What is radiotherapy?

In simple terms, radiotherapy means treatment with ionizing rays; obtained from different sources. External radiation is delivered mainly by linear accelerators (high-energy x-rays). Brachytherapy (internal radiation) is obtained from radioactive substances placed inside or against the tumour area. To understand how ionizing rays work, you must understand how cancer cells affect your body.

Cancer starts with one cell that has lost control over its growth. Normal cells divide in a highly controlled manner to form new cells. However, cancer cells also divide and form new cells, but at a more rapid rate. In addition, cancer cells do not know when to stop dividing – they continue dividing and multiplying until they have displaced or damaged the affected body tissue or organ.

The rapidly multiplying cancer cells do not grow within an enclosing capsule, with some cells breaking away where they are carried to the next organ by the lymph system or bloodstream, where they multiply further. This is called metastasis.

The goal of radiation therapy is to effectively damage and ultimately destroy the cancer cells, however, the rays are unable to distinguish between normal and malignant cells.

The success of irradiation lies in the fact that malignant cells are more sensitive to irradiation than normal cells. The goal of irradiation is, therefore, to irradiate until the malignant cells have been terminated or sterilised. The surrounding normal tissue is, however, still capable of complete recovery.

Radiation at ABJ

All our practices boast state of the art equipment which includes six different accelerators between four of our practices (ABJ Benoni, ABJ Klerksdorp, ABJ Vereeniging, ABJ Wilgers).

Since all our machines have multi-leaf collimators, these make shielding effortless, and the time between planning and treatment is reduced dramatically. As such, treatment can begin immediately.

Every unit has a dedicated 3D treatment planning system with experienced treatment planning radiographers. This makes the planning-to-treatment stage hands-on and far more efficient. Interaction with the prescribing oncologist is also face-to-face. Setup difficulties and problems are easily resolved as the planning radiographers are involved with the first treatment setup.

International prescribing and dose determination norms are used for all treatments and radiographers are regularly sent to local and international conferences to remain up to date with new developments. The knowledge and expertise of radiation physicists are available at all our oncology units.

Intensity Modulated Radiation Therapy (IMRT) is also available at all units. This is one of the latest innovations in radiotherapy. The dose is administered with dynamic multi leaves, which means the leaves slide open or closed throughout the treatment. This makes it possible to get a better dose distribution to the tumour and a lower dose to the surrounding organs.

Brachytherapy, especially for prostate seed implants, is available at all our oncology units. Our holistic approach in every department makes the patient’s journey through the treatment process much easier since all healthcare professionals are close at hand.

To ensure synergistic and holistic care, that provides for our patients’ optimal wellbeing we offer dietitian and social worker services at no cost.  In this way, all treatments are aligned and therefore more effective.

1How many radiotherapy treatments are needed?
In certain phases of division, cells are more sensitive than in other, dormant phases. To irradiate as many of the cells as possible in the sensitive phase, the treatments are fractioned; in other words, they are spread out over a defined period.

Another reason for fractionation is to give the normal cells, which recover faster than malignant cells, a chance to recuperate. It is for this reason that you do not receive only one treatment. The sensitivity of the various types of tissue and organs differ, therefore the number of treatments for different diagnoses will inevitably also differ. The number of treatments prescribed bears no relation to the degree to which the cancer has advanced.

If you are to receive thirty treatments and another person only five, please do not assume that your prognosis is worse than theirs. The dose administered, the number of treatments and the specific diagnosis is very closely linked. It is important to understand that because irradiation is used differently for diverse conditions, it is not wise to compare treatments, symptoms or side effects.

Irradiation treatments are only administered during the week and may be interrupted for a day whilst the machine is repaired.

