What is radiation therapy?
Radiation therapy is the use of high energy rays or particles to treat disease. High doses of radiation can kill cells or keep them from growing and dividing. Radiation therapy is a useful tool for treating cancer because cancer cells grow and divided more rapidly than many of the normal cells around them. All cells in the area are affected, but repeated exposure to a small amount of radiation over a period of time allows healthy cells to recover, while diseased cells cannot.
Radiation therapy is an effective way to treat many kinds of cancers in almost any part of the body. More than half of all people with cancer are treated with radiation, and the number of patients who have been cured is rising every day. Radiation therapy may be used along with, or in combination with chemotherapy and/or surgery. This depends on your type of cancer and the specifics of your disease.
Radiation therapy can be given in either two forms: external or internal. In external therapy, a machine directs the high-energy rays or particles at the cancer and the normal tissue surrounding it. Most people who receive radiation therapy for cancer have the external type.
Typically, external radiation treatment is given 5 days a week over 4-7 weeks. The total dose of radiation and the number of treatments you need will depend on the size and location of your cancer, type of tumor, your general health, and any other treatments you are receiving.
When internal radiation therapy is used, a radioactive substance, or source, is sealed in small containers such as thin wires or tubes called implants. The implant is placed directly into a tumor or inserted into a body cavity.
How does radiation therapy work?
The purpose of radiation therapy is to kill cancer cells. Radiation affects all rapidly dividing cells, both normal and abnormal. Treatment is designed to maximize the radiation dose to the tumor cells while minimizing harmful effects to normal tissue. Normal cells have a greater ability to repair themselves then do cancer cells. Because it is impossible to shield all normal tissue, some side effects may occur. Your doctor and nurse will discuss the specific side effects with you.
What happens if I miss a treatment?
It is important for you to receive each scheduled radiation treatment. If for some reason you need to miss a scheduled appointment, you should notify your radiation therapist. On occasion, your radiation oncologist may decide to give you a rest from treatment to allow normal tissue to heal. If a treatment is missed, that missed treatment will be added onto the end of your schedule, so your finish date will move back by however many days you have missed.
Will I feel the radiation?
Just as with a routine x-ray, there is no sensation to the radiation.
How can I prepare for treatment?
If radiation therapy is recommended and you consent, the next step is a treatment planning session which will occur at The Carl J. Shapiro Clinical Center at Beth Israel Deaconess Medical Center - East Campus. You will also meet your primary nurse who will provide you with written material, as well as a video, describing the radiation therapy process. Your primary nurse will be available to you throughout your treatment course.
Will anything touch me during treatment?
You will not see or feel anything as you are being treated, but you will hear the machine running.
Why do I need tattoos?
It is essential that you are set up and treated in the same position every day. The only way to ensure that is with permanent markings on your skin.
Why do you take my picture?
Your face photo is used for identification purposes in accordance with the law. Your set up photos are essential to your daily treatment.
Am I radioactive?
No, you are not radioactive and you will not be a danger to anyone during or after your course of radiation therapy.
Will I lose my hair?
You will lose your hair only in the area that is receiving radiation. The hair on your head will not be affected unless you are receiving radiation to your head. The loss usually is not permanent. Be sure to ask your radiation oncologists or primary nurse any additional questions about hair loss.
Where does the radiation come from?
The radiation is created by accelerated electrons and it comes out of the head of the gantry on the linear accelerator.
Can I see the radiation?
You cannot see, feel, taste, smell or touch the radiation.
What side effects will I have?
Side effects are site specific. So the side effects you receive depend on the area that is being treated. Most people do experience some skin reddening of the site of treatment. For further information about side effects please ask you primary nurse or physician.
How long does the treatment last?
Every person's treatment is specific to them, therefore different. Thus treatment times can range anywhere from 5 minutes to 1 hour. Plan on being in the department for an hour every day.
Can I show my friends/family the treatment room?
The therapists would be more then happy to show anyone accompanying to treatment the treatment consol and room.
Why do you take x-rays?
The therapists take x-rays to double check your positioning on the treatment table. They look at your bones in reference to the images that were taken during your initial simulation.
Can you see my tumor?
The type of x-ray we use isn't the same as the x-rays used to see soft tissue. So unfortunately, we cannot see your tumor when we take our x-rays.
Will I need blood work during treatments?
Blood tests may be done to check your blood counts. Your doctor may also order diagnostic tests or scans throughout the course of therapy, depending on your specific problem.
How do I arrange for follow up care?
Your radiation oncologist will determine what follow up visits are necessary. The doctor who referred you to the radiation oncologist will receive a complete report of your treatment. She/he may also wish to see you in a follow-up visit.
What is an OTV?
An OTV is an "on-treatment visit." One day a week is set aside for a brief visit with your radiation oncologist and primary nurse. Even though you maybe feeling well, it is important that you keep this appointment. It is an opportunity for you and your health care team to discuss any concerns you may have and to assess if there are any treatment related side effects.
What services are available at the hospital?
Social workers are available to provide emotional support and counseling. The social service department can also help arrange: lodging, transportation, and home or community services. If you are interested in patient support groups, ask your nurse or social worker for information. Nutritional support services are also available. A registered dietitian can be scheduled to meet with you and/or your family to discuss any nutritional concerns you may have.
What types of transportation are available?
Most patients are able to get to their daily treatment on their own. If you are not feeling well, you may wish to ask a family member, friend or neighbor to take you to and from treatment. Some communities provide transportation for eligible residents, and some chapters of the American Cancer Society have volunteers who transport patients to and from treatments. Be sure to let your primary nurse know as soon as possible if you are having transportation problems.
