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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.
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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.
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.
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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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