Radiation Therapy

Radiation Therapy

Technology advancements in radiation therapy have allowed treatment to be tailored to a patient's tumor type, size, and location to minimize the risk of damage to healthy tissue, improve survival, and minimize potentially serious side effects.

While radiologists once drew up treatment plans with a wax pencil on X-ray films, they now construct intricate, computerized treatment plans based on 3-D images of the tumor and can vary both the shape and intensity of radiation beams. One of the earliest radiation techniques, brachytherapy, now offers effective treatment for prostate, cervical and other tumors by directly implanting small radioactive sources temporarily or permanently into tumors via remote-operated equipment.

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2016

A new standard of care for high-risk, low-grade gliomas

A new standard of care for high-risk, low-grade gliomas

A federally-funded clinical trial shows that adding a chemotherapy regimen called PCV (procarbazine, CCNU, and vincristine) to radiation therapy slows cancer growth of grade 2 glioma and extends survival by a median of 5 years. Grade 2 gliomas are a rare, slow-growing type of brain tumor that occur most often in young people. As a result of this study, PCV chemotherapy after radiation therapy is now the standard of care for high-risk, low-grade gliomas.

2012

Adding radiation to chemotherapy after surgery still benefits some patients

Adding radiation to chemotherapy after surgery still benefits some patients

Building on the results of a 2011 Korean trial, a study suggests that for patients with stomach cancer that has spread to the lymph nodes, there is a small but significant improvement in survival from adding radiation to adjuvant (post-surgical) chemotherapy, in this case using the drugs capecitabine (Xeloda) and cisplatin. A larger trial is currently underway to confirm these results.

Because radiation only slightly improved outcomes, adjuvant chemotherapy alone after aggressive surgery also remains a viable treatment option for certain patients.

2009

Radiation after surgery or hormone therapy improves survival

Radiation after surgery or hormone therapy improves survival

Findings from a long-running clinical trial show that radiation therapy after surgery (known as adjuvant radiation) reduces the risk that prostate cancer will spread and increases survival time by nearly 30 percent in men with early-stage disease. A separate study finds that adding external beam radiation treatment to standard hormone therapy in prostate cancer that has spread to the surrounding areas can reduce the risk of death by more than 40 percent.

2007

Shorter course of radiation therapy is as effective as less frequent radiation therapy for early-stage breast cancer

Shorter course of radiation therapy is as effective as less frequent radiation therapy for early-stage breast cancer

Findings from the START Trial suggest that "hypofractionated" radiation therapy, which involves fewer but larger doses of radiation delivered over a shorter period of time, is as effective as conventional radiation for reducing the risk of cancer recurrence among women with early-stage breast cancer, and does not cause greater damage to healthy breast tissue. Since traditional radiation therapy for breast cancer can take five to six weeks to complete, this shorter course (as little as three weeks) is a more convenient option for some patients and makes it easier to complete all cycles of treatment.

2006

Genetic mutations affect survival for oligodendroglioma

Genetic mutations affect survival for oligodendroglioma

Two studies find that patients with oligodendroglioma tumors (a form of glioma) that lack certain parts of chromosomes 1 and 19 are more sensitive to treatment and have better survival than patients whose tumors are not missing this genetic material. Follow-up data later show that these patients fare much better, living several years longer, when they receive chemotherapy and radiation together, rather than radiation alone. 

2005

High-dose radiation helps men avoid cancer recurrence

High-dose radiation helps men avoid cancer recurrence

Studies find that men with localized prostate cancer who receive radiation treatment at a higher dose than was traditionally provided are less likely to have their cancer recur than men who receive conventional radiation. The high-dose approach is made possible by technological advances that allow doctors to precisely target more radiation to the tumor, while sparing healthy tissue.

2004

Chemotherapy and radiation before surgery reduce side effects for rectal cancer patients

Chemotherapy and radiation before surgery reduce side effects for rectal cancer patients

Results from a large clinical study show that giving chemotherapy and radiation therapy before, rather than after, rectal cancer surgery reduces the risk of local recurrence (cancer recurrence in the pelvis, near the original tumor). Survival was similar in both approaches, but because the pre-surgery treatment regimen was more tolerable, it is now the standard approach for treatment of rectal cancer.

2001

Adjuvant therapy improves long-term survival for patients with early-stage stomach cancer

Adjuvant therapy improves long-term survival for patients with early-stage stomach cancer

In 2001, a major trial shows that giving patients chemotherapy and radiation after surgery – an approach known as adjuvant therapy – significantly improves survival. The study compared surgery alone with surgery followed by the chemotherapy drugs fluorouracil and leucovorin, together with radiation.

These findings quickly establish adjuvant chemotherapy and radiation as a standard of care, and make stomach cancer one of several cancers in which adjuvant therapy can increase patients' chances of cure.

