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How to prepare for radiotherapy depending on the site of irradiation?

What is the recommended diet and how can complications be prevented?

We encourage you to read individual articles.

Radiotherapy of the head and neck area – advice

Radiotherapy of the chest area – advice

Radiotherapy of the abdominal cavity – advice

Radiotherapy of the pelvic region – advice

Nutrition is an important element of cancer treatment. A healthy and well-balanced diet is important for the success of treatment.

The most important dietary rules

  • Diet in cancer patients should be: individually selected – each patient may tolerate treatment and the diet used during it differently.
  • The patient should maintain proper body weight. Detecting mild malnutrition and modifying the diet has a huge impact on the results of treatment. In cancer patients, the body has a higher demand for calories and protein. You should try to eat a little more than before the diagnosis of the disease and gradually increase the volume and frequency of meals. In case of weakness and noticeable weight loss, the use of oral nutritional supplements may be considered.
  • Sometimes it is necessary to modify the diet due to the specific nature of the disease and the need to protect a specific organ. The best methods of preparing meals for sick people are: cooking, stewing and baking.
  • It should be drink plenty of fluids at room temperature, avoid sweetened drinks and highly processed foods with high sugar content. It is worth choosing still mineral water and light tea infusions.
  • You should not take dietary supplements, and in special situations (some diseases causing vitamin and mineral deficiencies) you should do so under the supervision of a doctor or dietitian. A properly balanced and varied diet covers the body's need for all the necessary nutrients. Do not eat apricot seeds! There is no medical confirmation that they fight cancer, but they may cause intestinal disorders.

The most important advice on how to deal with nutritional problems during treatment (loss of appetite, changes in taste and smell, constipation, diarrhea, nausea or flatulence, problems with chewing and swallowing) can be found in the detailed article – to download in PDF file:

Nutrition in cancer

During radiation therapy, the body uses a lot of energy to recover. The stress and effort associated with the disease and treatment may contribute to increased fatigue. The feeling of tiredness and weakness usually goes away after treatment ends. Until then, you should limit your activity and devote more time to rest.

Many patients undergoing radiotherapy can conduct normal professional and private activities. Others need more rest and cannot function at their previous activity level. Everyone should look for their own solution.

The doctor may suggest that the patient limit activities that may irritate the treated area. In most cases, patients can lead a normal sex life (provided they use contraception). However, the need for intimate contact is often reduced in patients because the treatment may affect hormone levels and increase the feeling of fatigue.

Almost all patients treated for cancer experience mood disorders to some extent. There are often feelings of depression, anxiety, anger, frustration, loneliness or helplessness. Radiotherapy may affect emotional life indirectly by increasing feelings of fatigue and changes in hormonal balance, but the treatment itself is not the direct cause of these fluctuations. Many patients find it helpful to talk about their feelings with a close friend, family member, clergyman, nurse, social worker or psychologist with whom they can establish a good relationship. At the Amethyst Radiotherapy Center, patients and their families can benefit from free consultations with a psycho-oncologist.

Cancer is a great stress. If your well-being is dominated by sadness, anxiety, guilt, sleep disturbances, irritability or fatigue for several weeks, you should consult a doctor. These may be symptoms of depression. Properly selected medications will allow for quick improvement.

After completing radiotherapy, it is important to have regular tests to monitor the effects of the treatment. Regardless of the type of cancer and the therapy used, you should undergo medical examinations and, if recommended, undergo laboratory or imaging tests.

Post-radiotherapy care may also mean further treatment of the cancer or rehabilitation. Most patients undergo follow-up examinations with a radiotherapist. Others are referred to a primary care physician, surgeon or clinical oncologist.

Here are some questions to ask your doctor after completing radiation therapy:

  • How often should I go for check-ups?
  • Why should additional laboratory or imaging tests be performed?
  • Will I need chemotherapy, surgery or another type of treatment?
  • How will we know if the patient is healthy and cured of cancer? What is the risk of disease recurrence?
  • How quickly can you return to normal life activities: work, sexual activity, sports?
  • Are there any special precautions that need to be taken? What should my diet and physical activity look like after completing radiotherapy?

Typically, during the first two years after completing cancer treatment, the patient has follow-up visits every 3 months. Over the next 3 years, they are usually scheduled every 6 months, and 5 years after the end of treatment, once a year.

For modern radiotherapy to save the lives of cancer patients, groundbreaking discoveries in chemistry and physics were needed. On November 8, 1895, Wilhelm Konrad Roentgen discovered mysterious radiation called X-rays. It turned out that X-rays easily penetrate the soft tissues of the human body, but are absorbed by the bones. This revolutionary discovery changed medical diagnostics, giving rise to not only radiology, but also radiotherapy.

