Dr. Leslie E. Botnick, MD

EBRT can be delivered through several different methods, which may be combined or used alone. The type and length of treatment vary based on the location of the cancer or tumor and its size. Techniques for EBRT include:

• Conventional external beam radiation therapy, which delivers a single beam of radiation from multiple directions. Conventional EBRT is commonly used to treat brain tumors, particularly when the entire brain needs treatment.
• Intensity-modulated radiation therapy (IMRT), which uses smaller beams with adjustable intensity levels, so the most intense beams can be directed at the tumor. IMRT is used in several types of cancers, including prostate, gastrointestinal, brain, and lung cancers.
• Orthovoltage, which uses low energy X-rays that do not penetrate the skin very deeply. Orthovoltage is typically used for skin cancers or other skin conditions.
• Proton therapy, which uses a particle accelerator to deliver positively charged particles (protons) for cancer treatment. Proton beams can be controlled more precisely than X-rays, so there is less risk of damage to healthy tissue. This makes proton therapy a good option for younger patients, as other types of EBRT pose long-term risks such as growth problems and heart disease.
• Stereotactic radiosurgery (SRS), which is a non-surgical type of radiation therapy that uses 3-D imaging to directly target tumors and avoid healthy tissue. SRS is often used for small tumors, particularly those in the brain (cranial radiosurgery) and spine (spinal radiosurgery). When performed outside of the brain and spine, it is called stereotactic body radiation therapy (SBRT).

Typically, patients will undergo treatment for five days a week over the course of several weeks, and they should be able to go home the same day. Each session can take less than an hour, with most of the time spent determining proper positioning of the body. Actual delivery of the radiation may only take a few minutes, and patients will wear a lead shield to protect healthy body tissues while receiving their treatment.

EBRT is painless, but it does come with some side effects, such as fatigue. Over the course of the therapy, oncologists will monitor patients' conditions and adjust their dosage, number of sessions, and length of treatment based on their body's response to the radiation.

Joint problems include bursitis and arthritis. Bursitis is the inflammation of a fluid-filled sac cushion on the outside of a joint, causing symptoms including pain and swelling. Arthritis is the inflammation and damage of a joint due to wear and tear or disease. There are several treatments for arthritis, but if the damage progresses far enough, joint replacement may be necessary. In joint replacement, a metal or plastic implant is surgically placed within the joint to make movement easier.

Bone problems include scoliosis, fractures, and osteoporosis. Scoliosis is a curvature of the spine, making the normally straight spine look like a 'C' or 'S.' It is treated with braces or surgery. Osteoporosis is a disease that causes bones to weaken and break easily. It's most common in women, especially older women. Fully half of all women over 65 have osteoporosis. Fractures are any break in the bone. They can be a simple crack or a severe and complicated shatter. Osteoporosis causes fractures in people who have it, but other causes are trauma (such as a fall) or overuse.

Tendon and ligament problems most often result from injury or overuse. Two good examples are ligament tears and tendonitis. The most common ligament tear is the ACL tear in the knee. This ligament supports and stabilizes the knee and is most often torn during sports activities. Tendonitis happens when a tendon, which connects muscles and bones together, becomes irritated and inflamed. This happens most often in older patients who push their bodies too far, leading to pain and swelling. Treatment for both tendon and ligament problems usually includes rest, ice, and supporting the area to let it heal.

Pain and numbness problems can be caused by overuse, disease, an injury, or a compressed nerve. Lower back pain and carpal tunnel syndrome are two of the most common conditions patients encounter. Lower back pain may be caused by sore muscles that have been overworked, or an injury to the disks separating the vertebrae in the spine. Lower back pain usually goes away on its own within a few days, but it may require medical treatment depending on the cause. Carpal tunnel syndrome occurs when the nerve at the base of the palm becomes trapped or pinched. Symptoms include tingling, pain, numbness, or weakness in the hand. Treatment involves rest and sometimes steroid injections.

Because the musculoskeletal system involves so much of the body, problems here can be incredibly varied in their type and severity. Some musculoskeletal problems will go away on their own or only require rest, while others may require medication, physical therapy, or even surgery.

To perform radioembolization, a catheter is inserted into an artery in the groin and threaded to the liver. Radioactive beads, or pellets, are delivered through the catheter. The pellets will continuously deliver radiation for 10-14 days. The pellets will remain in the body permanently without causing any complications. If the tumor or cancer is confined to one portion of the liver, radioembolization will be performed in one treatment session. If both sides of the liver are affected, a second treatment session will be done about 8 weeks after the first.

Typically, most patients can return home and do light activity within hours following the procedure. Patients will be given medication to treat any possible side effects, which can include nausea, fever, abdominal pain, or tiredness.