The Treatment Process: Today, radiation is delivered using highly sophisticated technologies that require a significant amount of preparation and planning, involving the physician, physicist and entire Radiation Oncology Team.
Dr. Gallardo will review your laboratory, pathology, radiology and surgical reports (all provided by your referring physician). With this information, past medical history, physical examination and perhaps with your medical oncologist’s recommendations, Dr. Gallardo will discuss the options available to you. If radiation therapy is a treatment option for your particular situation and disease stage, the details of this treatment including how many treatments will be prescribed, as well as side effects, risks and benefits which will also be detailed. Sometimes, no treatment or “watchful waiting” is the way to go. Your referring doctor and radiation oncologist may confer.
In addition to providing a thorough discussion of treatment options and details, we provide our patients with the “piece of mind” that comes through understanding the process and knowing “what comes next.” We are very aware that cancer can be frightening or anxiety-provoking. Gaining a thorough understanding of the process and having the opportunity to ask questions can sometimes feel like a huge weight has been lifted of your shoulders.
Chemotherapy or Hormone Therapy – in certain situations, your treatment may require chemotherapy or hormone therapy. In certain types of cancer treatment, such as Breast Cancer, Chemotherapy is typically given before Radiation Therapy begins. In certain cases of Prostate Cancer, Hormone Therapy may be given as well prior to beginning Radiation Therapy (and this treatment usually continues during and sometimes after radiation).
The CT simulation is the “Planning Session” where all the necessary information that the Radiation Oncologist needs to create an individualized course of radiation is gathered. As part of this process, a virtual “model” of your internal anatomy will be created, enabling a plan of treatment that perfectly matches your internal and external anatomy. Of course, since everyone’s internal anatomy is different, every plan of therapy must be different. This plan takes into consideration which areas will be targeted based on the area of the body where cancer is or may be, while at the same time avoiding tissues or organs that are not at risk. The simulation appointment is typically a 30-60 minute process where measurements of your body are taken, a scan of the region of treatment is taken, and small ink marks may “tattooed” on your skin to aid in daily set-up reproducibility. In certain types of cancer treatments, special immobilization devices are created to ensure that the anatomy will be accurately reproduced each day. Your scan may involve a type of IV or oral contrast so it is important that you let us know if you are taking medicine for diabetes. A special blood test may be ordered before and after your scan. After you leave your simulation appointment, your Radiation Oncologist will spend the next few weeks working with the images of your anatomy and other pertinent information during the Treatment Planning process.
The next step is perhaps the most important, and occurs “behind the scenes”. Once we have your anatomy on the computer (from the Simulation), the images from the scan will then be reviewed by the Radiation Oncologist with the aid of the Physicist and Dosimetry team. A 3-Dimensional representation of your anatomy will be made allowing for a careful and exacting look at the organs, structures and tissue density of your internal anatomy. Using sophisticated computers, the shape and angles of the radiation beams are optimized using state-of-the-art mathematical algorithms such as Inverse Planning. The results of this dosimetric work, which takes place over the next few weeks following your Simulation, is a precise “modeling” of the Intensity Modulated Radiation Therapy (IMRT) plan that will be used to deliver conformal, or “shaped” radiation to those areas that need to receive treatment, while at the same time avoiding to the best degree tissues and organs that do not. Targeting confirmation via Image Guided Radiation Therapy and or Rapid Arc planning is also performed and verified.
After the Simulation, the Radiation Oncologist and Physics team that helped to create a perfect modeled radiation plan for your anatomy. Your next visit to the office will be a few weeks later to begin therapy. However your first day is not an actual treatment, but will be where we will run-through the plan to provide confirmation and verification of the precision of the planning which had previously been confirmed on a computer model This “dry-run” or “dress-rehearsal” will take place with you in the actual treatment room. The Radiation Therapists will run through each step of an actual treatment, but will take films rather than give the actual treatment – films that are taken for review by the Radiation Oncologist. Any fine-tuning of the planning can be made prior to treatment, which can then proceed once is has been deemed “perfect” by the physician.
The typical course of radiation is given on a Monday through Friday basis, and can last for 15-50 daily treatments, depending on the type of cancer that is being treated and whether or not other types of treatment have been or will be used, such as surgery. Please arrive 5 minutes prior to your scheduled treatment time, and expect to be with us for approximately 30 in total (although the radiation treatment itself is only about 5 minutes. Notify the receptionist that you are here. You will be asked to put on a patient gown. The Radiation Therapist will escort you into the treatment room, and will get you into a comfortable position and make some basic adjustments using marks on your skin or immobilization device matched to external lasers in the room. The Therapist will then step out of the room, where they can still see and hear you via audio and video at the treatment console. In most cases, they will utilize radiation technologies for further precision, most specifically Image Guided radiation technology such as On-Board Imaging, Cone-Beam CT or kV Imaging to find the exact and precise location of the targeted region. You may feel the table move slightly in various directions as the Therapist moves you into an exacting position for treatment. Once positioned perfectly, the linear accelerator will rotate around you, with radiation treatment delivered over about the next 5 minutes. The treatments are “invisible”, and you will not feel any pain or discomfort when being treated. Once completed, the Therapist will re-enter the room and help you from table. You will be asked to return the next day at the same time.
Your first day and even first few weeks of treatments, you are likely to be without any side effects at all! Side effects that occur during radiation (“acute side effects”), are cumulative, in other words, as the days and weeks of treatment go by you may begin to experience some effects as the cumulative effect of the radiation causes an irritation of the normal tissues. Your Radiation Oncologist will explain these possible side effects to you during your initial consultation. You will arrive and receive your treatments each day by the Radiation Therapist. However, on a weekly basis, you will be seen by the radiation oncologist. During this weekly brief exam and discussion, the Radiation Oncologist will assess your response to treatment, assess any side effects that you may be experiencing, and prescribe any necessary medications or treatment modifications that may be warranted.
Once Radiation Therapy is completed, instructions for follow-up will be discussed with you by your Radiation Oncologist and our staff. Typically, you will be seen back in our offices one month following completion of treatment, and then on an on-going basis. During these follow-up visits, assessment of your response to treatment and disease status can be made, as well as review of any studies or tests that have been performed since your last visit, or requisitions for future studies or tests will be given. You will also continue close and careful follow-ups with your referring physician team, to ensure a collaborative multi-disciplinary monitoring of your case.