Podcast with Dr. Orit Gotfeld – Radiation Therapy in Oncology: When and Why It Is Used

Dr. Orit Gotfeld:
I almost always see the same reaction.
When a person hears the word “radiation”, there’s an immediate inner tension.

Sometimes you can see it right away.
Sometimes it appears later, through the questions they ask.

Many imagine something painful, heavy, almost destructive to the body.
So the first thing I always say, calmly and honestly, is this: the radiation procedure itself is not painful.

During the session, the patient doesn’t feel anything.
No pain, no burning, no sensations at the moment of radiation.
It’s very similar to an MRI: the patient lies still, there is some noise around, and after a few minutes it’s over.

What can be challenging are the side effects — and those depend on many factors: the area being treated, the dose, and how a particular person’s body reacts.

And this is where generalizations don’t work.
For one patient, treatment may barely affect daily life.
For another, fatigue, skin reactions, or other symptoms may appear — and we prepare for that in advance.

It’s important to me that patients understand we don’t “start treatment and see what happens.”
We discuss possible effects ahead of time, explain what is considered normal, and what should prompt a call to the doctor.

In most cases, side effects can be managed and adjusted.

Very often, patients tell me during treatment: “I expected it to be much harder”.
That’s probably the most common sentence I hear after the first few weeks.

Dr. Orit Gotfeld:
This is one of the most common — and most logical — questions.

Patients often think: “If the tumor can be removed, why do anything else”?

And it’s important to say clearly: radiation therapy is never given “just in case”.
It always has a specific purpose.

Sometimes we use radiation before surgery — to shrink the tumor and make the procedure more precise or less traumatic.
In other situations, it’s used after surgery, to reduce the risk of the disease returning in the same area.

There are also cases where radiation therapy becomes the primary treatment, without surgery at all.

It depends on the tumor type, its location, and how we can achieve the best result with the least risk for the patient.

I often tell patients: surgery and radiation therapy are not competitors.
They are tools that can complement each other.

Sometimes only one is needed.
Sometimes a combination.
And the decision is always based on the individual situation — not on a template.

These decisions are also not made alone.
They usually involve a team — surgeons, oncologists, radiologists.
The goal is to choose a path that is both effective and appropriate for that specific person.

Dr. Orit Gotfeld:
Formally, yes — there are different types.
But I always pause here, because this is the moment when many patients start to feel lost.

People hear terms like “external beam radiation,” “stereotactic,” “focused,” and feel they need to understand all of it.
In reality, patients don’t need to know the names. What matters is understanding the logic.

Put simply, the idea is always the same:
to deliver the radiation dose as precisely as possible to the tumor, while sparing healthy tissues around it.

Technically, this can be done in different ways.
Details depend on tumor location, size, and how nearby organs move.

Sometimes one method fits better, sometimes another.

I often tell patients: you don’t need to choose a “type” of radiation therapy yourself.
This isn’t an exam and there’s no single correct answer.

Our job is to select the approach that is most precise and safest for your situation.
All those terms are simply tools used within the professional team.

Dr. Orit Gotfeld:
These are two different treatment methods with different mechanisms.

Chemotherapy affects the entire body. Radiation therapy is local — it targets a specific area.

That’s why side effects are different as well.

It’s impossible to say that one method is “easier” or “harder”. Everything depends on the clinical situation and treatment goals.

It’s also important to note that in some cases treatments are combined,
and patients receive radiation alongside systemic therapy, such as chemotherapy or immunotherapy.

Dr. Orit Gotfeld:
The changes have been very significant. Modern radiation therapy is highly precise medicine.

We use advanced planning systems, imaging, and patient positioning control.
All of this increases treatment effectiveness and reduces the risk of side effects.

For example, today we often perform simulation — treatment planning — using MRI.
This allows us to reduce unnecessary radiation exposure to healthy tissues during treatment.

This is extremely important, and not every center in the world has this capability.

Dr. Orit Gotfeld:
Before treatment begins, there is a planning phase. It includes imaging, dose calculation, and equipment setup.

This planning usually takes from a few days up to a week.
Based on this plan, the entire treatment course is delivered.

At this stage, we aim for precision — so there are no doubts about the treatment area or radiation dose.

The treatment sessions themselves are usually short and take place several times a week.
After each session, patients can return to their normal daily activities.

Dr. Orit Gotfeld:
I’ll start a bit earlier, because this is where confusion often arises.

Many imagine that treatment starts immediately — you arrive and are “irradiated.”
That’s not how it works.

There is a planning phase beforehand, and it’s essential.
We perform imaging, calculate doses, and tailor everything to the individual patient.

This isn’t a formality — it’s the foundation for accurate and safe treatment.

Sometimes patients are surprised that this stage takes time and ask: “Why can’t we start sooner” ?
But this is exactly where treatment quality is determined.

The sessions themselves are usually short.
And at some point, people say: “I expected this to look completely different”.

Dr. Orit Gotfeld:
There is no “roughly the same” here.
And I always emphasize that from the start.

Even with the same diagnosis, treatment can look very different between patients.
We consider anatomy, tumor location, comorbidities, and previous treatments.

Sometimes patients say: “My acquaintance had it done differently”.
And that’s normal — because situations are rarely identical.

My task isn’t to follow a scheme, but to understand which option is most appropriate and safest for a particular person.

Dr. Orit Gotfeld:
Effectiveness is evaluated through imaging, clinical follow-up, and symptom dynamics.

It’s important to understand that the effect of radiation therapy often develops gradually, not immediately.
In some cases, the result becomes visible only a few months after treatment is completed.

Dr. Orit Gotfeld:
This question comes up often, and it’s important to answer it accurately.

Radiation therapy itself is always performed in public hospitals.
The same machines are used, following the same medical protocols, and treatment quality does not differ.

The difference lies in the consultation and support stages.

In private clinics, patients seek consultations to better understand recommendations, explore alternatives, or plan next steps before treatment begins.

Dr. Orit Gotfeld:
A second opinion makes sense whenever a patient has doubts or unanswered questions.

Sometimes it confirms the original plan.
Sometimes it helps explore alternatives.

The most important thing is that the patient feels confident in the decisions being made.