Talk:Radiation therapy/Archive 1

Questions
Does anyone know how the presence or absence of a wildtype TP53 gene affects radiation therapy? Does it make cancers without TP53 hard to treat with radiation?

would someone like to consolidate this with Radiotherapy? This has been done.

This is bogus, I spent a lot of time entering stuff in and so did someone else and its all GONE.

I will NOT be back to contribute again as a result. What I entered was based on my experience and training at one of the top institutions in the USA as a radiation oncologist.

Frankly, I cannot imagine why my contribution (which was inserted into someone else's elaborate effort, ALSO GONE) was snipped.

I don't have time to figure out where this goes, so please feel free to email a response to:

Thanks, Jay


 * Jay, I truly regret your work has been lost, but I have been unable to identify where it went. Could you be more specific as to when you made your edits, and what you wrote?
 * Your expertise is highly welcomed, and I hope this does not put you off working on Wikipedia in the future. JFW | T@lk  07:22, 14 Oct 2004 (UTC)


 * From what I see, most of the information Jay typed up is still present albeit edited and refined, such as fixing his typo of Grey to Gray. He shouldn't be discouraged, it was very good stuff :)AstroBlue 11:18, 21 Feb 2005 (UTC)

from what i see, you people have too much free time

Heading: Kinds of Radiation therapy
It makes little sense to state that there are 3 kinds of radiotherapy ie EBRT and 2 kinds of Brachytherapy. Brachytherapy includes a diverse set of applications should be better defined and expanded. There is no discussion here of radionucleotide therapy eg radioIodine. Likewise it is potentially confusing to discuss proton therapy without talking about particle therapy (electrons and high LET particles)in general. I am happy to oblige.Jellytussle 03:10, 13 October 2005 (UTC)

Reviewing the Radiation Therapy article (nicely done) I work at an academic radiation oncology center in the States. I would argue there are fundamentally two types of radiation therapy: brachytherapy and external beam radiation therapy. The third that is mentioned in the article is not always termed (at least, stateside) as a radiation therapy and is typically managed my nuclear medicine. Treatments include radioactive iodine for thyroid cancer, for example. I also believe that, at least stateside, the governing physics authority is different - as our board certified medical physicists aren't required to certify on this. Kate St. John 07:29, 6 December 2006 (UTC)

TBI
total body irradiation is not rare. It may be specialised, but it is performed most weeks in any radiotherapy centre linked with a bone marrow transplant unit. I have therefore edited that section accordingly, as well as giving a basic deescription of TBI on the linked page.Jellytussle 20:45, 18 October 2005 (UTC) 22:41, 14 October 2005 (UTC)


 * You're quite right. JFW | T@lk  14:16, 16 October 2005 (UTC)

…== Side effects ==

"Although the actual treatment is painless, using external radiation (see below) to tackle tumors inevitably leads to side effects."

Rubbish. Most low dose palliative schedules have minimal or no clinical side effects.Jellytussle 20:45, 18 October 2005 (U

I just finished 25 sessions of radiation treatment on Tuesday to the pelvic area. I was told by several people the were no side effects. When I told my doctor what I was experiencing & said there are now side affects he asked who told me that. Since your intestines are in the pelvic area the radiation causes stomach cramps & loose bowels.

Image guided Radiation Therapy.
Image-guided therapy is not a separate treatment modality in itself. Perhaps this should come under a broader heading of Tumour Localisation. This would include simulation, patient immobilisation, skin markings, respiratory gating, fiducial markers, cone-beam CT etc.Jellytussle 00:30, 11 November 2005 (UTC)

Implications.
This is getting better but I think that the heading of "Implications" is not the best. Also:
 * the point on prostate cancer, whilst true, has nothing to do with radiotherapy per se.
 * the point about radioresistance of brain tumours is correct. But other tumours, notably renal cell and malignant melanoma are also notably radioresistant despite sometimes rapid doubling times and metastatic potential. These may be better examples of anomolously radioresistant cancers.Jellytussle 01:01, 5 January 2006 (UTC)

Tirapazamine
Someone wrote tirapazamine, and I've expanded it a bit. Sounds interesting. JFW | T@lk  01:17, 5 January 2006 (UTC)
 * Yep. subject of active research in several centres. especially in relation to radiotherapy for head and neck cancers. The whole area of hypoxic sensitisers is very interesting.Jellytussle 01:20, 5 January 2006 (UTC)

