Although cancer prevalence increases ever day, new hopes also emerge thanks to new treatments and technological advancements. In recent years, radiotherapy, which is applied using advanced technological devices,

 is considered as one of the most effective methods used in cancer treatment. Liv Hospital Radiation Oncology Specialist Assoc. Prof. Dr. Merdan Fayda explained important questions about radiotherapy treatment.

- What is radiotherapy (radiation treatment)?

Radiotherapy is a type of treatment where ionizing radiation is used. Actually, we are not that unfamiliar with the energy being transmitted in the air. Today, many devices like mobile phones, television antennas,

 global positioning systems and radios operate based on the principle of energy transmission in the air. The rays we use for medical treatment purposes are called "radiotherapy" or "radiation therapy".

 The beams we use for radiotherapy purposes are ionizing i.e. they have the power to damage the DNA, the human genetic material. Applied radiotherapy causes damage on both the tumor DNA and DNA of the normal tissues. Tumor cells cannot survive the damage caused by radiotherapy but normal tissues can repair such damage. Therefore, radiation is successfully being used as medical treatment since it was first discovered in 1890s. 

· What is felt during radiotherapy (radiation therapy)?

Low-energy x-rays used in tomography cannot be felt by the patient as they enter and exit the body. Higher-energy rays used in radiation therapy are not felt similarly. Therefore, patients who are treated by radiation therapy do not feel much.

· I enter the radiotherapy device every day, would my relatives be affected by this? 

Radiation applied during radiotherapy is generally conducted by radiation devices (external radiotherapy) where patients lay still and the beam source rotates around the patient. Since these beams enter and exit

 your body at the speed of light, they don’t have any accumulative properties and they don’t transmit to your relatives. In brachytherapy (internal radiation therapy), which is another form of radiotherapy, implants that enables physicians to send radioactive sources into cavernous organs like uterus or into the tissues are utilized. After these implants are inserted into the patient, they go the region that will be radiated and radiation is applied. Then radioactive source is released from the implant. Patient, whose implant is removed, is sent to home. As no radiation accumulation occurs in patients after brachytherapy applications, no radiation is transmitted to relatives.

· What are the preparations before radiotherapy?

Radiation therapy may be applied at very different stages. Sometimes, missing examinations may be required to be completed before starting the treatment. Before starting the radiotherapy, radiation oncology specialist explains patient why the radiotherapy is required. Similar to surgical applications, most radiotherapy applications include whole or part of an organ, and sometimes lymph node areas where lymphatic fluid of the organ is discharged. Therefore, different preparations may be required according to the region to be irradiated. For example, preventive oral-teeth care is recommended for a patient who is preparing for head-neck radiotherapy. Adjustments related to fullness or emptiness of bladder and rectum may be performed for a patient who is being prepared for lower abdominal radiation. Blood cell count may be requested

 before starting the treatment as blood count values are very important during radiotherapy applications. 

· How is the duration of radiotherapy determined?

Radiotherapy planning generally starts with computerized tomography. Radiation oncology

 specialist, who decides the area to be radiated, performs necessary drawing on computerized tomography. For radiating

 the determined targets, adjustment of necessary areas and how these areas will be radiated are decided together with medical radiophysics specialist. This way, the duration for which the patient will remain in the treatment device each day and total number of days the treatment will continue are determined. In determination of these durations, operation history, status of the disease in the body, details of the pathology report and other accompanying diseases of the patient are important. 

· What should be considered during radiotherapy?

Radiotherapy applications are performed under the supervision and control o a radiation oncologist. Recommendations of the physician must be followed and controls must not be disrupted. It would be helpful to

 inform physician in case of complaints, especially ones like fever, swallowing difficulties that develop recently, and before using any kind of medication.

· How should be the nutrition during radiotherapy?

Nutrition during radiotherapy may vary depending on the irradiated region. For example, a diet consisted of soft, non-burning food are recommended during radiotherapies involving head-neck and esophagus, and non-lapactic diet would be more helpful during lower abdominal radiotherapy. You physician may suggest you not to gain weight as some cancer types like breast cancer are sensitive to hormones. It will be helpful to

 ask your physician about what needs to be considered about nutrition during your radiotherapy.

· How is sexual life and fertility affected by radiotherapy? 

You physician will inform you about sexual intercourse. As with gynecological cancers, sexual intercourse would not be suitable during lower abdominal radiotherapies. Since abdominal radiotherapy of male patients would affect sperm quality, it is not recommended to have a child during this period and 2 months after the radiotherapy is finished. If abdominal radiotherapy will be applied to a male cancer patient, this may lead to azoospermia (absence of alive sperm in semen) after the radiotherapy. This situation generally does not affect erection; however, if such patients plan to have children afterwards, it would be helpful to learn about semen cryopreservation prior to the beginning of radiotherapy. For female patients who received radiotherapy, menstruating and getting pregnant may not be possible without special preparations. In such cases, information should be obtained about ocyte cryopreservation and about embryo cryopreservation if there is a partner.

· Is social life affected by radiotherapy? 

Social life is not affected by radiotherapy as much as chemotherapy. However, it is necessary to talk to the physician and receive information. For example, you should learn from your physician whether it would be harmful to you to come together with people other than your family. Sharing some information about your illness with your family and other friends you may deem suitable would help you to overcome your radiotherapy and other treatments.