Radiation oncologist Melissa Zinovoy (right) and chief radiation therapist Beeban Natt with a patient at MSK Westchester.
Radiation treatment is one of the most common and effective ways to destroy cancer cells and shrink tumors. At Memorial Sloan Kettering, approximately half of our adult cancer patients undergo radiation therapy as a primary treatment or as part of a broader approach that includes chemotherapy, surgery, or other therapies. For many cancers, radiation therapy may be all that is needed to treat the disease.
There are different ways to deliver radiation treatment. With external-beam radiation therapy, treatment is delivered from a machine outside the body. With internal radiation (brachytherapy), sealed sources of radioactivity are placed near or within the tumor. Less commonly, radiation treatment can also be given using liquid materials in capsules by mouth or infusion through a vein (systemic radiation).
Although radiation treatment has been widely used for decades, there still is confusion and misunderstandings about its safety. We asked MSK clinical physicist Lawrence Dauer and medical physicist Matthew Williamson to tell us about the concerns they hear most frequently from patients and their families — and the answers and reassurance they provide.
Will receiving external-beam radiation make me radioactive or able to expose others to radiation?
External-beam therapy, the most common type of radiation treatment, does not make a person radioactive in any way. It is applied most often in the form of x-rays by a linear accelerator. The therapy is designed to deliver precise amounts of energy to tumor cells while sparing healthy tissue. The radiation is present only when the linear accelerator is operating. When you receive external-beam radiation, you are unable to contaminate or transfer that radiation to any other person.
How can I be sure that the external-beam radiation machine isn’t damaging normal, healthy tissue in my body?
We have carefully developed methods for calibrating radiation beams to ensure they reach the areas they are intended to target. Even when nearby normal tissues receive small amounts of radiation, it is rare for long-term damage to occur. Our doctors and physicists also know how much radiation healthy tissue can receive without causing significant damage. They use this information to develop a patient-specific treatment. We often use special masks, molds, or casts of body parts to keep you completely still during treatment so that we can aim the radiation beams precisely to the area that needs to be treated.
Back to topIs there any risk that internal radiation implants (brachytherapy) will leak or break free from where they are placed and move around my body?
With brachytherapy, we use a needle or a catheter to insert radioactive material contained within a sealed source such as a seed, pellet, wire, or capsule. As the radioactive material inside the implants decays naturally over time, it emits radiation that deposits energy to treat nearby cancer cells. This radioactivity travels only a certain distance beyond the implant. Within a few weeks or months, the implant no longer gives off any radiation. The implants are specially tested and sealed to ensure that the encapsulated radioactive material doesn’t leak, and we place them in such a way that it’s highly unlikely they will move. We give people specific precautions to minimize exposure to others from the implanted radioactive material.
Back to topShould I limit contact with anyone while brachytherapy implants are inside my body?
Most of our safety concerns are related to being in physical contact with children for extended periods of time because their bodies are undergoing such rapid change and growth. Because we vary the radiation dose in each implant as well as the number of implants we insert based on your particular cancer, we provide you with specific advice about precautions to take when you’re in close contact with children.
Back to topDo prostate seed implants put my sexual partner or the person I sleep next to at risk in any way?
Prostate seeds are sealed sources. You cannot contaminate another person by being in his or her physical vicinity, during sexual intercourse, or through any other form of intimate contact. Your doctor or a member of the radiation safety staff will discuss any special precautions you should take with sleep arrangements before you leave the hospital. For example, based on such factors as your age and the age of your partner, we may ask that for a short time you avoid embracing your partner from the back in the “spooning” position through the night.
Back to topDo I pose a danger to others after receiving radioactive iodine therapy for thyroid cancer?
Radioactive iodine treatment involves swallowing a capsule or liquid form of radioactive iodine that all thyroid cells take up (absorb), destroying them. It’s effective because other healthy cells in the body don’t usually absorb the radioactive iodine.
For several days following this therapy, radioactive substances can be emitted through body fluids such as saliva, urine, and sweat. We send patients home with detailed instructions on how to care for themselves for the first few days — from limiting contact with young children and pets to using separate utensils and towels.
Back to topI am having an imaging test using radioactive materials. Will I be radioactive after the test?
