What to Expect During Treatment
Fighting cancer is challenging. To help you prepare for the fight, here is a brief outline of what you can expect during external beam radiation therapy or radiosurgery. The details of some of the steps may differ depending on your particular case.
A Team Approach
Radiation treatment is administered to you by a team of highly qualified healthcare professionals. This team is comprised of specialists that among them have years of experience in treating cancer. Some of the typical members of the team are listed below; depending on your particular case, other specialists may be asked to join the team.
The radiation oncologist - a physician who specializes in the use of radiation to treat cancer — is your doctor throughout this process. The radiation oncologist will prescribe, plan and direct your treatment and is responsible for deciding what method of radiation is best for your case.
The radiosurgeon — a surgeon, one of whose specialties is in the delivery of radiosurgery or SRS/SBRT. Radiosurgeons for brain tumors are typically neurosurgeons.
The medical physicist works with the dosimetrist and radiation oncologist to measure the precision of your treatment plan, and works with the equipment to calculate the best angles to treat your tumor, or tumor site. The medical physicist also conducts frequent safety checks and makes sure that the equipment is working properly.
The dosimetrist works closely with the radiation oncologist and medical physicist in designing your treatment. The dosimetrist determines the best angles from which to deliver the radiation, prescribes the length of time for each pulse of radiation, and develops strategies on how best to avoid giving radiation to healthy tissue in your body.
The radiation therapist will conduct your treatment sessions. He or she will position you on the treatment "couch" — a platform designed to work with the radiation machine — run the equipment, and work very closely with the medical physicist during your treatment.
The radiation nurse coordinates your care, helps you learn about treatment and about managing any potential side effects that you might experience.
If radiation therapy is recommended to you, the first thing you will do is meet with your doctor, the radiation oncologist. Based on your specific case, your radiation oncologist will tell you what type of radiation therapy he or she recommends, whether it will be given alone or in conjunction with other treatment methods, what the specific goals of treatment are, and what side effects you may expect. You can talk to your doctor about your treatment options and make a decision together.
The consultation is an excellent opportunity for you to ask the doctor whatever questions you may have. Click here for a list of some common questions you could ask.
Next, you will come in for simulation. Detailed images will be taken of the brain to show the location of your tumor and the normal areas around it. These scans usually include a CT scan, but they can also include MRI, PET scan, and ultrasound scans. The scans are analyzed and combined by a sophisticated software program to create a detailed 3-D image of your tumor site and surrounding tissues. Your doctor can rotate the image on his computer screen in order to view the tumor from every angle. If you are interested in seeing the images, ask your doctor to show them to you.
During the simulation, your radiotherapy team will help you find a comfortable position relative to the machine delivering the radiation. Your radiation therapist will fit you for a custom immobilization mask that will help to keep your head still while you are lying on the treatment couch. This mask will be used only for your treatment, and has a special coordinate system drawn on it to line you up accurately for each session.
After simulation is completed, the radiation oncologist will meet with the radiation physicist and dosimetrist to design the details of your treatment plan. No two patients and no two targets are exactly alike. That's why your doctor will develop a treatment plan that's been carefully customized for you. After taking into account the location, type, and stage of your cancer, your medical history, lab tests, and other factors, your treatment team will use sophisticated computer software to assist them in prescribing the exact volume to be treated, the total amount of radiation that will be delivered to the tumor, the angles for the radiation beams, how many treatments you will have, and what kind of machine to use.
When you arrive for treatment, the radiation therapist (RT) will bring you into the linac room and help you lie down on the treatment couch. The couch will be adjusted so a laser light lines up to the coordinates on your face-mask, helping to position you correctly. If you are treated on a Varian machine, the two arms of the machine's On-Board Imager (OBI) will extend on either side of you in order to create an image of the tumor in that day's treatment position and match it to the position that was planned for you. Other machines may use alternative scanning technology. The scan is compared to the planned position, and if there is any difference between the two, the RT can, with the touch of a button, adjust the couch to align you properly for treatment.
Your RT may offer to play soft music while you are in treatment. You can also ask your team about other ways to help make you more comfortable.
Quality checks are especially rigorous for treating brain tumors, so you may have to be patient while your team prepares to deliver your treatment.
If you are treated on a Varian machine, it will have a gantry, which is the head of the machine. The gantry houses a device called a multi-leaf collimator that "shapes" the radiation beam so it conforms to the shape of the tumor from any given angle. During your treatment, the gantry will move around you to deliver the radiation. The radiation beam is not visible to the eye when it leaves the gantry so you will not see it. Depending on the type of treatment, the time that the radiation beam is on will vary from a few minutes to 15-20 minutes. For IG-VMAT, the radiation beam will typically only be on a few minutes, while for radiosurgery, the machine will most likely be on longer.
You may experience some side effects from radiotherapy or radiosurgery. If you do, they might not begin until after several sessions because the effects of radiation treatment are cumulative. Two of the most common side effects are irritation or damage to the skin near the treatment site, and fatigue. Talk to your doctor before and during treatment if you have any questions or experience discomfort. Click here to see more about possible side effects you may experience.
After your treatment has ended, your doctor will recommend a schedule for periodic checkups to monitor the results. Typically, checkups are scheduled at six-month intervals. If symptoms or clinical circumstances suggest a recurrence, diagnostic tests such as blood tests, ultrasound, CT scans, MRIs, chest x-ray (CXR), or a bone scan may be needed.
