Radiation Therapy: Recent Advances and Nursing Implications

Abstract

Radiation therapy is one of the oldest treatments available for cancer management. Since the discovery of x-rays and radioactivity in the 1890s, patients have been treated with radiation. Advances in equipment and in the understanding of radiobiology permit delivery of effective doses of radiation to tumors while minimizing normal tissue damage. Recent advances in radiation have expanded the scope of treatment. Large-field, large-dose radiation, such as half-body treatment, permits treatment of metastatic disease in an effective and well-tolerated manner in patients too ill to travel for therapy. Total skin electron therapy has been successful in managing extensive skin disease. Hyperfractionated treatment is an experimental approach that attempts to achieve better tumor control by treating with two fractions per day. Intraoperative radiation is a conceptually sound but logistically cumbersome plan in which treatment is given in a single fraction at the time of surgery. Its full potential may be realized when the technical difficulties of administration can be overcome. Brachytherapy is the use of radioactive sources implanted directly into the tumor or in a cavity in proximity to the tumor. Techniques have improved in both surgery and radiation, which allow previously inaccessible sites such as the brain to be implanted. Early-stage breast cancer has been effectively managed with lumpectomy followed by radiation. Hyperthermia is the use of heat in conjunction with radiation. Heat has been found to enhance the effect of radiation and limit the repair of radiation damage. The properties of heat cause it to be more damaging to tumor cells than to normal ones. The ability to sensitize cancer cells to radiation and protect normal cells from radiation injury has been an ongoing research objective. Clinical trials are in progress to isolate effective, easily administered, and nontoxic compounds. The nurse caring for the patient receiving radiation must have an understanding of how radiation works and what the treatment goals are for the patient. Radiation is a difficult modality for patients to understand. Many fears and concerns are based on this lack of comprehension. The nurse must be prepared to describe the experience of receiving radiation and assist patients to anticipate and manage side effects.14,31 Patients need to know what to expect from therapy in terms they can understand. Recent advances and experimental treatments should be explained in terms of what is known including the rationale for the procedures. The patient who understands what to expect and how to manage the sequelae of treatment will be able to tolerate therapy more effectively and maintain an optimal quality of life during treatment.