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Frequently Asked Questions about Radiation Therapy
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How Does Radiation Work
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Radiation therapy, sometimes called radiotherapy, is the use of various forms of radiation to safely and effectively treat cancer and other diseases. Doctors use radiation therapy to control the growth of the cancer or to relieve symptoms, such as pain.
Radiation therapy works by damaging the DNA within cancer cells and destroying the ability of the cancer cells to reproduce. When these damaged cells die, the body naturally eliminates them. Normal cells are also affected by radiation, but they are able to repair themselves in a way that cancer cells cannot.
While you undergo radiation therapy, a team of highly trained medical professionals will be working together to make sure you receive the best care possible. A radiation oncologist, a doctor who specializes in using radiation to treat cancer, leads this team.
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Brachytherapy Treatments
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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. At our center we offer temporary placement, also called HDR (High Dose Rate) To position the sources accurately, special catheters or applicators are used. Because the radiation sources are placed so close to the tumor, your doctors can deliver a large dose of radiation directly to the cancer cells with minimal exposure to normal tissue.
The radioactive sources used in brachytherapy, such as thin wires, ribbons, capsules or seeds, come in small sealed containers. Some sources are placed permanently and are referred to as implants. These radioactive sources remain in the body after their radiation has been expended and the source is no longer radioactive. Other sources are placed temporarily inside the body, and the radioactive sources are removed after the prescribed dose of radiation has been delivered.
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 a lumpectomy site (MammoSite), the vaginal vault or the windpipe or the prostate. With interstitial treatment, the radioactive sources are put directly into the tissues. This is occasionally used in 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 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.
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| How to Care For Yourself During Cancer Treatment |
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Get plenty of rest. Many patients experience fatigue during radiation therapy, so it is important to make sure you are well rested.
Eat a balanced, nutritious diet. A nutritionist, nurse or physician may work with you to ensure you are receiving the right calories, vitamins and minerals from the foods you eat and that you are eating the proper type of foods. With certain types of treatment, it may be necessary to modify your diet to minimize side effects. You should not attempt to lose weight during radiation therapy, since you require more calories due to your cancer and treatment.
Treat the skin that is exposed to radiation with extra care. The skin in the area receiving treatment may become red and sensitive. Your radiation oncology nurse will review specific instructions for caring for your skin with you. Some guidelines include:
- Cleanse the skin daily with warm water and a mild soap recommended by your nurse.
- Avoid using any lotions, perfumes, deodorants or powders in the treatment area unless approved by your doctor or nurse. Try not to use products containing alcohol and perfumes.
- Avoid putting anything hot or cold on the treated skin. This includes heating pads and ice packs.
- Protect the treated area from the sun by using a sunscreen with an SPF of at least 15. If possible, avoid exposing the treated area to the sun altogether.
Seek out emotional support. There are many emotional demands that you must cope with during your cancer diagnosis and treatment. It is common to feel anxious, depressed, afraid or hopeless. At times, it may help to talk about your feelings with a close friend, family member, nurse, social worker or psychologist. To find a support group in your area, ask your radiation oncology nurse.
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External Beam Radiation Therapy, What to Expect During Radiation Therapy
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Before Cancer Treatment
Radiation Therapy 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.
After reviewing your medical tests, including CT scans, MRI 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.
CT 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 CT simulation, your radiation oncologist and radiation therapist place you on the CT table 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.
Custom Immobilization devices such as masks, cradles and cushions 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. The treatment machine has built-in blocks or shutters called multileaf collimators (MLC’s) which also help shape the radiation. The MLC’s can also be designed to move during your treatment creating a field fluence and these are used for complex IMRT and IGRT treatments.
After CT simulation, your radiation oncologist and other members of the treatment team review the information they obtained during the simulation along with your previous medical tests to develop a treatment plan. 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.
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. You may not need to miss work or experience the type of recuperation period that can follow other treatments.
Treatments are available five days a week, every day except Saturday and Sunday. Treatments typically occur over a three-to ten-week period. 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. With the exception of the first day, it will take roughly five to 15 minutes for you to be positioned for treatment and for the equipment to be set up. On the first day films will be taken to verify the placement of the treatment fields. These can vary from x-ray films to complex CT slices to show the location of the treatment. The physicist may also ask for special measurements to be done during the first treatment. 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 each time.