We strive to make our patients’ treatment journey as seamless and stress-free as possible. With this said, accommodation is available for patients needing to receive chemo- or radiotherapy and who live far from our treatment centres. However, such accommodation is only available from Monday to Friday at the ABJ Wilgers, ABJ Benoni, ABJ Vereeniging and ABJ Klerksdorp consulting rooms. Transport to the respective consulting rooms can be also arranged.
2How is radiation administered?
Because the radiation passes through normal tissue to reach the affected area, the side effects need to be limited as far as possible. To ensure this, a CT scan is done, which is then transferred to a dedicated Treatment Planning System (TPS). On the TPS, a 3D image of the treatment area is created using the CT slices. The oncologist delineates the tumour on this 3D image. MRI images where soft tissue tumours are better shown can also be used in conjunction with CT images. The 3D image is used to plan the treatment with multi-field combinations with different angles and energies, to ensure that the dose to the normal tissue and sensitive organs is limited while an optimal dose to the tumour is achieved. The combined dose of the fields where they intersect gives the optimal dose required. The different tissue densities which the beam is travelling through, are also considered since they have different absorption properties.

To limit the dose to critical organs and normal tissue in the beam path, shielding is used to shape the radiation beam. Modern technology allows for this to be done easily with multi-leaf collimators (MLC) instead of lead shielding blocks which are time-consuming and labour intensive. To achieve optimum treatment planning, highly skilled and experienced planning radiographers, physicists and a specialised TPS is essential.

To ensure that the treatment is administered correctly, recording and verification systems are essential. This will prevent treatment from being given unless all parameters are correctly setup. The system also records treatment data for future reference. Anatomical verification is also required to ensure that the correct treatment position is used. This is done with a portal imager or the use of verification films.
Simulation and marking of the area

The area to be irradiated is determined using a localising scan or x-rays and then marked. This is called a simulation.

PLEASE BRING ALONG ANY PREVIOUS X-RAYS OR SCANS that may be of use. Sometimes the treatment area is decreased during the therapies. This is called a booster.

IT IS VERY IMPORTANT TO REMEMBER that the marks that have been made on your body remain there.You may bath or shower, but you must make sure that these marks are not washed off. A quick bath or shower is preferable. If you do take a bath, do not soak in the water and be sure to use a gentle soap, such as Dove.


  • You need to visit the oncologist once a week during irradiation.
  • Please arrange these appointments with the oncologist's receptionist in good time once you have received your irradiation dates.
  • Please get your irradiation file from the radiotherapists on the day on which you are to visit the oncologist and return the file to the radiotherapists after your appointment with the oncologist.
  • When a simulation/booster is done, please bring along all your scans and x-rays so that the position of the irradiation area can be determined.
  • To change radiotherapy appointments, please phone the relevant radiotherapy receptionist without delay.

YOU MAY BATH OR SHOWER, but you must make sure that these marks are not washed off. A quick bath or shower is preferable. If you do take a bath, do not soak in the water. Use a gentle soap, for example, Dove soap.

Irradiation is not painful, and patients are not radioactive after irradiation; therefore, you pose no threat to other people.

During irradiation, you will be alone in the treatment room, but you will be monitored on a television screen. There is also an intercom system.

It is extremely important that you keep very still, but you may breathe normally.

Side effects of Irradiation

It is only natural to be concerned about the side effects of irradiation, especially as there are so many misconceptions about this treatment.

However, if you have a clear understanding of what may happen, we can help you to avoid unnecessary anxiety and fear.

The following information aims to give you peace of mind.

1Nausea and Vomiting
Only patients who receive irradiation over their abdominal organs will sometimes experience nausea and vomiting. If you find that this is a problem, please ask your oncologist for a prescription for medication.

If the symptoms continue despite the medication, inform your oncologist immediately so that other medication may be prescribed.

It is extremely important that you take your medication as prescribed to prevent nausea, and not only when you feel nauseous.

It is also important that you continue to eat enough. If you start losing weight or find that you are no longer eating regularly, consult our dietician immediately.
Patients who receive irradiation over the lower abdominal area may suffer from diarrhoea, constipation, a burning sensation when urinating and / or piles. Please ask for medication immediately if you suffer from any of these ailments.

It is also important to ask the radiotherapists whether your bladder should be full or empty during irradiation.
3Mouth & Throat problems
Patients receiving irradiation over the throat area will start suffering from a sore throat after about ten treatments. Gargling with a solution of half a teaspoon of bicarbonate of soda mixed with half a teaspoon of salt, in a glass of lukewarm water will alleviate this. There will also be dryness of the mouth due to the irradiation affecting the salivary glands, and it is possible that this condition may be permanent. You may also experience a temporary loss of speech, but speech will return in time. You might also find that you develop a double chin after irradiation.

