Frequently Asked Questions

Radiation therapy is a medical treatment that utilizes various forms of radiation to target and damage the genetic material within cancer cells. This inhibits their ability to grow and divide, eventually leading to their death. The body's natural processes then clear away the dead cancer cells. Normal cells are also affected by radiation, but they possess better repair mechanisms compared to cancer cells.

Radiation therapy can be employed in different ways depending on the treatment goals:

Curative Intent:

• Eliminating tumors directly.
• Reducing the risk of cancer recurrence after surgery or chemotherapy by targeting any remaining cancer cells.
• Shrinking tumors before surgery, making them easier to remove.

Palliative Care or Palliation:

• Improving quality of life by alleviating symptoms caused by growing tumors.
• Shrinking tumors that are causing discomfort or impairing bodily functions.
• Relieving pain by reducing tumor size.
• Treating cancer in bones to prevent fractures.

The decision to use radiation therapy and the specific approach taken depend on several factors, including the type of cancer, its stage, the patient's overall health, and the treatment goals. A radiation oncologist, who is a specialized doctor, develops a treatment plan tailored to each individual's needs. The plan takes into account the precise location of the tumor, the desired outcome of treatment, and the balance between effectively treating the cancer while minimizing damage to healthy tissue.

Discussing the treatment goals and options with Dr. Sharma is crucial to making informed decisions about your cancer treatment journey. Our team can provide insights into the potential benefits and risks of radiation therapy, answer your questions, and help you determine the most appropriate course of action based on your specific circumstances.

The goal of radiation therapy is to administer enough radiation to kill the cancer cells while preventing long-term damage to the surrounding healthy tissue. Depending on the size, location, and type of cancer, patients may receive one or a combination of techniques. Your cancer treatment team will help you decide which treatments are best for you.

Radiation therapy can generally be delivered in three ways:

1. External Beam Radiation Therapy: This is the most common type of radiation therapy. It involves using a machine called a linear accelerator to deliver focused radiation beams from outside the body to the targeted tumor. The radiation beams can be in the form of high-energy X-rays or particles like electrons. The goal is to precisely target the cancer cells while minimizing exposure to surrounding healthy tissue. Techniques within external beam radiation therapy include stereotactic radiation therapy, which is a high-dose, precise form of external beam radiation therapy. It delivers intense radiation to a small, well-defined tumor area from multiple angles, often used for brain tumors and some other localized cancers.
2. Brachytherapy: In brachytherapy, radioactive sources are placed either directly inside or very close to the tumor. This allows for a high dose of radiation to be delivered to the tumor while reducing the impact on surrounding healthy tissue. There are two main types of brachytherapy: • Interstitial Brachytherapy: Radioactive sources are placed directly into the tumor or the tissue surrounding it, such as prostate seeds. • Intracavitary Brachytherapy: Radioactive sources are placed inside a body cavity near the tumor, often used for gynecological or esophageal cancers.
3. Systemic Radiation Therapy: Systemic radiation therapy involves using radioactive substances that travel through the bloodstream to target cancer cells throughout the body. This is also known as radiopharmaceutical therapy or internal radiation therapy. The radioactive substance, such as Pluvicto, Lutathera, or Xofigo, is injected into a vein to treat bone metastases.

The choice of which radiation therapy technique to use depends on factors such as the type and stage of cancer, the location of the tumor, the patient's overall health, and the treatment goals. Your radiation oncologist and treatment team will carefully assess your individual case and recommend the most appropriate approach or combination of techniques to achieve the best possible outcomes while minimizing side effects.

Radiation therapy is an effective treatment for cancer, but like many medical interventions, it can have side effects. It's important to note that the side effects of radiation therapy are typically localized to the area being treated, and they are often temporary, mild, and manageable. Here are some common side effects associated with radiation therapy:

Short-Term Side Effects:

1. Fatigue: Fatigue is one of the most commonly reported side effects of radiation therapy. It can vary in intensity and is often related to the area being treated and the patient's overall health. Rest and pacing activities can help manage fatigue.
2. Skin Changes: Skin in the radiation field may become irritated, red, dry, or sensitive, resembling a mild to moderate sunburn. Proper skincare, moisturization using 100% aloe or Aquaphor, and avoiding exposure to direct sunlight can help alleviate skin issues.
3. Hair Loss: Hair loss can occur in the area receiving radiation, but this side effect is limited to that specific region. For example, if radiation is given to the head, hair loss may occur on the scalp.
4. Swallowing Difficulty: Patients undergoing radiation therapy in the head and neck area may experience soreness or difficulty swallowing, which can affect their ability to eat. Dietary modifications and supportive care can help manage these symptoms. St. Mary’s offers nutritional support specialized for their particular treatment and cancer site from the start of their care in Radiation Oncology.
5. Nausea and Vomiting: Radiation therapy to the abdominal or pelvic area may cause nausea or vomiting. Medications can be prescribed to help alleviate these symptoms.
6. Diarrhea or Bowel Changes: Radiation to the abdominal area can lead to diarrhea or changes in bowel habits. Dietary adjustments and medications can help manage these symptoms.
7. Oral Mucositis: Radiation therapy to the mouth or throat can result in dry mouth and oral mucositis, characterized by painful sores in the mouth. Good oral hygiene and medications may be recommended to manage this side effect.

Long-Term Side Effects:

Long-term side effects of radiation therapy can occur in the normal tissues within the treated area. However, with advanced treatment planning and improved technologies, serious long-term side effects are uncommon.

The risk of long-term side effects depends on factors such as the area being treated, the radiation dose, and whether the same area has previously received radiation. Long-term side effects may include fibrosis (tissue scarring), changes in skin color or texture, and potential effects on nearby organs. It's crucial for patients to discuss the specific risks of long-term side effects with their radiation oncologist, as well as any potential concerns about radiation exposure to other tissues or organs.

Overall, while radiation therapy may cause side effects, its benefits often outweigh the risks, and side effects can usually be managed with supportive care and guidance from the medical team. Patients are encouraged to communicate openly with their healthcare providers about any discomfort or side effects they experience during or after radiation therapy. Additionally, adopting a healthy lifestyle, including quitting smoking and moderating alcohol consumption, can help reduce the risk of second cancers in the long term.

Here's what typically happens before, during, and after radiation therapy:

BEFORE TREATMENT

1. Multidisciplinary Consultation: After a cancer diagnosis, you may consult with various specialists, including a radiation oncologist, surgeon, medical oncologist, and others, depending on your case. Tumor board meetings may be held to discuss your treatment options and create a customized plan.
2. Radiation Oncologist Evaluation: You will meet with a radiation oncologist who will assess whether radiation therapy is appropriate for your cancer. This includes a thorough review of your medical history, physical examination, and possibly additional tests.
3. Simulation: Simulation is the process of precisely measuring your body and tumor to determine the treatment target. You may undergo CT scans, PET scans, or other imaging to assist in planning.

Treatment Planning:

1. Team Collaboration: A team of experts, including your radiation oncologist, medical physicist, and dosimetrist, collaborate to create a treatment plan. The goal is to maximize the radiation dose to the cancer while minimizing exposure to healthy tissues.
2. Computerized Planning: Advanced computerized systems are used to design the treatment plan, including the selection of radiation techniques, dose, beam angles, and shapes. Your radiation oncologist writes a prescription outlining the radiation dose and target areas.
3. Quality Assurance: The treatment plan undergoes quality assurance checks to ensure its accuracy and safety. A "dry run" or testing session is often conducted before treatment begins.

DURING TREATMENT

1. Daily Treatments: Radiation therapy is typically administered as a series of outpatient treatments, although inpatient treatments can also be done depending on the treatment plan. Each session, given Monday through Friday, is painless, non-invasive, and delivered by a machine called a linear accelerator.
2. Simulation Treatment Devices: If immobilization devices were created during simulation, they are used to ensure that you are positioned accurately and consistently for each treatment.
3. Radiation Therapy Process: Radiation therapists set up the equipment and patient, deliver radiation treatments, and monitor you throughout the treatment with both audio and video systems. The machine may make noises, but you will not see or feel the radiation. When patients are positioned by therapists prior to setup verification and treatment delivery, they are raised very high up in the air on a very narrow table. The most important thing you can do while in the treatment room is hold still until you are assisted off the table.
4. Treatment Monitoring: Your radiation oncologist monitors your progress during treatment and may make adjustments based on your response.
5. Weekly Checkups: You will have regular checkups with your radiation oncologist and medical team to evaluate your progress, address side effects, and manage any concerns.
6. Quality Assurance During Treatment: The position of the treatment beams is regularly verified using images made with the treatment beam itself to ensure accuracy.

AFTER TREATMENT

Follow-Up: After completing treatment, follow-up appointments will be scheduled to monitor your recovery. Additional tests and scans may be ordered to evaluate your progress and check for long-term side effects or cancer recurrence.

Continued follow-up is recommended, with the frequency of visits decreasing over time. Your radiation oncology team will be available for any questions or concerns you may have about your treatment.

