During the Pandemic, What Should Radiotherapy Patients Do?
Since the beginning of the pandemic, we have received many inquiries from cancer patients, and a significant number of them concern radiation therapy. On May 10, Dr. Zhao Ruping, Associate Chief Physician of the Radiation Oncology Department at Jiahui International Cancer Center, was invited to speak in the “Together Through the Pandemic” Jiahui Health Live Broadcast 2.0. She delivered an online talk on “How Cancer Patients Undergoing Radiotherapy Can Safely Navigate This Special Period,” which received enthusiastic feedback from viewers.
For those who missed the session, we’ve summarized some of the key points and insightful answers below.
Q1: Is radiation therapy only for patients who can’t undergo surgery? What are its indications?
Dr. Zhao Ruping:
Many patients and their families have misconceptions about the scope of radiation therapy. In fact, radiotherapy has a very broad range of applications — it can serve as a curative or adjuvant treatment for many cancers, or as a palliative therapy for patients with advanced or metastatic disease to help relieve symptoms and improve quality of life.
1. Curative Radiotherapy: For some cancers, radiotherapy can be the main treatment and even achieve a cure — for example, nasopharyngeal carcinoma and tonsil cancer.For many localized cancers that cannot be surgically removed, such as esophageal cancer, lung cancer, or laryngeal cancer, radiotherapy can provide curative effects comparable to surgery. Compared with surgery, radiotherapy also has the advantage of preserving organ function. For instance, in advanced laryngeal cancer, surgery would require complete removal of the larynx, leading to the loss of speech. In contrast, radiotherapy can preserve the voice and maintain patients’ social abilities. With advances in radiotherapy technology, it is now used for early-stage cancers that were previously treated only by surgery. For example, stereotactic body radiotherapy (SBRT) for early-stage lung cancer can achieve similar results to surgery.
2. Neoadjuvant and Adjuvant Radiotherapy: Based on treatment timing, radiotherapy given before surgery is called neoadjuvant radiotherapy, while treatment after surgery is called adjuvant radiotherapy.
· Neoadjuvant radiotherapy is mainly used in two situations: 1. When a tumor is difficult to remove surgically, preoperative radiotherapy can shrink it to make surgery possible; 2. For locally advanced tumors, preoperative radiotherapy can lower the risk of recurrence and metastasis. This approach — combined chemoradiotherapy — is now the standard treatment for cancers such as esophageal and rectal cancer.
· Adjuvant radiotherapy is often necessary even when a tumor has been surgically removed. Some patients wonder, “If the surgeon says it’s completely removed, why do I still need radiotherapy?” This is because cancer grows infiltratively — imaging and surgery remove the “body” of the tumor, but microscopic “arms” may remain. Radiotherapy eliminates these residual cancer cells, reducing the chance of recurrence. Common cancers requiring postoperative radiotherapy include breast cancer, head and neck cancers, rectal cancer without prior radiotherapy, and soft tissue sarcoma.
3. Palliative Radiotherapy: For patients with advanced disease who experience symptoms such as pain, bleeding, obstruction, or headache from brain metastases, radiotherapy can provide effective relief and improve quality of life. For example, pain relief from radiotherapy can reach an effectiveness rate of over 70%. As systemic therapies expand — including chemotherapy, immunotherapy, and targeted therapy — radiotherapy can also play a synergistic role. When localized progression occurs during drug treatment, adding radiotherapy can help control it and extend the effectiveness of systemic therapy. In some stage IV cancers (such as small cell lung cancer or nasopharyngeal carcinoma), adding radiotherapy to the primary site after systemic therapy has been shown to prolong survival.
4. Preventive Radiotherapy: For example, in small cell lung cancer, the risk of brain metastasis is about 70%, but prophylactic cranial irradiation (PCI) can significantly reduce that risk.
Q2: Will interrupting radiotherapy due to the pandemic affect treatment outcomes?
Dr. Zhao Ruping:
Cancer treatment is a continuous process, and interruptions in radiotherapy can reduce its effectiveness. Therefore, patients should try to maintain uninterrupted treatment whenever possible.
The effects of radiotherapy are often described using the “5 R’s” of radiobiology — one of which refers to the accelerated repopulation of tumor cells after radiation exposure. In other words, once exposed to radiation, surviving tumor cells may start to grow faster to compensate, making continuous treatment crucial. Interruptions can lead to treatment failure, especially in fast-growing cancers such as esophageal cancer. For cancers like breast cancer, radiotherapy should ideally start within six months after surgery; delays can reduce its therapeutic benefit.
