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What is Intensity-modulated radiation therapy (IMRT)?
Intensity-modulated radiation therapy (IMRT) is an advanced type of radiation therapy used to treat cancer and noncancerous tumors. IMRT uses advanced technology to manipulate photon and proton beams of radiation to conform to the shape of a tumor. IMRT uses multiple small photon or proton beams of varying intensities to precisely irradiate a tumor. The radiation intensity of each beam is controlled, and the beam shape changes throughout each treatment.
Why it is done?
Intensity modulated radiation therapy, or IMRT, is used to treat cancerous and noncancerous tumors. Radiation beams fit the shape of the tumor. The goal is to target the radiation to limit side effects and damage to healthy tissue. Radiation therapy, including IMRT, damages the DNA and stops cancer cells from dividing and growing, thus slowing or stopping tumor growth. In many cases, radiation therapy is capable of killing all of the cancer cells, thus shrinking or eliminating tumors. Radiation therapy may be used in conjunction with surgery (adjuvant radiation). In this scenario, radiation targets potential microscopic disease after surgery.
Before planning treatment, a physical examination and medical history review will be conducted. Next, there is a treatment simulation session, which includes CT scanning. A small mark or tattoo may be placed on the patient's skin to help align and target the equipment. The radiation oncologist uses this scan to make an individual plan for the patient. In some cases, a mask or other device to keep the patient still during treatment will be made. Sometimes the patient is instructed to follow a certain bowel and bladder preparation regimen or to fast prior to the simulation and treatment. Intravenous contrast material may be injected during the CT scan to help define the tumor better.
Occasionally, additional scanning procedures, including positron emission tomography (PET) and magnetic resonance imaging (MRI), might also be required for IMRT planning. These diagnostic images can be merged with the planning CT and help the radiation oncologist determine the precise location of the tumor target.
IMRT often requires multiple (fractionated) treatment sessions on different days. The radiation oncologist considers the type, location and size of the tumor, doses to normal structures, and the patient's health to decide the number of treatments. Typically, patients are scheduled for IMRT sessions five days a week for five to eight weeks.
At the beginning of the treatment session, the radiation therapist positions the patient on the treatment table, guided by the marks on the skin (tattoos) defining the treatment area. If molded devices were made, they will be used to help the patient maintain the proper position. The patient may be repositioned during the procedure. Imaging systems on the treatment machine such as x-ray or CT may be used to check positioning and marker location.
Treatment sessions usually take between 15 and 60 minutes.
Depending on the area being treated, other early side effects may include:
Hair loss in the treatment area
Mouth problems and difficulty swallowing
Eating and digestion problems
Nausea and vomiting
Soreness and swelling in the treatment area
Urinary and bladder changes
Late side effects, which are rare, occur months or years following treatment and are often permanent. They include:
Spinal cord changes
Colon and rectal changes
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IMRT allows the radiation dose to conform more precisely to the three-dimensional shape of the tumor by changing — modulating — the radiation beam into multiple smaller beams. This enables a higher dose of radiation to be delivered to the tumor while sparing healthy tissue around it.
Radiation can give you fatigue that gets worse over time (called cumulative fatigue). It usually lasts 3 to 4 weeks after your treatment stops, but it can continue for up to 3 months. Hormone therapy deprives the body of estrogen, and that can lead to fatigue that may last throughout your treatment or longer.
Radiation therapy can potentially affect your immune system, especially if a significant amount of bone marrow is being irradiated because of its role in creating white blood cells. However, this doesn't typically suppress the immune system enough to make you more susceptible to infections.
For example, if you are currently receiving radiation therapy or recently stopped, your doctor may recommend not eating cold deli lunch meat, unpasteurized milk, undercooked eggs, unwashed fruits and vegetables, undercooked/raw shellfish, sushi and more.
After surgery, chemotherapy, or radiation therapy, extra protein is usually needed to heal tissues and help fight infection. Good sources of protein include fish, poultry, lean red meat, eggs, low-fat dairy products, nuts and nut butters, dried beans, peas and lentils, and soy foods.
When it comes to early stages of disease, patients very frequently do well with either brachytherapy or external beam radiation. Success rates of around 90% or higher can be achieved with either approach.
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