by the patient, as well as any other treatment the patient is undergoing.

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Individual positioning aid

To ensure the same position, an individual positioning aid is used at the very start of the therapy. This is generally a mattress that adapts to the form of the patient’s body thanks to a vacuum, so that an impression can be made. The lying position on the mattress is determined by the position required for the radiotherapy and, above all, what is most comfortable for the patient. The procedure is as follows: The mattress adapts to the shape of the body. A vacuum is applied to the mattress so that it becomes hard and retains an impression of the body. The patient always lies in this specially formed mould when receiving their daily radiotherapy treatment. This guarantees that their body is always in the same position during each round of therapy.

Calculation of the radiation plan

With the help of this mould, a (CT) scan is then performed on the area which will subsequently receive the computed tomography treatment. This CT scan makes it possible to accurately plan the radiotherapy. On each of the various CT images, the doctor indicates which regions are to be treated with radiotherapy, as well as which areas are to receive the lowest possible dosage. Using this information, the physicist and his team can then exactly calculate the radiation plan. The area to be treated is generally divided into several fields. The linear accelerator is set up so that it directs the radiotherapy at the tumour region from several different directions. In the radiation plan, the size of the fields and the position of the shields are calculated according to the specifications of the tumour’.

Therapy

Once the preparatory work is finished, the routine therapy phase begins. Depending on the therapy concept and objective, the radiotherapy treatment is carried out between 10 and 40 times. Generally, one treatment per day is carried out on workdays from Monday to Friday. It is possible, however, that treatment is not carried out every day, or it may even be performed twice a day.

The first session

The first session is more time-consuming than the subsequent treatment, as all the details must once again be thoroughly checked. When the patient is lying on their individual positioning aid, the specially trained radiology assistants (MTRAs) and the physicist check the accuracy of the equipment settings. The physicist will only give the go-ahead once everything has been correctly adjusted. Thanks to the very latest systems used in the Hirslanden clinics, the patient can be sure that they will be treated with millimetre precision.

Control image

The various fields are then adjusted. During the first radiotherapy treatment another control image is taken for comparison with the image from which the calculations were made. Once again, the treatment will only be carried out once everything corresponds precisely. As a result of all these checks and controls, the initial treatment takes somewhat longer. Normally, this first session takes between 20 and 30 minutes.

Organising further appointments

After the first treatment, the following treatment program will be discussed with a member of the MTRA team and appointments will be made for the subsequent sessions. From the second treatment onwards, the sessions will follow a set routine. But here too, we are uncompromising in terms of quality. So before each radiotherapy treatment, the correct positioning will be checked and treatment will only begin once everything is absolutely perfect. From the second treatment onwards, treatment will only take around 15 minutes per day.

Optimal care

Should the patient have any questions, or if they experience any symptoms, the attending doctor will be happy to discuss these with them. Patients should contact the MTRAs or reception staff, who will immediately call the attending doctor. The doctor will then take time to discuss personally any concerns the patient may have.

 

How is the procedure performed?

Several sessions are usually necessary for the radiotherapy to be successful. The first session takes longer because the required adjustments are made. Depending on the type of tumour and cancer, one of the following types of radiotherapy is administered: percutaneous radiation, stereotactical radiotherapy, brachytherapy, intraoperative radiotherapy.

Percutaneous radiotherapy (linear accelerators)

Percutaneous radiotherapy is the most common radiotherapy procedure. In the process, the radiotherapy is applied from outside the body through the skin into the tumour. With the modern instruments (linear accelerators), electrically powered parts are accelerated and focused exactly on the tumour. This radiotherapy procedure is used to combat breast cancer, for example.

 

Learn more about treatment with the linear accelerator

Stereotactic radiotherapy (CyberKnife)

Stereotactic radiotherapy is also known as Cyberknife. It is an extremely precise, robot-assisted percutaneous radiotherapy procedure.  A compact, small radiotherapy instrument is mounted on a robotic arm which can always precisely focused with the help of x-ray and computer tomography images. With this technology, the radiotherapy can be undertaken at over one thousand different angles. Thanks to the robotic control, the exact radiotherapy position can be maintained continuously, even if the patient is breathing. The Cyberknife is used primarily patients with brain tumours and bone marrow tumours, as well as on those with pulmonary and liver metastases.

Learn more about CyberKnife treatment

Brachytherapy

Brachytherapy is an radiotherapy procedure in which radioactive particles are inserted into the body. A distinction is made between the seed implantation procedure and the afterloading procedure.