1999

Chemoradiation shown conclusively to benefit patients with advanced disease

Chemoradiation shown conclusively to benefit patients with advanced disease

A major clinical trial confirms the value of giving carboplatin chemotherapy and standard radiation therapy together to patients with advanced oropharynx cancer. While the approach, called concurrent chemotherapy, causes more side effects than radiation treatment alone, patients receiving the concurrent therapy lived almost twice as long as the patients receiving radiation alone.

Giving radiation to the chest twice-daily increases survival for small cell lung cancer

Giving radiation to the chest twice-daily increases survival for small cell lung cancer

A study finds that twice-daily radiation to the chest, together with chemotherapy, prolongs survival compared with once-daily radiation and chemotherapy in patients with small cell lung cancer that has not spread. Investigators showed that 26 percent of patients in the twice-daily group survived at least five years, compared with 16 percent in the once-daily group.

Simultaneous chemotherapy and radiation proven most effective for stage III non-small cell lung cancer

Simultaneous chemotherapy and radiation proven most effective for stage III non-small cell lung cancer

Researchers find that giving chemotherapy and radiation during the same treatment period, an approach known as concurrent chemoradiation, results in better survival for patients with stage III non-small cell lung cancer (disease with limited spread in the lungs and surrounding tissue) than the standard practice of waiting to give radiation therapy until after chemotherapy was completed. This finding echoes similar findings reported for small cell lung cancer in earlier years.

Cranial radiation reduces risk of small cell lung cancer spreading to the brain

Cranial radiation reduces risk of small cell lung cancer spreading to the brain

Radiation to the head is proven to significantly cut the risk that small cell lung cancer will spread to the brain, and thus improves survival. This result is initially shown in patients with earlier stage small cell lung cancer, and is later also proven effective in patients with advanced disease, who have an even higher risk of developing brain metastases.

1998

NCI recommends chemotherapy-radiation combination for invasive cervical cancer

NCI recommends chemotherapy-radiation combination for invasive cervical cancer

The National Cancer Institute issues an alert recommending that physicians consider adding chemotherapy to radiation therapy for women being treated for invasive cervical cancer (cancer that has spread within the cervix or pelvis). This updated approach is based on several randomized trials showing that women lived longer when treated with both radiation and chemotherapy, compared to those treated with the prior standard of radiation or surgery alone.

New radiotherapy technique enables precise targeting of tumors near sensitive tissue

New radiotherapy technique enables precise targeting of tumors near sensitive tissue

Doctors begin using intensity modulated radiation therapy (IMRT), a highly advanced radiation technique, to precisely target tumors that lie close to vital organs and other sensitive tissue that must be protected from radiation. IMRT uses sophisticated software and complex new machinery to vary both the shape and intensity of radiation. One of the clearest benefits has been in the treatment of head and neck cancers; IMRT allows doctors to minimize radiation exposure to the spinal cord, optic nerve and salivary glands, reducing side effects without compromising tumor control.

1997

New chemo-radiation therapy offers alternative to surgery for advanced disease

New chemo-radiation therapy offers alternative to surgery for advanced disease

The introduction of combination therapy - using both radiation and cisplatin chemotherapy together – offers an important new treatment alternative for patients with advanced bladder cancer who are older or otherwise unable to undergo bladder surgery. The strategy provides tumor shrinkage, limits nearby cancer growth, and enables many patients to retain normal bladder function – a key quality of life benefit.

In 2012, a Phase III study confirms the benefits of this approach, using the chemotherapy drugs fluorouracil and mitomycin. Researchers demonstrate this regimen improves survival, with no significant increase in side effects.

1993

Simultaneous radiation and chemotherapy boosts survival for small cell lung cancer

Simultaneous radiation and chemotherapy boosts survival for small cell lung cancer

Researchers demonstrate that starting radiation therapy together with chemotherapy dramatically improves the effectiveness of treatment for patients with early-stage small cell lung cancer, compared to starting radiation later in the course of treatment. This new approach is found to significantly delay cancer progression and improve survival.

1991

Combining chemotherapy and radiation prolongs survival for non-small cell lung cancer

Combining chemotherapy and radiation prolongs survival for non-small cell lung cancer

Two studies show that treatment programs involving both radiation and chemotherapy are more effective than either approach alone for patients with "stage III" non-small cell lung cancer (including patients with larger tumors that may or may not have limited spread within the lungs and in nearby lymph nodes). This two-pronged treatment approach soon becomes the standard of care for this disease.

1990

Shift to 3-D radiation treatment plans increases precision, safety of therapy

Shift to 3-D radiation treatment plans increases precision, safety of therapy

Thanks to the integration of powerful computers into medicine, doctors are able to dramatically improve radiation therapy by creating 3-D treatment plans. These plans require highly complex calculations and vastly more computing power than earlier, two-dimensional treatment plans. Thanks to this advance, radiation can be targeted at tumors from multiple angles, with beams of varying power, in ways that minimize the damage to healthy, surrounding tissue.

