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Therapy: What To Expect
|How Does the
Doctor Plan My Treatment?
The high energy rays used for radiation therapy
can come from a variety of sources. Your doctor
may choose to use x-rays, an electron
beam, or cobalt-60, gamma rays.
Some cancer treatment centers have special
equipment that produces beams of protons or
neutrons for radiation therapy. The type of
radiation your doctor decides to use depends on
what kind of cancer you have and how far into your
body the radiation should go. High-energy
radiation is used to treat many types of cancer.
Low-energy x-rays are used to treat some kinds of
After a physical exam and a review of your medical
history, the doctor plans your treatment. In a
process called simulation, you will be
asked to lie very still on an examining table
while the radiation therapist uses a special x-ray
machine to define your treatment port or
field. This is the exact place on your body
where the radiation will be aimed. Depending on
the location of your cancer, you may have more
than one treatment port.
Simulation may also involve CT scans or
other imaging studies to plan how to direct the
radiation. Depending on the type of treatment you
will be receiving, body molds or other devices
that keep you from moving during treatment
(immobilization devices) may be made at this time.
They will be used each time you have treatment to
be sure that you are positioned correctly.
Simulation may take from a half hour to about 2
The radiation therapist often will mark the
treatment port on your skin with tattoos or tiny
dots of colored, permanent ink. It's important
that the radiation be targeted at the same area
each time. If the dots appear to be fading, tell
your radiation therapist who will darken them so
that they can be seen easily.
Once simulation has been done, your doctor will
meet with the radiation physicist and the
dosimetrist. Based on the results of your medical
history, lab tests, x-rays, other treatments you
may have had, and the location and kind of cancer
you have, they will decide how much radiation is
needed, what kind of machine to use to deliver it,
and how many treatments you should have.
After you have started the treatments, your doctor
and the other members of your health care team
will follow your progress by checking your
response to treatment and how you are feeling at
least once a week. When necessary, your doctor may
revise the treatment plan by changing the
radiation dose or the number and length of your
remaining radiation sessions.
Your nurse will be available daily to discuss your
concerns and answer any questions you may have. Be
sure to tell your nurse if you are having any side
effects or if you notice any unusual symptoms.
How Long Does the Treatment Take?
For most types of cancer, radiation therapy
usually is given 5 days a week for 6 or 7 weeks.
(When radiation is used for palliative care, the
course of treatment is shorter, usually 2 to 3
weeks.) The total dose of radiation and the number
of treatments you need will depend on the size,
location, and kind of cancer you have, your
general health, and other medical treatments you
may be receiving.
Using many small doses of daily radiation rather
than a few large doses helps protect normal body
tissues in the treatment area. Weekend rest breaks
allow normal cells to recover.
important that you have all of your scheduled
treatments to get the most benefit from your
therapy. Missing or delaying treatments can
lessen the effectiveness of your radiation
During the Treatment Visits?
Before each treatment, you may need to change into
a hospital gown or robe. It's best to wear
clothing that is easy to take off and put on
In the treatment room, the radiation therapist
will use the marks on your skin to locate the
treatment area and to position you correctly. You
may sit in a special chair or lie down on a
treatment table. For each external radiation
therapy session, you will be in the treatment room
about 15 to 30 minutes, but you will be getting
radiation for only about 1 to 5 minutes of that
time. Receiving external radiation treatments is
painless, just like having an x-ray taken. You
will not hear, see, or smell the radiation.
The radiation therapist may put special shields
(or blocks) between the machine and certain parts
of your body to help protect normal tissues and
organs. There might also be plastic or plaster
forms that help you stay in exactly the right
place. You need to remain very still during the
treatment so that the radiation reaches only the
area where it's needed and the same area is
treated each time. You don't have to hold your
breath — just breathe normally.
