Radiation Therapy (RT)
- Localized effect
- Can be used to relive pain caused by obstruction
- Can used in Pre-operative if the mass is so big to operate (radio therapy before the surgery)
- Can used in Post-operative – to aid in destruction of cancer cells lalo kapag cytology reports when have many
lymph nodes, it requires radio therapy
- May be used as a primary adjuvant, or a pallative treatment modality
- Can be used in Conjuction Therapy – to enhance the destruction of cancer cells
- Primary Modality it is the only treatment used and aims to achieve local cure of a cancer
- Adjuvant Therapy radio therapy can be done pre-operatively or post operatively to the agent of destruction
of cancer cells
- Adjuvant Therapy aid in destruction of cancer cells in conjuction with chemotherapy to enhance destruction
of cancer cells.
- Pallative Theray to relieve pain, no goal to treat patient. It just lessen the symptoms
- Can use Radiation Therapy in Pallative Treatment
Types
1. Adjuvant
2. Neo Adjuvant
3. Pallative
Radiation Therapy
-High energy ionizing radiation that destroys a cell’s ability to reproduce by damaging its DNA.
-Use machine and focused on area which is localized cancer,
-Cancer cells – most sensitive in radiation than normal cells
CANCER RESEARCH UK
- Radiation also damage healthy cells
- Radiation Therapy – used outside the body using X-rays
- MRI Scan – can help to tract or guided radiotherapy, but difficult to track EX. LUNG CANCER
- IMRT – shapes the radiation in the tumor , it reduces the damage of surrounding health tissue EX. SPINE
- Technical SABR – it gives the chances of killing 2 cells and need hospital treatment to finish it Ex. LIVER
- X-ray Radiotherapy – PROTON BEAM THERAPY – Damage cells and help treat sensitive locations EX. BRAIN
- RADIOACTIVE IODINE - Inside the Body - EX. THYROID
- BRACHYTHERAPY – is a surgical technique where radioactive implanted inside the tumor EX. PROSTATE
PELLETS INSIDE THE TUMOR
DIFFERENT TECHNIQUES IN RADIOTHERAPY
1. PROTON BEAM THERAPY
2. RADIOACTIBE IODINE
3. MRI-GUIDED RADIOTHERAPY
4. IMRT
5. SABR
6. RACHYTHERAPY
- This helps in radiation therapy to be more precise minimizing the damage in healthy cells
- Through Research It reduces side effects and speeds up recovery time
TYPES OF RADIATION THERAPY
1. EXTERNAL RADIATION THERAPY (TELETHERAPY, DXT)
- advantage is its skin
- sparing effect cannot affect skin
- There is NO NEED FOR ISOLATION
- administered to a high energy X-ray or Gammaray Machine EX. Linear Accelerator / or COBAL
- Maximum effect occurs at tumor deep effect of the body and NOT IN SKIN SURFACE
2. INTERNAL RADIATION THERAPY
-This is administered near the tumor or into the systemic circulation
-Used Radiation NEAR TUMOR
-INTERNAL in the body
2 TYPES of INTERNAL RADIATION
1. Sealed Source (Brachythrapy) – ex. Cervical cancer, has pellets of radiation
2. Unsealed Source (Radioactive Iodine)
1. Sealed Source (BRACYTHRAPY)
- Isotope is place within or directly near the tumor
- SEEDS na nilalagay sa patient using guide
- Radioactive material is sealed in a container – in MALE necrosis
- In Female used in CANCER UTERUS and CERVIX
- Radio isotopes is place in the body = generally for 24-72 hrs / 2-3 days stay in patient the Radioactive seeds
- Radio isptope – cannot separate to the clients body nor, it cannot contaminate cancer in the blood or vomitus
SEALED – not contaminated secretion like Urine, sweat, blood and vomitus NOT radioactive
However – RADIATION EXPOSURE can result is from direct contact with the SEALED RADIO ISOTOPE such as touching the
container with their hands or length exposure to the sealed isotope
IF nahawakan seeds of radio isotope
2. Unsealed Source
- Maybe administered IV, ORAL, and installation directly to body cavity in patients circulation
-Radioisotope Circulates through the clients body
- URINE, SWEAT, BLOOD AND VOMITUS contain the Radioactive isotope.
- EX. IODINE 131 – ginagamit sa GRAVE DISEASE or THYROID CANCER ORAL
PRINCIPLE OF RADIATION PROTECTION (DTS)
Like COVID
DISTANCE
- The greater the distance the lesser exposure
- Maintain a distance of at least 3 FEET / 1 METER when not performing nursing procedures
TIME
- Limit contact of 5 minutes each time, a total of 30 minutes per 8 – hour shift.
