Radiotherapy: Types and Techniques

Radiotherapy, also known as radiation therapy, is a cornerstone in the management of cancer, utilized in approximately 50% of all cancer patients. It employs ionizing radiation to eradicate cancer cells, shrink tumors, and alleviate symptoms. Over the past century, radiotherapy has undergone significant evolution, transitioning from rudimentary techniques to sophisticated, precision-based treatments. This article provides a comprehensive overview of radiotherapy, encompassing its history, types, applications, technological advancements, side effects, and future directions.

Historical Evolution of Radiotherapy

The inception of radiotherapy dates back to the late 19th century, following Wilhelm Röntgen’s discovery of X-rays in 1895 and Henri Becquerel’s identification of natural radioactivity in 1896. Marie and Pierre Curie’s subsequent isolation of radium paved the way for the therapeutic application of radiation.

Early radiotherapy techniques were rudimentary, often leading to significant damage to healthy tissues due to the lack of precise targeting. However, the 20th century witnessed remarkable advancements:

• 1920s-1930s: Introduction of superficial X-ray machines for skin cancers.
• 1950s: Development of cobalt-60 teletherapy units, enabling deeper tissue penetration.
• 1970s: Advent of linear accelerators (LINACs), providing higher energy beams and improved dose distribution.
• 1990s-Present: Emergence of computer-assisted planning, intensity-modulated radiation therapy (IMRT), and image-guided radiation therapy (IGRT), enhancing precision and sparing healthy tissues.

Types of Radiotherapy

Radiotherapy techniques vary significantly depending on how radiation is generated, delivered, and targeted. The major categories include External Beam Radiation Therapy (EBRT), Brachytherapy, and Systemic Radiotherapy, each with its unique characteristics and clinical applications.

External Beam Radiation Therapy (EBRT)

EBRT is the most widely used form of radiotherapy. It involves delivering high-energy beams—such as X-rays, gamma rays, electrons, or protons—from outside the body to the tumor site.

Conventional (2D) Radiotherapy

• Description: Early EBRT methods that used X-ray images for treatment planning. Beams were directed from fixed angles.
• Limitation: Poor tumor conformality, often irradiating surrounding healthy tissues.

Three-Dimensional Conformal Radiation Therapy (3D-CRT)

• Description: Uses CT or MRI imaging to create a 3D model of the tumor and surrounding organs. Beams are shaped to match the tumor’s geometry.
• Benefit: Improves targeting, sparing adjacent tissues better than 2D methods.

Intensity-Modulated Radiation Therapy (IMRT)

• Description: Advanced 3D-CRT that varies the beam intensity across the treatment field using multileaf collimators.
• Clinical Use: Particularly beneficial for tumors near critical organs (e.g., prostate, head and neck cancers).
• Advantage: Allows higher doses to tumors while minimizing dose to normal tissues.

Image-Guided Radiation Therapy (IGRT)

• Description: Incorporates imaging (CT, X-ray, or MRI) during treatment sessions to adjust for movement and ensure accurate targeting.
• Clinical Use: Critical for tumors that shift due to respiration or bladder/bowel filling.
• Benefit: Enhances precision, allows for tighter treatment margins.

Volumetric Modulated Arc Therapy (VMAT)

• Description: Delivers IMRT while rotating the radiation source around the patient in an arc.
• Advantage: Faster treatment delivery with superior dose conformity.

Stereotactic Radiosurgery (SRS) and Stereotactic Body Radiotherapy (SBRT)

• SRS:

  Advertisements

  • Use: Typically for brain tumors, arteriovenous malformations, and functional disorders.

  • Key Feature: Delivers a single, high-dose fraction with sub-millimeter precision.

• SBRT:

  • Use: Extra-cranial sites such as lungs, liver, and spine.

    Advertisements

  • Benefit: Delivers very high doses over fewer sessions (hypofractionation) with excellent local control.

Proton Beam Therapy

• Mechanism: Uses protons, which deposit most of their energy at a specific depth (Bragg peak), minimizing exit dose.
• Clinical Use: Pediatric tumors, skull base tumors, and cases near sensitive structures.
• Limitation: High cost and limited availability.

Heavy Ion Therapy (e.g., Carbon Ions)

• Benefit: Higher biological effectiveness than protons or photons, causing more lethal DNA damage in resistant cancers.
• Use: Radioresistant tumors like sarcomas, pancreatic cancer.
• Note: Currently available in select centers globally.

