What to Expect
Before
Treatment
Consultation
If you are considering radiation
therapy, you must first schedule a visit with a radiation oncologist
to see if radiation therapy is right for you. During your initial
visit, the doctor will evaluate your need for radiation therapy
and its likely results. This includes reviewing your current medical
problems, past medical history, past surgical history, family history,
medications, allergies and lifestyle. The doctor will also perform
a physical examination to assess the extent of your disease and
judge your general physical condition. Depending on where your radiation
oncologist practices, you may also be seen by a medical student,
a resident (radiation oncologist in training), a nurse practitioner,
a physician assistant or a nurse.
After reviewing your medical
tests, including CT scans, MR scans and positron emission tomography
scans (PET scans) and completing a thorough examination, your radiation
oncologist will fully discuss with you the potential benefits and
risks of radiation therapy and answer your questions.
Simulation and Treatment
Planning
To be most effective, radiation
therapy must be aimed precisely at the same target or targets each
and every time treatment is given. The process of measuring your
anatomy and marking your skin to help your team direct the beams
of radiation safely and exactly to their intended locations is called
simulation.
During simulation, your radiation
oncologist and radiation therapist place you on the simulation machine
in the exact position you will be in during the actual treatment.
Your radiation therapist, under your doctor's supervision, then
marks the area to be treated directly on your skin or on immobilization
devices.
Immobilization devices are
molds, casts, headrests or other devices that are constructed and
placed on a certain part of your body to help you remain in the
same position during the entire treatment. The radiation therapist
marks your skin and/or the immobilization devices either with a
bright, temporary paint or a set of small permanent tattoos.
Your radiation oncologist
may request that special blocks or shields be made for you. These
blocks or shields are put in the external beam therapy machine before
each of your treatments and are used to shape the radiation to your
tumor and keep the rays from hitting normal tissue. Some treatment
machines have built-in blocks or shutters called multileaf collimators,
which also help shape the radiation.
Although simulation is typically
only one session, your physician may schedule additional sessions
depending on the type of cancer you have and the type of radiation
therapy that is being used.
After simulation, your radiation oncologist
and other members of the treatment team review the information they
obtained during simulation along with your previous medical tests
to develop a treatment plan. Often, a special treatment planning
CT scan is done to help with the simulation and treatment planning.
This CT scan is in addition to your diagnostic CT scan. Frequently,
sophisticated treatment-planning computer software is used to help
design the best possible treatment plan. After reviewing all of
this information, your doctor writes a prescription that outlines
the exact course of your radiation therapy treatment.
During
Treatment
Treatment Administration
External
beam radiation therapy is administered differently from brachytherapy.
You may receive one or both of these treatments. The following sections
describe what you may experience during treatment administration.
External
Beam Radiation Therapy Treatments
When you undergo external
beam radiation therapy treatment, each session is painless, like
getting an X-ray. The radiation is directed to your tumor from a
machine located outside of your body. One of the benefits of radiation
therapy is that it is usually given as a series of outpatient treatments
and you may not need to miss work or experience the type of recuperation
period that can follow other treatments.
Treatments are usually scheduled
five days a week, every day except Saturday and Sunday, and continue
for three to 10 weeks. Some patients receive hyperfractionated radiation
therapy, in which radiation treatments are given more than once
a day. Other times, only one or a few treatments are required, such
as for the treatment of cancer that has spread to the bone. This
is called hypofractionated radiation therapy. The number of radiation
treatments you will need depends on the size, location and type
of cancer you have, your general health and other medical treatments
you may be receiving.
The radiation therapist will
administer your external beam treatment following your radiation
oncologist's instructions. It will take roughly five to 15 minutes
for you to be positioned for treatment and for the equipment to
be set up. If an immobilization device was made during simulation,
it will be used during every treatment to make sure that you are
in the exact same position every day.
Once you are positioned correctly,
the therapist will leave the room and go into an adjoining control
room to closely monitor you on a television screen while administering
the radiation. There is a microphone in the treatment room so you
can always talk with the therapist if you have any concerns. The
machine can be stopped at any time if you are feeling ill or uncomfortable.
