Radiation Treatment: Is It the Same for All Cancers?

When you hear the word “radiation,” you might think of a big, scary machine that delivers large doses of radioactive energy. Or you have heard about severe side effects like hair loss, nausea, vomiting, and debilitating fatigue. As a radiation therapist, I have given a variety of different radiation treatments, so let me clear things up!

What are the different kinds of radiation treatment?

Radiation for treating skin cancer is vastly different than radiation used for other types of cancer, such as breast, prostate, or lymphoma. For those cancers, you would typically see two forms of radiation treatment – external beam radiation therapy or internal radiation therapy.

External beam radiation therapy

This is the radiation given in a hospital or radiation center with the big machine. It is designed to treat cancers inside your body with higher energies of radiation, not cancers on the skin. This type of radiation is powerful and can be tough on the body. People who receive this type of radiation often have side effects, such as fatigue.¹

Internal radiation therapy

As it sounds, internal radiation therapy is a source of radiation that is placed inside the body. This is a procedure that is done in a cancer center or radiation oncology department. This source could be a solid – like pellets, seeds, ribbons, wires, needles, capsules, balloons, or tubes – that give off radiation in the area where it is implanted. It could also be a liquid, which travels around the body via the blood system.²

Because these radiation sources are inside your body, there is a possibility that you will give off radiation for a period of time. Internal radiation may harm the healthy cells around cancer and can have strong side effects.²

Radiation for skin cancer

My specialty is radiation therapy for the treatment of non-melanoma skin cancers. These are basal and squamous cell skin cancers. I help people with skin cancers learn that radiation treatment for skin cancer is different than radiation for other types of cancer.

The following are the four types of radiation that are currently used to treat skin cancers.

Image-guided superficial radiation therapy (IG-SRT)

This is the type of treatment I provide together with the dermatologist, right in the dermatology office. Image-guided superficial radiation therapy (SRT) uses low-energy X-rays and is currently the most precise, effective, and safe form of radiation treatment for non-melanoma skin cancers. I like to compare the X-rays to those you get at the dentist’s office. The radiation does not have a lot of power; it can only go skin-deep.³

I use ultrasound images to measure the size and depth of the skin cancer throughout the treatment course. With image-guided SRT we get to track how the cancer is responding and watch it shrink and disappear. This imaging has allowed dermatologists to minimize their patient's side effects and successfully achieve over a 99 percent cure rate.³

Superficial radiation therapy (SRT)

SRT also delivers low-energy X-rays to the skin’s surface. However, it does not use imaging. Without imaging the dermatologist will estimate the size and depth of the cancer using your biopsy results and what they can see. Unfortunately, without imaging, you cannot track the cancer’s response during treatment.⁴

SRT is considered an exceptional treatment for non-melanoma skin cancer with its high cure rate, and mild to moderate side effects.⁴

Electron-beam radiotherapy (EBRT)

EBRT uses a very large, multi-ton, kitchen-aid-mixer-looking machine, called a linear accelerator to deliver treatments using electrons. These powerhouses are often found in the basements of hospitals, in the radiation oncology department. Compared to SRT, the energy of EBRT is higher and the dose goes a little bit deeper than just the skin's surface. The treatment is aimed at a larger area, called the treatment field, around the skin cancer. While the side effects are still mild to moderate and most patients approve of the treatment, the cure rates are lower than the previously mentioned therapies.¹

Electronic brachytherapy (EBX)

Electronic brachytherapy uses a special shielded machine to deliver high-dose X-rays, often to smaller skin cancer areas. There is not as much scientific evidence on the effectiveness of the therapy, perhaps because its use has been limited, leaving little data go by.⁵

Radiation is not one size fits all

Not only does radiation therapy vary for different cancers, but there are even different types of radiation available just for skin cancer. Be sure to talk with your dermatologist to determine which treatment is best for you. Be your own advocate!