A year later, a French physicist Henri Becquerel discovers the phenomenon of radioactivity, the study of which he focuses on Maria Sklodowska-Curie and her husband Pierre Curie. In 1898, they discovered radium and polonium, two radioactive elements, and their knowledge laid the foundations for the development of radiochemistry, radiology and radiotherapy. At the same time, he also became interested in the phenomenon of radioactivity Ernest Rutherford, discoverer of the nucleus of the atom. The scientist received a sample of pure uranium from Becquerel to study the radiation emitted. He divided them into three components: alpha, beta and gamma radiation.

X-rays and other discoveries in the field of radioactivity were immediately implemented by medicine. The first use of X-rays for treatment came two months after their discovery, in a woman with breast cancer in the US. Then, over the following years, the treatments began to be used in Germany, France and Austria. In Poland, the first cancer treatment institute was opened in 1932 in Warsaw, as a result of the activities of the Maria Skłodowska-Curie Foundation and President Ignacy Mościcki. The Radium Institute still operates today as the Oncology Center - Institute. Maria Skłodowska-Curie. Initially, only radium was used for treatment, later mainly cobalt bombs were used, and now it is one of the leading oncology centers in Poland.

Another breakthrough event in the development of radiotherapy was the introduction of therapeutic megavoltage devices in the 50s, which replaced conventional orthovoltage radiotherapy. Megavoltage devices include, among others: linear accelerators (accelerators), cobalt bombs, betatrons, cyclotrons. Megavolt radiation has many advantages over conventional radiation:

  • greater penetration (allows for irradiation of deep lesions),
  • lower ability to be absorbed by bone tissue, which allows for irradiation of tumors located inside the bone walls,
  • better treatment tolerance (fewer side effects).

The next impetus for a breakthrough in radiotherapy came from the IT revolution in the 90s. The use of computer computational techniques and three-dimensional imaging has opened the way to 3D conformal radiotherapy. Its aim is to deliver a high dose of radiation to the area of ​​the cancerous tumor while minimizing the irradiation of healthy tissues. This type of treatment requires the use of state-of-the-art equipment, increased standards and requirements for a team of doctors, medical physicists and technicians.

Modern radiotherapy is possible thanks to close cooperation between medicine, technology and IT. The latest generation of accelerators enable the use of numerous irradiation fields and precise dose determination.

IMRT (Intensity Modulated Radiation Therapy) technology allows for spatial sculpting of the radiation dose to precisely irradiate irregular tumor volumes, sparing healthy tissues penetrating the diseased area. In such treatment, planning is carried out using advanced computer programs, networked with a computed tomography or magnetic resonance imaging scanner.

In terms of equipment and technology, the Amethyst network of centers cooperates with the Swedish company Elekta, a supplier of the most modern and advanced radiotherapy equipment in the world. Elekta's oncology and neurosurgery solutions are used in 6 hospitals around the world. The company cooperates with the best clinical centers and participates in the work of many research teams.

The Amethyst network uses the latest, most effective and fully precise Elekta solutions. Elekta VMAT (Volumetric Modulated Arc Therapy) is a multi-arc dynamic radiotherapy technique performed by specific rotation of the accelerator head with simultaneous modulation of the beam intensity during rotation. It combines arc technique and IMRT. First of all, it allows for shortening the duration of irradiation compared to other available methods. Advantages of Elekta VMAT technology used at the Amethyst Radiotherapy Center:

  • The 3D technology used in Elekta systems contributes to significant growth precision beams of rays aimed at the tumor. Regardless of its shape and size, the irradiation of healthy tissue is clearly limited, which reduces the risk of side reactions.
  • Elekta VMAT allows for administration optimal therapeutic doses, which ensures the effectiveness of the therapy and increases the chances of complete cure of the cancer.
  • Immediately during therapy, doctors observe the tumor and adjust the therapy so that the radiation dose is appropriate and healthy tissue is exposed to the least possible amount.
  • Using Elekta VMAT, the duration of radiotherapy sessions is shortened to 8-12 minutes (the irradiation itself lasts only 2-4 minutes), which significantly increases the patient's comfort. Even in the case of patients who cannot maintain one position for a long time, the precision of exposure remains undisturbed.

Although patients are often unaware of their involvement in the entire treatment process, medical physicists are essential members of the medical teams responsible for radiotherapy. They are the ones who prepare treatment plans, selecting the appropriate irradiation technique, type and energy of radiation, and parameters of therapeutic beams. They control the operation of specialized devices used in the treatment of patients. However, the path to obtaining this specialization is long and demanding.