- 6 times in patient room
SHIELDING
- Use LEAD SHIELD during contact with client
- Use BADGE to measure exposure in radiation
PREGNANT STAFFS
- Cannot be in radio therapy
- Has teratogenic effects
- If caring for a client internal radio therpay USE DOSIMETER BADGE
- To prevent feelings of ISOLATION Maintain contact with the client while keep the distance from radiation
exposure
- Talk with the client from the doorway of the room
CARE OF PATIENTS WITH
RADIOISOTOPE IMPLANT INTO THE UTERUS
- If the client has Cancer in Cervix and use Radioisotope implant into the uterus
NURSING CONSIDERATION
1. Clients back is turned towards the door.
2. Should be on COMPLETE BED REST to prevent dislodgement of isotope
Turn to sides at regular intervals
3. Client should be GIVEN and ENEMA before the Procedure or BOWEL PREPARATION
If not – galaw galaw patient and promote dislodgement of radio isotope
Low Fiber Diet stay device 2-3 days para di tae ng tae
Because HIGH FIBER promotes DEFICATION
4. Foley Catheter in Place during the procedure – COMPLETE BED REST
To prevent bladder distention and inflammation to bladder
USE IFC or Foley Catheter
FISTULA – Insertion of 2 body parts
5. Have a long forceps and lead container readily available in BED SIDE for Seeds of radio isotope
NURSING CARE FOR UNSEALED RT
- Private room and bath
- All surfaces are covered with CHUX or PAPER (single use only)
- Disposable Plates and utensils
-Trash and linens are kept in the client’s room and are NOT removed until the client is ready for discharge.
Linens are not change
- Rinse the sink with COPIOUS (madami) amount of Water after toothbrushing and flush toilet several times (to
prevent radiation contamination)
- Use gloves when handling body fluids
- Any EMESIS should be covered with absorbent pads, and radiation safety officer should be called IMMEDIATELY
If vomit – absorbent pad
TEACHING GUIDELINES REGARDING EXTERNAL RT
1. It is painless
2. Lie very still in special table
3. Each treatment usually lasts for few minutes
4. You will remain alone in the treatment room
5. THERE IS NO RESIDUAL RADIOACTIVITY AFTER RADIATION THERAPY
CLIENT EDUCATION ON SKIN CARE IN EXTERNAL RADIATION
1. Keep your skin dry
2. Do not wash the treatment area until you are instructed to do so (PATH DRY) use cool water NOT HOT WATER
3. Do not remove the lines or ink marks placed on your skin
4. Avoid using powders, lotions, creams, alcohol and deodorants on the treated skin
5. Wear loose- fitting clothing to avoid friction over the treatment area
6. Shave with an electric razor ( masusugat sarili)
NURSING INTERVENTIONS FOR SIDE EFFECTS OF RT
Skin Reactions
- Erythema, dry / moist desquamation
- Athropy, telangiectasia (a condition in which tiny venules or blood vessels cause red lines or patterns in the
skin) , depigmentation, necrotic/ ulcerative lesions.
NURSING INTERVENTIONS FOR SKIN REACTIONS
1. Observe for early signs of skin reaction and report to the AP.
2. Keep area dry.
3. Wash area with water, no soap and pat dry (do not rub).
Mild Soap is permitted
4. Do not apply ointsments, powders or lotion on the area,
Cornstarch may be used.
5. Do not apply heat; avoid direct sunshine or cold on the area
6. Use soft cotton fabrics for clothing
7. Do not erase markings
NURSING INTERVENTIONS FOR SIDE EFFECTS OF RT
INFECTION
- Due to bone marrow suppression( if na tamaan)
- Monitor CBC especially WBC count ( usually is less than 1 or 0)
Bigay GCSF or Granulocyte Stimulating Factor Example is
FILGRASTIM ( Subcutaneous) to increase WBC
- Good personal hygiene, nutrition, adequate rest.
HEMORRHAGE
- Platelets are vulnerable to radiation
- Monitor platelet count (dapat not lower the 150)
- Avoid physical trauma or use of
ASPIRIN (ASA) / SALICYLIC ACID– stop aggregation of platelet NOT BLOOD CLOT
- Tech signs of hemorrhage to report (e.g., gum bleeding, nose bleeding, black stools)
- Monitor stool and skin for signs of hemorrhage
BLACK STOOL / MELENA
- Signifies If upper GI bleeding ( esophagus or stomach)
FRESH BLOOD / HEMATOCHEZIA
- Signifies lower GI bleeding in large or small intestine
- Bright red
NURSING INTERVENTIONS FOR SIDE EFFECTS OF RT
FATIGUE
- Results of high metabolic demands for tissue repair and toxic waste removal
- Plenty of rest and good nutrition
WEIGHT LOSS
- Anorexia, Pain and effect of cancer
NURSING INTERVENTION FOR SIDE EFFECTS OF RT
- Stomatitis and Xerostomia (DRY MOUTH)
NURSING INTERVENTIONS
- Administer analgesics before meals, as prescribed
- Bland diet avoid smoking and alcohol
- Good oral hygiene with saline rinses every 2 hrs
- Sugarless lemen drops or mint increase salivation
The following hospitals will have a linear accelerator
Chemotherapy
- Systemic effect