During the seed implantation procedure, the radioactive particles are administered in the vicinity of the tumour under general anaesthetic, using a hollow needle. They remain in the body and have an effect as long as they remain radioactive. After around 20 days, half of the radiation dose is dispensed.

During the afterloading procedure, a needle or a tube (applicator) is inserted into the tumour tissue and fixed there. The irradiation device is attached to the needle or the tube. A thin wire is fed into the tumour tissue through the applicator and emits the required radiation dose for a short period. This procedure can be repeated many times and the patient can get up between each of the sessions. Brachytherapy is used primarily in patients with prostate cancer.

 

 

Learn more about Brachytherapy

Intraoperative radiotherapy (Intrabeam)

Intraoperative radiotherapy with an intrabeam offers an opportunity to irradiate the tumour while an operation is taking place. This technology is used primarily in patients with small cancerous tumours of the breast. After the surgical removal of the tumour, the surrounding tissue is directly irradiated. This makes targeted radiotherapy possible. As the radiotherapy does not take place through the skin, the rays do not damage the skin.

Learn more about Intrabeam

What are the possible complications and risks of this procedure?

Despite the fact that radiotherapy is becoming progressively more precise and more gentle, the irradiation itself should not be underestimated. Damage can appear locally in healthy tissue in the area where the radiotherapy was applied. In the process, certain organs react more sensitively than others. It can lead to redness on the skin, similar to that of a sunburn. If the head is irradiated, this can cause the patient's hair to fall out. However, it usually regrows after the radiotherapy. If radiotherapy is administered to the abdominal area, this can lead to digestive disorders, diarrhoea, nausea and a general feeling of discomfort. If radiation is administered in the area of the testicles or the ovaries, this can affect the recipient's ability to have children.

Possible side effects 

All types of therapy have side-effects, including radiotherapy. However thanks to precise radiation techniques and better supportive measures, the potential side effects have been significantly reduced in recent years. Serious side effects such as skin burns, for example, are well and truly a thing of the past.

Skin reactions

A skin reaction may occur depending on the type of radiotherapy (location, volume, single dose and total dose). With radiotherapy of a tumour in the mouth or throat region, or with breast cancer, the skin is more greatly affected. After 2 to 3 weeks of treatment, patients may experience a skin reaction similar to sunburn. Patients experiencing such symptoms should contact the nursing staff who will coordinate further treatment with the doctor. Household remedies should not be used without prior consultation with the doctor. Many normal skincare lotions and creams contain traces of heavy metals. The use of such creams causes the radiation to be dispersed on the surface of the skin and can cause increased skin damage.

Reactions of the mucous membranes

With radiotherapy of the throat and thorax areas (e.g. for lung or oesophageal cancer), part of the mucous membranes of the mouth, throat and oesophagus often also receive treatment. These react by becoming inflamed, usually starting in the 2nd or 3rd week of radiotherapy. This inflammation causes a reddening of the membranes, swelling and above all pain, which mainly affects the patient when eating. If such symptoms occur, the patient should notify the nursing staff. Further treatment and care, for example the prescription of a painkiller, will be coordinated by the nursing staff in conjunction with the doctor.

Diarrhoea and “radiation hangover”

With radiotherapy in the stomach and abdomen areas, side effects often include diarrhoea. Treatment of the rectum often causes increased urge to defecate (although no bowel movement follows). Such symptoms are caused by inflammation of the intestines in the treated area as a result of the radiotherapy. Occasionally, patients who receive radiation in the intestinal area may feel nauseous for an hour or two after treatment. This usually occurs at the start of a series of radiotherapy and during the first sessions and is also known as “radiation hangover”. Such symptoms usually disappear after one to two weeks of treatment and can be easily controlled with medication. Such symptoms should also be discussed with the nursing staff.

What is the success rate of this procedure?

Radiotherapy is an effective treatment for many cancers. The success rates depend on the stage of the cancer and the type of tumour. The risk of metastisation or the reoccurence of the tumour can often be reduced with the irradiation. Sometimes tumours which are too large for the surgery can be reduced in size with radiotherapy, making surgery possible.

What happens after the treatment?

There is usually further treatment after the radiotherapy. Depending on the cancer, this can be chemotherapy, immunotherapy or hormone therapy. The progression of the cancer will be closely monitored and the success rate with regular check-ups.

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FAQ

Frequently asked questions about radiotherapy