Is parking available?
There is a designated outside parking lot where you can park once your treatments begin. Your nurse will discuss this with you once your treatments begin.
Where will I be receiving bills from?
You and your insurance company will usually receive bills from the following sources: The physician group, for your radiation oncologist's services; the hospital(s) where your initial and follow-up consultations occur; Beth Israel Deaconess Medical Center, where your treatment planning occurred; the hospital where you received your actual radiation treatments. If you have any questions about your hospital bills, please contact their billing offices.
What community resources are available to me?
American Cancer Society: refer to your telephone book for local chapters
Cancer Information Service: 1-800-4-CANCER
National Cancer Institute, Physician Data Query (PDQ): 301-496-4000
The Learning Center at The Carl J. Shapiro Center at Beth Israel: 617-667-9100
What is the simulation process?
The Radiation Oncology Treatment Planning Center is located on the 5th floor of The Carl J. Shapiro Clinical Center at Beth Israel Deaconess Medical Center - East Campus. There is ample, convenient parking in the clinical center's underground garage located just around the corner from the main hospital, through the entrance on Binney Street (off Longwood Avenue). For directions, please click the "Contact this Program" icon.
When you and your radiation oncologist decide to pursue radiation therapy, the specific technique for your treatment must be planned. The first step in establishing a treatment plan is to identify the area to be treated. This "mapping" of the treatment area is done on special machines which are called simulators or CT/simulators. These simulators "simulate" or mimic the treatment machine by taking X-ray or CT films which help identify the exact treatment approach. You do not receive radiation at this session.
This simulation will be done by radiation therapists who work in conjunction with members of your radiation oncology team. At your planning session you may need to receive contrast material (barium or IVP dye) to pinpoint the area to be treated. If you need to receive contrast material, the radiation oncologist will discuss it with you before the simulation procedure begins.
You will be asked to change into a hospital gown. You will then be escorted into the simulation room, which may be chilly, and you will be asked to lie on an X-ray table. The area to be planned will be exposed. It is important to remain very still during the procedure. If you are taking pain medication, plan to take it a half-hour before your appointment so that you will be comfortable. If any kind of contrast material is needed, it will be given to you at this time. If you are aware of any allergies to contrast materials, please inform the therapists and/or your physician.
X-rays are taken from the simulator at various angles. The planning is very technical and may feel impersonal. However, you will be closely monitored and the procedure will be explained as it progresses. You will have temporary marks made on your skin. Then, once the exact area to be treated is identified, you will be marked with a few tiny permanent "tattoos" the size of freckles. These will help the radiation therapist to direct the radiation beam precisely to the treatment area during each of your visits. Photographs will be taken to document your treatment position. Following the procedure, you will be escorted back to the dressing room. You should not feel any side effects from the treatment planning.
The treatment planning session will take approximately one hour, depending upon the nature and complexity of the treatment to be planned. After the simulation is completed, calculations are done by the Radiation Oncology Treatment Planning Center staff to determine the specific dose of radiation to be given to the treatment area. Depending on the area of your treatment, lead blocks may need to be made for placement in the treatment machine to shield normal tissue.
Before you leave the Radiation Oncology Treatment Planning Center, your appointment to start treatment will be confirmed. On the day you start treatment you will have an opportunity to meet with your radiation oncology nurse and the radiation therapist on your treatment team to discuss treatment details. We encourage you to call your radiation oncologist or radiation oncology nurse with any questions you may have in the meantime. A signed consent for treatment is needed before treatment begins.
What can I expect during treatment?
It is not at all unusual to feel anxious on the first day of treatment. Your health care team is available to answer any questions. We hope you will share your concerns with us. When you arrive for your first treatment, you will meet with your primary nurse for a pretreatment teaching session. You will learn about the specifics of your treatment, including the number of treatments, treatment field, daily dose and clinical set up. Your nurse will also review the common side effects specific to your treatment and their management. She will also answer any questions you may have. You will be shown where to change into a hospital gown, if necessary. One of the radiation therapists will escort you to the treatment room, which may be chilly, where you will be positioned on the treatment table. As previously mentioned, treatment may include the use of customized lead blocks. These blocks are placed in the treatment machine and will not touch you.
During treatment, the therapists can see you on closed-circuit television and can hear you through an intercom system. You will not see or feel anything as you are being treated, but you will hear the machine running. It is important to follow the therapists' instructions to ensure safe and complete treatment. When the treatment machine is turned off, there is no residual radiation in the room. You are not radioactive.
During the course of your treatment, X-rays called portal films, are taken from time to time to verify that you are in the correct treatment position. They are not used to evaluate your response to treatment. The films are checked by the radiation therapists, radiation oncologists, and the quality assurance team.
Following your first treatment session, the therapist will set up a time schedule with you for the rest of your treatments. Generally, your appointments take place at the same time each day throughout the course of your treatment unless circumstances require a change.
One day a week is set aside for a brief visit with your radiation oncologist, resident physician where applicable, and primary nurse. This is usually right after you scheduled treatment time. Even though you may be feeling well, it is important that you keep this appointment. It is an opportunity for you and your health care team to discuss any concerns you may have and to assess if there are any treatment-related side effects.
Your radiation oncologist will determine what follow-up visits are necessary. The doctor who referred you to your radiation oncologist will receive a complete report of your treatment. She or he may also wish to see you in a follow-up visit.