The radiation therapist will leave the treatment
room before your treatment begins. The radiation
machine is controlled from a nearby area. You will
be watched on a television screen or through a
window in the control room. Although you may feel
alone, keep in mind that the therapist can see and
hear you and even talk with you using an intercom
in the treatment room. If you should feel ill or
very uncomfortable during the treatment, tell your
therapist at once. The machine can be stopped at
The machines used for radiation treatments are
very large, and they make noises as they move
around your body to aim at the treatment area from
different angles. Their size and motion may be
frightening at first. Remember that the machines
are being moved and controlled by your radiation
therapist. They are checked constantly to be sure
they're working right. If you have concerns about
anything that happens in the treatment room,
discuss these concerns with the radiation
What Is Hyperfractionated Radiation Therapy?
Radiation is usually given once daily in a dose
that is based on the type and location of the
tumor. In hyperfractionated radiation
therapy, the daily dose is divided into smaller
doses that are given more than once a day. The
treatments usually are separated by 4 to 6 hours.
Doctors are studying hyperfractionated therapy to
learn if it is equal to, or perhaps more effective
than, once-a-day therapy and whether there are
fewer long-term side effects. Early results of
treatment studies of some kinds of tumors are
encouraging, and hyperfractionated therapy is
becoming a more common way to give radiation
treatments for some types of cancer.
What Is Intraoperative Radiation?
Intraoperative radiation combines surgery and
radiation therapy. The surgeon first removes as
much of the tumor as possible. Before the surgery
is completed, a large dose of radiation is given
directly to the tumor bed (the area from which the
tumor has been removed) and nearby areas where
cancer cells might have spread. Sometimes
intraoperative radiation is used in addition to
external radiation therapy. This gives the cancer
cells a larger amount of radiation than would be
possible using external radiation alone.
IMPROVING RADIATION TREATMENT
in the field of radiation therapy continue to seek
ways to improve the outcome of treatment. Their
challenge is to get a high dose of radiation to
the tumor while the surrounding normal tissue is
protected from radiation damage. New methods for
using radiation to treat cancer are being
investigated. Many are promising but they are not
yet widely available. You may hear the following
terms that describe some of these new methods of
Three-dimensional conformal radiation therapy
is a radiation technique that is being used in
some cancer centers. Computer simulation produces
an accurate image of the tumor and surrounding
organs so that multiple radiation beams can be
shaped exactly to the contour of the treatment
area. Because the radiation beams are precisely
focused, nearby normal tissue is spared. This
technique is being used to treat prostate cancer,
lung cancer, and certain brain tumors.
Stereotactic radiosurgery, which uses gamma
rays or a linear accelerator, is useful for
treating certain kinds of brain tumors and some
malformations in the brain's blood vessels. One
technique, called the 'gamma knife,' uses
many powerful, precisely focused radiation beams.
The patient wears a special helmet to focus the
gamma rays and aim them at the target tissue from
many directions. The treatment is painless and
bloodless and, unlike conventional brain surgery,
there is no danger of infection. Other systems use
a linear accelerator to deliver the radiation in
arcing paths around the patient's head.
cyberknife is a new, but less common,
treatment that is being used to treat brain
tumors. This system uses a miniature radiation
machine and a robotic arm that moves around the
patient's head while delivering small doses of
radiation from hundreds of directions. During
treatment a computer analyzes hundreds of brain
images and adjusts for slight movements by the
patient. This makes it possible to deliver the
treatment without using a frame to hold the
patient's head still. Only the tumor receives the
high doses of radiation and healthy tissue is
Peacock system is a variation of the
cyberknife. It uses special machinery that
delivers tiny focused beams of radiation while it
rotates around the patient's head. The beams
continuously change shape and size to conform to
the shape and size of the tumor while avoiding
vital structures in the brain. Computer software
controls the intensity of the radiation.
Precision therapy is a method of radiosurgery
recently developed in Sweden. It uses high doses
of radiation delivered in fewer fractions than in
conventional radiation therapy. An advanced
treatment planning system permits precise
targeting from many angles. As with other advances
treatment, it allows high doses of radiation to be
delivered to tumor tissue while reducing radiation
damage to healthy tissue.
Are the Side Effects of Treatment?