Graves disease or Graves-Basedow disease?
Does anyone really use the longer appellation? I've seen lots of Graves disease, and never heard this until I saw it mentioned here. Is that just a British thing? Graves was a West Country GP. Jellytussle 23:44, 18 January 2006 (UTC)


 * No, it's one of those medical eponyms where there is a British and a German namesake. I've never heard anyone in the UK call it Basedow. In contrast, my professor in a Dutch university referred to sarcoid as "Boeck's disease", despite the fact that it has both a French and a German namesake. I suggest we stick to "Graves' disease" on the English Wikipedia. JFW | T@lk  23:46, 18 January 2006 (UTC)

Fractionation
I think there is a sweeping generalisation in the fractionation section. It mentions that doses in the north of uk are generally higher per fraction, while that may be true of some treatments, it is not (in my experience) true on the whole. And i know that rosemere, clatterbridge and christie radiotherapy centres all generally go by 2.0Gy per fraction. If this is true of the other centres some citation would be nice to back it up.Alex uk 86 20:08, 25 May 2006 (UTC)


 * The classic example is "Northern" schedule of 40Gy/15# for adjuvant treatment of breast cancer, compared to the more common schedule of 50Gy/25# elsewhere in the UK. This is not as clear as it was a few years ago: other centres are now using the shorter fractionation schedules more, partly because they do not seem to be excessively morbid, and partly because of the resource implications.
 * The Christie historically had a particular reputation for having developed locally idiosyncratic schedules. Whether this is still justified is debateableJellytussle 13:42, 8 August 2006 (UTC)


 * The lack of citations here bothers me. Surely there must be authoritative documents that outline the treatment schedules for those wishing to verify this data with outside sources?   Also, the "thinly spread NHS" comment sounds like it may be biased/political, but at the very least not really applicable to this section (fits better in "criticims of NHS" on the NHS page).  Just from the discussion above me here, it looks like there may be other reasons for different schedules.   I'm not a doctor, but I feel this section needs some updating (with citations) by one!  Thx1200 20:07, 3 May 2007 (UTC)

Safe dose
'any tissue has a maximum lifetime tolerance for radiation, so retreatment of a site which received a maximum safe dose years before can cause problems'
 * This is very controversial in my opinion; I have not heard of anything like 'maximum lifetime tolerance'. Does ICRP (or any other regulatory body) mention this term? Any tissue/organ response for radiation depends not only on dose, but also very strongly on dose rate, radiation in question is being delivered, therefore something like 'maximum lifetime tolerance' may not be defined.


 * "Most literature looks at the effect of RT delivered at 2Gy/#. Various formulae are used to try to convert this to a Biological Equivalent Dose when different fraction sizes are used."


 * Though I have not found the paper mentined by you (electronically is accessible only from 1995 onwards), but I see your point. VicM 15:35, 17 August 2006 (UTC)


 * Another expression I've never heard of is 'safe dose'. It is well known fact that for medium and high doses long term risks following irradiation increase linearily. For low doses there is on-going discussion as to whether beneficial or harmful effects prevail. VicM 15:21, 15 August 2006 (UTC)


 * "It is well known fact that for medium and high doses long term risks following irradiation increase linearily. " I don't really understand your point here. Can you be more precise, and provide references?


 * "For low doses there is on-going discussion as to whether beneficial or harmful effects prevail." I am not sure that this is relevant to the rest of this discussion.Jellytussle 08:07, 16 August 2006 (UTC)


 * I'm referring to linear no-treshold model - in short: the more radiation the bigger risk of long term effects. That's why any "safe dose" cannot be defined. According to this model even small dose of radiation can be harmful.
 * It is widely discussed however ie Radiat Res. 2004 Oct;162(4):447-52. - The linear no-threshold model does not hold for low-dose ionizing radiation. VicM 15:35, 17 August 2006 (UTC)


 * Small doses of radiation might even be beneficial, i.e. radiation hormesis. --WS 17:11, 17 August 2006 (UTC)

VicM, I think I understand now. Loose terminology is at the root of the problem. It is generally accepted that there is no "safe" dose of radiation, with respect to long term increased risk of carcinogenesis. Eric Hall, amongst others, has published widely on this. This should be distinguished from the "lifetime tolerance" discussed in the article, which pertains to tissue recovery following therapeutic doses of radiation: above a certain cumulative lifetime dose, a tissue will start to ulcerate and necrose. This is a problem when treating patients with recurrent cancer, where a second radical dose of radiotherapy cannot safely be given to a previously treated field; long term concerns about second malignancies are not usually an issue in these cases.Jellytussle 09:21, 19 August 2006 (UTC)

when?
When was radiation first used to treat cancer? HighInBC 00:51, 1 September 2006 (UTC)

