Central Care Cancer Center

Radiation therapy, sometimes called radiotherapy or irradiation, is the use of various forms of radiation to safely and effectively treat cancer and other diseases. Radiation oncologists may use radiation therapy to try to cure cancer, 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 cancer 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.

Sometimes radiation therapy is the only treatment a patient needs, and other times it is only one part of a patient’s treatment. For example, prostate and larynx cancer are often treated with radiation alone, but a woman with breast cancer may be treated with surgery, radiation therapy and chemotherapy. Sometimes radiation therapy is used as adjuvant therapy to make your primary treatment more effective. For example, you can be treated with radiation therapy (the adjuvant treatment) before surgery (the primary treatment) to help shrink the cancer and allow less radical surgery than would otherwise be required, or you may be treated with radiation after surgery to destroy microscopic cells that may have been left behind.

Why is Radiation Therapy used?
A radiation oncologist may choose to use radiation therapy in a number of different ways. Sometimes the goal is to cure the cancer. In this case, radiation therapy may be used to: destroy tumors that have not spread to other parts of your body or reduce the risk that cancer will return after you undergo surgery or chemotherapy by killing tiny cancer cells that may remain.

In other cases, the goal is to reduce the symptoms caused by growing tumors and to improve your quality of life. When radiation therapy is administered for this purpose, it is called palliative care or palliation. In this instance, radiation may be used to: shrink tumors that are interfering with your quality of life, such as a lung tumor that is causing shortness of breath or alleviate pain by reducing the size of your tumor.

What are the different kinds of Radiation?
The goal of radiation therapy is to get a high enough dose of radiation into the body to kill the cancer cells while sparing the surrounding healthy tissue from damage. Several different radiation therapy techniques have been developed to accomplish this. Depending on the location, size and type of your tumor or tumors, you may receive one or a combination of these techniques. Your cancer treatment team will work with you to determine which treatment and how much radiation is best for you. Radiation therapy can be delivered in two ways, externally and internally.
During external beam radiation therapy, the radiation oncology team uses a machine to direct high-energy rays at the cancer. Internal radiation therapy, also called brachytherapy, involves placing radioactive sources (for example, radioactive seeds) inside the patient.

EXTERNAL BEAM RADIATION THERAPY
During external beam radiation therapy, a beam of radiation is directed through the skin to a tumor and the immediate surrounding area in order to destroy the main tumor and any nearby cancer cells. To minimize side effects, the treatments are typically given every day for a number of weeks. The radiation beam comes from a machine located outside of your body that does not touch your skin or the tumor. Receiving external beam radiation is similar to having an X-ray taken. It is a painless, bloodless procedure. The most common type of machine used to deliver external beam radiation therapy is called a linear accelerator, sometimes called a “linac.” It produces a beam of high-energy Xrays or electrons. Using sophisticated treatment planning software, your radiation oncology treatment team plans the size and shape of the beam, as well as how it is directed at your body, to effectively treat your tumor while sparing the normal tissue surrounding the cancer cells. There are several special types of external beam therapy. These are used for particular types of cancer, and your radiation oncologist will recommend one of these treatments if he or she believes it will help you.

Three-Dimensional Conformal Radiation Therapy (3D-CRT)
Tumors usually have an irregular shape. Three-dimensional conformal radiation therapy, or 3D-CRT, uses sophisticated computers and computer assisted tomography scans (CT or CAT scans) and/or magnetic resonance imaging scans (MR or MRI scans) to create detailed, three-dimensional representations of the tumor and surrounding organs. Your radiation oncologist can then shape the radiation beams exactly to the size and shape of your tumor. The tools used to shape the radiation beams are multileaf collimators or blocks. Because the radiation beams are very precisely directed, nearby normal tissue receives less radiation exposure.

Intensity Modulated Radiation Therapy (IMRT)
Intensity modulated radiation therapy, or IMRT, is a specialized form of 3D-CRT that allows radiation to be more exactly shaped to fit your tumor. With IMRT, the radiation beam can be broken up into many “beamlets,” and the intensity of each beamlet can be adjusted individually. When using IMRT, it may be possible to further limit the exact amount of radiation that is received by normal tissues that are near the tumor. In some situations, this may also allow a higher dose of radiation to be delivered to the tumor, increasing the chance of a cure.

