7(b): Radiation therapy
At a briefing for patients and carers organised by the NSW Cancer Institute in October 2008, Dr Koh Eng-Siew, radiation oncologist at Liverpool Hospital, said that radiotherapy, contrary to myth, does not do more harm than good.
It is the best supportive care. Dr Koh also emphasised that timing is important: there are queues (the situation much improved from 2000-2001), there is a need for preparation, including the making of a mask so the patient is treated accurately, but the sooner radiotherapy is begun after debulking surgery, the better the results.
The most readily available, standard radiotherapy treatment, known as 'conformal' involves targeting of selected areas by a source mounted on a gantry, which provides appropriate doses from three directions as in the illustration. The patient remains clothed, the daily routine is scarcely more complex than going for x-ray ...you lie down and the mask is fitted so your head is in the right place.
You have this treatment over a period of six weeks, daily with weekend and other breaks, to fit the pattern that best [a] enables recovery of healthy brain cells [b] enables death of more cancer cells.
At some locations in Australia there are other 'more advanced' machines, offering 'stereotactic' radiotherapy, sharper targeting. This is also a single dose treatment. However, for malignant glioma a 2004 study in the United States showed no benefit from stereotactic over conformal radiotherapy. Stereotactic radiotherapy may suit other types of tumour in particular small brain metastases from other bodily cancers.
There are side effects. Dr Koh listed these:
short term
fatigue
patchy hair loss
mild to moderate scalp reaction
headache and nausea 10-15%
medium term
ongoing somnolence – need for an unusual length of sleep
long term
steroidal hormone disturbance
pituitary disturbance
cognitive function impacts
Where patients were less fit, older, given lower than standard dose, or waited longer for treatment, Dr Koh said... all did worse. So the argument for standard radiotherapy is powerful.
Since 2005, following a major international trial, Medicare has covered the 'Stupp Protocol' combining radiotherapy and chemotherapy, concurrently – see next section.
How do you deal with this long period of treatment?
A daily routine of six weeks or so of radiotherapy makes demands on patients and carers. Some must travel from country locations, either to residences near treatment centres or daily long distance.
It seems important to work out how to fit this daily appointment into a routine of life so that it is not front and centre of life, so that you make good use of time. It is well worthwhile to allow rest time, especially in later weeks of treatment. But in general it is good to build other life activities in a positive way. Given the need for the patient to be driven to and fro, it is very much worthwhile, if possible, for the carer to take off the time to spend these weeks in a positive and relaxed way together. Whatever the grade of tumour, this is an experience that comes early in the experience of dealing with brain tumour and time spent together may be very positive and constructive. See what you can do. Consult Centrelink, see section 10.