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. Depending on where your radiation oncologist practices, you may also be seen by a medical student, a resident (radiation oncologist in training), a physician assistant or a nurse.

After reviewing your relevant 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 & 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 multileaf collimators, which also help shape the radiation.

Although simulation is typically only one session, your physician may schedule additional sessions depending on the type of cancer you have and the type of radiation therapy that is being used.

After 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
External beam radiation therapy is administered differently from brachytherapy. You may receive one or both of these treatments. The following sections describe what you may experience during treatment administration.

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 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 three 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. 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. It will take roughly five to 15 minutes 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.

Brachytherapy Treatments
This treatment approach is offered to patients when deemed appropriate by the radiation oncologist. Brachytherapy, also sometimes referred to as internal radiation, HDR (high dose rate) or seed implants (such as for prostate), 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, known as a prostate seed implant.

Sometimes these procedures require anesthesia and this may include overnight hospitalization. Patients with permanent implants, typically prostate seed 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, such as with Mammosite breast brachytherapy. While the radioactive sources are in place, you will stay in a private or shielded room. Doctors, nurses and other medical staff will continue to take care of you, but they may need to take special precautions to limit their exposure to radiation.

Devices called high dose rate (HDR) 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 under computer control 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. For example, Mammosite breast brachytherapy patients get treated twice per day for 5 treatment days.

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.

Weekly Status Checks
During radiation therapy, your radiation oncologist and nurse will see you regularly, typically once per week, 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. You are encouraged to ask questions of anyone on staff at any time and can see the doctor any day of the week if necessary.

Case Review
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.

During treatment, your treatment 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.

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.

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.

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 cure your cancer. 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.