Only a handful of centers across the country offer this type of sophisticated treatments. Central Care Cancer Center’s physicians and staff is experienced and well-versed in this treatment method which is seen in large cities and well-known cancer centers and universities.

INTERNAL RADIATION THERAPY
Brachytherapy
Also known as internal radiation, brachytherapy involves placing radioactive material into a tumor or its surrounding tissue. 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.

OTHER RADIATION THERAPY OPTIONS
Radiosensitizers and Radioprotectors
Two types of drugs are being studied for their effect on cells undergoing radiation. One type includes drugs designed to make tumors more sensitive to radiation. It is hoped that these radiosensitizers will help radiation better destroy tumors. Other types of drugs are being evaluated to better protect the normal tissues near the area being treated. These are called radioprotectors . An example of a radioprotector is a drug designed for head and neck cancer patients that helps decrease soreness some patients may feel during treatment and some patients may experience dryness of the mouth after treatment is completed.

Investigational Radiation Therapies
Several specialized types of radiation therapy are available in a limited number of facilities in the United States. These treatments are currently being studied to determine their best use. You can discuss with your radiation oncologist whether these therapies may benefit you.

What happens before, during, and after treatment?

Before you can begin treatment, your doctors must first run tests to determine what type of cancer you have and if it has spread to other parts of the body. Once the diagnosis has been made, you will probably talk with your primary care physician along with several oncology specialists, such as a surgeon, a medical oncologist and a radiation oncologist, to discuss your treatment choices. Often, these specialists will work together to help recommend the best treatment for you. In some cases, your cancer will need to be attacked by using more than one type of treatment. For example, if you have breast cancer, you might have surgery to remove the tumor (by a surgeon), then have radiation therapy to destroy any remaining cancer cells in or near your breast (by a radiation oncologist). You also might receive chemotherapy (by a medical oncologist) to destroy any remaining cancer cells that have traveled to other parts of the body.

Before Treatment

Consultation With a Radiation Oncologist
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, MR 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.

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 simulation, your radiation oncologist and radiation therapist place you on the simulation machine 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.

Immobilization devices are molds, casts, headrests or other devices that 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. Some treatment machines have built-in blocks or shutters called multi-leaf collimators, which also help shape the radiation. Although simulation is typically only one session, your physician may schedule more than one session depending on the type of cancer you have and the type of radiation therapy that is being used.

Once you have finished with the simulation, your radiation oncologist and other members of the treatment team review the information they obtained during simulation along with your previous medical tests to develop a treatment plan. Often, a special treatment planning CT scan is done to help with the simulation and treatment planning. This CT scan is in addition to your diagnostic CT scan. 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.

Treatment Administration
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 and you may not need to miss work or experience the type of recuperation period that can follow other treatments. Treatments are usually scheduled five days a week, every day except Saturday and Sunday, and continue for 3 to 10 weeks. 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.

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. It will take about five to 15minutes for you to be positioned for treatment and for the equipment to be set up. 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 every day.

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 daily 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 daily 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) 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.

Weekly Beam Films
During treatment, your team will routinely use the treatment machines to take special X-rays called beam or port films. Your treatment team routinely reviews these films to be sure that the treatment beams remain precisely aimed at the proper target. These X-rays are not used to evaluate your tumor.

Brachytherapy Treatments
Brachytherapy 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. To position the sources accurately, special catheters or applicators are used. 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 the cervix, the vagina or the windpipe. With interstitial treatment, the radioactive sources are put directly into the tissues, such as 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 of 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.

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 physicians. 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.

Are there any 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.

Who are the members of the Radiation Oncology Team?

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.

