Radiation therapy uses high-energy rays to kill cancer cells. It damages their DNA, stopping them from growing or spreading. We aim the radiation at the tumor while protecting nearby healthy cells.

Radiation can be the only treatment your child needs. Other times, we use it before or after surgery or chemotherapy. Sometimes, your care team will suggest radiation if your child isn’t able to have surgery to remove a tumor.

We give radiation in different ways, depending on where the tumor is, how big it is and what kind of cancer your child has. We will explain how radiation fits into your child’s cancer care plan and what your options are.

We can give radiation treatments in one of two ways. Your child’s doctor will choose the best type of based on their needs.

External radiation is when a large machine points high-energy beams at the tumor or over the entire body. Radiation therapy is not painful but can destroy cancer cells.

Types of external radiation we use include:

• Proton beam: A newer, extremely precise type of external radiation. It causes less damage to healthy tissues.
• 3-D conformal: Uses a digital 3-D image of the child's brain to target the tumor.
• Gamma Knife: Advanced radiation technology that uses more than 200 focused beams for very precise treatment.
• Image-guided: Uses many imaging tools together to locate the tumor precisely. It improves the accuracy of the treatment.
• Intensity-modulated: Uses many computer-controlled beams of varying intensity. It gives a higher and more precise dose while protecting healthy brain tissue.

Internal radiation is when we put a radioactive substance near the cancer. We also call this brachytherapy. It lets us deliver strong radiation directly to the tumor site.

Your child can get radiation treatments by:

• Swallowing it as a pill or liquid medicine
• Injecting it into the tumor
• Implanting it into the tumor
• Attaching it to the tumor

For instance, for retinoblastoma, we sew a tiny metal disc (called a plaque) onto the white part of the eye near the tumor. It holds radioactive seeds that emit strong radiation.

When children have this type of internal radiation, they may give off small amounts of radiation during the treatment. To keep others safe during this time, there are some precautions to follow.

For short treatments of internal radiation, you may stay in the hospital, limit visitors and use protective shielding. For longer treatments, your child may need to avoid hugging or sitting close to others for long periods and maintain a safe distance during the active period.

Children’s Wisconsin always puts safety first. The care team will guide you through everything, answer questions and make sure your child and family understand what to expect.

Depending on several factors, including the diagnosis, radiation may be a part of your child’s treatment plan. Your care team will talk with you about your options and what to expect for each step of your child’s journey.

We use radiation therapy to:

• Shrink a tumor before surgery
• Kill leftover cancer cells after surgery
• Treat cancer that we can’t take out with surgery
• Help relieve pain or pressure caused by tumors
• Lower the chance that cancer comes back

Your child’s care team will explain all the options. We’ll talk with you about the risks and benefits and help you make the best decision.

Before starting, we plan the radiation by taking CT or MRI scans. These scans help us aim the radiation safely and accurately.

Most radiation treatments happen daily, Monday through Friday, for a few weeks. Each session takes only a few minutes and the treatment itself doesn’t hurt.

The radiation must go exactly where it needs to and not on healthy tissues. We sometimes use equipment to hold your child in place. These are immobilization devices. For young children who can't stay still, we partner with our pediatric anesthesiologists to provide sedation for daily treatments.

They’re custom-made for each child, soft where they touch the skin and they don’t hurt. The mask or mold might look a little strange, but it doesn’t hurt. Your child can see, hear and breathe the whole time.

Depending on where the cancer is, we may use:

• Thermoplastic face mask: A soft plastic mask that we shape to your child’s face and head. It hardens as it cools and keeps the head still. We use this for brain tumors or cancers in the head and neck.
• Body mold or cradle: A mold that fits around the body like a soft shell, helping the child stay still during treatment to the chest, belly or limbs.
• Vacuum cushions: These are like soft beanbags that harden slightly around the body to create a snug, comfy fit.
• Braces or bite blocks: Sometimes, we use a mouthpiece to keep the mouth or jaw in the right position.

Making the device is usually fast and done on your first visit. The team will explain everything and go slowly to make sure your child feels safe. Some kids decorate their masks to make them less scary. Ask your radiation care team if your child can paint it or add stickers.

Your child may get radiation:

• In a special treatment room at our cancer center
• As an inpatient, in rare cases
• With anesthesia or sedation, if they need help staying still

We’ll tell you what to expect at each step and how to prepare.

Radiation side effects depend on what body part we’re treating and the type of radiation used. Many side effects go away after treatment ends.

Before receiving radiation, your child may take some tests to establish the pre-treatment state. These tests may check their heart, kidneys, lungs, eyes, ears and reproductive organs.

Common side effects during radiation treatment include:

• Tiredness: Your child may feel more tired than usual, especially later in treatment.
• Skin changes: The skin where we give radiation might get red, dry or sore. We give special creams to help.
• Hair loss: Radiation can cause hair loss in the treated area. It is usually temporary.
• Appetite changes: Some children eat less during treatment. We help with snacks, drinks and support from nutritionists.
• Headaches: If the radiation is near the brain or head, your child may get headaches. We can give medicine to help with the pain and work with your child to track when and why the headaches happen.
• Coughing: Radiation near the chest or lungs may cause coughing or a dry throat. This can be annoying or tiring. We can offer fluids, lozenges and medicine to ease the symptoms.
• Nausea: Some children feel sick to their stomach during or after treatment, especially if the radiation is near the belly. We give anti-nausea medicine to help and suggest foods that are easier to eat.

Sometimes, late side effects can affect organ function months to years after your child completes treatment. Some treatments may affect fertility. If that’s possible, you’ll meet with our Fertility Preservation Clinic to discuss your child’s options.

Let us know if your child has any new symptoms. We’re here to help.