Doctors sometimes use small amounts of radioactive material to diagnose disease. This is called nuclear medicine. The radioactive substance is injected into your body, locating specific cells or tissues ― including cancer cells ― and binds to them. The radioactive material will stay in your body for several hours or days, depending on the type that is used. Eventually, the material decays and your body naturally flushes it out through urine, sweat, and other forms of biological elimination. We make sure the specifics are clear to you before the test, and we may also issue an information card explaining your treatment in case you are questioned by someone in airport security, for example. You can learn more about nuclear medicine approaches here.
Back to topComments
Irma Abramson
Apr 30, 2014 • 7:39 PM
Roger Rose
May 1, 2014 • 4:43 AM
Following Brachytherapy and beam radiation is there a limit to the amount of radiation to a particular site?
If further cancer develops in the bone area already treated can further radiation be used to quell or kill the cancer?
What is the outcome of too much radiation to a bone or soft tissue site?
Are there further options in such circumstances?
Thanks for your help.
Memorial Sloan Kettering
May 23, 2014 • 2:45 PM
In reply to Following Brachytherapy and by Roger Rose
Roger, thanks for reaching out! There are no specific regulatory limits on the amount of radiation to a particular site during treatment when that treatment has been deemed appropriate and justified by your doctor. Our doctors follows appropriateness criteria and accepted professional guidance, along with best procedures based on the latest research to deliver appropriate treatments. They always seek to target the most effective dose of radiation directly at the cancer, while minimizing radiation to the healthy parts of a patient’s body. Decisions about the best therapy and best technology are based on each individual case. Also, different tissues have a different sensitivity and response to various types of radiation. Each case is unique.
Unfortunately we can’t answer personal medical questions on our blog. But if you or someone you care for has had radiation to the bone and you are wondering about treatment options, we encourage you to consult with one of our specialists. Please call our Physician Referral Service at 800-525-2225.
Bhaskar Kavi
May 1, 2014 • 8:48 AM
Carol Ferraro
May 1, 2014 • 10:11 AM
Memorial Sloan Kettering
May 23, 2014 • 3:02 PM
In reply to I too am interested in the by Carol Ferraro
Thank you for writing, Carol! Unfortunately we cannot answer personal medical questions on our blog. If you would like to make an appointment for a consultation with one of our specialists who can provide a personalized assessment of your treatment options, please call our Physician Referral Service at 800-525-2225.
Lana Wainman
Aug 30, 2014 • 2:29 PM
Memorial Sloan Kettering
Sep 2, 2014 • 5:23 PM
In reply to It is stated above, "it is by Lana Wainman
Lana, we sent your question to Beryl McCormick, Chief of our External Beam Radiotherapy Service, who responded that there have been several studies of the long-term effects of breast radiation. Two of the largest were reported in the New England Journal of Medicine in 2002
(http://www.ncbi.nlm.nih.gov/pubmed/12393820) and in the Lancet Oncology in 2005 (http://www.ncbi.nlm.nih.gov/pubmed/16054566). She noted that this area has been studied with much longer follow-up than some of the newer chemotherapy regimens. Thank you for your comment.
Joe Minnella
Feb 10, 2015 • 8:34 AM
Joe, radioactive materials are not used during regular CT scans, but they are used during PET scans and PET/CT scans. It’s possible to have an allergic reaction to the tracer. If you think you have had an allergic reaction, we recommend that you discuss this with your doctor. Thank you for your comment.
AEileen Rogersnonymous
Jun 20, 2015 • 11:21 AM
Memorial Sloan Kettering
Jun 20, 2015 • 10:28 PM
In reply to Are you allowed to go by AEileen Rogersnonymous
Anonymous
Jul 17, 2015 • 3:05 AM
External-beam therapy does not make a person radioactive in any way. The therapy only affects your cells for the very short time that you are receiving treatment. A person who has received external-beam radiation is unable to contaminate or transfer that radiation to any other person. Thank you for your comment.
Anonymous
Sep 28, 2015 • 1:56 PM
I have had a full hysterectomy and was classified as stage one. Soon I will be receiving brachytherapy to my vaginal cuff. How long is the possible risk of radiation exposure to my young grandchildren and others? I don't want to be treated as a leper but also don't want to harm others in even the slightest way.