External radiation therapy does not cause your
body to become radioactive. There is no need to
avoid being with other people because you are
undergoing treatment. Even hugging, kissing, or
having sexual relations with others poses no risk
of radiation exposure.
Most side effects of radiation therapy are related
to the area that is being treated. Many patients
have no side effects at all. Your doctor and nurse
will tell you about the possible side effects you
might expect and how you should deal with them.
You should contact your doctor or nurse if you
have any unusual symptoms during your treatment,
such as coughing, sweating, fever, or pain.
The side effects of radiation therapy, although
unpleasant, are usually not serious and can be
controlled with medication or diet. They usually
go away within a few weeks after treatment ends,
although some side effects can last longer. In
Section 4, "Managing Side Effects," you
will find advice on how to cope with the side
effects that might occur during and after your
therapy. Always check with your doctor or nurse
about how you should deal with side effects.
Throughout your treatment, your doctor will
regularly check on the effects of the treatment.
You may not be aware of changes in the cancer, but
you probably will notice decreases in pain,
bleeding, or other discomfort. You may continue to
notice further improvement after your treatment is
Your doctor may recommend periodic tests and
physical exams to be sure that the radiation is
causing as little damage to normal cells as
possible. Depending on the area being treated, you
may have routine blood tests to check the levels
of red blood cells, white blood cells,
and platelets; radiation treatment can
cause decreases in the levels of different blood
What Can I Do To Take Care of Myself During
Each patient's body responds to radiation therapy
in its own way. That's why your doctor must plan,
and sometimes adjust, your treatment. In addition,
your doctor or nurse will give you suggestions for
caring for yourself at home that are specific for
your treatment and the possible side effects.
Nearly all cancer patients receiving radiation
therapy need to take special care of themselves to
protect their health and to help the treatment
succeed. Some guidelines to remember are given on
the following pages:
- Before starting
treatment, be sure your doctor knows about any
medicines you are taking and if you have any
allergies. Do not start taking any medicine
(whether prescription or over-the-counter)
during your radiation therapy without first
telling your doctor or nurse.
- Fatigue is
common during radiation therapy. Your body will
use a lot of extra energy over the course of
your treatment, and you may feel very tired. Be
sure to get plenty of rest and sleep as often as
you feel the need. It's common for fatigue to
last for 4 to 6 weeks after your treatment has
- Good nutrition
is very important. Try to eat a balanced diet
that will prevent weight loss. For patients who
have problems with eating or diet planning, the
section, "Managing Side Effects," offers
- Check with your
doctor before taking vitamin supplements or
herbal preparations during treatment.
- Avoid wearing
tight clothes such as girdles or close-fitting
collars over the treatment area.
- Be extra kind to
your skin in the treatment area:
- Ask your
doctor or nurse if you may use soaps, lotions,
deodorants, sun blocks, medicines, perfumes,
cosmetics, talcum powder, or other substances
in the treated area.
- Wear loose,
soft cotton clothing over the treated area.
- Do not wear
starched or stiff clothing over the treated
- Do not
scratch, rub, or scrub treated skin.
- Do not use
adhesive tape on treated skin. If bandaging is
necessary, use paper tape and apply it outside
of the treatment area. Your nurse can help you
place dressings so that you can avoid
irritating the treated area.
- Do not apply
heat or cold (heating pad, ice pack, etc.) to
the treated area. Use only lukewarm water for
bathing the area.
- Use an
electric shaver if you must shave the treated
area but only after checking with your doctor
or nurse. Do not use a preshave lotion or hair
removal products on the treated area.
- Protect the
treatment area from the sun. Do not apply
sunscreens just before a radiation treatment.
If possible, cover treated skin (with light
clothing) before going outside. Ask your
doctor if you should use a sunscreen or a
sunblocking product. If so, select one with a
protection factor of at least 15 and reapply
it often. Ask your doctor or nurse how long
after your treatments are completed you should
continue to protect the treated skin from
- If you have
questions, ask your doctor or nurse. They are
the only ones who can properly advise you about
your treatment, its side effects, home care, and
any other medical concerns you may have.