The radiation therapist may move the
treatment machine and treatment table to target the radiation beam
to the exact area of the tumor. The machine might make noises during
treatment that sound like clicking or whirring. These noises are
nothing to be afraid of, and the radiation therapist is in complete
control of the machine at all times.
The radiation therapy team
carefully aims the radiation to decrease the dose to the normal
tissues surrounding the tumor. Still, radiation will affect some
healthy cells. The time in between daily treatments allows your
healthy cells to repair much of the radiation damage. Most patients
are treated on an outpatient basis, and many can continue with normal
daily activities.
Sometimes a course of treatment
is interrupted for a day or more. This may happen if you develop
side effects that require a break in treatment. These missed treatments
may be made up by adding treatments at the end. Try to arrive on
time and not miss any of your appointments.
Your radiation oncologist
monitors your daily treatment and may alter your radiation dose
based on these observations. Also, your doctor may order blood tests,
X-ray examinations and other tests to see how your body is responding
to treatment. If the tumor shrinks, another simulation may be done.
This allows your radiation oncologist to change the treatment to
destroy the rest of the tumor and spare even more normal tissue.
Brachytherapy
Treatments
Brachytherapy, also called
internal radiation or seed implants, is the placement of radioactive
sources in or just next to a tumor. The radioactive sources may
be left in place permanently or only temporarily, depending upon
your cancer. To position the sources accurately, special catheters
or applicators are used.
There are two main types
of brachytherapy: intracavity treatment and interstitial treatment.
With intracavity treatment, the radioactive sources are put into
a space near where the tumor is located, such as the cervix, the
vagina or the windpipe. With interstitial treatment, the radioactive
sources are put directly into the tissues, such as the prostate.
Often these procedures
require anesthesia and brief hospitalization. Patients with permanent
implants may have a few restrictions at first and then can quickly
return to their normal activities. Temporary implants are left inside
of your body for several hours or days. While the sources are in
place, you will stay in a private room. Doctors, nurses and other
medical staff will continue to take care of you, but they will need
to take special precautions to limit their exposure to radiation.
Devices called high dose
rate remote afterloading machines allow radiation oncologists to
complete brachytherapy quickly, in about 10 to 20 minutes. Powerful
radioactive sources travel through small tubes called catheters
to the tumor for the amount of time prescribed by your radiation
oncologist. You may be able to go home shortly after the procedure.
Depending on the area treated, you may receive several treatments
over a number of days or weeks.
Most patients feel little discomfort during brachytherapy. If the
radioactive source is held in place with an applicator, you may
feel discomfort from the applicator. There are medications that
can help this. If you feel weak or queasy from the anesthesia, your
radiation oncologist can give you medication to make you feel better.
Weekly Status Checks
During radiation therapy,
your radiation oncologist and nurse will see you regularly to follow
your progress, evaluate whether you are having any side effects,
recommend treatments for those side effects (such as medication
or diet changes) and address any concerns you may have. As treatment
progresses, your doctor may make changes in the schedule or treatment
plan depending on your response or reaction to the therapy.
Your radiation therapy
team may gather on a regular basis with other healthcare professionals
to review your case to ensure your treatment is proceeding as planned.
During this session, all the members of the team discuss your progress
as well as any concerns.
Daily or Weekly Beam
Films
During treatment, your treatment team
will routinely use the treatment machines to take special X-rays
called beam or port films. Your treatment team routinely reviews
these films to be sure that the treatment beams remain precisely
aimed at the proper target. These X-rays are not used to evaluate
your tumor.
After
Treatment
Follow-Up
After treatment is completed,
follow-up appointments will be scheduled so that your radiation
oncologist can make sure your recovery is proceeding normally and
can continue to monitor your health status. Your radiation oncologist
may also order additional diagnostic tests. Reports on your treatment
can be sent to your other doctors.
As time goes on, the frequency
of your visits will decrease. However, you should know that your
radiation oncology team will always be available should you need
to speak to someone about your treatment.
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