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 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 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 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.
Treatment Field Imaging
During treatment, your treatment team will routinely use the treatment machines to take special X-rays and/or CT slices. Your treatment team routinely reviews these images to be sure that the treatment beams remain precisely aimed at the proper target. These images 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.
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Questions to Ask Your Doctor About Radiation Therapy
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It is important that you fully understand the potential benefits, side effects and goals of radiation therapy. Your radiation oncologist, radiation oncology nurses and therapists are available to answer any questions you may have during treatment. They are the best source of accurate information about your particular case.
Coping with a diagnosis of cancer and researching the various treatment options can be a stressful experience. To assist you in this process, below is a list of questions you may want to ask your radiation oncologist if you are considering radiation therapy.
- What type and stage of cancer do I have?
- What is the purpose of radiation treatment for my type of cancer?
- How will the radiation therapy be administered? Will it be external beam or brachytherapy? Will the treatments hurt?
- For how many weeks will I receive radiation? How many treatments will I receive per week?
- What are the chances that radiation therapy will work?
- What is the chance that the cancer will spread or come back if I do not have radiation therapy?
- Will I need chemotherapy, surgery or other treatments? If so, in what order will I receive these treatments, and how soon after radiation therapy can I start them?
- How can I expect to feel during treatment and in the weeks following radiation therapy?
- Can I drive myself to and from the treatment facility?
- Will I be able to continue my normal activities?
- What side effects may occur from the radiation and how are they managed?
- Will radiation therapy affect my sex life or my ability to have children?
- Do I need to take any special precautions, like staying out of the sun or avoiding people with infectious diseases?
- Do I need a special diet during or after my treatment?
- Can I exercise?
- Will side effects change my appearance? If so, will the changes be permanent or temporary? If temporary, how long will they last?
- How often do I need to return for checkups?
- How and when will you know if I am cured of cancer?
- What are the chances that the cancer will come back?
- How soon can I go back to my regular activities? Work? Sexual activity? Aerobic exercise?
- Do you take my insurance?
- How should I prepare for this financially?
- What are some of the support groups I can turn to during treatment?
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| Managing Radiation Therapy Side Effects |
Patients often experience little or no side effects from the radiation therapy and are able to continue their normal routines. However, some patients do feel some discomfort from the treatment. Be sure to talk to a member of your radiation oncology treatment team about any problems you may have.
Many of the side effects of radiation therapy are related to the area that is being treated. For example, a breast cancer patient may notice skin irritation, like a mild to moderate sunburn, while a patient with cancer in the mouth may have soreness when swallowing. These side effects are usually temporary and can be treated by your doctor or other members of the treatment team.
Side effects usually begin by the second or third week of treatment, and they may last for several weeks after the final radiation treatment. In rare instances, serious side effects develop after radiation therapy is finished. Your radiation oncologist and radiation oncology nurse are the best people to advise you about the side effects you may experience. Talk with them about any side effects you are having. They can give you information about how to manage them and may prescribe medicines that can help relieve your symptoms.
The side effect most often reported by patients receiving radiation is fatigue. The fatigue patients experience is usually not very severe, and patients can often continue all or some of their normal daily activities with a reduced schedule. Many patients continue to work full time during radiation therapy.
Many patients are concerned that radiation therapy will cause another cancer. In fact, the risk of developing a second tumor because of radiation therapy is very low. For many patients, radiation therapy can put your cancer in remission. This benefit far outweighs the very small risk that the treatment could cause a later cancer. If you smoke, the most important thing you can do to reduce your risk of a second cancer is quit smoking. |
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Cancer Treatment Equipment and Options
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Our Cancer Treatment Options
- IGRT – Image Guided Radiation Therapy
- IMRT-Intensity Modulated Radiation Therapy
- 3D Conformal Radiation Therapy
- Full Range of Electron Energies for Superficial or Skin Cancer
- HDR – Brachytherapy
- Combined Modality Therapy
Our Cancer Treatment Equipment
- Varian iX with ConeBeam and OBI Imaging
- Mozaiq Information Management System
- Impac Record and Verify System
- Eclipse Treatment Planning with Helios Optimization
- G.E. Advantage Sim Localization Software with Lap Lasers
- Dedicated CT and PET/CT unit for Simulation
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