Early 20th century. Can probably find the dates with a bit of a google. The first paper about radiotherapy for breast cancer was published in the BMJ or the Lancet in the early 1920s I think, but there were certainly a radiotherapy clinic in London before then. Not sure where the first radiotherapy unit was. Paris possibly.Jellytussle 07:13, 1 September 2006 (UTC)

According to this document on the ASTRO web site the first treatment began 3 weeks after Roentgen's publication of his x-ray discovery.  The treatment was for a breast cancer and involved 18 1-hour treatments! A very interesting paper.--Rishackie 21:12, 20 September 2006 (UTC)

Leopold Freud published the first paper on radiotherapy in 1897.

At least four physicians are credited the first treatment : Despeignes, Grubé, Voigt and Williams for malignant tumors and Freud for the treatment of a naevi. All these observations were made in 1896, only a few months after the publication of the discovery of X-rays by Röntgen. I was very impressed when I read that. And without Internet —Preceding unsigned comment added by 86.196.29.242 (talk) 12:52, 24 August 2008 (UTC)

I took out "therapeutic index"
I took out the mention of "therapeutic index", because I don't think it can work the way it was described.

Let's say that EBRT for a particular tumor has a therapeutic index (TI) of 2.5. Let's say that IMRT lets us safely deliver ten times the EBRT dose. With IMRT, the TI might be different -- 2.9 or 2.3 or whatever. The deliverable dose is ten times higher. That does not change the TI by a factor of ten. The TI has to compare lethal dose of a therapy with therapeutic dose of that therapy, not lethal dose of a therapy with therapeutic dose of some other therapy.

If this is wrong, please fix it, and please fix therapeutic index, and please make sure this issue stays out in the light of day.

TH 03:11, 11 October 2006 (UTC)

deleted: "maximum lifetime tolerance"
I elided the phrase "maximum lifetime tolerance" because (a) someone complained about it above and the complaint made sense to me; (b) the phrase violates the "dictum of classical physics which states that in nature everything is continuous" (Wikipedia on continuous function, giving a flower as an example); (c) I typed "maximum lifetime" radiation into http://pubmed.org and got zero hits; and (d) it doesn't make sense that one would be treated up to a "maximum lifetime" level in one's thirties, and then twenty years later the tumor comes back but the doctor says "we can't give you radiation because that would put you over your maximum lifetime tolerance". TH 04:08, 16 October 2006 (UTC)


 * I think this needs to be looked into more closely. Radiation damages DNA, and that damage is passed on to future generations of cells, so it seems likely that tissues does in fact have a maximum lifetime tolerance. It's also worth noting that radiation therapy patients have their treatment fields permanently marked on their bodies with small tattoos. This serves two purposes, one of which is unrelated to the discussion, but the second of which is so that radiation oncologists can tell where a person has been treated previously in case they need more treatment in the future. If there is a limit, it might not be so well-defined that an oncologist would be able to say "you're over your limit," but evidently previous treatments are considered by oncologists when planning treatment. In any case, it was an unsourced statement, but I'd like to check it out a little more before we remove it for good. —Captaindan 06:47, 16 October 2006 (UTC)

Thanks for your interest folks. TH, try doing a pubmed search on "Radiation AND Tolerance" or somesuch. With respect to your dictum of classical physics, I don't see what that necessarily has to do with a biological system. And the idea of long-standing cumulative damage does make sense from a biological point of view. Apart from theory, it is observed in practice in radiotherapy clinics every day.

See the following:

Seminal paper on tissue tolerance to radiation:

Int J Radiat Oncol Biol Phys. 1991 May 15;21(1):109-22. Tolerance of normal tissue to therapeutic irradiation. Emami B, Lyman J et al

And the following on re-irradiation:

Semin Radiat Oncol. 2000 Jul;10(3):200-9. Tissue tolerance to reirradiation. Nieder C, Milas L, Ang KK. Department of Radiation Oncology, The University of Texas, M.D. Anderson Cancer Center, Houston, TX 77030, USA.

