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Prior clarification of the extent of the tumor is necessary for effective and at the same time gentle use of radiation treatment. This information is often discussed between the various specialists at tumor conferences before the initiation of targeted cancer therapy. The best therapy concept for each individual patient is determined and offered to the patient and, if desired, to relatives or friends in a detailed information session. The advantages and disadvantages of the various sensible treatments are explained in detail. For us, this joint, open discussion is one of the most important steps in the treatment decision. Wishes, concerns and questions on all topics relating to cancer treatment can be discussed, including complementary medical measures. Questions can be asked at any time, even after treatment has begun.

Discussion and determination of the best individual therapy concept among the specialists of the treatment centers for medical oncology, surgical oncology and radiation oncology as well as all diagnostic disciplines.

Radiotherapy is involved in the recovery of around 55 percent of cancer patients. It can be carried out alone or in combination with surgery, chemotherapy or hormone therapy. Radiation therapy is so effective because the rays penetrate the tumor region in a targeted manner. Structures of the cancer cell that are particularly sensitive to radiation are the cell nucleus with the control center (DNA) and the cell's power plants (mitochondria). Many of the tumor cells cannot repair the changes caused by radiation. If the individual cells are switched off, the tumor can no longer survive. This is successful in a large number of cases in which radiotherapy is used.

Contact with the radiotherapy staff usually begins with a detailed information and consultation in the outpatient clinic or during a consultation on the ward. Depending on the optimal sequence of the oncological therapy, the planning of radiotherapy begins immediately or after the end of the drug-based cancer therapy.

In order to ensure that the therapy is well tolerated, it is planned and carried out with the utmost care. In addition, the radiation dose is usually divided into small portions over several approx. 15-minute sessions. This avoids unnecessarily high exposure of healthy tissue.

First, the patient is positioned in a CT scanner. Here, positioning aids specially produced for radiation treatment are used (head shells, mask systems, body shells, etc.).

We distinguish between early, acute side effects and late, persistent or newly occurring changes weeks to years after completion of radiotherapy. We inform our patients in detail about the individual risk of developing such side effects. In principle, however, most of the acute adverse effects of radiotherapy subside quickly and serious, chronic side effects are rare nowadays.

General symptoms:

Slight tiredness, slight loss of appetite and somewhat limited performance.

Side effects of radiation in the head area:

Hair loss; rarely headaches or pressure, concentration problems; reddening of the scalp.

Side effects of radiation to the neck region:

Irritation of the mucous membranes of the oral cavity, pharynx and larynx with difficulty swallowing, pain and hoarseness; dry mouth; temporary changes in taste up to loss of taste; temporary reddening of the skin and dryness of the skin; hair loss in the beard area; increased tendency to caries and periodontal disease.

Side effects of radiation in the chest area:

Reddening of the skin and itching; temporary swelling of the chest; temporary difficulty swallowing similar to heartburn and mild coughing irritation.

Side effects of radiation in the abdominal and pelvic area:

Nausea, malaise and vomiting; changes in bowel movements up to and including diarrhea; mild abdominal cramps; frequent urination and burning when urinating.
The side effects mentioned are usually temporary and generally subside spontaneously without further treatment within a few weeks. If more severe side effects occur, individually tailored supportive treatment is given (special skin care; medication against nausea, vomiting or diarrhea; painkillers; additional nutrition such as an "astronaut diet").

During radiotherapy, you should continue with your usual lifestyle. Physical activity is permitted and even encouraged. It protects you and helps to combat therapy-related fatigue.

You may wash yourself with clean water and mild medical soaps or shampoos. However, please ensure that the markings on the skin are not washed off. Unfortunately, saunas, baths or swimming are not permitted during radiotherapy, but can usually be resumed a few days after the end of radiotherapy. Please let us know if you would like to go swimming during your radiotherapy. We can also apply small tattoos instead of skin markings. These usually disappear completely within three months.

Please eat a balanced diet. You should eat a varied diet with several small meals a day. You should reduce high-fat and highly sweetened foods as much as possible. Eat plenty of vegetables, potatoes and little acidic fruit. Bananas, pears and melons, for example, make sense and are usually well tolerated. Tasty and carefully prepared meals are recommended. You should avoid carbonated or very acidic drinks if you are having radiation treatment to the head, neck or chest region. The addition of vitamins, minerals and trace elements (e.g. selenium, iron, iodine, zinc) is permitted, but is not necessary with a balanced diet and is not recommended by us.

