Module #4: Assignment – External Beam Radiation Treatment of Brain

Cancer – Written By: Nehasri Sagineedu

• What is the Most Common Radiation Treatment?

Radiation therapy is a common treatment option for brain cancer, also known as brain
tumors. The type of radiation therapy used can vary based on the specific type and
location of the brain tumor, as well as the patient's overall health and medical history.
External Beam Radiation Therapy (EBRT) is the most common type of radiation therapy
for brain tumors. It involves directing high-energy X-rays or other types of radiation
beams from outside the body to target the tumor. EBRT is usually delivered in multiple
sessions over several weeks to allow healthy brain tissue to recover between
treatments. Intensity-modulated radiation therapy (IMRT) and stereotactic radiosurgery
(SRS) are variations of EBRT that allow for more precise delivery of radiation to the
tumor while minimizing damage to surrounding tissues.

• How Long Does it Take?

The duration of External Beam Radiation Therapy (EBRT) for brain cancer can vary
based on several factors, including the type and size of the tumor, the specific
treatment technique used, and the overall treatment plan prescribed by the medical
team. Typically, EBRT for brain cancer is administered over the course of several weeks,
with daily treatments.
A common treatment schedule for EBRT involves receiving radiation therapy sessions
five days a week, Monday through Friday, with weekends off to allow healthy brain
tissue to recover. The total number of sessions can vary but often ranges from 20 to 30
sessions. Each individual session usually lasts around 15 to 30 minutes, including the
time it takes to position the patient and deliver the radiation.
The reason for delivering EBRT over multiple sessions is to allow the radiation dose to
be spread out over time, which helps minimize damage to healthy brain tissue and
allows for better healing between treatments. The treatment schedule is determined by
the radiation oncologist based on the specific characteristics of the tumor and the
patient's overall health.
These are general guidelines, and the actual treatment duration can vary for each
patient. The radiation oncology team will provide a personalized treatment plan and
schedule based on the individual's case.
 • What is that Radiation Treatment Like, Including How is the Patient
Prepared?
External Beam Radiation Therapy (EBRT) is a non-invasive treatment that involves the use
of high-energy X-rays or other forms of radiation to target and destroy cancerous cells in
the body, in this case, brain cancer cells. Here's what the treatment process typically
entails, including how the patient is prepared:

1. Treatment Planning:
Before the actual radiation treatment begins, the patient undergoes a comprehensive
planning process. This involves imaging studies such as CT (computed tomography) scans,
MRI (magnetic resonance imaging), or PET (positron emission tomography) scans. These
imaging techniques help the radiation oncology team precisely locate the tumor and
surrounding healthy tissues. Advanced computer software is used to create a treatment
plan that determines the exact angles, doses, and positions for the radiation beams.
2. Simulation and Treatment Setup:
Once the treatment plan is ready, the patient undergoes a simulation session. During this
session, the patient is positioned on the treatment table in the same way they will be
positioned during actual treatments. Immobilization devices, such as masks or headrests,
might be used to ensure consistent positioning for each treatment session. Small marks or
tattoos might be placed on the skin to help align the patient accurately in subsequent
sessions.
3. Daily Treatment Sessions:
The patient begins daily radiation treatment sessions, typically scheduled on weekdays
(Monday through Friday). The patient lies on the treatment table in the same position as
during the simulation. The radiation therapist ensures precise alignment using the marks or
tattoos placed during simulation. Modern radiation therapy machines often use image
guidance to verify the patient's position before each treatment.
4. Delivering Radiation:
Once the patient is properly aligned, the radiation therapist leaves the treatment room but
remains in constant communication through an intercom system. The radiation therapy
machine is then programmed to deliver the prescribed dose of radiation. The patient needs
to remain still during this process, as any movement could affect the accuracy of the
treatment delivery.
5. Treatment Duration:
The actual delivery of radiation usually takes only a few minutes, typically around 15 to 30
minutes. However, the entire process, including patient setup and verification, might take
slightly longer.
6. Side Effects and Monitoring:
EBRT for brain cancer is carefully planned to minimize damage to healthy brain tissue, but
there can still be side effects. Common side effects might include fatigue, skin irritation or
redness in the treated area, and hair loss in the irradiated field. These side effects can vary
based on individual factors.

