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When a doctor says “radiation” for the first time, most people picture something crude and dangerous. In fact modern radiotherapy is one of the most calculated fields in medicine: a large part of the work happens not in the treatment room but in a computer, where physicists spend a week working out how to deliver the dose to the tumour without touching the neighbouring organs. Here is how it is organised in Munich, and why radiation is used for more than cancer.
What radiotherapy actually does
Radiation damages the DNA of cells. Tumour cells divide more actively and repair such damage less well than healthy ones — and the whole method rests on that difference. It is also the reason the course is split up: the dose is given in small portions so that healthy tissue has time to recover between sessions.
Radiotherapy is used in different ways. Sometimes it is the main treatment — in certain tumours of the head and neck or of the prostate, for instance, where irradiation competes with surgery. Sometimes it comes before an operation, to shrink the tumour, or after it, to lower the risk of the disease returning. A separate and very practical task is the relief of pain from bone metastases: here the course is often short and the effect is noticeable within a few weeks.
How the plan is prepared
Before the first session a planning CT is done, sometimes together with MRI or PET. On the images the doctor outlines by hand both the tumour and every organ that must be spared. The medical physicist then calculates from which directions and at what intensity the beams are to be delivered. That is precisely what lies behind the abbreviations you will see in the documents: IMRT — intensity-modulated radiotherapy, where the shape and strength of the beam change during the session itself; IGRT — image guidance, where the position of the target is checked with an image before every session, because organs shift with breathing and with the filling of the bowel.
This works as a team, and that is not a figure of speech. The plan is calculated by a medical physicist, the session is in the hands of a radiology and radiotherapy technologist (MTRA), every step is approved by the radiation oncologist, and the indications and the timing are agreed by the tumour board together with surgeons and oncologists. In Munich a typical arrangement is one in which an outpatient radiotherapy practice works in the same building as a partner hospital: the patient is irradiated as an outpatient but can be admitted if needed. The radiotherapy practice in Pasing at the Helios Klinikum München West is organised in exactly this way.
Radiation for benign conditions
This field is almost unknown in Russia, while in Germany it is ordinary practice with a guideline of its own: the German Society for Radiation Oncology (DEGRO) issues a separate recommendation on the irradiation of benign diseases, the latest version dating from 2022. The doses involved are tens of times lower than those used against tumours.
Best studied is the heel spur and the associated inflammation of the plantar fascia: here the method has the highest level of evidence on the German scale. It is also used for painful arthrosis of the large joints, inflammation of the tendons of the shoulder and elbow, Ledderhose disease, prevention of bone overgrowth after joint replacement, and keloid scars. The logic is the same as in oncology — the anti-inflammatory and analgesic effect of low doses. An important caveat: such treatment often relieves pain for a long time, but it does not undo the wear of the joint itself.
What to ask before starting
The sensible questions are simple. What is the aim of the course — to cure, to complement an operation, or to relieve a symptom. How many sessions and why exactly that many: in recent years many regimens have become shorter for the same task. Which organs fall within the irradiated area and what side effects to expect — early ones (tiredness, irritation of the skin and mucous membranes) and late ones. What will happen to the teeth if the head and neck region is irradiated: dental treatment is planned before the course begins, not after. And who looks after you between sessions.
This material is for information only and does not replace a consultation with a doctor. The indications for radiotherapy, the regimen and the result can be determined only after an examination at the clinic in person.