Brachytherapy (Internal Radiotherapy)

Brachytherapy involves placing sealed radioactive sources directly into or near a tumor, enabling localized high-dose radiation.

Types by Placement

• Intracavitary: Placed in a body cavity (e.g., cervix, uterus).
• Interstitial: Placed directly into tissues (e.g., prostate, breast).
• Surface (Mould): Positioned on the skin surface for superficial tumors.

Types by Dose Rate

• Low-Dose Rate (LDR):

  • Delivers radiation over hours to days.

  • Often used in prostate brachytherapy with permanent seed implants.

    Advertisements

• High-Dose Rate (HDR):

  • Delivers treatment in short, high-intensity bursts, often outpatient.

  • Used in gynecologic, breast, and skin cancers.

Advantages

• Highly conformal—radiation affects only the target.
• Shorter treatment durations in many cases.
• Reduced exposure to adjacent healthy tissues.

Limitations

• Invasive procedure.
• Requires skilled personnel and specialized equipment.

Systemic Radiotherapy (Radiopharmaceutical Therapy)

This method delivers radioactive substances via oral ingestion or intravenous injection, allowing the agent to travel systemically and target cancer cells.

Radioisotopes and Applications

• Radioiodine (I-131):

  • Standard therapy for thyroid cancer and hyperthyroidism.

    Advertisements

• Radium-223 (Xofigo):

  • Targets bone metastases in prostate cancer.

• Lutetium-177 (Lu-177):

  • Used in peptide receptor radionuclide therapy (PRRT) for neuroendocrine tumors.

    Advertisements

• Yttrium-90 (Y-90):

  • Employed in selective internal radiation therapy (SIRT) for liver tumors.

Targeted Radioligand Therapy (RLT)

• Combines radiation with antibodies or ligands that specifically bind to tumor markers (e.g., PSMA in prostate cancer).
• Benefit: Delivers radiation directly to cancer cells while sparing normal tissues.

Advantages

• Useful for widespread disease or metastases.
• Minimal invasiveness.

Limitations

• Systemic exposure may still cause side effects (e.g., marrow suppression).
• Requires specific diagnostic imaging and dosimetry.

Intraoperative Radiation Therapy (IORT)

• Description: Delivers a concentrated dose of radiation directly to the tumor bed during surgery.
• Use: Common in breast cancer, pancreatic cancer, and colorectal recurrences.
• Advantage: Immediate treatment of residual microscopic disease.
• Challenge: Requires coordination between surgical and radiation teams.

Total Body Irradiation (TBI)

• Description: Delivers radiation to the entire body.
• Purpose: Used primarily as part of conditioning before bone marrow or stem cell transplantation.
• Side Effects: High risk of toxicity—used with extreme caution and supportive care.

Emerging Modalities

FLASH Radiotherapy

• Mechanism: Delivers radiation at ultra-high dose rates in milliseconds.
• Potential: Reduces side effects by sparing normal tissue without compromising tumor control.
• Status: Preclinical and early clinical trials.

Boron Neutron Capture Therapy (BNCT)

• Mechanism: Involves neutron irradiation after tumor cells selectively take up boron-containing compounds.
• Use: Experimental; explored for glioblastoma and head and neck cancers.

Summary Table: Modalities Overview

Clinical Applications of Radiotherapy

Radiotherapy plays a pivotal role in the management of cancer, serving as a curative, adjuvant, neoadjuvant, palliative, and even preventive tool depending on the clinical scenario. It may be used alone or in combination with surgery, chemotherapy, immunotherapy, or targeted therapy. Each application aims to either eradicate cancer, prevent recurrence, shrink tumors, or alleviate symptoms.

Curative Radiotherapy

Curative (radical) radiotherapy aims to destroy all cancer cells to achieve long-term disease control or a cure. It can be used as the sole treatment or in combination with other modalities.

As Sole Modality

• Prostate Cancer: IMRT or brachytherapy offers curative outcomes, especially for localized disease.
• Lung Cancer: Inoperable early-stage non-small cell lung cancer (NSCLC) can be effectively treated with SBRT.
• Cervical Cancer: Combined external beam radiotherapy and brachytherapy is the standard for locally advanced disease.
• Head and Neck Cancers: Radical radiotherapy, often with concurrent chemotherapy, can cure many oropharyngeal, laryngeal, and nasopharyngeal cancers.

