How Knowledge of the Chronic Radiation-Induced Long Term Side Effects Have Impacted on Treatment Practices - Coursework Example

Introduction The technology that makes use of radioactive elements has been applied within the healthcare area for a long time. Its main aim is to treat a number of diseases that could not get cured using other conventional methods. However, it has been discovered that radiation used in the treatment of certain areas at times leads to the effect on other unintended organs. This is because the long term application of radiation has been depicted to possess adverse effects on the patients. At times, these impacts turn chronic in the sense that the resultant condition leads to the death of the patient instead of the initial illnesse (Charmaz 2000, pp. 64-78). Because of this knowledge there have been a number of transformations that have been implemented in relation to the current treatment options to eliminate the chances of such long term chronic effects that are induced by the use of radiation on patients in the treatment of various illnesses. In this paper, this will be expansively analyzed to reveal the use of new treatment methods to avoid the long term side effects on the lungs during the treatment of breast cancer (Bodenheimer, Wagner & Grumbach 2002, p. 1910). Hoskin (2012) highlights the fact that most of the long term side effects of radiation have occurred in areas that are not affected by the tumour could have been prevented. They include firmness or shrinkage of the breast, skin tanning or effects on the lungs such as radiation pneumonitis. They are mostly risky in the sense that they cause trauma, may require additional treatment and may be serious to the extent of causing death. To prevent this, there are a number of current medical techniques that have been developed to ensure that only the affected regions are targeted by the treatment method. In this way, the chances of experiencing side effects greatly reduced. In the current times, the radiation therapy can be planned in a number of ways (Bentzen, 2006). Darby, McGale, Taylor and Peto (2005) show that the mean lung dose on the same side of the breast cancer is double or triple that of the mean lung dose on the contra-lateral side. During the 1970s, the exposure of radiation to the lung was higher than today where the mode by which breast cancer could be treated could affect the mortality of breast cancer a number of years after the treatment. In the 1970s they used the adjuvant radiation therapy techniques for breast cancer while currently there is the application of radiation dose fractionation. These are diverse in the sense that current methods have a higher dose killing rate of the cells and a nature of exposure that is fractionated and with less exposure. An analytical research study was performed on a population of 308,861 women in the U.S. They had laterally known breast cancer of either the right or left side. 37% of them received radiotherapy. It was found that the higher mortality of 26% from the general population and 15% from the cancer patients who did not receive radiation. It was as a result of the application of the lateral mode. With time, this trend reduced with the advanced irradiation techniques. The sample size was large enough and was conducted for a long time to prove that the current techniques have reduced long term risks among populations (Furstenberg, Ahles & Henderson 2004). Apparently, the advancement in treatment has extensively reduced the exposure of radiation to the lungs and other healthy tissue. Some of the vital procedures that are employed during the simulation process include detailed imaging scans that show the exact position of the tumour within the patient as well as the normal positions around it (Hewitt, Herdman & Holland 2004). These skills have been established to be extremely important since the radiation is able to focus on the exact position and not spread to the other areas that are not affected by the tumour (Park, Pritz, Zhang, Froster & Harris, 2012). It has reduced the need to treat the whole breast. Park, C. K., Pritz, J., Zhang, G. G., Forster, K. M., & Harris, E. E. (2012). Validating fiducial markers for image-guided radiation therapy for accelerated partial breast irradiation in early-stage breast cancer International Journal of Radiation Oncology* Biology* Physics, 82(3), e425-e431. During simulation and the treatment that are offered on a daily basis, the patient is placed in the same position in relation to the machine that is performing the treatment or that which is conducting the imaging process. It is done using the 3D conformal radiation therapy or the localization system that makes use of portable ultrasound (Hewitt, Herdman & Holland 2004). Other materials that have been put into use to eliminate the chances of spreading the harmful rays to other unaffected parts include body masks, body moulds, and head masks that make it possible for the patients to lie still. It is thus after the simulation treatment that the clinical oncologist is able to identify the exact areas that should be treated. This is in addition to the total dose of radiation that is supposed to be delivered to the tumour area as well as the amount of the dose to be allowed to the normal tissues that surround the tumour tissues (Hewitt, Herdman & Holland 2004). Thus, there is a type of equipment used in radiation therapy to track the heart beat and movement of the lung to block them from radiation exposure. It is called respiratory gating. As indicated by Berson et al., (2004), they reduce the anatomic motion that is induced by respiration thus increasing the distance from the breast to other organs. There are also other tools that include therapy that is intensity modulated radiation to allow for a change in the intensity of radiation during treatment. It ensures that the tissue at risk gets an even dose and to prevent healthy tissue from harmful damage. Berson et al., (2004) show that the gating system minimizes anatomic motions that are reduced by respiration during free breath technique. This is through the role of the reflective marker that is placed on the anterior surface of