Radiation Oncologists

Radiation oncologists is a doctor who specializes in using radiation to treat cancer, leads this team, and also are the doctors who will oversee your radiation therapy treatments. These physicians work with the other members of the radiation therapy team to develop your treatment plan and ensure that each treatment is accurately given. Your radiation oncologist will also monitor your progress and adjust the treatment as necessary to make sure the radiation is hitting its target while minimizing side effects. Before, during and after your radiation therapy treatments, your radiation oncologists work closely with other cancer doctors, such as medical oncologists and surgeons, to maximize the radiation's effectiveness. Radiation oncologists have completed at least four years of college, four years of medical school, one year of general medical training, and four years of residency or specialty training in radiation oncology. They have extensive training in cancer medicine and the safe use of radiation to treat disease.

Radiation Oncology Nurses

Radiation oncology nurses work collaboratively with radiation oncologists and radiation therapists to care for you and your family at the time of consultation, while you are receiving treatment and during your follow-up care. They will explain the possible side effects you may experience and will describe how you can manage them. They will assess how you are doing throughout treatment and will help you cope with the changes you may experience. They will also provide support and counseling to you and your family. Radiation oncology nurses are licensed registered nurses or licensed practical nurses. Many registered nurses in radiation therapy have additional accreditation in the specialty of oncology nursing.

Radiation Therapists

Radiation therapists work with radiation oncologists to administer the daily radiation treatment under the doctor's prescription and supervision. They maintain daily records and regularly check the treatment machines to make sure they are working properly. Radiation therapists go through a two to four year educational program following high school or college. They take a special examination and may be certified by the American Registry of Radiologic Technologists. In addition, many states require that radiation therapists be licensed.

Dosimetrists
Dosimetrists carefully calculate the dose of radiation to make sure the tumor gets enough radiation. Using computers, they develop a number of treatment plans that can best destroy the tumor while sparing the normal tissues. Since treatment plans are often very complex, dosimetrists work with the radiation oncologist and the medical physicist to choose the treatment plan that is right for you. Many dosimetrists start as radiation therapists and then, with very intensive training, become dosimetrists. Others are graduates of one- to two-year dosimetry programs. They are certified by the Medical Dosimetrist Certification Board.

Medical Radiation Physicists

Qualified medical radiation physicists work directly with the radiation oncologist during treatment planning and delivery. They oversee the work of the dosimetrist, and help ensure that complex treatments are properly tailored for each patient. Medical physicists are responsible for developing and directing quality control programs for equipment and procedures. Their responsibility also includes making sure the equipment works properly by taking precise measurements of the radiation beam and performing other safety tests on a regular basis. Qualified medical physicists have doctorates or Master's degrees. They have completed at least four years of college, and then generally two to four years of graduate school. They also typically have one to two years of clinical physics training. Medical physicists are certified by the American Board of Radiology or the American Board of Medical Physics.
During your treatment, you may work with a number of other healthcare professionals while undergoing radiation therapy. These specialists ensure that all of your physical and psychological needs are met during your treatment.

Additional members of the team

Social Workers
Social workers are available to provide a variety of supportive services to you and your family. They can provide counseling to help you and your family cope with the diagnosis of cancer and evaluate your treatment options. They may also help arrange for home healthcare and other services.

Nutritionists
Nutritionists, also called dietitians, work with patients to help them maintain proper nutrition during their treatments. They will help you modify your eating plan if the side effects of treatment are affecting your appetite and what you can eat, and can provide recipes, menu suggestions and information on ready-to-use nutritional supplements. They address dietary issues and current developments that may affect cancer treatment outcomes.

Physical Therapists
Physical therapists use therapeutic exercises to ensure that your body functions properly while you are undergoing treatment. These exercises are used to help manage side effects, alleviate pain and keep you healthy.

Dentists
Dentists may be involved in the care of patients who are receiving radiation for oral or head and neck cancers. They will help prevent the radiation from damaging the healthy areas of your mouth and oral cavity, and may recommend that you have preventive dental work prior to radiation. They will also help you manage oral complications of cancer therapy, such as dry mouth. A dental hygienist may also perform these services under the supervision of a dentist.

Financial Counselors
The Financial Counselors are available to discuss your insurance benefits relating to your treatments and will answer any questions you may have relating to coverage verification, necessary referrals, payment plans, and balances for which you are responsible.

Radiation Oncology

Medical Oncology

Surgery