Men who are receiving irradiation over the face must not shave the treatment area, as it will cause skin irritation.

It is important that you drink a lot of fluids.If you experience problems with your diet due to a sore throat or mouth, please consult our in-house dietician who is on-hand to assist you every step of the way.
If you have three or four loose stools a day, you should drink clear fluids (soup, soft drinks, tea and about two litres of water per day). Also, consult your general practitioner or oncologist immediately as it is important to prevent your body from dehydrating.

Eat a lot of bananas, carrots (cooked) and grated apple (without the skin). Our dietician can compile a special diet for you to help combat the diarrhoea, and it may be advisable to take one or more nutritional supplements which can be prescribed by the dietician. You may also take medication for the diarrhoea, so we urge you to ask the nursing staff to assist you with this.
5Skin reactions
CAUTION: Please do not use any ointment, powder or deodorant spray on the irradiation area as these will make any skin irritation worse. We recommend that you use a roll-on deodorant (like Dove). If the skin feels tender, you may use aqueous, water-soluble cream. If necessary, your doctor will prescribe a special topical cream.

Do not expose the treatment area to direct sunlight and be sure to wear a hat and suitable clothing in the sun. If a skin reaction is to be expected, the oncologist or radiotherapist will tell you. Although, a reddening of the skin will become visible after about fifteen treatments.
6Hair Loss (Alopecia)
Your hair will only fall out if you receive irradiation over the scalp. Irradiation of other parts of the body will not cause hair loss on the head. Your hair may only start falling out after about fifteen treatments, and in most cases will start growing again after about three months
7White blood cells
White blood cells are the body's protective mechanism against infections. The white blood cell count of patients receiving irradiation over large areas of bone may decrease; therefore, regular blood counts will be taken if you are such a patient. When smaller areas of the body are irradiated, the loss of white blood cells is so small that regular blood counts are not necessary.
What to expect during treatment

First Visit: Simulation and Marking of the Treatment area

  • During your first visit, a CT scan could be done for computerised simulation purposes. Your doctor will then use the CT images to reconstruct a 3D model and to plan the radiation treatment. The area to be irradiated is determined by means of a localising scan or X-rays and then marked. This is called a simulation.
  • It is possible that some reference marks will be made on your body and the radiographer will inform you if you need to preserve these or if you can wash them off.
  • Special equipment may be used to immobilise your body in the same position every day. It is very important that the marks that have been made on your body remain there.

Irradiation is not painful, and patients are not radioactive after irradiation; therefore, you pose no threat to other people.

During irradiation, you will be alone in the treatment room, but you will be monitored on a television screen. There is also an intercom system.

It is extremely important that you keep very still, but you may breathe normally.

Diet & nutrition during treatment

Nutrition plays a vital role in your treatment regimen, and as such a health, balanced diet will help you deal with some of the side effects far better. The dietician can assist you with a diet plan and vitamin supplements specifically for your type of cancer and treatment.

Try to take in a lot of fluids. In some cases, it will be necessary to take nutritional supplements, which can be prescribed by the dietician.

If you get very tired, the dietician can also assist you with supplements or review your diet. An analysis of your diet to determine which nutrients it lacks is essential.

Whilst you may feel tired, you will still be able to perform most of your normal tasks. Try to maintain your normal activities as far as possible.


1How often do you need radiotherapy?
Several weekly treatment sessions are typical for radiation therapy, which is typically administered over several weeks. The precise number of radiation therapy sessions needed might vary significantly, but most treatment plans call for between 10 and 30 sessions. Typically, daily, thus, five treatments per week (Monday- Friday). The number of radiation therapy sessions needed will depend on the number of treatments prescribed by the treating oncologist.
2How long does a typical radiotherapy treatment last?
Even though each treatment session only lasts 10-30 mins, the setup and preparation can extend the duration of the appointment.
3How long is the radiotherapy recovery period?
After completing treatment, the immediate side effects of the treatment will subside two weeks after completion of treatment. Some individuals may still have longer-lasting side effects like exhaustion or changes in their skin after finishing treatment.