There are increasing requests for delivering a second course of radiation to patients who develop second primary tumors within or close to previous radiotherapy portal or late in-field recurrences. Rational treatment decisions demand rather precise knowledge on long-term recovery of occult radiation injury in various organs. This article summarizes available experimental and clinical data on the effects of reirradiation to the skin, mucosa, gut, lung, spinal cord, brain, heart, bladder, and kidney. The data reveal that, in general, acutely responding tissues recover radiation injury within a few months and, therefore, can tolerate another full course of radiation. For late toxicity endpoints, however, tissues vary considerably in their capacity to recover from occult radiation damage. The heart, bladder, and kidney do not exhibit long-term recovery at all. In contrast, the skin, mucosa, lung, and spinal cord do recover subclinical injury partially to a magnitude dependent on the organ type, size of the initial dose, and, to a lesser extent, the interval between radiation courses. The available clinical data have inspired many radiation oncologists to undertake systematic studies addressing the efficacy and toxicity of reirradiation in various clinical settings. Hopefully, systematic scoring, collection, and analysis of patient outcome will produce quantitative data useful for clinical practice. Jellytussle 11:13, 16 October 2006 (UTC)

The FDA, the US Agency responsible for regulating radiation emitting products, lists a radiation record so that a patient has a record of all the radiation exposures they are subject. http://www.fda.gov/downloads/Radiation-EmittingProducts/ResourcesforYouRadiationEmittingProducts/Consumers/UCM142630.pdf This is especially important regarding CT scans and barrium enema treatments. (They are the most agressive radiation emitting devices outside of radiotherapy) See:http://www.fda.gov/radiation-emittingproducts/radiationemittingproductsandprocedures/medicalimaging/medicalx-rays/ucm115317 This is why Tomotherapy, which uses a CT scan before each procedure, is so dangerous. You have the poor accuracy of IMRT (IGIMRT) the weak energy of xrays vs particle beams plus the power of 400-900X of a chest x-ray for every procedure. Xrays only damage a single strain of DNA which the cell can quickly repair while the more precise and heavier particle beam cuts BOTH strains of DNA making cell death much more likely. Whats really gauling is the newest compact proton therapy device, developed by the LLNL and UC Davis has been given to Tomotherapy to develop into a new compact proton therapy machine. http://www.youtube.com/watch?v=ODuZcLHcsnI UC Davis CPRT Tomotherapy

Tomotherapy will lose $ for every Compact Proton machine delivered and the machine will be dangerous. Secondary carcinoma is the issue at hand. Bgordski (talk) 07:09, 8 November 2010 (UTC)

I added to a section on charged particle therapy and referenced the dangers of IMRT vs. particle beam. Bgordski (talk) 04:07, 20 November 2010 (UTC)

long-term effects
Seems to me that if long-term effects are well discussed, there's no advantage to discussing the idea of "lifetime maximum". Otherwise, somebody please make the case that "lifetime maximum" is an independent phenomenon and not something that just falls out as an implication from long-term effects.

TH 20:58, 16 October 2006 (UTC)

It is worth making a distiction, since it is relevant to retreatment with radiotherapy. There is a cumulative damage to irradiated tissues. This may be completely subclinical, and may manifest itself years later only if a previously treated area is re-irradiated. It is for precisely this reason that radiotherapy doses are modified during re-treatement.

Long term side effects are arguably different, in that they manifest regardless of whether there is further radiation exposure. Long term effects include second malignancy, cardiac problems, tissue fibrosis etc.Jellytussle 08:32, 17 October 2006 (UTC)

Article items 5 and 6 (conventional radiation and then techniques)
I suggest it is a misnomer to put 'conventional' before 'external beam radiation therapy' in article section 5. My primary reason for this, is stateside the term 'conventional' refers to AP/PA treatments, commonly done for craniospinal irradiation. To put it simply, 'conventional' is not having to do with the treatment, it has to do with the treatment planning.

As such, I would suggestion article heading 6 be considered to be changed. I think a summary title of "treatment techniques." or "treatment planning techniques" would be more appropos. The reason is that the virtual simulation (typically done with CT or CT/MRI) is done to create the radiation plan, and then it is delivered via one (of many) techniques: conventional, 3D conformal (often abbreviated 3DCRT), intensity modulated radiation therapy (IMRT), and also now 4D, which is commonly referred to as respiratory gated. Also not mentioned is ultrasound based localization, commonly used for prostate cancer. I did notice that cone-beam CT was mentioned, which is cutting edge and kudos to the person who brought it up.