Throughout the treatment period, the patient's overall health and any side effects are
monitored by the medical team. Patients are encouraged to communicate any discomfort
or side effects they experience, as the medical team can provide supportive care to manage
these issues.
Remember that the specific details of the treatment process can vary based on the
individual case and the facility where the treatment is being administered. Your medical
team will provide you with personalized information and instructions based on your
situation.

• What are the Provider’s Concerns When Administering Radiation

Treatment?
When administering external beam radiation treatment (EBRT) for brain cancer or any
other type of cancer, radiation oncologists and the medical team have several important
concerns to consider to ensure the effectiveness of the treatment while minimizing
potential risks and side effects. Some of the key concerns include:

1. Target Localization and Precision:

One of the primary concerns is accurately localizing and targeting the tumor while
minimizing exposure to healthy surrounding tissues. Modern imaging techniques and
treatment planning software are used to precisely define the tumor's location and shape,
allowing radiation beams to be directed with high accuracy.

2. Dose Calculation and Delivery:

The medical team carefully calculates the appropriate radiation dose based on factors such
as tumor type, size, location, and the patient's overall health. The goal is to deliver an
effective dose to the tumor while minimizing the dose to nearby critical structures and
normal tissues.

3. Treatment Planning:
Creating a treatment plan that optimizes the balance between delivering an effective dose
to the tumor and sparing healthy tissues is a crucial concern. Treatment plans are tailored
to the individual patient's anatomy and the unique characteristics of their tumor.

4. Patient Positioning and Immobilization:

Accurate patient positioning and immobilization are essential to ensure consistent
treatment delivery. Devices like masks, headrests, and body molds are used to help the
patient maintain the same position during each treatment session.

5. Monitoring and Quality Assurance:

Regular quality assurance checks are conducted to ensure that the radiation therapy
equipment is functioning correctly and delivering the intended dose accurately. This
includes machine calibration, imaging system accuracy, and other technical aspects.

6. Managing Side Effects:

Radiation therapy can lead to side effects, both short-term and long-term. The medical
team closely monitors the patient's progress and manages side effects to ensure the
patient's comfort and well-being. This includes addressing issues such as skin irritation,
fatigue, and other potential complications.

7. Patient Education and Communication:

Patients need to be well-informed about the treatment process, potential side effects, and
what to expect during and after treatment. Clear communication between the medical
team and the patient is essential for managing expectations and addressing any concerns.

8. Multidisciplinary Collaboration:
Radiation oncologists often work closely with other medical professionals, such as
neurosurgeons, medical physicists, and radiologists, to create comprehensive treatment
plans and ensure the best possible outcome for the patient.

9. Long-Term Impact and Follow-Up:

The medical team considers the potential long-term impact of radiation treatment on the
patient's quality of life and overall health. Follow-up appointments and imaging studies are
scheduled to monitor the patient's progress and assess the treatment's effectiveness.

Overall, the provider's concerns revolve around delivering an effective and precise
treatment while minimizing risks and adverse effects. The treatment plan is tailored to each
patient's unique circumstances, and constant communication and collaboration are
essential throughout the entire treatment process.

• What Types of Side Effects are Common?

External Beam Radiation Therapy (EBRT) for brain cancer can lead to various side effects,
which can vary depending on factors such as the dose of radiation, the specific location of
the tumor, the patient's overall health, and individual sensitivity. Common side effects of
EBRT for brain cancer include:

1. Fatigue:
Fatigue is a common side effect of radiation therapy. It can range from mild to severe and
may continue for weeks after treatment ends.

2. Skin Irritation:
Skin in the treatment area may become red, dry, itchy, or sensitive, similar to a mild
sunburn. Skin changes are usually temporary and resolve after treatment ends.

3. Hair Loss:
Hair loss can occur in the area being treated. For brain cancer, this might involve hair loss
on the scalp where the radiation beams are directed. Hair usually starts to grow back
several weeks to months after treatment completion.
4. Headache and Nausea:
Depending on the location of the tumor and the dose of radiation, some patients might
experience temporary headaches and nausea. These symptoms typically resolve after the
treatment course.

