What You Can Expect
Before Treatment
Consultation
During your initial visit with a radiation oncologist, the doctor will evaluate your need for radiation therapy and its likely results. This includes reviewing your current medical problems, medical and surgical histories, 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.
After reviewing your medical tests, including any CT scans, MRI scans and/or positron emission tomography scans (PET scans) you may have had, 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 radiation oncology direct the beams of radiation safely and exactly to their intended locations is called simulation.
During simulation, you will be placed on the CT simulator in the exact position you will be in during the actual treatment. Your radiation therapist will mark the area to be treated directly on your skin or on immobilization devices. The latter 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 radiation from hitting normal tissue. The treatment machines at Samaritan Regional Medical Center 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 other medical tests to develop a 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
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 for a number of days each week and may 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 about five to 20 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 oncology 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.
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 oncology team may gather on a regular basis with other health care professionals to review your case to ensure your treatment is proceeding as planned.
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.
Above information presented in collaboration with
the American Society for Therapeutic Radiology And Oncology
(ASTRO).
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