Combined-Modality Curative Therapy

• Chemoradiotherapy: Used in cancers like anal, esophageal, and some head and neck cancers to enhance radiosensitivity.
• Radiation + Immunotherapy: Investigated in several trials for synergistic effects (e.g., melanoma, NSCLC).

Adjuvant Radiotherapy (Postoperative)

Adjuvant radiotherapy is used after surgical removal of the tumor to eliminate microscopic residual disease, reducing the risk of local or regional recurrence.

Examples:

• Breast Cancer: Post-lumpectomy radiotherapy is standard in breast-conserving therapy, significantly lowering recurrence.
• Rectal Cancer: Radiotherapy after surgery may be used depending on pathological stage and margin status.
• Brain Tumors: Glioblastoma patients receive radiotherapy post-surgery to target residual cells.
• Gynecologic Cancers: Endometrial and cervical cancers often require adjuvant pelvic radiotherapy based on risk factors.

Neoadjuvant Radiotherapy (Preoperative)

Neoadjuvant (pre-surgical) radiotherapy is used to shrink tumors, improve resectability, and potentially improve long-term outcomes.

Examples:

• Rectal Cancer: Neoadjuvant chemoradiotherapy improves local control and allows for sphincter-preserving surgery.
• Esophageal Cancer: Radiotherapy combined with chemotherapy prior to surgery has shown survival benefits.
• Soft Tissue Sarcomas: Radiation can shrink tumors, making limb-sparing surgery possible.

Palliative Radiotherapy

When cure is not feasible, radiotherapy is a powerful tool for symptom relief and improvement in quality of life. It is often given in lower doses over shorter courses.

Common Palliative Uses:

• Bone Metastases: Rapid pain relief with single or fractionated treatments (e.g., 8 Gy in one fraction).
• Brain Metastases: Whole brain radiotherapy (WBRT) or SRS to reduce neurological symptoms.
• Spinal Cord Compression: Emergency radiotherapy to relieve pressure and preserve neurological function.
• Bleeding Tumors: Pelvic or lung tumors causing bleeding can be controlled with targeted radiation.
• Obstructive Tumors: Tumors in the trachea, esophagus, or ureters that impair function may be shrunk with radiation.

Prophylactic Radiotherapy (Preventive Use)

Prophylactic radiotherapy is used to prevent the spread or emergence of disease in high-risk but currently uninvolved areas.

Examples:

• Prophylactic Cranial Irradiation (PCI): Small Cell Lung Cancer (SCLC): High risk of brain metastases; PCI improves survival in selected patients with good response to initial treatment.
• Skin Cancer Prevention: Radiation may be used for fields with extensive pre-malignant changes (e.g., actinic keratosis in immunosuppressed patients), though not standard.

Special Populations and Applications

Pediatric Cancers

• Unique Considerations: Children are more sensitive to radiation; long-term risks like growth impairment, neurocognitive effects, and secondary malignancies must be considered.

• Common Pediatric Uses:

  Advertisements

  • Medulloblastoma: Craniospinal irradiation followed by a boost to the posterior fossa.

  • Rhabdomyosarcoma: Often treated with combined modality including radiotherapy.

Geriatric Oncology

• Benefit: Radiation is a non-invasive alternative for patients unfit for surgery or intensive chemotherapy.
• Approach: Often uses hypofractionated schedules to minimize treatment burden.

Organ-Specific Applications

Integration with Other Therapies

• With Chemotherapy (Chemoradiation):

  Advertisements

  • Enhances tumor cell killing through radiosensitization.

  • Examples: Anal cancer, cervical cancer, NSCLC, head and neck cancers.

• With Immunotherapy (Radioimmunotherapy):

  • Radiation can promote antigen release and immune activation.

    Advertisements

  • Ongoing trials are exploring combinations for melanoma, lung, and renal cancers.

• With Targeted Therapy:

  • Agents like cetuximab (EGFR inhibitor) used with radiation in head and neck cancers.

  • PARP inhibitors in BRCA-mutated cancers may work synergistically with radiation.

    Advertisements

Personalized Radiotherapy

• Biomarker-Driven Radiation:

  • Emerging field where genetic markers influence radiation dose or inclusion.

  • Example: p16-positive oropharyngeal cancer may need lower doses due to radiosensitivity.

• Functional Imaging:

  Advertisements

  • PET or MRI used to guide dose painting (higher doses to more active tumor regions).

