Radiation therapy is delivered either through external beams or by brachytherapy, which involves placing radioactive elements in the form of tiny wires or seeds next to a malignant tumor. Radiation therapy is a type of cancer treatment that uses beams of intense energy to kill cancer cells. Radiation therapy most often uses X-rays, but protons or other types of energy also can be used

How radiation therapy is used in people with cancer

Your doctor may suggest radiation therapy as an option at different times during your cancer treatment and for different reasons, including:

• As the only (primary) treatment for cancer
• Before surgery, to shrink a cancerous tumor (neoadjuvant therapy)
• After surgery, to stop the growth of any remaining cancer cells (adjuvant therapy)
• In combination with other treatments, such as chemotherapy, to destroy cancer cells
• In advanced cancer to alleviate symptoms caused by the cancer

Types of Radiation Techniques

Three-Dimensional Conformal Radiation Therapy (3D-CRT)

3D-CRT relies on imaging tests to map out radiation treatment. Based on what’s shown on the imaging tests, doctors deliver external radiation beams from multiple angles to destroy cancer cells, but relying on imaging tests alone doesn’t always allow doctors to deliver treatment with pinpoint accuracy. Also, 3D-CRT techniques require patients to be placed in immobilizing devices so that they can’t move during treatment.

Intensity-Modulated Radiation Therapy (IMRT)

Like 3D-CRT, IMRT machines rely on imaging tests to create a radiation treatment pathway. These machines, in addition to delivering external radiation beams from multiple angles, can deliver beams of different intensity to different parts of a tumor. One type of IMRT, called volumetric modulated arc therapy (V-MAT), delivers an IMRT treatment as a machine rotates once around the body. Although patients are immobilized for shorter periods of time with V-MAT, the immobilization techniques can make this treatment uncomfortable for patients.

High-Dose/Low-Dose Rate Brachytherapy

Some doctors use brachytherapy, which involves surgically placing tiny pieces of radioactive material near a tumor. However, the surgery required to place these radioactive wires and seeds can be painful. For example, to treat prostate cancer with brachytherapy, doctors have to surgically place tiny wires through the rectum and into the prostate.

Stereotactic Body Radiation Therapy (SBRT)

SBRT is also called stereotactic radiosurgery (SRS), even though no actually cutting ever happens. It uses machines, to perform image-guided radiation therapy (IGRT). Using these precise computer images, oncologists can deliver short bursts of radiation to tumors in different parts of the body. There are several types of machines that perform radiosurgery, require immobilization, breath holds, or gating and have differing levels of precision.

Intensity-Modulated Proton Therapy (IMPT)

IMPT, also known as proton therapy, uses protons instead of photon beams to deliver external radiation to cancer cells. However, the machines that deliver proton therapy are extraordinarily expensive, and they require dedicated expert usage and maintenance. Because of the expense and lack of supporting clinical data, very few cancer treatment centers in Los Angeles currently use proton therapy, and insurers don’t always cover it.

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