However, for some cancers such as rectal cancer, both preoperative and postoperative radiotherapy are options. During special circumstances, chemotherapy can be performed first, since it usually requires hospital visits only once every three weeks, and radiotherapy can be resumed once conditions allow — minimizing the overall impact.
If a patient cannot attend treatment as scheduled due to public health restrictions, they should consult their oncologist as soon as possible or seek online medical advice. When radiotherapy must be postponed, doctors may adjust the total dose or number of sessions to maintain efficacy. The exact adjustment depends on many factors, such as tumor type, interruption length, and normal tissue tolerance. Patients are encouraged to stay in close contact with their treatment team, but there is no need to panic.
Q3: Can follow-up appointments after radiotherapy be delayed?
Dr. Zhao Ruping:
After completing a full treatment plan, regular follow-ups are crucial for monitoring disease status.
• For patients who have completed curative or adjuvant radiotherapy and whose tumors are under control, follow-up visits can be appropriately delayed.
• For those who received palliative radiotherapy and whose symptoms (such as pain or bleeding) are now under control, follow-up can also be postponed moderately.
• However, patients who underwent neoadjuvant radiotherapy — that is, radiotherapy before surgery — usually have an optimal time window for surgery or the next stage of treatment. For example, rectal cancer patients typically need surgery 6–8 weeks after completing chemoradiotherapy. For these patients, timely follow-up is important so doctors can plan subsequent steps based on imaging and test results.
Q4: How should patients adjust their diet while staying at home during radiotherapy?
Dr. Zhao Ruping:
With the advancement of precision radiotherapy, treatment-related side effects have been greatly reduced compared to the past.
However, radiotherapy remains a high-intensity anti-cancer treatment, and both the absorption of necrotic tumor tissue and the repair of normal tissue require adequate energy and nutrients. Patients are advised to: eat plenty of fresh vegetables and fruits to supplement vitamins and trace elements, consume high-protein foods such as eggs, milk, and lean meat, and avoid overly bland diets, but also stay away from spicy or pickled foods.
During pandemic restrictions, eggs and milk are ideal foods to prioritize — they are easy to store and rich in high-quality protein. I often recommend my patients try boiled eggs dipped in light soy sauce, which eliminates any strong odor while providing both protein and sodium. Another practical tip: “Drink milk like water.” Many of my patients who initially felt weak reported noticeable improvement within just 3–4 days after increasing their milk intake.
Q5: There are many radiotherapy techniques, such as SBRT, IGRT, and IMRT. Does a newer technique always mean better results?
Dr. Zhao Ruping:
In the past decade, radiotherapy technology has advanced rapidly. Radiotherapy has evolved from the 2D era (simple opposing fields) to 3D-CRT (three-dimensional conformal radiotherapy), and then to IMRT (intensity-modulated radiotherapy), which can adjust the radiation intensity according to the 3D shape of the tumor, resulting in more precise dose distribution. However, IMRT delivers treatment only from fixed angles, which can make treatment time relatively long. Building on IMRT, VMAT (volumetric modulated arc therapy) was developed. This technique allows treatment while the machine rotates, significantly shortening treatment time and is now widely used.
SBRT (stereotactic body radiotherapy) delivers a high dose to a small tumor target over a limited number of sessions, achieving effects comparable to surgery.
Precise implementation of radiotherapy relies on IGRT (image-guided radiotherapy). At Jiahui International Cancer Center, IGRT uses CBCT (cone-beam CT) and SGRT (surface-guided radiotherapy) before and during every treatment session for real-time monitoring. If a patient moves involuntarily—e.g., coughing beyond a preset threshold—the machine automatically stops until the patient is back in the correct position. If the patient cannot return to the proper position independently, the radiotherapy therapist will reposition them. Our center currently sets the threshold at 3 millimeters, which ensures highly accurate targeting and reduces radiation toxicity.
Over my 10+ years of experience in radiotherapy, I have witnessed these technological breakthroughs. Today’s treatments are more effective, with fewer side effects, and patients benefit more. However, conventional radiotherapy still has its place. For example, patients with severe cancer-related pain may move during treatment; pursuing extreme precision in such cases may lead to a “missed target,” so traditional techniques may be more suitable.
Q6: What are the common side effects of radiotherapy, and how can they be managed?
Dr. Zhao Ruping:
Radiotherapy side effects can be divided into general effects—common to most patients, such as fatigue, weakness, loss of appetite, weight loss, local swelling, and pain—and site-specific effects depending on the treated area. Throughout treatment, patients should avoid smoking and alcohol, maintain a balanced diet, get adequate sleep, and avoid heavy physical labor to keep their body in good condition.
