In my first of an occasional series of Blog posts, I wanted to take a few moments to answer questions that frequently arise for patients referred for radiation therapy.
What is radiation and how does it work?
Radiation therapy uses high energy X-rays to kill cancer cells. Precisely focused X-rays damage the DNA inside cancer cells causing them to die, either right away or when they try to grow. There are even new data suggesting that radiation may help the body’s immune system (the same system that fights infections) attack cancers. Cancers in any part of the body can be treated, and in any age patient.
How is radiation delivered?
Often radiation is delivered from the outside (external beam radiation). You don’t feel anything while you’re getting radiation – it’s like getting an X-ray or a CT scan. The machine is not enclosed and you lie comfortably on your back. X-rays pass through your body. You are not radioactive either during or after treatment. Radiation may also be delivered internally (brachytherapy). In such cases temporary “applicators” are placed and removed after each treatment. Sometimes radioactive seeds are implanted. Finally, radiation can be given through an IV (such as for radionuclide administrations).
Your radiation oncologist (the doctor who is responsible for your radiation treatment) will be able to discuss which of these options is/are available to you and what the pros and cons of each are.
Isn’t it an old technology, why are we still using it to treat cancer?
Using radiation to treat cancers has been in existence for several decades, though the technologies and machines for treatment delivery have totally changed. Today’s machines are capable of delivering high doses of radiation with millimeter accuracy, enabled by advanced imaging and other guidance systems. Our computer programs for delivering treatment, as well as our understanding of radiation side effects and dosing have also improved remarkably. Though the term “radiation” is the same as it once was, it is a totally different technology today, and one that will continue to evolve in the future.
What are the side effects? Is it safe?
This is our patients’ most frequent concern, and we often find that actual side effects are, in general, not as bad as one might think. Side effects depend on the site of the body being treated, the dose, the use of other medicines (such as chemotherapy), and your other health conditions. We also have many medications to help with symptoms that patients experience. Most side effects are temporary and resolve soon after treatment is done, although there can be long term effects in some cases. Your radiation oncologist will speak with you in detail about expected side effects prior to embarking on any course of treatment.
Who are the members of the radiation treatment team?
The radiation oncologist is the doctor who prescribes and is responsible for all aspects of your treatment. They work with other doctors on your treatment team in developing your overall plan of care. Radiation nurses work closely with radiation oncologists to care for patients’ clinical needs and are an important resource in your care. Radiation therapists are trained individuals who are responsible for delivering the radiation treatment each day under the doctor’s prescription and supervision. Medical physicists and dosimetrists work with the radiation oncologist to develop complex treatment plans for each patient and ensure the machines are working correctly. Other individuals you may work with include our colleagues in social work, nutrition, palliative care, as well as trainees in one of the above disciplines who may be working in our department under supervision.
What happens before, during, and after treatment?
You will first meet with the radiation oncologist and nurse in a consultation, where your medical history will be reviewed and a plan of care developed. Additional tests may be ordered. If radiation is recommended, you will be scheduled for a simulation (planning) session. This session takes about an hour. No treatment is delivered, but you will be positioned comfortably on the treatment table in exactly the position you’ll be in for treatment. We will take some scans and use this information to plan your treatment. At the time of your simulation, you’ll be given your first treatment date and time (you’ll receive the rest of your treatment calendar at your first treatment). It will be several days, typically, between this session and when radiation begins. During this time, we work carefully to develop your treatment plan and do numerous safety checks to ensure your plan is ready to administer.
Once you start treatment, radiation is usually given each day. You will be seen by your doctor and nurse at least once per week while on treatment. After treatment is done you’ll be seen in follow up, typically in coordination with your other cancer doctors. The further you get away from treatment, the less frequently we’ll need to see you. The purpose of these visits is to monitor your progress, ensure you’ve been healing well, and answer any questions that have arisen.
What about natural supplements and radiation?
Though many of these compounds are likely safe to take with radiation, they have not been well-studied and may interfere or have unanticipated side effects with radiation. We advise only taking prescription medications and other medications approved/recommended by your radiation oncologist.
What should I do to take care of myself during treatment?
Your treatment team will give you information regarding self-care during radiation. Every type of treatment is different in this regard. In general, we suggest patients obtain as much rest and nutrition as they can. Many patients find they can continue to work or maintain their commitments during treatment. Regardless of your situation, we will work with you to find an optimal strategy.
Are there any other kinds of conditions where radiation is used?
While we most often treat patients with cancer, there are several non-cancerous conditions where radiation is used. Some examples include the following: benign brain tumors, refractory warts, Dupuytren’s contracture, thyroid ophthalmopathy, and keloids.
Our centers provide high quality, contemporary treatments that you’ll find in much larger centers with the convenience and personal touch that you would expect from a smaller practice. We see our patients frequently during treatment, and the vast majority of our patients (many of whom still drive from distance) find coming to our practice to be easy and worthwhile. And because radiation is specifically tailored to you (similar to a surgical procedure), the skill of your doctor and team is very important to achieving the best possible outcome.