Radiation Therapy for Childhood Cancers

Radiation therapy is treatment with high-energy x-rays. High levels of radiation can kill cells or keep them from growing and dividing. Radiation therapy is used to treat cancer because cancer cells are growing and dividing more rapidly than many of the normal cells around them. In addition, most normal cells appear to recover more fully from radiation effects than cancer cells.

Radiation may be used alone, in combination with surgery or chemotherapy, or both. There is no pain or discomfort during the treatment. It is much like having an ordinary x-ray taken, except that the child needs to hold still for a few minutes longer. In some cases, young children need to be sedated in order to hold still for the radiation treatment. You will not be allowed in the room during treatment, because this would expose you to needless x-rays. Younger children may find it frightening to be left alone in the room during radiation therapy. If you accompany your child to treatment, it may be reassuring to explain that you are just outside the room. In some hospitals, closed-circuit television or viewing windows allow you to watch your child receive treatment, and in these cases, the child may feel easier knowing that you can see him or her all during the treatment. Most radiation departments are willing to give you and your child a tour of the treatment area before the first treatment. During this time, the technologist will explain the machines. A trip to the radiation therapy room ahead of time may also help quiet fears about the equipment, especially its large size.

Before therapy is started, a physician specializing in radiation therapy will talk with you and explain the details of the treatment. The physician will also use dye to mark the area to be irradiated. Once in place, this dye should not be washed off for the duration of the treatments, because it will be used as a guide for aiming the radiation. While radiation therapy is being received, soap or lotion should not be used on these lines or within the radiation field, where the skin will become tender. The area should also be kept dry.

Areas of the body not being treated are often protected from radiation by special shields made of lead.

Side Effects of Radiation Therapy and Controlling Them

Your child will not be radioactive during or after radiation therapy. Neither you nor anyone else need fear contact with the child. Among the real side effects of treatment, which vary according to the site receiving the radiation, are:

1. Skin damage. The skin in the treated area may be somewhat sensitive and therefore should be protected against exposure to sunlight and irritation. During treatment, it should not be exposed to sunlight. After treatment is completed, the skin will still be sensitive, and a sun-blocking lotion containing PABA should be used to prevent burning. If the head is affected, soft hats and scarves may be worn. Your physician may also prescribe baby powder or cornstarch, an antibiotic ointment, or steroid cream to relieve itching and pain and to speed healing. Nothing, however, should be applied to the treatment area without the recommendation of the person in charge of the treatment.

2. Sore mouth (if the head and neck are within the irradiated area). Your physician may prescribe a mouth rinse, and the hints on mouth care provided in "Common Health Issues" will also help.

3. Hair loss. Hair is frequently lost from the area receiving the radiation therapy. This loss is usually temporary, with hair growth beginning about 3 months after the completion of treatment. Initial adjustment to even temporary hair loss can be difficult, but after a time, children are able to play, work, and go to school without undue embarrassment. Some will want to wear a wig, cap, or scarf.

4. Nausea, vomiting, and headaches. A few children have these symptoms following radiation therapy to specific sites, such as the head or abdomen. These problems may last for about 4 or 5 hours and can be relieved by medicines prescribed by your doctor. In terms of diet, small, frequent meals are recommended. You may want to see that your child eats 3 to 4 hours before treatment.

5. Diarrhea after radiation to the abdomen (or pelvic area). This condition usually responds to simple measures such as nonprescription drugs or medications prescribed by your doctor. A low-residue diet avoiding fresh fruits, vegetables, and fried foods may also help. Occasionally, treatment will have to be suspended until the symptoms subside.

6. Late effects. Following irradiation to the brain and/or central nervous system, some children seem to be drowsy and need more sleep. This symptom may begin at various times, even as late as 5 to 7 weeks after therapy has been completed. It usually lasts about 5 to 10 days. Several days before the drowsiness occurs, the child may lose his appetite, have fever or headache, have nausea and vomiting, and be irritable in general. This is a temporary condition; nevertheless, it is important to report such symptoms to your physician. Other post therapy symptoms your doctor will want to evaluate are dizziness, sight disturbances, increased appetite, and stiff neck. None of these may occur, but if they do, you should contact the physician.

7. Long-term effects. Research suggests that radiation therapy to the head may affect intelligence and/or coordination, depending on several factors, including the age of the child at the time of exposure. In some cases, growth may be affected. Research also points to the increased possibility of developing a second tumor in an area treated with radiation. Your child's physician or radiation therapist can tell you more about these long-term effects in relation to your child and the treatment.

Each year, Medical College of Wisconsin physicians care for more than 180,000 patients, representing nearly 500,000 patient visits. Medical College physicians practice at Children's Hospital of Wisconsin, Froedtert Memorial Lutheran Hospital, the Milwaukee VA Medical Center, and many other hospitals and clinics in Milwaukee and southeastern Wisconsin.