What to Expect Before, During and After Radiation Therapy?
Before receiving radiation therapy
Typically you will be seen by a radiation oncologist to make sure radiation therapy is appropriate for your case. Usually you will be referred to the radiation oncologist by a medical oncologist or surgeon.
How is radiation therapy planned for me?
A radiation oncologist develops a patient’s treatment plan through a process called treatment planning, which begins with a procedure called a simulation.
During simulation, detailed imaging scans show the location of the area to be treated and the normal areas around it. These scans are usually computed tomography (CT) scans, but they can also include magnetic resonance imaging (MRI), positron emission tomography (PET), and ultrasound scans.
The staff working with the radiation oncologist (including physicists and dosimetrists) use sophisticated computers to design the details of the exact radiation plan that will be used. After reviewing and approving the plan, the radiation oncologist authorizes the start of treatment. On the first day of treatment, and regularly after that, many checks are made to ensure that the treatments are being delivered exactly the way they were planned.
The type of radiation therapy prescribed by a radiation oncologist depends on many factors, including:
The type of cancer.
The size of the cancer.
The cancer’s location in the body.
How close the cancer is to normal tissues that are sensitive to radiation.
How far into the body the radiation needs to travel.
The patient’s age, general health and medical history.
Whether the patient will have other types of cancer treatment.
What else does the doctor consider?
Each time radiation therapy is given there needs to be a balance between destroying the cancer cells and minimizing damage to the normal cells. Radiation can damage some types of normal tissue more easily than others. For example, the gastrointestinal tract is more sensitive to radiation than bones. The radiation oncologist takes all of this information into account during treatment planning.
If an area of the body has previously been treated with radiation therapy, a patient may not be able to have radiation therapy to that area a second time, depending on how much radiation was delivered during the initial treatment. If one area of the body has already received the maximum safe lifetime dose of radiation, another area might still be treated with radiation therapy if the distance between the two areas is large enough.
The area selected for treatment usually includes the whole tumor plus a small amount of normal tissue surrounding the tumor.
The normal tissue is treated for two main reasons:
To take into account body movement from breathing and normal movement of the organs within the body, which can change the location of a tumor between treatments.
To reduce the likelihood of tumor recurrence from cancer cells that have spread to the normal tissue next to the tumor (called microscopic local spread).
Why does the doctor sometimes adjust the treatment plan?
During the several weeks of radiation therapy, a tumor may shrink and your body weight may change. This might require a new treatment plan be developed to account for these changes.
What is a CT Simulation?
CT (Computed Tomography Scanner) scans are often used in treatment planning for radiation therapy. During CT scanning, pictures of the inside of the body are created by a computer linked to an x-ray machine.
During simulation and daily treatments, it is necessary to ensure that you will be in exactly the same position every day relative to the machine delivering the treatment. Body molds, head masks, or other devices may be constructed uniquely for you, to make it easier for you to stay still. The mask helps keep your head from moving so that you are in the exact same position for each treatment. Temporary skin marks and even very small tattoos (permanent marks) are sometimes used to help with precise patient positioning.
How long does a CT Simulation (also called marking appointment) take?
Please allow approximately one hour for the first CT Simulation. During the simulation you may have to stay in one position for an extended period of time without moving.
If you need pain medication, please take it before you arrive so that the medication will be in effect while you are on the table. This is true for regular treatment appointments as well. Bring additional medication if needed for “breakthrough” pain.
What happens after the CT Simulation?
After simulation, the radiation oncologist then determines the exact area that will be treated, the total radiation dose that will be delivered to the tumor, how much dose will be allowed for the normal tissues around the tumor, and the safest angles (paths) for radiation delivery. Before you leave from your CT scan, you will be given an appointment date and time to return to begin your treatments.
When do I see my doctor?
The doctor has a designated day to see his patients each week. The therapists will let you know which day, so that you can be seen before or after your treatment. Family members or friends may join you if you wish. Your regular weekly visit is the best time to ask for refills on your medications if needed. Please note that narcotics or pain medicine may require a new prescription each time a refill is needed. This process may require a minimum of 24 hours as the nurse will need to speak with your physician first and obtain a written prescription. Please notify your nurse as soon as possible if refills are needed. The weekly visit day may change if the doctor is off or otherwise not available on the scheduled day. The staff will keep you informed of any changes. There is some flexibility in seeing your doctor, as he is often available more than once a week. Please let the nurse or therapist know if you are having any problems and they can advise you on what to do, or have you see the doctor. A doctor is always available for emergencies.
How do I plan a doctor visit?
Typical treatment hours for most radiation therapy facility are Monday-Friday, 8:00am-4:30 pm.
How many days do I come for treatment?
Five days per week, unless otherwise noted by your physician.
How long does each treatment take?
As a rule, when receive conventional radiation therapy with photon (X-ray), the first actual treatment takes 30-40 minutes. This amount of time is necessary to verify that the treatment setup matches the treatment plan precisely. After that, each visit is generally about 10-15 minutes. The actual time the machine is turned on is generally less than 5 minutes. Proton therapy can range from 15 to 45 minutes for your entire treatment visit.
How to schedule appointments?
You will need to speak with the radiation therapists at the time of your CT simulation to discuss daily scheduling or to discuss any changes in scheduling. These are the people who will treat you daily and can handle any scheduling issues.
How long will I be in the department each day?
Plan to be here about 30 minutes to one hour each day. This will allow for some time to change into patient gowns and seeing the doctor (one day each week). When emergencies or unforeseen delays occur, you may need to be here longer, and you will be informed by a staff member.
What to expect during treatment?
Same as CT Simulation, temporary skin marks and even very small tattoos are used to help with precise patient positioning. If you are going to get radiation to the head, a mask may be needed. The mask helps keep the head from moving so that the patient is in the exact same position for each treatment.
The actual radiation delivery is painless and typically lasts about 2-5 minutes. You will be required to lie completely still during the treatment, however if you are uncomfortable please inform the radiation therapist. They will try to make you as comfortable as possible without jeopardizing the accuracy of your treatment. You will be alone in the room while you are receiving the radiation, but the radiation therapist can see you on a video monitor and can hear you through an intercom.
Treatments are usually given five days a week with weekends off for a duration of two to seven weeks. In most cases, you will be treated the same time every day. Occasionally, scheduling conflicts arise and your appointment time may have to be changed or delayed. Regularly through the course of treatment, the radiation therapist will verify your positioning with X-rays or CAT scans they take while you are on the treatment table. Based on the results of this imaging, the physician may make adjustments. This is to be expected because as patients become more comfortable with therapy they tend to relax which can alter their skin marks.
What happens if I miss a treatment?
You should always try and keep your appointments, as the radiation is more effective if there are no breaks in the treatment schedule. However, if you cannot come in, please call the front desk, the nurse, or the radiation therapists as soon as you can. If you need to come in for an unscheduled visit, please call us first. This helps the radiation oncology team plan for you and may shorten your waiting time. If you are sick, your nurse can assess the situation quickly to help you receive the care that you need. If you cannot come in for personal reasons, your therapist can cancel your appointment for that day, notify your physician and let you know if you will need to see your physician when you come to the clinic for your next appointment. Any missed treatment will be given at the end of your treatment so you receive the fully prescribed dose.