Here are some common tumor-specific side effects and management strategies:
Head and Neck Cancer Radiotherapy
Due to the complex anatomy of the head, high doses are often required, increasing the risk of acute and late side effects.
1. Preparation: Quit smoking and alcohol; have a dental check-up, control oral infections, and remove residual roots. Avoid dental extractions for two years post-radiotherapy to reduce the risk of osteoradionecrosis.
2. Common side effects during treatment:
• Radiation dermatitis: Skin redness, swelling, heat, itching, and in severe cases, moist desquamation. Protective measures include gentle cleansing with water (no soap), patting dry, wearing soft cotton clothing, avoiding sun exposure, and using alcohol-free lotion or protective sprays.
• Radiation-induced mucositis: Redness, ulcers, painful swallowing, hoarseness. Start around the second week of treatment. Recommendations: avoid alcohol, smoking, acidic/spicy foods; maintain oral hygiene; use anesthetic mouth rinses if necessary; nasal irrigation for nasopharyngeal cancer; eat fresh fruits and vegetables for mucosal repair. Symptoms usually improve 2–3 weeks post-treatment.
• Xerostomia (dry mouth): Caused by salivary gland damage. Carry water, use herbal teas (e.g., Malva nut, wild chrysanthemum, honeysuckle) to moisten mouth.
• Taste changes: Patients may experience altered taste (bitter, sweet, salty, or absent). Continue eating regardless; caregivers should maintain consistent meal seasoning to avoid electrolyte imbalance.
3. Long-term side effects: Temporomandibular joint dysfunction: Limited mouth opening; start jaw exercises early, e.g., biting a modified hot water bottle cork three times daily for 10 minutes. Radiation-induced otitis media: Tinnitus, hearing loss; refer to ENT specialists for professional management.
Breast Cancer Radiotherapy
Many breast cancer patients can maintain their normal routines, attending outpatient sessions during work breaks.
1. Acute side effects:
• Skin reactions: redness, swelling, itching, and mild pain, managed similarly to head and neck skin care.
• Pain or tenderness in the breast, especially post-breast-conserving surgery.
• Axillary lymph node irradiation may cause swallowing discomfort due to nearby esophageal exposure; cooling herbal teas (Malva nut, honeysuckle, wild chrysanthemum) can help. Jiahui uses hypofractionated radiotherapy (15–16 sessions), significantly reducing side effects, often without additional medication.
2. Long-term toxicity: Left breast irradiation may increase the 10-year risk of coronary heart disease. DIBH (deep inspiration breath-hold) reduces heart exposure by roughly two-thirds compared to free breathing.
Lung Cancer Radiotherapy
Acute side effects: 1. Radiation pneumonitis: chest tightness, shortness of breath, fever; requires prompt medical attention. 2. Radiation esophagitis: painful swallowing; cooling herbal teas or oral sucralfate may help. 3. Radiation tracheitis: coughing, pain; antitussive syrup may be used.
Late side effects: Esophageal stricture, pulmonary fibrosis, heart dysfunction, coronary heart disease. Prevention relies on precise treatment planning; timely management is essential if they occur.
Gastrointestinal Tumor Radiotherapy
Effects vary by treatment site:
1. Upper abdomen (stomach, pancreas, liver): Acute nausea, vomiting, diarrhea, constipation, or pain. Medications like ondansetron can relieve symptoms. Late complications (rare) include adhesions, strictures, obstruction, and ulcers.
2. Lower abdomen and pelvis:
• Common acute effects: nausea, vomiting, diarrhea, constipation.
• Radiation proctitis: urgency, incomplete evacuation; probiotics or antidiarrheal agents may help.
• Bladder exposure: urinary frequency, urgency, pain; increase fluid intake.
• Female patients: vaginal or vulvar inflammation, pain; topical gynecologic medications may be recommended.
• Male patients: temporary or lasting sperm damage; discuss fertility preservation before radiotherapy.
Jiahui International Cancer Center has a comprehensive radiotherapy side-effect management system. Close collaboration among oncologists, physicists, therapists, and nurses ensures patient safety. Patients experiencing urgent or sudden side effects should contact medical staff immediately for timely intervention.
During the current COVID-19 pandemic, cancer patients face extra challenges. Jiahui International Cancer Center continues to maintain rigorous infection control, safely manage inpatient care, and ensure smooth outpatient treatment and follow-up.
We encourage patients to comply with government and hospital pandemic guidelines, protect themselves and others, maintain balanced nutrition, exercise moderately, get sufficient sleep, and manage stress and emotions. Keeping the body in its “best state” helps everyone fight both the virus and cancer.
Feel free to share this information with patients who may benefit.
