Still reservations about radiation therapy despite success By Annika Graf

dpa German Press Agency Published: Sunday February 11, 2007

By Annika Graf, Karlsruhe, Germany- Radiation therapy has long been part of standard cancer treatment. About two-thirds of all cancer patients undergo radiation in the course of their therapy. The method is highly successful - about 60 per cent of cancer cases that go into remission were treated with radiation, said professor Marie-Luise Sautter-Bihl of the public hospital in Karlsruhe.

As they go through the process many cancer patients have an uneasy feeling about radiation, which is completely intangible.

"They are afraid they will become radioactive," said Sautter-Bihl, the head of radiation therapy at the hospital.

There's no basis for the fear. Radioactive material does not spread through the body. Although radiation applied in the therapy is in fact physically the same as used in an atomic bomb, it is not dangerous because of the precise dosage used, said professor Peter Huber, head of the clinical cooperative radiation therapy unit at the German cancer research centre in Heidelberg.

Radiation therapy has become an important pillar in cancer treatment along with chemotherapy and surgery. As opposed to chemotherapy, however, radiation therapy in most cases is applied only locally, said Huber. Seldom is the entire body put through radiation. Normally, only the tumour and the tissue surrounding the growth are targeted.

The location of the tumour is pinpointed with the help of a computer or magnetic resonance imaging. A radiation plan is established based on that information, which should guarantee that only the tumour and designated surrounding tissues receive radiation.

"You can think of it as a strong X-ray," said professor Jürgen Dunst, chairman of the radio-oncology study group at the German cancer society and head physician at the radiation therapy clinic in Luebeck.

Photons or tiny electrons are deployed with the goal of damaging the DNA of the tumour's cells so severely that they are unable to regenerate. Healthy cells are not affected because, as opposed to the cancer cells, they can better recover from the exposure. Cancer cells, however, die off bit by bit. Up to 30 treatments are necessary to completely kill the tumour, said Huber. Normally, patients are scheduled for five appointments per week.

Radiation is used to treat nearly all forms of cancer, but especially if an organ is to be preserved, said Sautter-Bihl. The therapy can be used to treat prostate or laryngeal cancer in place of an operation, and the risk involved is often considerably less.

Radiation therapy also is used prior to an operation to shrink a tumour, and it often is suggested after an operation. It's frequently used after a breast cancer operation that preserves the breast to battle single cancer cells dispersed in the tissue, said Huber.

Even in cases of incurable cancer, radiation therapy plays a role in restricting the growth of the tumour and minimizing suffering. An example is when cancer cells are distributed in the lungs in a way that makes them inoperable.

Compared to methods used when first radiation therapy was new, side effects of the therapy today are minor thanks to the precision of modern equipment. The intensity of the side effects depends on the area targeted, the dose of radiation and the patient's overall condition, said Dunst. A common side effect is an inflammatory reaction, such as skin irritation, in the area targeted.

A treatment that involves the larynx can leave the patient with difficulty swallowing. The patient's general condition is less affected by radiation therapy than by chemotherapy. While chemotherapy almost always causes temporary hair loss, for example, radiation causes it only when the head is part of the area targeted.

"The side effects subside normally about four to six weeks after the treatment," said Dunst. The risk of long-term complications is about 1 per cent in simple a radiation therapy treatment and 5 to 10 per cent in complicated treatments such as the prostate.

"These risks, however, are lower than the risks of surgery," said Dunst, adding that the danger that the radiation could cause cancer is negligible.

Most patients who undergo radiation therapy are in their 50s or 60s. The risk of a second tumour developing due to the radiation becomes relevant 20 to 30 years after the therapy. In children, however, this danger must be weighed before undergoing the therapy.

A 10-year-old who must undergo radiation therapy over a large area faces a 10 per cent risk of developing cancer from the radiation after 25 years, said Huber. Thus, radiation therapy targeting a large area in a child is usually not prescribed.

For the majority of patients, the advantages of radiation therapy basically outweigh the risks, said Huber.

"Radiation therapy in the future will have a fundamentally different standing," Dunst said.

Sautter-Bihl said people just need to be educated about improvements in the therapy that already are available especially because the level of unease over radiation remains widespread.

© 2006 dpa German Press Agency