A medical physicist is a person who usually works in a radiotherapy center, but can also find employment wherever ionizing radiation is used in the medical industry - including: in nuclear medicine, radiology or in scientific centers related to research based on the use of radiation. In the field of radiotherapy, the two main areas in which medical physicists operate are quality control of medical equipment (e.g. daily and weekly inspection of accelerators and other specialized devices used in the treatment of patients and verification of the functioning of the equipment after periodic technical inspections of these devices) and treatment planning , i.e. working with computerized treatment planning systems. It involves selecting the parameters of therapeutic beams based on a previously performed tomographic examination and the target areas introduced by the radiotherapist (contours of the tumor lesion with appropriate margins), which will allow for precise administration of the dose of ionizing radiation ordered by the doctor in the area of ​​the tumor lesion and protection of healthy tissues. and organs surrounding the tumor. Protecting healthy organs and tissues is very important because it significantly affects the patient's quality of life.

- The cooperation between a radiotherapist and a medical physicist is similar to the cooperation between a surgeon and an anesthesiologist - says Krzysztof Czaja, head of a team of medical physicists at the Amethyst Radiotherapy Center in Krakow. – The effectiveness of treatment, health and quality of life of the treated patient depend on the effectiveness of the cooperation of these people. However, we must not forget about the role of the technician in the patient's treatment process, because he is the one who has direct contact with the patient throughout the entire treatment cycle, he implements carefully prepared treatment plans and the effectiveness of the treatment depends on the accuracy of his work.

Precision and empathy

After interviewing the patient and conducting thorough examinations, the doctor indicates the area to be irradiated. The task of a medical physicist is to prepare a comprehensive treatment plan: first, determining the irradiation technique, type and energy of radiation, and then the parameters of therapeutic beams, e.g. angles of the accelerator head, size of therapeutic fields. This is to achieve the radiation dose distribution expected by the doctor in the treated area, while maximizing protection and sparing of the mentioned healthy tissues and organs. The treatment plan prepared in this way is assessed by the medical team and dosimetric verification, i.e. it is controlled using specialized devices for measuring the distribution of radiation dose, allowing for the assessment of compliance of the dose planned in the computer system with that administered by the accelerator during the treatment process. Only after this stage can proper treatment of the patient begin. Precision plays a key role in radiotherapy at every stage of preparation and implementation of the patient's treatment process.

- In the profession of a medical physicist, you need to be precise, attentive and responsible, but empathy is also important, even though we work at computers and rarely have direct contact with patients – emphasizes Krzysztof Czaja. – When preparing treatment plans or verifying them dosimetrically, we must always remember that behind the digital images there are specific, seriously ill people who come to us for help. We are here to do our job carefully. The life and health of a person who is often unaware of our existence depends on it.

Education path for a medical physicist

The three most famous universities in southern Poland educating medical physicists are the AGH University of Science and Technology with the Faculty of Physics and Applied Computer Science, the Jagiellonian University and the University of Silesia. The five-year studies are two-cycle: first engineering, which lasts 3,5 years, and then master's studies for 1,5 years. After completing them, you must complete several years of professional internship and then start specialization conducted by designated reference centers (oncology centers in Warsaw, Krakow, Gliwice, Poznań or Kielce).

The specialization, currently lasting 3,5 years (after recent changes to the specialization program), covers a wide range of issues, topics in the field of anatomy, nuclear medicine, radiobiology, imaging, bioelectricity and biomagnetism, statistics and medical informatics. After completing the specialization course, you can take the state specialization exam. Only passing this exam and obtaining the title of specialist in medical physics completes the education process and allows a physicist to work independently in a clinical team.

Breast cancer is the most common malignant tumor in women worldwide. However, it is still diagnosed too late - half of the cases are in advanced stages III and IV. For this reason, the cure rate for breast cancer in Poland is lower than in many other European countries. Knowledge can save lives.

More information about the prevention, diagnosis and treatment of breast cancer in the article (download in PDF):

Knowledge for health – breast cancer

1011 cases of malignant prostate cancer were recorded in 2013 in the Lesser Poland Voivodeship. 262 cases occurred in Kraków. Prostate cancer accounts for 15 percent. cancer incidence among men in Poland.

Brachytherapy treatments for prostate cancer are performed at the Amethyst Radiotherapy Center in Krakow. This innovative use of irradiation allows patients to avoid surgery and gives them a good chance of recovery.

More information about the symptoms, diagnosis and treatment of prostate cancer in this extensive article (PDF file download):

Knowledge for health – prostate cancer

Up to 95 percent carriers of hepatitis C virus are not aware of their disease. In Poland, approximately 700 people are infected with this virus. people, and only 20 thousand patients were diagnosed with hepatitis C. Undetected and untreated hepatitis leads to cirrhosis and liver cancer. In Poland, 2 patients die annually from liver cancer (data from the National Cancer Registry from 000).

More information about the prevention, diagnosis of viral hepatitis, liver cancer and its treatment in a comprehensive article (PDF file download):

Knowledge for health – hepatitis C