Radiation Oncology Top Page

HOW TO MAKE THE DECISION

The decision whether or not to receive radiotherapy is a question that you, the patient, will decide. This decision is made just as any other decision for medical care, such as an operation. It should be made with knowledge of expected benefits and possible side effects. Obviously, the input of your physicians is essential in this. Especially important is the input of the Radiation Oncologist, since he is the only specialist specifically trained to know what radiation can accomplish and what its side effects might be.

Radiation Oncologists are physicians who have four years of postgraduate medical training (after medical school). Additionally, study in radiation equipment, biology, and physics is required. Their residency is the only residency program that studies only cancer and tumor treatment.

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: treatment schedules are made on an individual basis. Each patient's disease, stage, and clinical condition is considered. This is combined with the data from years of experience with x-ray treatment as documented in many medical studies. The Radiation Oncologist is the only specialist who is trained and has the experience to determine the correct treatment schedule. 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.

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 informed of this decision and how it will affect you.

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 physicians' 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.

HOW LONG DOES THE TREATMENT 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.

The total dose of radiation and the number of treatments you need will depend on 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. In fact, on 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 some x-rays or other tests to pinpoint the location and size of the cancer. 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 is used with simulation for exact tumor localization (CT planning).

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.

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

After you have started 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, and it's very important that you adhere to the schedule to obtain the optimum benefit.

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 changes or fine tuned.

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.

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. 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 needed.

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

The Therapist will move to a nearby room before turning on the machine. From there, 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 Radiation Therapist through a speaker between the rooms.

The machines used for radiation treatments are very large, and they may make noises as they move around to aim at the cancer from different angles. Their size and motion may be frightening at first. Remember that the machines are under the Therapist's control and that they 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 Radiation 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 that you feel comfortable with.

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 are given below. 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. Above all, feel free to ask your Radiation Oncologist any questions you may have. He is the only one who can properly advise you about your treatment side effects, at-home care, and any other concerns you may have.

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 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.