However, I feel that I must argue one comment. The following: There has been some concern, particularly with IMRT, about increased exposure of normal tissues to radiation and the consequent potential for secondary malignancy. Overconfidence in the accuracy of imaging may increase the chance of missing lesions that are invisible on the planning scans (and therefore not included in the treatment plan) or which may move between treatments or during a treatment (for example, due to respiration or inadequate patient immobilization). "

Articles by Studer, et al [Radiation Oncology 2006, 1:40 http://www.ro-journal.com/content/1/1/40 as well as Yao, et al [Int J Radiat Oncol Biol Phys 2005, 63(2):410-421.] have demonstrated that IMRT is proven and marginal error does not exist. The caution in using the technique, stateside, does not stem from failure of planning the margin too narrowly, but from not having the manpower (a board certified medical physicist is required for an independent chart check) as well as having the available table time (it takes up to 30 minutes to deliver a complex IMRT) and the type of treatment facility.

Also, I would respectfully argue that Image Guided Radiation Therapy (IGRT) and 4-Dimensional Radiation Therapy are different entities. It is implied that they are, in fact, the same in the statement: "This new technology is called image-guided radiation therapy (IGRT) or four-dimensional radiotherapy."

4DRT is typically refers to RT delivered over a respiratory pattern (it coincides with 4DCT). Image guided radiation therapy refers to accounting for the daily shifting from bladder filling, bowel movements, and/or weight loss. It can be redirected through cone-beam CT or ultrasound localization or fiducial markers.

Also under radiation therapy techniques, I believe radiosurgery should be mentioned. While I understand it has its own page, radiosurgery is still, fundamentally, an external beam technique that is a highly technical form of IMRT. Perhaps a mention of it should be made with the link?

I welcome your comments, critiques, and insights! Thank you Kate St. John 07:52, 6 December 2006 (UTC)

Gray correction
Corrected the term 'grays' to simply 'Gray' The plural, in radiation oncology is "Gray" and not "Grays." Similarly, it is to be capitalized upon use. Thanks! Kate St. John 14:32, 6 December 2006 (UTC)
 * Are you sure about that? I've seen "grays" used in literature. Also, Gray is an SI unit, and my understanding is that SI units aren't capitalized. —Captaindan 15:14, 8 December 2006 (UTC)
 * When we publish (UIHC in Iowa City) we use Gray and Gy. However, I just went back through the International Journal of Radiation Oncology * Biology * Physics (our journal of choice); the term Gray it is used both as 'gray' and "Gray" - but never as 'grays.' I did a search and found the NRC (http://www.nrc.gov/reading-rm/doc-collections/cfr/part020/part020-1004.html) who list it as 'gray' with the abbreviation as "Gy." So, I stand corrected, but the abbreviation is capitalized (http://www.dep.state.pa.us/dep/subject/advcoun/rpac/2003/Draft_Minutes_112002_RPAC_Mtg_Rev_3.pdf)
 * Thanks! Kate St. John 05:18, 11 December 2006 (UTC)
 * Just checking. The limited knowledge I have about this stuff comes from being a (decidedly curious) patient, so I'm certainly not an expert. —Captaindan 05:28, 13 December 2006 (UTC)

Chapter order & cumulative side effects?
I wonder why after introduction the first chapter is "Side effects"? I think it is not the most important aspect of radiation therapy.

Also, though I am rather familiar with the field of radiation protection, I have not before seen the term "cumulative side effects". I believe side effects are usually divided into acute (due to radiation damaged cells) and long term (such as fibrosis or cancer). If you want to keep cumulative side effects in the article, please explain better why so. The abstract of the given reference does not give justification, in my opinion. To me cumulative side effects just seem like a special case of acute or long term side effects. 80.222.17.246 13:50, 19 March 2007 (UTC)

No, not the same. It is usual to have subclinical tissue damage after a course of radiotherapy (long term side effects without the side effects, if you like.) Add more radiation dose on top of that at a much later date and you get worse acute and and late side effects, because the tissue threshold for radiation damage is lowered by the original treatment.Jellytussle 17:35, 19 March 2007 (UTC)

Radiation therapy accidents
Do you think the article should include a section on accidents involving radiation therapy? Off the top of my head, I can think of the Therac-25 incident, which killed 5 people. I don't know how many other high profile accidents there have been involving radiation therapy and radiotherapy equipment though --Darksun 11:29, 5 May 2007 (UTC)

I agree, this would be useful, and should also include cases where not enough radiation was given. --Norman21 (talk) 09:01, 3 June 2008 (UTC)
 * I've added a section on Radiation Therapy Accidents citing a NYT article that appeared today. Norman21 (talk) 11:48, 26 February 2010 (UTC)

