Colon Cancer Radiotherapy

Introduction

Colon cancer radiotherapy is focused cancer therapy involving high-energy rays or particles to kill cancer cells in the colon. While not the first choice of treatment for colon tumors, radiotherapy serves an important role in certain instances, especially when tumors are near the rectum, have penetrated surrounding tissues, or when surgical intervention is limited. Radiotherapy is usually paired with chemotherapy or surgery to enhance results.

About Disease

Colon cancer develops in the inner layer of the colon, which is the large intestine’s main part. It begins as benign polyps, which will eventually turn malignant after many years. The principal risk factors are genetic mutations, inflammatory bowel disease, physical inactivity, smoking, alcohol consumption, and a diet with red or processed meat.

Although colon cancer is usually treated by surgery and chemotherapy, radiotherapy becomes imperative when the tumors are located in sites that are difficult to reach or when total resection is not feasible. In contrast to radiotherapy use in rectal cancer, radiotherapy use in colon cancer is selective.

Indications

Radiotherapy for colon cancer is recommended in the following situations:

• Locally advanced colon cancer: When the tumor has invaded nearby structures or organs.

• Non-resectable tumors: Radiation helps shrink tumors to make them operable.

• Palliative care: To relieve pain, bleeding, or obstruction in advanced cases.

• Residual disease post-surgery: If microscopic cancer cells are suspected to remain.

• Recurrence: Localized recurrence after surgery may be treated with radiation.

Treatment Details

How Radiotherapy is Delivered

• External Beam Radiotherapy (EBRT): Most commonly used, where high-energy X-rays are aimed at the tumor site.

• Intensity-Modulated Radiotherapy (IMRT): More precise, reduces damage to surrounding tissues.

• Stereotactic Body Radiotherapy (SBRT): Delivers high doses in fewer sessions; used in select advanced or metastatic cases.

• Intraoperative Radiotherapy (IORT): Radiation is delivered directly during surgery.

Radiotherapy Planning

• A CT or MRI scan is used to map the tumor and surrounding structures.

• The radiation oncologist plans a customized dose and angle for maximum effect.

• The treatment is usually given over 5 to 6 weeks, 5 days a week.

Medicines Used

While radiotherapy doesn’t involve drugs directly, it is often used in combination with radiosensitizing chemotherapy, which makes cancer cells more sensitive to radiation:

• 5-Fluorouracil (5-FU)

• Capecitabine (Xeloda)

These may be given orally or intravenously during the course of radiotherapy.

Effectiveness

Though not routinely used, colon cancer radiotherapy can be effective when:

• Used pre-operatively to shrink tumors for surgical removal.

• Combined with chemotherapy to improve local control.

• Relieving symptoms such as bleeding or pain in advanced cancer.

In locally advanced or recurrent colon cancer, radiotherapy can control disease progression and improve survival when surgery is not an option.

Risks and Side Effects

Radiation therapy is generally well tolerated, but side effects may include:

Common Side Effects

• Fatigue

• Skin irritation or redness in the treated area

• Nausea or vomiting

• Diarrhea

• Abdominal cramping

Long-Term Side Effects

• Bowel obstruction or strictures

• Radiation enteritis

• Urinary problems

• Rarely, fertility issues or secondary cancers

Side effects depend on the dose, area treated, and whether it’s combined with chemotherapy.

Recovery and Aftercare

After radiotherapy, recovery depends on the individual’s response and the stage of cancer. Key aftercare steps include:

• Nutritional counseling: A low-residue diet may be recommended to reduce bowel stress.

• Hydration and rest: To manage fatigue and gastrointestinal symptoms.

• Routine monitoring: Follow-up imaging and tumor markers like CEA (Carcinoembryonic Antigen).

• Managing long-term effects: Medications and physiotherapy if needed.

Patients are usually able to resume light daily activities during or soon after treatment.

Cost and Availability

Radiotherapy is available at major cancer hospitals and tertiary medical centers across the globe. In countries like India and China, radiotherapy is affordable and widely accessible.

In India

• Public hospitals (Tata Memorial, AIIMS) offer subsidized treatments.

• Private hospitals (Apollo, Fortis) offer advanced technologies like IMRT and SBRT.

• Cost may be covered under Ayushman Bharat or private insurance.

In China

• National cancer centers in Beijing, Guangzhou, and Shanghai offer state-of-the-art radiotherapy facilities.

• Local government programs provide financial support to eligible patients.

Patient Experiences

Many patients undergoing colon cancer radiotherapy describe the experience as manageable, especially compared to chemotherapy. Most complete their daily sessions without severe issues. Palliative radiotherapy provides significant relief in advanced stages.

Patients often share:

• Relief from pain and bleeding within 1-2 weeks of starting radiation.

• Tolerable side effects with good supportive care.

• Confidence in the technology and care provided by major cancer centers.

Cost in Countries Like China, India, Israel, Malaysia, Korea, Thailand, Turkey and USA

Note: Prices vary based on radiation type (IMRT, SBRT), hospital, and treatment length.

List of Ongoing Clinical Trials in China

China is actively involved in improving radiotherapy techniques and integrating them with chemotherapy and immunotherapy. Current trials include:

1. IMRT with concurrent chemotherapy for locally advanced colon cancer.

2. SBRT for liver metastases from colon cancer.

3. Neoadjuvant radiochemotherapy protocols combining Capecitabine and radiation.

4. Combination of radiotherapy and immunotherapy for advanced or unresectable cases.

5. Radiogenomics studies to personalize radiation based on genetic biomarkers.

6. IORT vs EBRT trials for recurrent colon cancer.

Key institutions include:

• Fudan University Cancer Center

• Sun Yat-sen University Cancer Center

• Peking University Cancer Hospital

FAQ

Is radiotherapy commonly used for colon cancer?
Not routinely. It’s mainly used in specific cases where surgery is not feasible or as palliation.

What is the success rate of colon cancer radiotherapy?
Success varies based on the cancer stage and combination with other therapies but is effective for symptom control and tumor shrinkage.

How long is colon cancer radiation therapy?
Typically, 5 to 6 weeks of daily (Monday to Friday) sessions.

Can radiotherapy replace surgery?
No, surgery is the mainstay. Radiotherapy is used when surgery isn’t possible or for additional support.

Is radiation therapy painful?
No. The process itself is painless, although it can cause mild to moderate side effects.

Can I eat normally during radiation treatment?
Yes, but a low-fiber, low-residue diet is usually recommended.

Is radiation safe for elderly patients?
Yes, especially newer techniques like IMRT and SBRT are safer and better tolerated.

Can I travel during radiation treatment?
Short travel is fine, but regular hospital visits will be required for several weeks.