• Radiogenomics:

  • Study of genetic variations influencing patient response to radiation.

Technological Advancements in Radiotherapy

Radiotherapy has progressed from simple X-ray machines to high-precision, image-guided, and computer-assisted techniques. These technological leaps have vastly improved treatment accuracy, efficacy, and safety—enabling personalized cancer care while minimizing damage to healthy tissues. Below is an in-depth exploration of the most significant innovations shaping modern radiotherapy.

Advanced Linear Accelerators (LINACs)

Linear accelerators (LINACs) are the primary machines used to deliver external beam radiotherapy.

Recent Enhancements Include:

• Multileaf Collimators (MLCs): Shape the radiation beam in real-time to conform to tumor boundaries.
• Flattening Filter-Free Beams: Enable higher dose rates for faster treatments, especially in stereotactic therapies.
• 6DoF (Six Degrees of Freedom) Couch: Allows precise positioning of patients along all spatial planes.
• Integrated Imaging (kV, MV, CBCT): Built-in imaging systems improve localization and setup accuracy.

Benefit:

Faster, more precise treatments with real-time verification of patient and tumor positioning.

Intensity-Modulated Radiation Therapy (IMRT)

IMRT uses computer-controlled linear accelerators to deliver variable intensities across multiple radiation beams.

• Precision: Conforms the dose to the 3D shape of the tumor.
• Clinical Use: Widely used in head and neck, prostate, and gynecologic cancers.
• Advantage: Allows for dose escalation to tumors while sparing adjacent organs (e.g., spinal cord, salivary glands).

Volumetric Modulated Arc Therapy (VMAT)

VMAT delivers IMRT in a continuous arc as the machine rotates around the patient.

• Speed: Shortens treatment time from 15–20 minutes (IMRT) to 2–4 minutes.
• Flexibility: Modulates dose rate, gantry speed, and MLC shape simultaneously.
• Clinical Application: Frequently used in pelvic, thoracic, and brain tumors.

Image-Guided Radiation Therapy (IGRT)

IGRT incorporates imaging—such as cone-beam CT (CBCT), ultrasound, or MRI—during treatment to verify and adjust patient setup.

Key Developments:

• Daily imaging allows correction for internal organ motion or patient shifts.
• MRI-LINACs provide real-time soft-tissue visualization during treatment.
• 4D-CT accounts for respiratory motion in tumors of the lung and upper abdomen.

Clinical Benefit:

Enhanced precision allows for tighter margins and reduced normal tissue irradiation.

Stereotactic Radiation Techniques (SRS/SBRT)

Stereotactic techniques deliver very high doses of radiation in 1–5 sessions with millimeter-level precision.

• SRS (Stereotactic Radiosurgery): Used primarily in brain lesions.
• SBRT (Stereotactic Body Radiotherapy): Applied to body sites like lung, liver, adrenal glands, and spine.

Technology Platforms:

• CyberKnife: Robotic radiosurgery system offering real-time tracking.
• Gamma Knife: Specialized for intracranial targets using focused cobalt-60 beams.
• TrueBeam and Edge Systems: Advanced LINACs capable of high-dose stereotactic delivery.

Benefits:

• Fewer sessions (hypofractionation).
• High local control rates.
• Minimal disruption to surrounding tissues.

Proton and Particle Therapy

Proton Therapy

Uses protons instead of photons. The key physical advantage is the Bragg peak, which allows the proton beam to deposit maximum energy at a specific depth, with no exit dose.

• Indications: Pediatric cancers, brain tumors, spinal tumors, ocular melanomas.
• Benefit: Reduces long-term side effects by sparing normal tissues.
• Limitation: High cost and limited availability.

Carbon Ion Therapy

• Higher Linear Energy Transfer (LET): More effective DNA damage to radioresistant tumors.
• Biological Advantage: Greater cell-killing capacity than protons or photons.
• Status: Available in select centers in Japan, Germany, and China.

Adaptive Radiotherapy (ART)

Adaptive radiotherapy customizes treatment over time based on changes in patient anatomy, tumor response, or organ motion.

• Online Adaptation: Replans the treatment immediately before delivery based on new images.
• Offline Adaptation: Adjusts the plan periodically (e.g., weekly).

Tools Enabling ART:

• Daily IGRT or MRI.
• Artificial Intelligence (AI)-driven contouring.
• Dose recalculation software.

