Be informed about benefits & side effects.

When radiation therapy is recommended as part of your treatment, there are many factors to consider. It’s important that you are fully informed about the benefits, side effects and consequences of the decision you make as to whether or not to receive radiotherapy.

How to Make the Decision

The decision as to whether or not to receive radiation therapy (also known as radiotherapy) is one that you, the patient, makes. When this course of treatment is recommended, you gain the input of a Radiation Oncologist as part of your treatment team, in addition to your physician’s input. Consulting with both these experts in your health care is essential to making a well-informed decision.

What is a Radiation Oncologist?

Your primary care physician will refer you to a cancer specialist — a Radiation Oncologist — who can prescribe the type and amount of treatment that best suits your needs.

Radiation Oncologists are specialized.

Radiation Oncologists are the only medical specialists specifically trained to know what radiation can accomplish and what its side effects might be. These physicians have four years of postgraduate medical training (after medical school). Additionally, study in radiation equipment, biology and physics is required. Radiation Oncology residency is the only residency program that studies only cancer and tumor treatment.

What is Radiation Therapy?

Radiation at high levels — ten thousands of times the amount used, for instance, to produce a chest X-ray — destroys the ability of cells to grow and divide. Both normal and diseased cells are affected, but most normal cells are able to recover quickly.

Radiation is an effective tool in cancer treatment.

By carefully aiming and timing the high-energy rays, Radiation Oncologists use radiation as an effective tool in cancer treatment. Fifty-five to 60 percent of all people with cancer are treated with it at some point. For many patients, radiotherapy is the only kind of therapy utilized to destroy the cancer.

What are the benefits of Radiation Therapy?

Radiation Oncologists use radiation to treat cancer in almost every part of the body. Sometimes radiation is used before surgery to shrink a cancerous tumor. After surgery, it may be used to stop the growth of any cancer cells that remain.

Radiation can be used instead of surgery.

In some cases, doctors prefer to use radiation and anti-cancer drugs, rather than surgery, to destroy a cancerous growth and prevent its reappearance.

Radiation is used to shrink tumors.

In cases of advanced disease, when a cure of the cancer is not likely, treatment with radiation can still bring a large measure of relief. Many patients find the quality of their lives improved when radiotherapy is used to shrink tumors and reduce pressure, bleeding, pain or other symptoms.

Are there risks involved?

As with any other treatment for disease, there are risks with radiation. Radiotherapy uses relatively high doses of radiation to destroy cells. The risk of destroying some healthy cells (that is, the risk of side effects), however, is usually outweighed by the benefits of killing cancer cells.

Your Radiation Oncologist will advise you.

Your Radiation Oncologist will not advise any treatment unless the benefits you expect — such as control of disease and relief from symptoms — exceed the known risks.

Is the treatment schedule flexible?

Treatment schedules are made on an individual basis, in consideration of each patient's disease, stage and clinical condition, combined with the data from years of experience with X-ray treatment as documented in many medical studies.

The treatment schedule needs to be followed.

Once the decision has been made to pursue a course of radiation therapy, it is imperative that the treatment schedule prescribed by the Radiation Oncologist be followed. The Radiation Oncologist is the only specialist trained and experienced in determining the correct treatment schedule.

Breaks in schedule will be determined by the Radiation Oncologist.

Decisions concerning possible breaks in the schedule should be based on your consultation with the Radiation Oncologist. No other specialist can assume responsibility for what will happen to your body if the treatment schedule is interrupted, especially when the treatments are given with curative intent.

The Radiation Oncologist decides the outcome of treatment interruption.

Sometimes it becomes necessary to interrupt your treatment — either because of a medical problem, a social problem or a technical problem (machine maintenance, etc.). When these situations occur, the Radiation Oncologist will decide what is to be done about your treatment schedule. You will be advised of this decision and how it will affect you.

How long does a course of radiation therapy take?

Radiation treatment is usually given 5 days a week for several weeks. This schedule helps to protect healthy body tissues by spreading out the total dose of radiation and giving weekend rest breaks in which normal cells can rebuild.

Highly individual factors determine treatment.

The total dose of radiation and the number of treatments you need will depend upon a set of highly individual factors. Your Radiation Oncologist must consider the size and location of your cancer, your general health and any other treatment you’re having.

The Radiation Oncologist thoroughly reviews the clinical situation.

