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Commonly Asked Questions about Radiation Therapy
Stella Ling, MD
Q: What is radiotherapy and what is a radiation oncologist?
A: Radiotherapy or radiation oncology is the branch of medicine concerned with treatment of tumors with high energy X-rays. This treatment can be given in multiple small doses or a few large doses depending on the kind of tumor and the goal of treatment. It can be given externally from a machine called a linear accelerator or internally via radioactive sources which are implanted into the body, brachytherapy. The radiation therapy team usually consists of the physician who is called the radiation oncologist and who prescribes the treatment and oversees the results and side effects; the physicist and dosimetrist who help determine the best treatment plan and who maintain the accuracy of the treatment; and the therapist or technician who positions the patient on a daily basis and administers the treatment.
Q: Who else will be on my treatment team?
A: Often the initial physician who made the referral remains on the treatment team. If you have cancer, your team will usually consist of several physicians. These will often include your surgeon (either a general surgeon or one specializing in a particular organ system, such as a urologist for the prostate, an ENT physician for head and neck cancer or a neurosurgeon for brain cancer), a medical oncologist (the physician who prescribes chemotherapy or hormonal therapy) and the radiation oncologist. Nurses, social service workers, nutritionists, psychologists and counselors, the radiation therapist, dosimetrist and physicist are also part of your team.
Q: How will I know if I need radiation? A: Often the indication for radiation is clear-cut, however at other times, the decision is not so clear and you may have multiple treatment options. When you have your consultation with the radiation oncologist, he or she will usually explain all your treatment options as well as the benefits and downsides of each particular treatment decision.
Q: What are the side effects of radiation?
A: The side effects often depend on the area of the body which is being irradiated, as well as the over-all time frame of the treatment, and the dose given at each treatment. Patients often try to compare side effects of their treatment in the waiting room, however they are not aware that they may be receiving very different treatments even if ostensibly for the same conditions. No two patients are exactly alike and therefore the treatment must be tailored to their particular constellation of disease stage, location, age, and multiple other associated factors. Common side effects of radiation therapy could include skin dryness and peeling, sometimes even redness, like you might get with a bad sunburn. Often the patients feel tired or listless. Blood counts may go down especially if chemotherapy is also being given or if a large area is being treated. However, some patients breeze through the treatment with few if any side effects. An informed consent listing all the possible side effects should be discussed with you and your family if they are present prior to starting treatment. Each week during radiotherapy treatment, you will see the physician in order to voice any of your concerns. At these weekly visits, the physician can also tell you about the progress of treatment and recommend any treatment for side-effects that you may be experiencing. These weekly visits are VERY important and the patients should not miss them if they can help it.
Q: Once I have had my consultation with the radiation oncologist and have decided to for forward with radiation treatments, what is the next step?
A: The next step is planning your treatment. (See article on Simulation by Pam Akazawa, CMD.) You will be scheduled for a planning session or simulation which will generally take 1-2 hours. This is the longest session that you will have, as all the treatment once they start will probably take only about 15 minutes/ day. You can help with planning your treatment by taking pain medications ahead of time if you have difficulty laying still on a hard surface. During the planning session, we will be taking X-rays and other measurements. After the planning session, the area to be treated will be marked with a special tattoo - a tiny ink dot under the skin.
Q: How will I know if my treatment has been successful?
A: Unfortunately we often do not know immediately if the treatment has been successful. Radiation enters the cancer cells and causes them to die when they would normally be multiplying. So, the cancer cell may not die until after the radiotherapy treatments have been completed. It may take up to several months or even a year to know whether all the cancer cells have been killed. All the physicians who have been caring for you will see you periodically after the treatments are completed. Sometimes there is a good blood test or X-ray which can help to assess the shrinkage of the tumor or decrease in tumor cells. Sometimes we can tell from your clinical response. Other times, it is simply a waiting game.
Q: Is radiation used for anything besides cancer?
A: Yes, it is also used for benign conditions such as Graves ophthalmopathy (the bulging eyes typically seen in certain thyroid conditions), to prevent cheloid formation, to prevent heterotopic bone formation, sometimes for life-threatening hemangiomas, for prevention of coronary artery restenosis. Many new uses for radiation therapy are constantly being discovered.
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