Learning Objectives

Learning Objectives

By the end of this section, you will be able to do the following:

  • Explain the concept of radiotherapy and list typical doses for cancer therapy

Therapeutic applications of ionizing radiation, called radiation therapy or radiotherapy, have existed since the discovery of X-rays and nuclear radioactivity. Today, radiotherapy is used almost exclusively for cancer therapy, where it saves thousands of lives and improves the quality of life and longevity of many it cannot save. Radiotherapy may be used alone or in combination with surgery and chemotherapy (drug treatment) depending on the type of cancer and the response of the patient. A careful examination of all available data has established that radiotherapy's beneficial effects far outweigh its long-term risks.

Medical Application

Medical Application

The earliest uses of ionizing radiation on humans were mostly harmful, with many at the level of snake oil as seen in Figure 15.7. Radium-doped cosmetics that glowed in the dark were used around the time of World War I. As recently as the 1950s, radon mine tours were promoted as healthful and rejuvenating—those who toured were exposed but gained no benefits. Radium salts were sold as health elixirs for many years. Legislation in the 1950s prohibited these uses.

The image shows an old advertisement of radium material branded as UNDARK with the tagline 'Shines in the Dark.'
Figure 15.7 The properties of radiation were once touted for far more than its modern use in cancer therapy. Until 1932, radium was advertised for a variety of uses, often with tragic results. (Struthious Bandersnatch.)

Radiotherapy is effective against cancer because cancer cells reproduce rapidly and, consequently, are more sensitive to radiation. The central problem in radiotherapy is to make the dose for cancer cells as high as possible while limiting the dose for normal cells. The ratio of abnormal cells killed to normal cells killed is called the therapeutic ratio, and all radiotherapy techniques are designed to enhance this ratio. Radiation can be concentrated in cancerous tissue by a number of techniques. One of the most prevalent techniques for well-defined tumors is a geometric technique shown in Figure 15.8. A narrow beam of radiation is passed through the patient from a variety of directions with a common crossing point in the tumor. This concentrates the dose in the tumor while spreading it out over a large volume of normal tissue. The external radiation can be X-rays, 60Co γ rays,60Co γ rays, or ionizing-particle beams produced by accelerators. Accelerator-produced beams of neutrons, π-mesons,π-mesons, and heavy ions, such as nitrogen nuclei have been employed, and these can be quite effective. These particles have larger QFs or RBEs and sometimes can be better localized, producing a greater therapeutic ratio. But accelerator radiotherapy is much more expensive and less frequently employed than other forms.

The image shows a man lying on a flat surface. A gamma ray machine is rotated around the man.
Figure 15.8 The 60Co60Co source of γradiationγradiation is rotated around the patient so that the common crossing point is in the tumor, concentrating the dose there. This geometric technique works for well-defined tumors.

Another form of radiotherapy uses chemically inert radioactive implants. One use is for prostate cancer. Radioactive seeds (about 40 to 100 and the size of a grain of rice) are placed in the prostate region. The isotopes used are usually 135I135I size 12{"" lSup { size 8{"135"} } I} {} (6-month half life) or 103Pd103Pd size 12{"" lSup { size 8{"103"} } "Pd"} {} (3-month half life). Alpha emitters have the dual advantages of a large QF and a small range for better localization.

Radiopharmaceuticals are used for cancer therapy when they can be localized well enough to produce a favorable therapeutic ratio. Thyroid cancer is commonly treated utilizing radioactive iodine. Thyroid cells concentrate iodine, and cancerous thyroid cells are more aggressive in doing this. An ingenious use of radiopharmaceuticals in cancer therapy tags antibodies with radioisotopes. Antibodies produced by a patient to combat his cancer are extracted, cultured, loaded with a radioisotope, and then returned to the patient. The antibodies are concentrated almost entirely in the tissue they developed to fight, thus localizing the radiation in abnormal tissue. The therapeutic ratio can be quite high for short-range radiation. There is, however, a significant dose for organs that eliminate radiopharmaceuticals from the body, such as the liver, kidneys, and bladder. As with most radiotherapy, the technique is limited by the tolerable amount of damage to the normal tissue.

Table 15.6 lists typical therapeutic doses of radiation used against certain cancers. The doses are large, but not fatal because they are localized and spread out in time. Protocols for treatment vary with the type of cancer and the condition and response of the patient. Three to five 200-rem treatments per week for a period of several weeks is typical. Time between treatments allows the body to repair normal tissue. This effect occurs because damage is concentrated in the abnormal tissue, and the abnormal tissue is more sensitive to radiation. Damage to normal tissue limits the doses. You will note that the greatest doses are given to any tissue that is not rapidly reproducing, such as in the adult brain. Lung cancer, on the other end of the scale, cannot ordinarily be cured with radiation because of the sensitivity of lung tissue and blood to radiation. But, radiotherapy for lung cancer does alleviate symptoms and prolong life and is therefore justified in some cases.

Type of Cancer Typical Dose (Sv)
Lung 10–20
Hodgkin's disease 40–45
Skin 40–50
Ovarian 50–75
Breast 50–80+
Brain 80+
Neck 80+
Bone 80+
Soft tissue 80+
Thyroid 80+
Table 15.6 Cancer Radiotherapy

Finally, it is interesting to note that chemotherapy employs drugs that interfere with cell division and is, thus, also effective against cancer. It also has almost the same side effects, such as nausea and hair loss, and risks, such as the inducement of another cancer.