In fact, during your first Radiation Oncology visit, you most likely won't have a treatment because your Radiation Oncologist must spend a significant amount of time reviewing your clinical situation and formulating a treatment plan.

How does the radiation oncologist choose the best treatment?

After talking to you about your medical history, the Radiation Oncologist may need X-rays or other tests to pinpoint the location and size of the cancer.

A simulation process is used for exact tumor localization.

In a process called “simulation” (a major step in planning your treatment), you will be asked to lie very still on a table while a therapist uses a special machine to X-ray the cancer and locate your “treatment port.” This is the exact place on your body where the high-energy rays will be aimed. Simulation may take from a half-hour to about 2 hours. Often, CT (computed tomography) is used with simulation for exact tumor localization (CT planning).

Indelible ink is used to mark the treatment area.

After locating the treatment port, the Therapist will mark your skin with indelible ink to define the treatment area. The ink marks must not be washed off until instructed. At some point, tiny permanent dots will replace the ink marks.

The Radiation Oncologist consults with his/her team.

Using the knowledge gained from the simulation and your medical background, your Radiation Oncologist may consult with a Radiation Physicist or Dosimetrist, who will assist the physician in implementing his treatment plan and dosage.

The treatment progress is closely monitored.

After starting the treatments, your Radiation Oncologist will watch over your progress and monitor your overall well-being. Your Radiation Oncologist may revise the treatment plan as needed. It's very important that you adhere to the schedule to obtain the optimum benefit.

More than one simulation may be needed.

It is often necessary to perform more than one simulation during the course of treatment. The Radiation Oncologist may prescribe a “boost” or reduction of your radiation area at some point. If so, another set of marks will need to be drawn on your skin in the simulator. A second simulation is sometimes required after the first if the CT planning requires that the treatment ports be changed or fine-tuned.

The Radiation Oncologist needs to know of any other existing medical conditions.

Many patients who are being treated with radiation therapy have other medical problems unrelated to their cancer. Radiotherapy does, however, have some effects on certain medical conditions and is affected by some drugs. Therefore, it is important not only that you continue following your primary care physician's advice, but also that the Radiation Oncologist knows of your medical conditions and the drugs that you are taking. If any changes need to be made, the Radiation Oncologist will consult with you and your primary care physician concerning these.

What happens during a treatment visit?

Before your treatment is given, you may need to change into a hospital gown. It's best to wear clothing that is easily removed.

The ink marks help with placement beneath the treatment machine.

In the treatment room, the Radiation Therapist will use the ink marks on your skin to help you get in place on the table or in a chair. You will lie or sit very still beneath the treatment machine.

External sessions last about 15 minutes each.

For each external session, you will be in the treatment room about 15 minutes, but you will be getting a dose of radiation for only 1 to 5 minutes of that time. The 120 computer-controlled metal leaves will protect the normal tissues and organs. There might also be plastic or plaster forms to help you stay exactly in place. You will need to remain very still during the treatment so that the radiation is delivered only to the area where it is needed.

X-ray images are taken on the first day.

On the first day and periodically, X-ray images will be taken in the treatment room. These are only used to check your position.

The Therapist monitors the patient in a nearby room.

The Therapist will move to a nearby room before turning on the machine. From there, he/she can control the machine and watch and hear you on TV and intercom. You may feel very much alone for the next few minutes. Keep in mind that your treatment is constantly monitored, however, and that you can talk with the Therapist through a speaker between the rooms.

Radiation machines are large and may make noises.

The machines used for radiation treatments are very large and may make noises as they move around to aim at the cancer from different angles. Their size and motion may be frightening at first.

Ask the Therapist any questions you might have.

Remember that the machines are under the Therapist’s control and are constantly checked to be sure they’re working properly. If you are confused or frightened by anything that happens in the treatment room, ask the Therapist to explain.

You will not see, hear or feel the radiation. You should not have any discomfort. If you feel ill or very uncomfortable during the treatments, call the Therapist at once.

What are the effects of treatment?

Your Radiation Oncologist will check you periodically. Your own reports of how you feel may be the best sign of the therapy's progress. You may not be aware of changes in your cancer, but you will be able to notice any decrease of pain, bleeding or other discomforts you may have had.

Occasionally, your Radiation Oncologist may recommend some tests to be sure that the radiation is causing as little damage to normal cells as possible. For instance, you may have more blood tests to check the level of white blood cells and platelets.