Radiation with neuro-muscular disease
My husband spent 2 1/2 months in ICU on a ventilator and 3 1/2 months on a feeding tube due to either Myasthenia Gravis or Botulism, they're not sure which, this winter. This hit immediately after the surgical removal of a adenocarcinoma from his parotoid gland, 12/06. Due to the paralysis,they could not do radiaton. CT scans of all organs and Bone Scan show no spread. He was still sometimes fatigued and short of breath when we started radiation treatment 3 weeks ago. After 12 treatments, he is starting to digress with paralysis returning to his throat, mouth and face and shortness of breath. The neuro-muscular structures are not yet healed. What effect will radiation have in this case. It's a rare complication and we wonder if anyone has experience with such a case. We cannot take a chance of extensive relapse. He was totally paralyzed from his eyes through his diaphragm. Any opinions and information are welcome. I might add he was a very healthy, strong person prior to this. Thank you. Pam Hightower 08:08, 30 July 2007 (UTC){| class="wikitable"

Does radiotherapy work?
This article and most online information starts from the assumption that radiotherapy works, then says something vague about how it works. There are also a number of pages saying that it doesn't work or that the medical profession has no evidence that it works. I think its important to add a section summarizing the evidence that radiation therapy actually works. Dr d12 03:31, 19 August 2007 (UTC)

tomotherapy?
The subject is there but its no where in the article... —Preceding unsigned comment added by 205.211.160.1 (talk) 19:07, 19 October 2007 (UTC)

computed tomography
A pendantic point, but did Hounsfield "discover" CT? Would "development" not be a more appropriate term? Kerabow 17:20, 20 October 2007 (UTC)kerabow

Success rates
Please could someone tell me where I might find out the success rates of radiotherapy in treating cancer. I know it's a vague question as there are 3 types of rediotherapy, but just point me in the right way please :) Ryan4314 (talk) 08:38, 13 December 2007 (UTC)

More questions
Do you have to get this done more than once if you have breast cancer? Also do you need to stay in a hospital over night, what is the recovery, what do they give you? Are you awake as you are getting this done? —Preceding unsigned comment added by 70.131.93.245 (talk • contribs) 4:12, 1 December 2008 (UTC)

Effect on different types of cancer
'" Effect on different types of cancer Different cancers respond differently to radiation therapy.[4][5][6]

Some cancers are very sensitive to radiation and radiotherapy may effect a complete cure if the disease is caught early. These include: breast carcinoma, cervical carcinoma, vaginal carcinoma, prostate carcinoma, lymphomas, myeloma, seminoma, Ewing's sarcoma, medulloblastoma, neuroblastoma, Wilms' tumour, and most brain tumours.

Radiotherapy may palliate or, in conjunction with other treatments, cure the following cancers: esophageal carcinoma, gastric carcinoma, rectal carcinoma, anal carcinoma, squamous and basal cell carcinomas of the skin, most oral cancers, laryngeal carcinoma, small cell lung cancer, bladder carcinoma, ovarian carcinoma, teratoma, and hypernephroma.

Other cancers are not as responsive to radiotherapy, such as colorectal cancer, pancreatic carcinoma, osteosarcoma, fibrosarcoma, liposarcoma, melanoma, and glioma."'


 * The current paragraph, quoted in full above is absolutely terrible. It fails to distinguish between radiosensitive and radioresitsant tumours, and between tumours which may be radically treated with RT but where it may be impossible because of their position relative to other structures.
 * It is also very inaccurate. for example: radiotherapy almost never cures primary brain tumours, which are notably radioresistant. Myeloma is not generally curable with RT (though it is extremely radiosensitive) because it is a systemic disease (not to be confused with solitary plasmacytoma.) Radiotherapy alone is a very effective radical treamtnet for localised squamous and basal cell skin cancers, anal cancer, and squamous cancers of the head and neck (oral, laryngeal.) Teratoma is HIGHLY radiosensitive. Renal cancer (hypernephroma) is generally radioresistant.
 * There are some very good trials demonstrating the benefits of RT in the treatment of colorectal cancer.
 * So, in conclusion, can the person who wrote this ill-informed, misleading piece please edit it to reflect current medical practice and opinion, or else delete it altogether?

thanksJellytussle (talk) 14:39, 11 March 2009 (UTC)