the patient. They show that between 2000 and 2002, 108 patients out of 136 were treated up to 110 sites out of 2230 sessions of treatment with the use of simulated gating techniques for varied cancer types. Thus 97% of the patients were able to complete the treatment with the therapy that involves gated treatment. With this, they proved the efficacy rate of respiratory gating in minimizing the induction of respiration by target motion during treatment and simulation. At the same time, it helped to reduce the chances of other unaffected organs from being exposed to high radiation doses. According to research studies that have been conducted to determine the cause of death in patients who have had previous breast cancer treatment, it has been evidenced that there is a high likelihood of the lung to receive some of the radiation during the treatment of breast cancer (Clarke et al., 2005). Cox, Davidson, Dodge & Wermirth (2005) report that there had been some number of non-cancer hence lung related deaths among patients who had been treated for breast cancer. This is shown in the high level of recurrence in 25,000 patients among the 42,000 who are studied by Clarke et al., (2005). It was initially speculated that the lung was affected by the accumulation of small amounts of radioactive substances. They came up with techniques through which they could reduce the amount of doses that reached the lungs. As indicated by Remouchamps et al., (2003), the new radiation techniques that reduce long term side effects include the moderation deep inspiration breathe hold (mDIBH) that is made possible with the use of a device, which enables active breathing control instead of free breathing. Contrary to the efforts that were used to reduce and eliminate chances of breast cancer through radiation, Preston (2003) discovered that it was the small doses that were being received regularly during the treatment of breast cancer that cause an elevated risk of long term cardiac arrest by 26%. It is in the same way that Ozasa et al., (2011) also explain the high incidence of heart attack and other heart related conditions in patients who have undergone radiotherapy for the treatment of breast cancer before. Besides these, other research studies that have been conducted in a number of populations have also revealed similar facts (Eipsten & Street 2007). It had been caused by the dosimetric effect of the loco-regional irradiation procedure on the breast cancer patients due to the treatment of the deep tangent areas. Thus the 5-field technique which made use of electron fields that covered the IM regions worked to reduce the amount of dose to the lungs. The breath hold technique only uses the active breathing control device to move the vital organs a distance from the breast that is receiving radiation therapy. It is in the way that it initiates breath hold with a lung volume that is predefined and reproducible. It thus uses Abches to reduce the cardiac dose for patients who are receiving irradiation on the left-sided breast. With this, it has a high potential of decreasing the irradiated cardiac volume significantly. It is similar to the multi-leaf collimator cardiac shielding that is used in breast radiotherapy, since cardiac doses are reduced in patients undergoing adjuvant therapy to the left sided breast (Barlett et al., 2013). . However, the latter is performed at the expense of the coverage of the target tissue. As such, the breath hold technique is more cost effective and more efficient hence the better method in relation to cardiac shielding (Barlett et al., 2013). In this regard, quite a number approaches have been taken to help in the reduction of cardiac problems that have been largely caused by the use of radiation in treatment of certain cancers. These mainly aim at reducing the dose that is received by the heart. One of the techniques that are especially used among patients who are undergoing treatment for their left breast includes the breathing manoeuvres that include the breath hold technique (Remouchamps et al., 2003). This technique revolves around the reasoning and physiology that the expansion of the rib cage due to the deep expiration, the chest is bound to expand and thus moving the breast some distance away from the heart. In this sense, there is a reduced chance of the chemical substances reaching the heart. Even in the event that some of these substances get access into the heart it is assumed that they will be very minimal. It is thus beneficial since it reduces the amount of radiation dose that is able to reach the heart and cause extensive damage (Remouchamps et al., 2003). In the study, in comparison to the 9 patients who received the 5-technique wedged technique, the mean percentage of the dosage received to the lung by the 15 patients who received the mDIBH doubled. Thus, the latter technique reduces the doses to the heart and lung significantly if deep tangent fields are used on the internal mammary nodes. There have also been cases of oedema or swollen breasts as well as secondary cancers that are associated with a lack of uniformity of the dose (Vicini et al, 2002). The treatment efficacy in patients can be achieved through intensity radiated radiation therapy. A study was conducted on 281 patients who had cancer in the stages 0, I and II. They were treated with a therapy that conserved the breast after lumpectomy. This was the IMRT technique that used a multi-leaf collimator. It was found to be an efficient method in achieving the uniformity of the dose in the breast tissue to avoid acute and chronic toxicity. It is a clinically tested method to show the need for reduction of dose levels during treatment of breast cancer to avoid presentation of harm to the lungs (Remouchamps et al., 2003). 157 patients received radiation therapy and got skin toxicity in the oncology group of grade 0 and I. 102 of them got grade II while as a result of the radiotherapy that is intensity modulated only 3 got grades III skin toxicity. References Bentzen SM. (2006). Preventing or reducing late side effects of radiation therapy: radiobiology meets molecular pathology. National Review of Cancer. Vol. 6(9):702-13. Read More