Radiotherapy & Immunotherapy

Better for a narrow set of situations, not in general. Protons deposit their dose and stop, which spares tissue beyond the target — genuinely valuable in children, in tumours next to the spinal cord, eye or brainstem, and in some re-treatments. For most common adult cancers, well-planned modern photon radiotherapy gives the same tumour control at a fraction of the price. Being offered protons for a routine case is a pricing decision, not a clinical one.

Often yes, and it is a common arrangement — but only when the two teams are actually talking. Many regimens deliver chemotherapy and radiotherapy concurrently, precisely timed against each other, and splitting them across countries without a shared written protocol is where harm happens. Ask for the radiotherapy plan, dose and fields in a document your own oncologist can read, and confirm they accept the arrangement before you travel.

Not with external beam radiotherapy, which is what almost everyone receives. The machine switches off and nothing remains in you; you can hug your children and share a bed the same evening. The exception is brachytherapy, where a radioactive source is placed inside the body, and certain radioactive drugs — in those cases the team gives explicit, temporary distance rules and tells you exactly how long they last. If nobody has given you such rules, you do not need them.

No — you feel nothing at all during a session, exactly as with an X-ray. You lie still for 10 to 20 minutes while the machine moves around you, and the beam itself has no sensation. What can become uncomfortable is the cumulative skin reaction after two or three weeks, which resembles sunburn and settles within a month of finishing.

No — with standard external radiotherapy you carry no radiation whatsoever once you leave the room, and normal contact with children and pregnant women is completely safe. The machine emits the beam only while it is on, and nothing remains in your body. The exception is internal radiotherapy, where a source is placed inside you and short, clearly explained precautions apply for a few days.

Standard courses run 15 to 33 sessions, one per weekday, so plan on three to seven weeks in the country. Stereotactic treatment such as SBRT compresses the same dose into 1 to 5 sessions and needs only a week. The number depends on the tumour and its site, and is fixed at the planning CT before treatment begins, not adjusted along the way.

Chemotherapy attacks dividing cells directly; immunotherapy releases the brakes on your own immune system so it recognises and attacks the tumour. That difference shapes everything else: immunotherapy causes little hair loss or nausea, but can inflame healthy organs such as the thyroid, bowel or lungs. It also works only in cancers that carry the right markers, which is why testing comes first.

Fatigue, skin rash and diarrhoea are the common ones, and most patients tolerate the infusions better than chemotherapy. The reactions that matter are inflammatory: the thyroid, the bowel, the liver and occasionally the lungs can become inflamed, usually between weeks four and twelve. These respond well to steroids when caught early, which is why any new persistent symptom should be reported the same week rather than at the next appointment.

SBRT delivers a very high dose to a small, precisely mapped target in 1 to 5 sessions instead of spreading a lower dose over several weeks. Sub-millimetre imaging and breath control let the beam stop sharply at the tumour edge, sparing surrounding tissue. It suits small, well-defined tumours — early lung cancer, isolated liver or spine lesions — rather than large or diffuse disease.

Sometimes — it depends on how much dose the surrounding healthy tissue already absorbed and how long ago. Re-irradiation is realistic when the earlier course was years ago, the area was different, or modern stereotactic technique can spare the previously treated tissue. Bring the original radiotherapy plan and dose records; without those documents no one can safely tell you whether a second course is possible.

Yes, and the combination is now standard in several cancers, most clearly in locally advanced lung cancer where immunotherapy follows chemoradiotherapy. Radiation exposes tumour antigens and can make the immune response stronger. The two are usually sequenced rather than given on the same day, and the plan is set by the tumour board so that lung and bowel inflammation risks are watched deliberately.