Most side effects that occur during radiotherapy, although unpleasant, are not serious. They usually disappear within a few weeks after treatment ends. Some radiotherapy side effects are more lasting. Many patients have no side effects at all.

Do the side effects limit activity?

Many patients are able to work, keep house and enjoy leisure activities as usual while they are having radiation therapy. Others find that they need more rest and therefore cannot do as much. In general, it's best to pursue the normal activities with which you feel comfortable.

There is no need to avoid being with other people because of external radiation. Your body will not contain any radioactive substance, so you are not a hazard to others — even in intimate contact.

Your desire for physical intimacy may be lower because radiation therapy may cause some fatigue. Treatment to organs in the pelvic area may require limitations in sexual activities. In most cases, though, you may have sexual relations if you wish.

Your Radiation Oncologist may suggest that you limit any activities, such as sports, that might irritate the area being treated.

What can I do to take care of myself?

Nearly all cancer patients having radiotherapy need to take a few extra measures to protect their overall health and help the treatment succeed. Some guidelines to remember:

• Ask your Radiation Oncologist any questions you may have. Your Radiation Oncologist can properly advise you about your treatment side effects, at-home care and any other concerns you may have.
• Be sure to get plenty of rest. Sleep as often as you feel the need. Your body will use a lot of extra energy over the course of treatment.
• Good nutrition is a must. Try to maintain a balanced diet that will prevent weight loss.
• Do not remove the ink marks from your skin until instructed by the Therapist. If the lines marking the treatment area begin to fade, tell the Therapist at your next treatment visit. Do not draw over faded lines at home.
• Avoid wearing tight clothing, such as girdles or close-fitting collars, over the treatment area. Since some of the ink marks may rub off on your clothes, it's best to wear loose, soft, older garments that will feel good and that you can discard if they get stained.
• Be sure your Radiation Oncologist knows about any prescribed medications.
• Be extra kind to the skin in your treatment area.
• Wear soft cotton clothing
• Do not rub or scrub treated skin
• Do not use any medications, ointments, perfumes, cosmetics or other substances in the treated area.
• Do not apply extreme heat or cold (heating pad, ice pack, etc.) to the treatment area. Even hot water can injure your sensitive skin, so use only lukewarm water for bathing.
• Use an electric shaver if you must shave the area.
• Protect the area from the sun. Cover the treated skin with light clothing before going outdoors; otherwise, use a PABA sunscreen (protection factor 30) or a sun-blocking product. This should be continued after treatments are completed.

How is the therapy given?

You might have radiation therapy in one or both of its forms: external and internal.

Most people having radiation for cancer have the external type, given during outpatient visits to the hospital. In external therapy, a machine directs the high-energy rays to the cancer and some of the tissue around it.

The various machines that direct radiation to the cancer (the Oldelft superficial unit, Varian linear accelerators, etc.) work in slightly different ways. Some are better for treating cancer near the skin surface; others work best on cancers deeper in the body.

For most patients having internal therapy, a small capsule of radioactive material (implant) is placed inside a body cavity or directly into the cancer (such as with the Nucletron High Dose Rate Unit).

Are treatments expensive?

Treatment of cancer with radiation can be costly. It involves very complex equipment as well as the services of many health care professionals. The exact cost of radiation therapy varies, of course, with the type and number of treatments required. The hospital and the physicians bill separately for their respective services.

Most health insurance policies, including Part B of Medicare, cover charges for radiation therapy. You will need to discuss your policy and expected costs with the doctor's business manager and/or the hospital business office.

The Medicaid program may help you pay for therapy. Contact the office that handles social services in your city or county to find out if you are eligible for Medicaid and whether Radiation Oncology treatment is a covered expense.

If you need financial aid, contact LMC's Social Services Department, the Cancer Information Service or the local office of the American Cancer Society. They may be able to direct you to sources of help. Also, the LMC Business Office can work with you to set up a payment plan for the hospital charges, if needed.

How will I know if the treatments worked?

After completion of treatments, you will be monitored with X-rays and/or lab tests periodically. Generally, tests are performed more than a month after you finish treatment and periodically thereafter. The Radiation Oncologist and your other physicians will review the test results to determine the cancer's response to your treatment. If you were treated with the intent of relieving symptoms such as pain, physical improvement will be the best indication that the treatments worked.

You will return for follow-up visits to discuss these results and to check your overall well-being.