Application:

Head and neck, bladder, and lung cancers, where anatomy can change daily.

Artificial Intelligence (AI) and Machine Learning

AI is rapidly transforming radiotherapy workflows by automating and optimizing multiple steps.

Applications:

• Automated Contouring: AI algorithms quickly and accurately delineate tumors and organs-at-risk.
• Treatment Planning: AI-based optimizers improve dose distribution and plan quality.
• Toxicity Prediction: Predict which patients may experience severe side effects.
• Outcome Prediction: AI models integrate imaging, genomics, and clinical data to personalize therapy.

Clinical Impact:

• Reduces planning time.
• Enhances consistency and quality.
• Paves the way for individualized radiotherapy.

FLASH Radiotherapy

FLASH delivers ultra-high dose rates (>40 Gy/sec) in milliseconds, producing a unique biological effect.

Radiobiological Benefit:

• Normal tissues show reduced toxicity.
• Tumor control remains comparable or superior.

Mechanism (The FLASH Effect):

• Hypothesized to involve transient oxygen depletion, reducing damage to normal cells.

  Advertisements

Current Status:

• Preclinical studies are promising.
• Early human trials are underway in Europe and the U.S.

Radiomics and Big Data Analytics

Radiomics involves extracting quantitative data from medical imaging to uncover patterns that are not visible to the naked eye.

Applications:

• Predicting treatment response.
• Guiding adaptive therapy.
• Stratifying patients based on tumor heterogeneity.

Big Data Platforms are integrating imaging, genetics, demographics, and outcomes to create predictive models and inform clinical decision-making.

Integration with Genomics (Radiogenomics)

Radiogenomics studies how individual genetic variations influence response to radiation.

• Goal: Personalize treatment dose and field sizes.
• Tools: SNP (single nucleotide polymorphism) analysis, gene expression profiling.
• Clinical Relevance: Some patients may be genetically predisposed to radiation toxicity or benefit from dose escalation.

Real-Time Tumor Tracking

Advanced tracking systems compensate for tumor motion, especially due to breathing.

• Techniques:

  Advertisements

  • Fiducial markers tracked with imaging.

  • Surface tracking systems (e.g., VisionRT).

  • Respiratory gating—radiation delivered only during certain phases of the breathing cycle.

• Application: Lung, liver, and pancreatic cancers.

  Advertisements

3D Printing and Radiotherapy

3D-printed boluses, immobilizers, and even patient-specific shielding devices are enhancing comfort and accuracy.

Uses:

• Custom molds for head and neck treatments.
• Boluses for irregular body surfaces.
• Phantom creation for QA (Quality Assurance) testing.

Treatment Workflow Automation

Integrated software ecosystems are streamlining radiotherapy delivery from simulation to verification.

Examples:

• Automated QA checks.
• Workflow management platforms (e.g., ARIA, MOSAIQ).
• Cloud-based treatment planning and review.

Side Effects and Management

Radiotherapy, while effective in targeting and destroying cancer cells, can also affect nearby healthy tissues, leading to a range of side effects. These effects depend on the treatment site, dose, fractionation, patient’s general health, and concurrent therapies (e.g., chemotherapy). Proper side effect management is crucial for maintaining quality of life, treatment adherence, and long-term outcomes.

Classification of Side Effects

Side effects are generally categorized by their timing:

• Acute Effects: Occur during or shortly after treatment (within 3 months).
• Subacute Effects: Appear weeks to months post-treatment.
• Late (Chronic) Effects: Develop months or years after treatment.
• Very Late Effects: Manifest years or decades later and may include secondary malignancies.

Common Acute Side Effects by Body Region

1. Head and Neck Region

• Mucositis: Painful inflammation of the mucous membranes.
• Xerostomia (Dry Mouth): Due to salivary gland damage.
• Taste Changes: Metallic or altered taste perception.
• Skin Reactions: Redness, peeling, or ulceration of facial/neck skin.
• Swallowing Difficulties: Esophagitis or pharyngitis.

Management:

• Saline mouth rinses, mucosal coating agents, pain management.
• Sialogogues (e.g., pilocarpine), hydration, and artificial saliva.
• Nutritional support via feeding tube if necessary.

2. Thoracic Region (Chest and Lungs)

• Esophagitis: Painful swallowing, especially with mediastinal or lung RT.
• Cough, Breathlessness: Radiation-induced inflammation (pneumonitis).
• Skin Reactions: Radiation dermatitis on the chest wall.