 * The information was added by a new editor about six weeks ago. I cleaned up the formatting.  I was going to encourage you to just sofixit, but you might want to fix your rather rude remarks on this page first.  I don't suppose that you've ever read WP:CIVIL?  WhatamIdoing (talk) 23:32, 12 March 2009 (UTC)

Have toned down my comments. I have also completely rewriten that section. Jellytussle (talk) 16:32, 20 March 2009 (UTC)
 * Thanks. I think it's a substantial improvement.  WhatamIdoing (talk) 00:21, 24 March 2009 (UTC)

Lorraine Day and Opposition to radiation therapy
There is a section at the bottom titled "Opposition to radiation therapy" which seems to be a thinly veiled excuse to link to Dr. Day's web site. Dr. Day's views are well outside the scientific mainstream at minimum. See for example http://www.quackwatch.org/01QuackeryRelatedTopics/Cancer/day.html

The paragraph just notes that she feels a particular way, and her opinion contradicts the available evidence. This is not noteworthy in the context of this article. Wikipedia shouldn't be an avenue for the promotion of quackery. I will delete this paragraph soon unless others feel it is inappropriate to do so. - Dan 193.60.81.67 (talk) 14:29, 22 April 2009 (UTC)


 * Thanks - I thought I'd removed that section, but obviously I hadn't. Graham 87 09:20, 23 April 2009 (UTC)

Name
I'm doing an essay on the bystander effect and thought I would just check something on here. I found it odd that the term "radiation therapy" is used both as the title and many times throughout the article. While reading several papers and many more abstracts, I have never seen this term used and this is the first time I have ever come across it, I have always known it as radiotherapy. Is "Radiation therapy" a laymen's term used somewhere? Will Bradshaw (talk) 17:17, 6 November 2009 (UTC)


 * A Google search returned 4,240,000 for "Radiation therapy" today. So yes, "radiation therapy" is used. It is not a laymen's term. Try a search for "radiation therapy" and physics and you will get several text books as results. Wantdouble (talk) 01:34, 18 November 2009 (UTC)


 * Fair enough it is used, but where, and who by? Most articles where a different term is used in different countries say what it is called where.  I've never heard "radiation therapy" used in the UK. Will Bradshaw (talk) 22:40, 23 November 2009 (UTC)


 * I looked into it a bit more and it seems that "radiotherapy" is more common in the UK/Australia and "radiation therapy" is more common in the US/Canada. I'm a medical physicist in the US and don't hear people say radiotherapy very often. I think having both listed as variants at the top is probably fine as far as the article is concerned. Wantdouble (talk) 08:51, 24 November 2009 (UTC)


 * Done. Will Bradshaw (talk) 22:47, 24 November 2009 (UTC)

Please see German version of Radiation Therapy article
For editors looking for ideas about how to improve this article, please take a look at the German version of the article. Even if you don't know a single word of German, you can get some ideas from the layout and numerous images used. Currently the German version appears to be the best across all of the various Wikipedia languages for the Radiation Therapy article. Wantdouble (talk) 08:17, 29 December 2009 (UTC)

Major Issues
As an oncologist, this article is a mess and very unclear and poorly laid out. I will endeavour to slowly fix this article over the next few weeks. GG The Fly (talk) 03:06, 13 February 2010 (UTC)


 * Sounds good, it's great to have an expert on board here. I know nothing about the subject and only watch this article for vandalism. Graham 87 05:32, 13 February 2010 (UTC)


 * Thanks Graham! GG The Fly (talk) 14:50, 13 February 2010 (UTC)

Thats great. I (a RadOnc) wrote large chunks of this 5-6 years ago. In the interrim well-meaning and sometimes ill-informed editing and additions have caused some deterioration, and I do not have the time or energy to do the spring cleaning/arguing which is necessary to maintain a page such as this. Jellytussle (talk) 17:06, 7 January 2011 (UTC)

It's a mess to an oncologist!?
Imagine how the ordinary man in the street is supposed to understand this article. It contains huge amounts of incomprehensible technical terms, it has disjointed display of information and seems largely to be an 'infofest' for people who already understand the topic. An encyclopaedic article for the enlightenment of the common man it is not! Richard Avery (talk) 21:51, 29 October 2010 (UTC)

History: London Hospital
It should probably be noted that London Hospital were the first to use radiotherapy, and expanded research in the field extensively. I came here to find more information on the historic application at London Hospital and was disappointed to find it's not even mentioned when it was so integral in development and use of radiotherapy. Poor form. 60.228.56.223 (talk) 22:01, 23 March 2011 (UTC)


 * Fair enough. If you know about it please write something. Otherwise stop whinging. Jellytussle (talk) 15:22, 2 December 2011 (UTC)

Mechanism of action
The following is nonsense: "The cyclotron's, dielectric wall accelerator (DWA),[2] or Still River Systems's super conducting high field magnet [3](two new compact protron replacements) provide the energy source for charged particle therapy. These particles can be charged to different amounts to provide the desired tissue penetration."