If you experience any side effects from radiotherapy, please inform your team immediately. You will be advised on supportive therapy, including medication in some cases. This will be prescribed by us accordingly and carried out together with nutritional advice.

If you are exposed to radiation in the mouth, throat or larynx, the mucous membranes will become irritated. In addition, the flow of saliva decreases and saliva becomes viscous. Dry mouth means that viruses, bacteria and fungi have a greater chance of infecting the oral mucosa, further exacerbating the irritation.

This makes eating more difficult and can cause severe pain, making chewing and swallowing almost impossible. To alleviate this discomfort, we have the following recommendations for you.

We have the following tips for dry mouth:

• Make sure you always have a bottle of non-carbonated water with you to moisten your mouth regularly.
• Avoid chamomile tea, which dries out even more.
• Chewing stimulates the flow of saliva, so chew your food well.
• Sucking mild sugar-free sweets can stimulate salivation.
• Make sure you drink enough during the meal and use sauces (cream sauce, brown sauce or mild apple sauce).

If you have thick saliva, we have the following tips:

• Drink plenty of water or other mild drinks.
• Avoid sticky, very sweet foods.
• Rinse your mouth with lukewarm fennel, sage or peppermint tea.

We have the following tips for chewing and swallowing difficulties:

• Eat small portions several times a day.
• Avoid hard and dry foods such as bread and meat. Instead, eat minced meat, eggs, fish, soft cheese, pasta, mashed potatoes, boiled or steamed vegetables and lots of sauce because of the calories.
• Do not eat spicy, sour or hot dishes, as they could be painful.
• Instead of citrus fruits, eat ripe and soft fruits, e.g. bananas, pears, melons, strawberries.
• Drink enough fluids in the form of water, tea, yogurt and soup.
• Also try cold drinks and desserts to relieve pain, e.g. cold milk, syrup, drinks with ice cream, mild ice cream, quark, pudding, cream desserts, crèpes and pancakes.
• Avoid alcoholic drinks and fruit juices. You can drink some beer (especially malt beer).

Dietary tips:

• Eat a balanced and varied diet.
• Remember to eat fruit and vegetables to get all the necessary nutrients such as vitamins, minerals and trace elements.
• Eat light meat dishes and fish to get enough protein and carbohydrates.
• You should lose as little weight as possible during the radiotherapy period so that you can recover quickly after the treatment.

Tips on oral hygiene:

• Keep your mouth clean to minimize the risk of infection or inflammation in the mouth area.

If you have your own teeth:

• Brush your teeth regularly after every meal with a soft toothbrush; use a mild toothpaste.
• Rinse your mouth regularly with water or mild teas.

If you have dentures:

• Please discuss the use of dentures with the doctor in charge at the radiation oncology department. It is often only allowed to be used for eating, as otherwise it can cause pressure points in the inflamed oral mucosa.
• Clean your denture with a toothbrush after every meal.

Contact your radiotherapy treatment team so that we can prescribe additional solutions for mouth rinsing and high-calorie liquid food if required. We will also clarify the cost coverage of these measures with your health insurance company.

We have the following tips for skin care:

• You may wash the skin in the irradiated area. Please use mild soaps or shampoos for this purpose. The use of bathtubs, whirlpools or bathing facilities is not permitted during radiation treatment until approx. 2 weeks after the end of treatment. Your doctor will give you further recommendations at the end of the radiation treatment.
• No special skin care is required. If you have previously used an oily cream on your skin, you can continue to use it. Please show the product you are using to the doctor. When caring for your skin, please ensure that the markings are preserved. If you experience severe skin irritation, you will be prescribed specific skin care by your doctor.

We have the following tips for pain and difficulty swallowing:

• Eat a balanced and varied diet.
• Remember to eat fruit and vegetables to get all the necessary nutrients such as vitamins, minerals and trace elements.
• Eat light meat dishes and fish to get enough protein and carbohydrates.
• Eat small portions several times a day.
• Avoid hard and dry foods such as bread and meat. Instead, opt for minced meat, eggs, fish, soft cheese, pasta, mashed potatoes, boiled or steamed vegetables and lots of sauce because of the calories.
• Do not eat spicy, sour or hot dishes, as they could be painful.
• Instead of citrus fruits, eat ripe and soft fruits, e.g. bananas, pears, melons, strawberries.
• Drink enough fluids in the form of water, tea, yogurt and soup.
• Avoid sticky, very sweet foods.
• Please avoid any intake of alcohol.
• Also try cold drinks and desserts to relieve pain, e.g. cold milk, syrup, drinks with ice cream, mild ice cream, quark, pudding, cream desserts, crèpes and pancakes.
• Avoid alcoholic drinks and fruit juices. You may drink some beer (especially malt beer).
• If you can no longer eat well because of the pain or for other reasons, also inform your doctor. If necessary, he will prescribe liquid food ("astronaut food") so that you do not lose any more weight. We will also clarify the cost coverage of these measures with your health insurance company.
• Should any further difficulties arise, please inform your treatment team immediately. You will receive immediate and adequate support, including additional medication if necessary.