Thank you for your comment. There are no radiation hazards to you or your family from the brachytherapy. There is no need to avoid young children or others after the procedure. You can learn more here:
https://www.mskcc.org/cancer-care/patient-education/intravaginal-brachy…
Anonymous
Oct 22, 2015 • 10:17 AM
I have been diagnosed with breast cancer, and have a choice between mastectomy and lumpectomy with radiation. I also have extensive psoriasis, which has been kept under control for several years with short daily UVB-narrow spectrum radiation treatments. Would I be able to continue those treatments if I have radiation therapy for the cancer? Thank you for your answer.
Memorial Sloan Kettering
Oct 22, 2015 • 11:12 AM
In reply to I have been diagnosed with… by Anonymous
Linda
Jan 4, 2016 • 7:35 PM
My husband had brachy therapy may 2015. June2015 I developed a topical dermatitis on my hands which I only managed to clear by December. I have now developed shingles on my face. The only changes was hisbrachy treatment. I'd it possible that my immune system has weakened from sleeping inthe same bed
Linda, thank you for reaching out. We passed your question on to MSK expert Laurence Dauer, who responds:
Several studies have been performed that have shown that the exposure to any family members from brachytherapy patients are well below any recommended precaution limits. As such, it is not at all likely that your immune system was weakened from sleeping in the same bed. The potential dose rates are simply much to small to have any effect.
Karen
Feb 11, 2016 • 11:51 AM
Linda
Feb 16, 2016 • 11:21 PM
Marie
Mar 21, 2016 • 9:45 PM
Anonymous
Apr 1, 2016 • 5:47 PM
Memorial Sloan Kettering
Apr 4, 2016 • 7:57 AM
In reply to Can a person that has stared… by Anonymous
Lorraine
Apr 24, 2016 • 10:35 AM
I understand that EBRT focuses on the tumor or tumor site thus reducing harm to nearby healthy tissue. But what if it is being used as a preventive: If there is no evidence of disease and it is being used in case a microscopic cancer cell remained behind after surgery, then it is zapping healthy tissue. Will that lead to long term side effects?
Dear Lorraine, we sent your inquiry to medical physicist and radiation safety expert Jean St. Germain and she responded:
“The goal of modern techniques such as Intensity Modulated Radiation Therapy [IMRT] or Image Guided Radiation Therapy [IGRT] is to maximize the dose to the tumor while sparing as much normal tissue as possible. Neither of these techniques are used as a preventative. There must be a disease process present to prescribe radiation therapy. That disease process is usually a cancer, although there may be the rare circumstance in which radiation therapy is used on a serious, but non-cancerous, disease process such as an aterio-venous malformation [AVM]. The potential for cancer cells to escape during surgery or radiation treatment depends on the type of tumor, its location, and the profession’s overall experience with the type of disease involved. Typically, chemotherapy, a systemic treatment, may be used in these cases.”
We hope this information is helpful. Thank you for reaching out to us.
Frank
Apr 28, 2016 • 11:19 PM
Yesterday I took 9 small dose pills of 1-123 iodine radiation for a full body scan last month I had almost all of my thyroid removed for papillary cancer I have a 1/4 of my thyroid left cause of the location of a mass and the one nerve left for my voice box still attached with no damage the doctor wants to see if we can kill the rest of the cancer with radiation but the pet scan showed up 2 spots in my lungs so that's why I got a full body scan today but curious how long I have to stay away from my very young great nieces and nephews being I'm a important part of their lives!
Eric
May 19, 2016 • 7:17 PM
My 20 year old daughter received radioactive iodine treatment for her thyroid cancer (small tumor) on Tursday. My 16 year old son wants to go see her for a little while which I'm not sure is a good idea just yet and haven't decided to let him do so. If he does what is the risk to him and is there a risk that he can pass along any radioactive material to his younger brother and sister?
Eric, we sent your question to Jean St. Germain, who replied, “Radioiodine (I-131) is used for treatment of thyroid tumors because the thyroid concentrates the iodine. Approximately 50% of the administered dose is excreted within 24 hours, primarily in urine, but also in sweat and saliva with a small amount in feces. The biological excretion continues in smaller amounts, and eventually, all iodine remaining in the body is concentrated in the thyroid itself. After approximately 72 hours, there is little biological elimination. As long as your son does not contact bodily fluids, the chief problem would be exposure from the iodine in her thyroid. It would usually be recommended that visitors remain at a distance of approximately 1 meter (about 3 ft.) for a period of about 1 week. Since these statements are in general, you may wish to consult with the authorized nuclear medicine physician who administered the therapy.” Thank you for your comment.