The electric charge of the proton in a constant, protons can not be charged to different amounts. Magnets are used for steering or focusing the beam, not as "energy source". There are just no "proton replacements", sorry. — Preceding unsigned comment added by 95.245.68.245 (talk) 18:41, 6 August 2011 (UTC)

DNA repair
There is no evidence in the literature that I'm aware of that suggests that cancerous cells have turned off their DNA repair mechanisms. This should be cited at the very least. 159.117.1.11 (talk) 02:51, 30 November 2011 (UTC)


 * The article says that cancer cells often have DEFECTIVE DNA repair, which is quite different from DNA repair turned off. Problems with DNA repair (e.g: mutated p53, Rb) are very well documented in cancer.Jellytussle (talk) 15:20, 2 December 2011 (UTC)

The article states in the introduction:

It is believed that cancerous cells may be more susceptible to death by this process as many have turned off their DNA repair ability during the process of becoming cancerous.

A citation would help clarify this statement - I'm aware that impaired DNA repair mechanisms occur but this causes extreme radiosensitivity and the more likely explanation is that cell death occurs due to incomplete and/or improper DNA repair mounting up over a few mitotic divisions as the cell's DNA repair mechanism is incapable of dealing with the higher frequency of DSBs induced by ionising radiation. 159.117.1.11 (talk) 23:50, 4 December 2011 (UTC) ********* Part of the DNA repair process is telomerase activation and the extension of telomeres, which allow the cancer stem cell to continue replication without encountering the Hayflick limit on growth. Certainly telomerase is turned on in cancer stem cells and the telomerase gene is a master cancer gene that causes about 214 other genes to switch to cancer mode (per Elizabeth Blackburn webcast, Nobel in Medicine) About 60 of the switched genes are associated with promoting cellular replication so far. Robert A. Weinberg, an important cancer researcher can create cancer in "many human cell types", switching only 3 master genes, without using a carcinogen, he turns on Telomerase in every case, turns off a tumor suppressor gene, and turns on an oncogene. But the point is, cancer greatly relies on the DNA repair process and overexpressed telomerase to grow fast, and divide without encountering the Hayflick Limit. Sourced from Geron presentations, Blackburn's webcasts and papers. Also, an associate of Blackburn, Mohamed Sabet, was able to return melanoma cells to originial pigmentation by inhibiting telomerase. Geron is testing telomerase inhibitor, Imetelstat, now in multiple FDA human trials for multiple caner types. Cancer cells without an intact RNA binding site on it's telomerase, loses it's replicative immortality, and could cause the reversal of the massive gene switching. Imetelstat binds tightly to the RNA template of telomerase that is the active site of telomere extension. — Preceding unsigned comment added by Prime3end (talk • contribs) 17:04, 9 December 2011 (UTC)
 * That looks like an advert for Geron, and not related to this article. Can we hide it ? - Rod57 (talk) 12:53, 3 January 2018 (UTC)

Radiation makes Cancer Stem Cells grow faster
I've read a piece of research that claims that ionizing radiation makes cancer stem cells grow faster, unless they receive enough to be killed by it. Since the cancer stem cells do most of the growing, this seems important to address on the main page. Some cancer stem cells are quiescent (G e r o n Corp) and emerge after chemo with chemo resistance. The culprit in cancer is the cancer stem cell, and radiotherapy, heat/light therapies need to have targeting and imaging technology that can illuminate cancer stem cells and even identify single cells for targeting, when radiation, light/heat, or even chemo are the treatment. I hope someone will do the legwork for links, the work has been done, it's out there. — Preceding unsigned comment added by Prime3end (talk • contribs) 16:52, 9 December 2011 (UTC)

File:Axesse Radiotherapy.png Nominated for Deletion
Agree Delete. Refers to specific commercial interest. Not about radiotherapy per se. Not even one of the major linac or software manufacturers.Adds nothing to the page. Jellytussle (talk) 16:53, 17 June 2012 (UTC)