Management:

• Analgesics, proton pump inhibitors, dietary modifications.
• Corticosteroids (e.g., prednisone) for symptomatic pneumonitis.
• Monitor lung function via pulmonary function tests.

3. Abdomen and Pelvis

• Nausea/Vomiting: Particularly with upper abdominal irradiation.
• Diarrhea: Radiation enteritis or proctitis.
• Urinary Frequency or Burning: Radiation cystitis.
• Fatigue: Systemic response to radiation.

Management:

• Antiemetics (ondansetron), anti-diarrheals (loperamide), dietary changes.
• Bladder training, hydration, and antispasmodics.
• Encourage rest and moderate activity for fatigue relief.

4. Skin and Soft Tissue

• Radiation Dermatitis:

  • Grades: From mild erythema to moist desquamation.

  • Common Sites: Breast, head and neck, groin folds.

Management:

• Gentle skin care: lukewarm water, fragrance-free soap.
• Topical corticosteroids or emollients.
• Avoid tight clothing, adhesives, and sun exposure.

Subacute Side Effects

These occur weeks to a few months post-treatment and may include:

• Radiation Pneumonitis: Inflammation of lung tissue, seen in thoracic RT.
• Radiation Myelitis: Spinal cord inflammation—rare but serious.
• Transient Brain Edema: May follow cranial irradiation or SRS.

Management:

• Close monitoring, corticosteroids, symptomatic support.
• Imaging (CT/MRI) to differentiate from tumor progression.

Late Side Effects

Late effects are often irreversible and result from fibrosis, vascular injury, or cellular depletion.

1. Fibrosis and Organ Dysfunction

• Skin Fibrosis: Thickening or hardening in irradiated areas.
• Lymphedema: Especially after breast or pelvic RT.
• Pulmonary Fibrosis: Scarring of lung tissue post-radiation.
• Infertility: Ovarian or testicular damage depending on dose and shielding.

Management:

• Physical therapy, compression garments (for lymphedema).
• Respiratory therapy, oxygen support.
• Fertility counseling before treatment and cryopreservation options.

2. Neurocognitive Effects

• Seen after cranial radiation, especially in pediatric patients.
• Includes memory loss, attention deficits, and reduced processing speed.

Management:

• Cognitive therapy, stimulants (e.g., methylphenidate), educational support.
• Consider proton therapy or hippocampal-sparing RT for prevention.

3. Endocrine Dysfunction

• Thyroid dysfunction (hypothyroidism) after head/neck RT.
• Pituitary insufficiency after cranial base irradiation.

Management:

• Routine monitoring of hormone levels.
• Lifelong hormone replacement therapy as needed.

4. Secondary Malignancies

• Risk increases with time and younger age at treatment.
• Linked to higher cumulative doses and genetic predisposition.

Management:

• Long-term surveillance and patient education.
• Risk mitigation through advanced techniques (IMRT, proton therapy).

Pediatric Considerations

Children are more susceptible to both acute and late side effects due to ongoing development.

• Growth Delays: Especially with spinal or limb irradiation.
• Developmental Delays: Cognitive and behavioral issues with brain radiation.
• Dental Abnormalities: With head/neck exposure during growth periods.

Preventive Measures:

• Use of proton therapy to limit exposure.
• Endocrine and neurocognitive assessments during follow-up.
• Interdisciplinary care with pediatric oncologists and rehabilitation specialists.

General Symptom Management Strategies

Preventive and Supportive Care

Before Treatment:

• Dental Evaluations: For head/neck patients to reduce risk of osteoradionecrosis.
• Fertility Counseling: Sperm or egg preservation when gonads may be affected.
• Nutritional Screening: Baseline weight, swallowing assessments.

During Treatment:

• Weekly Reviews: To catch early toxicity.
• Symptom Diaries: Empower patients to track and report issues.
• Hydration and Nutrition Support: Crucial for mucositis and GI toxicity.

After Treatment (Follow-Up):

• Late Toxicity Monitoring: Every 3–6 months initially.
• Psychosocial Support: For survivors dealing with body image, anxiety, or depression.
• Rehabilitation Services: Including physiotherapy and speech therapy.

Conclusion

Radiotherapy has evolved into a sophisticated, precision-based modality integral to cancer management. Ongoing research and technological advancements continue to enhance its efficacy and safety, offering hope for improved patient outcomes globally.