The principles outlined above will help you to tolerate the radiation treatment as well as possible. The doctor treating you will help you if you inform him or her of your difficulties.

We are confident that we will be able to support you well during the radiation treatment and that you will recover quickly from the temporary side effects of the treatment.

1. You may wash the skin in the irradiated area. Please use mild soaps or shampoos for this purpose. The use of bathtubs, whirlpools or bathing facilities is not permitted during radiation treatment until approx. 2 weeks after the end of treatment. Your doctor will give you precise recommendations at the end of the radiation treatment.
2. No special skin care is required. If you have previously used an oily cream on your skin, you can continue to use it. Please show the product you are using to the doctor. When caring for your skin, please ensure that the markings are preserved. If you experience severe skin irritation, your doctor will prescribe specific skin care.
3. If you experience pain or difficulty swallowing, please inform your doctor immediately so that he or she can prescribe appropriate painkillers.
4. If you are no longer able to eat well due to pain or for other reasons, please also inform your doctor. If necessary, he will prescribe liquid food ("astronaut food") so that you do not lose any more weight.
5. If you experience any further difficulties, please inform your treatment team immediately. You will receive immediate and adequate support, including additional medication if necessary.

The principles outlined above will help you to tolerate the radiation treatment as well as possible. The doctor treating you will help you if you inform him or her of your difficulties.

As it is particularly important for the best possible treatment of your illness that the therapy is carried out on time, we ask for your cooperation. Delays or interruptions that are not planned could impair the success of your treatment.

We are confident that we will be able to provide you with good support during the radiation treatment and that you will recover quickly from the temporary side effects of the treatment.

If you are irradiated in the abdominal or pelvic area - for example in the case of prostate or uterine cancer - you may experience intestinal irritation. You may experience flatulence, diarrhea and mucus or a small amount of blood in the stool. You may feel a strong and sudden urge to defecate. To avoid or at least alleviate these unpleasant symptoms, we have put together the following recommendations for you.

Recommendations for patients who have no side effects from radiotherapy:

• Eat several small portions a day, this is less stressful for the bowel.
• Take your time when eating.
• Drink 1.5 to 2 liters a day (e.g. water, iced tea, tea, yoghurt, soup, some beer or wine are permitted).
• Eat boiled or steamed vegetables and fruit regularly.

If you suffer from flatulence, you should avoid or reduce the following foods:

• Onions, cabbage (such as red cabbage, Brussels sprouts, etc.), leeks, peppers, asparagus, beans, peas and carbonated drinks.

If you have intestinal irritation with a strong urge to defecate and diarrhea, you should avoid or reduce the following foods:

• Strong black coffee (espresso), fruit juices, strong alcoholic drinks, hot spices (such as sambal oelek, pepper, paprika, curry), grapes, nuts, seeds, Bircher muesli, coarse wholemeal bread.

There are numerous known factors that can cause loss of appetite, bloating and nausea. Please let us know if you have or experience such symptoms. We will investigate the causes and offer you a suitable therapy. Below we give you some advice that may already bring you an improvement.

We have the following tips for loss of appetite or a rapid feeling of fullness:

• Eat when you feel like it.
• Eat what you like or what you enjoy.
• Eat smaller meals several times a day.
• Eat a varied diet.
• Let someone cook for you.
• Prepare your meals in an appetizing way.
• Try to eat high-calorie snacks between meals.
• Try to exercise to stimulate your appetite.
• As a rule, you can also eat small sweet foods or drink small amounts of alcohol to stimulate your appetite.

We have the following tips for nausea:

• Nibble on dry crispbread or cookies first thing in the morning.
• Prefer cold foods.
• Avoid strong food odors.
• Let others cook for you.
• Ventilate the kitchen and dining room.
• Breathing calmly with the window open can have a beneficial effect.
• Drink peppermint tea after a meal.
• Avoid large quantities of carbonated drinks, nicotine and alcohol.