5. Cognitive Changes:
Some patients might experience cognitive changes, often referred to as "brain fog." This
can include difficulty concentrating, memory changes, and mild cognitive impairment.
These effects are generally mild and tend to improve over time.

6. Swelling or Edema:
Radiation therapy can sometimes cause swelling in the brain tissue around the treated
area. This is more common with larger tumors or tumors located in specific areas. Steroids
might be prescribed to manage edema.

7. Nausea and Vomiting:

Depending on the location of the tumor and the radiation dose, some patients might
experience mild nausea or vomiting. These symptoms are usually temporary.

8. Changes in Taste and Smell:

Radiation therapy might temporarily affect a patient's sense of taste and smell. These
changes are typically reversible and improve after treatment.

9. Hearing Changes:
If the tumor is located near the ears, radiation therapy could lead to changes in hearing,
including hearing loss or tinnitus (ringing in the ears).

10. Seizures:
In some cases, radiation therapy might cause an increase in the frequency or severity of
seizures, especially if the patient had a history of seizures before treatment.
It's important to note that while these side effects are common, not all patients will
experience them, and their severity can vary widely. Your medical team will monitor your
progress closely and provide supportive care to manage any side effects that arise.
Communication with your healthcare providers about any symptoms you experience is
crucial so that they can offer appropriate management strategies to help minimize
discomfort and ensure the best possible outcome.

• Are There Common Complications?

External Beam Radiation Therapy (EBRT) for brain cancer, like any medical treatment,
can have potential complications or adverse effects. However, it's important to note
that modern radiation therapy techniques and careful treatment planning aim to
minimize these complications. Here are some potential complications associated
with EBRT for brain cancer:

1. Radiation Necrosis:
This is a potential long-term complication where the healthy brain tissue surrounding
the treated area can develop damage due to radiation exposure. It might cause
symptoms similar to a tumor recurrence, including neurological deficits and changes
in cognitive function.

2. Cognitive Changes:
While mentioned earlier as a common side effect, cognitive changes, including
memory difficulties and trouble concentrating, can sometimes be more pronounced
and long-lasting, particularly with higher doses of radiation.

3. Risk to Developing Brain:

In children or young adults receiving radiation therapy, there is a concern about the
potential impact on the developing brain. The medical team carefully considers the
balance between treating the tumor and minimizing harm to healthy brain tissue.

4. Radiation-Induced Tumors:
In rare cases, radiation therapy might increase the risk of developing a new tumor
(secondary tumor) in the treated area. The risk is relatively low, but it's a
consideration, especially for younger patients with a longer life expectancy.

4. Hormonal Changes:
Radiation therapy to certain areas of the brain can affect the function of the pituitary
gland, leading to hormonal imbalances. This might require hormone replacement
therapy.

5. Risk to Other Organs:

Depending on the location of the tumor, there might be a risk of radiation exposure
to adjacent organs, such as the eyes, ears, or spinal cord, which can lead to
complications like vision changes, hearing loss, or spinal cord damage.

6. Skin Changes:
While typically temporary and mild, skin changes in the radiation field can
sometimes be more severe, leading to ulceration or other complications.

7. Seizures:
In some cases, radiation therapy might trigger or worsen seizures, especially if the
patient had a history of seizures before treatment.

It's important to emphasize that these complications are relatively rare, and the
majority of patients undergoing radiation therapy experience manageable side
effects. Additionally, modern radiation therapy techniques, such as intensity-
modulated radiation therapy (IMRT) and stereotactic radiosurgery (SRS), are
designed to precisely target the tumor while sparing healthy tissue, reducing the risk
of complications.

The potential benefits of radiation therapy in treating brain cancer are weighed
against the potential risks and complications by the medical team when developing a
treatment plan. Patients are closely monitored during and after treatment to detect
any potential complications early and provide appropriate management. Open
communication with your medical team is essential to ensure the best possible
outcome and to address any concerns you may have.