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Radiotherapy for Children and Adolescents

Introduction
In general, most types of cancer, whether in children or adults, are best treated by a multidisciplinary approach, that is by close co-operation between the members of a team which has representatives of all major treatment modalities: surgery, radiotherapy and chemotherapy. Depending on the exact type of cancer and the special needs of each patient the relative roles of the members of the team may vary.

Nature of Radiotherapy
Radiotherapy is the use of high energy (ionising) radiations to treat the cancer with all its roots and extensions. Unlike surgery which aims to remove all the cancer cells from the body, radiotherapy aims to destroy all the cancer cells by a series of gradual processes. First, the radiation beam destroys the dividing mechanism of the cancer cells, which gradually become fragmented. Then the body's own defence system gets to work and special cells eat up the fragments of these dead cells. Finally, the cells involved in the healing process reshape the normal tissues.

Radiotherapy acts by stopping the dividing mechanisms of the cells located in the nucleus of each cell. The high energy radiation beam works in the nucleus and breaks the chromosome strands responsible for the division and multiplication of the cancer cells. Normal cells, however, repair and recover more efficiently than most cancer cells following each dose of radiation. This is why a typical course of radiotherapy consists of multiple treatments given daily or sometimes twice daily over several days or weeks so that after each treatment a greater proportion of the cancer cells are inactivated whilst more of the normal cells are allowed to recover. By careful planning and administration of radiotherapy the maximum effect is confined within the tumour and side effects on normal tissues are minimised.

Staff Involved in Radiotherapy
The radiation oncologist is the specialist with the overall responsibility for the management of patients by radiotherapy. In each individual case, the decision to give radiotherapy requires careful consultation and assessment by the radiation oncologist as well as consultation and discussion with the other specialists involved. As part of this decision making process a frank and informative discussion is also undertaken with the parents and the aims of treatment, its benefits and side effects, which depend very much on each child's circumstances, are considered in detail.

Other members of the Department of Radiation Oncology who are involved with the care of the child during a course of radiotherapy are the radiation oncology Registrars, nurses, radiation therapists (radiographers), technicians, medical physicists, clerical staff, social work staff and medical secretaries.

Radiotherapy Machines
Each course of radiotherapy is planned individually in the Planning Room before treatment can begin. Parents are encouraged to assist during the first few visits. The simulator is the machine for taking accurate measurements of the part of the body which requires radiotherapy. Temporary ink marks are placed on the skin and are used as reference lines for each day's quick and accurate treatment set-up. The radiation oncologist, the radiation therapists and physicists all work closely to design a specific treatment plan that suits the particular needs of each patient. The precise calculations for each individual plan are carried out efficiently and accurately on another machine, the planning computer, specially designed for this purpose.

The linear accelerator is the treatment machine that actually delivers each day's treatment. The treatment set-up is exactly as was planned and rehearsed on the simulator and each treatment session lasts a short time, usually 20 to 30 seconds. During the administration of radiotherapy the patient feels nothing.

During the actual delivery of the radiation beam only the patient is inside the treatment room. Except in the case of babies and very young infants there is usually no need to sedate the child for
radiotherapy since, by the time planning has been completed and the child is ready to start, the child and parents are fully familiar with the procedures involved. Parents can and often do help the radiation therapist staff during the set-up procedures but must remain outside the treatment room once the radiation beam is turned on. They can watch the child on the television monitor and will be in voice contact with the child throughout the treatment.

Information Regarding Treatment
The radiation oncologist reviews the child's progress regularly during treatment and every opportunity is taken to discuss the treatment and the child's progress with the parents. After completion of radiotherapy regular follow-up visits with the radiation oncologist and nurses are arranged to review long-term progress and to assess any future needs.

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