Combination chemoradiation first emerges

Combination chemoradiation first emerges

Researchers report successful results of a new approach for head and neck cancer therapy – so-called "chemoradiation." This approach involves giving cisplatin chemotherapy and radiation together (concurrently), rather than one after the other (sequentially). The two-pronged approach helps prevent the spread of advanced squamous cell cancers of the head and neck to other parts of the body and causes greater tumor shrinkage, compared to radiation therapy alone.

Several years later, another trial finds that a similar approach – combining radiation with both cisplatin and fluorouracil chemotherapy – helps reduce the size of tumors enough so that patients can eventually undergo surgery to remove them. This approach is proven to significantly extend survival and reduce the risk of recurrence.

1985

Chemotherapy plus radiation effective as adjuvant therapy
Gamma Knife therapy introduced for treating brain tumors

Gamma Knife therapy introduced for treating brain tumors

After nearly two decades of research, doctors begin using a non-invasive technique known as Gamma Knife to treat certain brain tumors. Also called stereotactic radiosurgery, the approach utilizes precisely focused radiation waves to disrupt cancer cell function and replication, while leaving the brain tissue surrounding the tumor largely untouched. Gamma Knife may also be combined with other forms of cancer therapy, including surgery. The approach continues to be refined today.

1981

Chemotherapy plus radiation effective for patients who cannot be treated surgically

Chemotherapy plus radiation effective for patients who cannot be treated surgically

Adding the chemotherapy drug 5-fluorouracil to standard radiation is shown to boost one-year survival from 10 percent to 40 percent for patients with locally advanced inoperable pancreatic cancer (disease that has spread to nearby tissues but cannot be surgically removed). The findings show the benefits of combining different treatment approaches for this stage of disease.

1977

Many women can opt for breast-conserving surgery

Many women can opt for breast-conserving surgery

Studies show that a procedure called lumpectomy – involving the removal of only the tumor, and not the entire breast – followed by radiation therapy is as effective as mastectomy for women with early-stage breast cancer. The finding helps dramatically reduce the physical and cosmetic side effects of breast cancer treatment and enables women to recover more quickly after surgery and return to their normal lives.

Radiation established as standard treatment for glioblastoma

Radiation established as standard treatment for glioblastoma

Radiation therapy becomes a mainstay of treatment for glioblastoma, a highly aggressive form of glioma, based on data showing it extends median survival from 3 months to about 9 months. This is the first time a treatment is proven effective against any brain cancer. Today, radiotherapy is used alone or with chemotherapy, both before and after surgery, and in patients with inoperable tumors.

1970

Increased use of radioactive "seeds" to target prostate and other cancers

Increased use of radioactive "seeds" to target prostate and other cancers

Studies suggest that an approach called brachytherapy extends the lives of patients with prostate cancer, compared to surgical removal of the prostate and surrounding tissue. In this approach, tiny radioactive sources or "seeds" are implanted directly into the prostate gland, delivering a high dose of radiation directly to the tumor while leaving healthy tissue beyond the prostate relatively unaffected.

Brachytherapy has been used since the early 1900s, but became less common after the widespread adoption of external beam radiation. With refined techniques and conclusive data on its effectiveness, the approach once again becomes a central part of treatment for prostate, cervical and other cancers.

1965

First use of radioactive isotope for treatment of inoperable liver cancer

First use of radioactive isotope for treatment of inoperable liver cancer

Investigators report the first use of the radioactive isotope Yttrium 90 (Y90) for the treatment of inoperable liver cancer, for which previously there were no treatment options.

For this therapy, the Y90 is chemically bound to a glass or resin bead called a microsphere. The microsphere is then implanted into the liver, providing radiation therapy directly to the nearby tumor and surrounding tissue with a goal of shrinking tumors or stalling their growth.

Today, treatment with Y90 is known to be particularly effective in certain patients, such as those with mild liver cirrhosis whose tumors invade nearby large blood vessels.

1945

Radiation cures some patients with Hodgkin lymphoma

Radiation cures some patients with Hodgkin lymphoma

Early in the 20th century, doctors find that use of radiation therapy can cure some patients with Hodgkin lymphoma, one of two major classes of lymphomas. When studies show that radiating larger parts of the body improves cure rates, physicians begin increasing the size of the radiation fields during therapy. In later decades, however, the long-term effects of radiation to the chest (including cardiovascular disease and second cancers) are recognized, and efforts are taken to reduce radiation exposure to healthy tissue.

1903

First use of radiation to treat cancer

First use of radiation to treat cancer

Five years after Marie Curie's discovery of radium, doctors report the first successful of use of this radioactive element to treat cancer, in two Russian patients with skin cancer. In the following decades, radiation becomes widely used to treat many different cancers, including cervical, prostate, breast and other tumors. In these first decades, doctors use an approach known as brachytherapy, in which small pieces of radioactive material are implanted inside or next to tumors, delivering radiation to cancer cells at close range. Brachytherapy remains an essential part of cancer treatment today, but has been refined to more precisely target tumor cells while leaving healthy tissue unharmed.