Treatment

Your First Visit
The purpose of your initial visit to the Department of Radiation Oncology is to meet with the radiation oncologist to determine if radiotherapy is suitable for you. An initial assessment will be taken by the radiation oncology nurse prior to seeing the physician. Your radiation oncologist will determine your suitability based on your type of cancer and stage/extent of disease, as well as your symptoms and overall general health. It may be necessary for your radiation oncologist to arrange additional investigations or test prior to determining the final treatment plan. It will also be important for the physician to examine you during this appointment.

Once it has been determined that you are a candidate for treatment, the physician will explain the radiotherapy including the length of treatment as well as side effects. Once you understand and agree to a course of treatment, you will be asked to sign a consent form and a subsequent appointment for a radiation planning session (simulation) will be provided to you. This usually occurs within days of your consultation.  Non-emergent radiotherapy typically starts within seven days of simulation.

The initial consultation appointment usually takes one to one and a half hours.

Simulations
CT Simulation: The CT Simulation is a planning session, in which we map the site to which radiation will be given. This procedure will take approximately one to one and a half hours. During this time you will be required to lie very still on a hard table. Please inform the physician if this may be a problem for you. In some cases a special mask or treatment cushion will be made specifically for you. During this appointment time, tiny pinpoint tattoos will be placed on your skin to mark the area that will be treated.

Verification Simulation: This takes place a few days after the CT Simulation procedure.  The radiation therapist will take you to the Linear Accelerator Room. This is the room that you will go for each of your radiation treatments. The radiation therapist will position you on the treatment table. Images will be taken to verify the treatment field. Tiny pinpoint tattoos will be placed on the skin and will be used daily during the treatment field set up. The verification simulation takes approximately one hour.

Preparation for Treatment
The Center for Cancer Prevention and Treatment at St. Joseph Hospital strives to make you as comfortable as possible during your radiation treatment. After you arrive for your treatment and check in, you will be asked to change into a hospital gown or robe and will go to your treatment room.

On the day of your treatment, wear loose clothes that are comfortable and made of soft fabric. Avoid tight waistbands or collars, or anything that might be tight or constricting around your treatment area. Soft cotton fabrics are preferable.

Do not use deodorant soap the day of your treatment, or apply powders, lotion or deodorant in or near your treatment area. Please leave jewelry and other valuables at home.

Bring something to read or do in the waiting room. While we make every effort to start your treatment right away, there are sometimes unavoidable delays.

Treatment
Treatments are usually given Monday through Friday at the same time each day. The doctor will prescribe the number of treatments on simulation day. Your daily appointments will be arranged with the radiation therapist who will be treating you. We will try to give you the appointment time that you request whenever possible. Your appointment can be changed if a preferred time becomes available. Please call if you are unable to make your appointment.

Plan to be at the Center about 30-45 minutes for each treatment. Please arrive just a few minutes prior to your appointment time. To prevent long waits, please do not arrive more than 15 minutes early. You will be in the treatment room for approximately 15-30 minutes. For directions to The Center for Cancer Prevention and Treatment click here.

On occasion, you may find yourself waiting because of unavoidable delays. We will always get you into the treatment room as quickly as possible. Remember to report in daily at the Center reception desk. Laboratory work will be obtained throughout your treatment. Every attempt will be made to coordinate lab work with your regular doctor, so lab work will not be done unnecessarily. Results are usually available the next day. Some tests, such as a PSA level, take three days. Any questions concerning lab tests can be directed to the nurse.

Seeing the Radiation Oncologist (Weekly Management)
You will be seen by one of the radiation oncologists at least once a week during your course of treatment. On this day, plan to be here at least 15 minutes longer. The visit will usually be with your primary physician. Because the physicians at the Center are in a group practice, each physician is kept informed of your progress or any problems you may have. If you do see another doctor for your weekly visit, please do not hesitate to ask any questions or discuss concerns.

What to Expect
External Beam Radiation Therapy
If you are receiving external beam radiation therapy treatment, the radiation therapist will position you for treatment. The radiation therapist may place the special cushion, body mold or mask that was created during the CT Simulation. You may see colored lights that line up with the tattoos or pen marks on your skin. These lights are used to line up the radiation machine and position the beam. They are harmless.

The radiation therapist will leave the room to begin your treatment, but you will not be left alone. The radiation therapist will be in the next room and can see, hear and talk with you at all times through a television monitor. Please tell the radiation therapist if you are uncomfortable at any time. You will need to hold still during the length of the treatment, but will be able to breath normally. You will not feel, see or smell anything during your treatment.

Brachytherapy (Internal Radiation Therapy)
Brachytherapy is a form of treatment in which a catheter or an applicator is placed inside the body through which the radiation treatment is applied. Most patients have their catheter or applicator put in place in the hospital. You might have anesthesia to put you to sleep for the insertion of the catheter or applicator. Or you may simply have that area of your body numbed, depending on what type of brachytherapy you receive, what type of cancer you have and where it is in your body. You should tell your doctor or nurse if you feel any pain.

There are different types of brachytherapy. How long you are in the hospital and the safety precautions you will need to take during and after your treatment depend on which type you receive. Your doctor and nurse will carefully review all of the safety measures with you and your family.

High-dose rate (HDR) Implants
This type of brachytherapy depends on what type of cancer you have, and where it is in your body. You may be in the hospital for the duration of your treatment, or you may come in for treatment on a specific schedule. Your catheter or applicator may stay in place the entire time, or may be inserted each time you come in. Your doctor will remove the radiation and the catheter or applicator once treatment is complete.

Low Dose Rate Permanent Seed Implants
With permanent implants, the radiation source is placed using a catheter, and then left in your body. Over time, the radiation will gradually go away. You will not be able to feel the implants and they cause no harm. The implants are left in place permanently.

Side Effects
Varying degrees of physical and emotional side effects are normal for patients undergoing radiation treatment, depending on what type of treatment you are receiving, your illness, and whether or not you are also receiving chemotherapy. Some people have few, if any, side effects; others have many.

Your doctor and nurse will talk with you about possible side effects you may experience, and then monitor you closely during your treatment. Talk with them if you notice any problems so your radiation oncology team can best help you manage them.

Side effects may vary widely, depending on the part of your body that’s being treated. Common side effects may include fatigue and skin changes, such as dryness, itching, peeling or blistering. Your nurse will show you special ways to care for your skin during your treatment.

There are many things you and your family can do to help cope with these feelings, including talking about them with your radiation oncology team, particularly your social worker, and participating in a St. Joseph Hospital support group.