Sheila
Jun 17, 2016 • 2:11 AM
Sheila, we’re sorry to hear that you’re experiencing complications from your treatment. We recommend you discuss these with your healthcare team. You may find this brochure from the National Cancer Institute on radiation therapy useful: http://www.cancer.gov/publications/patient-education/radiationttherapy…
Best wishes to you, and thank you for your comment.
Mamie Waites
Jun 21, 2016 • 7:20 PM
In regard to lung cancer resulting from radiation therapy treatment for breast cancer, I read in an article from cancergrace stating that data from the United States and Sweden indicates that patients treated before the mid 1980’s were noted to have approximately a 0.5% increase in the risk of developing lung cancer – almost all secondary lung cancers appear to be in smokers. However, among patients treated in the last 30 years, this increased risk of lung cancer has disappeared. In your experience, would you say that this is true?
Memorial Sloan Kettering
Jun 23, 2016 • 8:35 AM
In reply to In regard to lung cancer… by Mamie Waites
Mamie, thank you for your question. We consulted with MSK radiation oncologists, who state that “Techniques have improved dramatically since the 1980’s, but it will take at least 15 years after treatment refinements have been routine to detect the impact on long term consequences of radiation, of which secondary cancers are one.”
Ralph
Jun 26, 2016 • 11:59 AM
Dear Ralph, we forwarded your inquiry to Dr. Michael Zelefsky, Chief of MSK’s Brachytherapy Service. He responded:
“With modern day radiation techniques, the likelihood that radiation seeds cause scarring to the effect that the prostate adheres to other organs would be extremely unusual. Radiation of course can cause some scarring on the sphincter muscles making subsequent prostate surgery riskier for incontinence of urine. After prostate radiation, surgery can still be done on other parts of the body in general without difficulty.”
We hope this is helpful. Thank you for reaching out to us.
Jackie Becker
Aug 3, 2016 • 8:35 AM
Had small stage 1 breast cancer in left breast removed 11/2015. Clean margins, sentinel node negative. Tumor analysis showed HER2+, ER+, PR+
Treatment: 12 weeks of Taxol + Herceptin, followed by 1 year Herceptin every 3 weeks for the HER2+. Because I had lumpectory oncologist suggested radiation to left breast after Taxol completed. I asked for research on the value of this - I am 82 yrs. old. He found conflicting reports. What is your opinion?
Memorial Sloan Kettering
Aug 8, 2016 • 9:18 AM
In reply to Had small stage 1 breast… by Jackie Becker
Hi Jackie, we are not able to answer medical questions on our blog. If you’d like to arrange to talk to someone at MSK about care or a second opinion, you can call 800-525-2225 or go to https://www.mskcc.org/experience/become-patient/appointment for more information on making an appointment. Thank you for your comment.
Angela
Aug 21, 2016 • 12:06 PM
Angela
Aug 21, 2016 • 12:13 PM
John Caparaso
Sep 23, 2016 • 2:14 PM
Memorial Sloan Kettering
Sep 24, 2016 • 3:05 PM
In reply to what is the normal time… by john caparaso
Chrissy Santos
Oct 23, 2016 • 9:10 PM
Memorial Sloan Kettering
Oct 24, 2016 • 10:49 AM
In reply to My friend had radiation… by Chrissy santos
Dear Chrissy, according to this Q&A: “Most of our safety concerns [regarding brachytherapy] are related to being in physical contact with children for extended periods of time, since their bodies are undergoing such rapid change and growth and are therefore more vulnerable to abnormal cell changes. Because we vary the radiation dose in each implant as well as the number of implants we insert based on your particular cancer, we provide you with specific advice about precautions to take when you’re in close contact with children.”
We recommend that your friend discuss your particular concerns with her physician. Thank you for reaching out to us.
Mary
Nov 23, 2016 • 10:47 AM
no one ever told me when I had radiation 8 years ago that I could develop an Angiosarcoma...So it's a big surprise that I now have a full blown sarcoma.