The radiation therapy team is composed of various highly trained medical professionals who work together to provide comprehensive care during radiation therapy. The key members of the radiation therapy team include:

1. Radiation Oncologists: These doctors specialize in using radiation to treat cancer. They lead the team and are responsible for developing your treatment plan, overseeing treatments, monitoring your progress, and adjusting the treatment as needed. Radiation oncologists work closely with other cancer specialists, such as medical oncologists and surgeons, to coordinate care.
2. Radiation Therapists: Radiation therapists are responsible for patient and equipment setup, pre-treatment simulations, obtaining scans in preparation of treatment, and delivering daily radiation treatments under the supervision of the radiation oncologist. They operate the radiation therapy machines (linear accelerators) and ensure that patients are correctly positioned for each treatment.
3. Radiation Oncology Nurses: These professionals provide care and support to patients and their families before, during, and after treatment. They educate patients about potential side effects, help manage side effects, and assess patients' well-being throughout treatment.
4. Medical Physicists: Medical physicists work alongside the radiation oncologist during treatment planning and delivery. They also work with dosimetrists and ensure that complex treatments are tailored to each patient's needs. Medical physicists perform all quality control checks on equipment and treatment plans to ensure safety.
5. Dosimetrists: Dosimetrists collaborate with the radiation oncologist and medical physicists to create precise treatment plans. They calculate radiation doses to ensure that the tumor receives the prescribed amount while minimizing exposure to healthy tissue.

Additional team members may include interventional radiologists, nurse practitioners, physician assistants, social workers, nutritionists, patient navigators, radiation engineers, physical therapists, and dentists. In cases where radiation therapy is combined with systemic therapy (chemotherapy or immunotherapy) or surgery, a multidisciplinary team involving medical oncologists and surgeons may also be part of the care team.

The coordinated efforts of these professionals ensure that patients receive safe and effective radiation therapy while minimizing side effects and maximizing treatment outcomes.

During radiation therapy, patients can take several steps to care for themselves and optimize their well-being:

1. Get Adequate Rest: Fatigue is a common side effect of radiation therapy. Ensure you get plenty of rest and sleep to help your body recover. If possible, ask friends and family for assistance with daily tasks and errands to allow for more rest.
2. Engage in Light Physical Activity: Moderate daily exercise, such as short walks, can help reduce treatment-related fatigue. Consult your radiation oncologist for guidance on suitable physical activities during your treatment.
3. Follow Medical Instructions: Strictly follow your doctor's orders and any instructions provided by your treatment team. This includes adhering to recommended guidelines for contacting your medical team if you experience specific symptoms or issues.
4. Maintain a Balanced Diet: Consume a nutritious, balanced diet that provides essential vitamins and minerals to support your immune system and healing process. Consult with a nutritionist, dietitian, or healthcare professional for dietary guidance tailored to your needs. St. Mary’s Radiation Oncology provides nutritional support by a registered dietician to any patient in need that is under our care.
5. Stay Hydrated: Ensure you stay well-hydrated throughout your treatment. Depending on your treatment and side effects, your medical team may recommend specific fluids or strategies to prevent dehydration.
6. Skin Care: Pay special attention to the skin in the treated area, as it may become sensitive and develop radiation-induced skin reactions similar to a sunburn. Follow the skincare instructions provided by your radiation oncology team, which may include gentle cleansing and avoiding certain skincare product and deodorant, and utilizing 100% aloe vera or Aquaphor after treatment sessions. We do not want patients to apply anything to the affected area 4 hours prior to each treatment session. Doing so could cause a more severe skin reaction.
7. Sun Protection: If the treated area is exposed to the sun, protect it by wearing a hat and clothing that covers the skin. Additionally, apply sunscreen with a minimum SPF of 15 after treatment.
8. Seek Emotional Support: Coping with cancer diagnosis and treatment can be emotionally challenging. Reach out for emotional support when needed. Consider joining a support group, either in person or online, to connect with others going through similar experiences. Counseling or therapy may also be beneficial.
9. Stay Informed: Stay informed about your treatment plan and any potential side effects. Ask questions and communicate openly with your treatment team to address concerns and receive guidance.
10. Stay Hygienic: Maintain good hygiene practices, including regular handwashing, to minimize the risk of infections during treatment.
11. Manage Stress: Explore stress-reduction techniques such as relaxation exercises, meditation, or mindfulness to help manage the emotional toll of cancer treatment.
12. Seek Financial Support: If you have financial concerns related to treatment costs or insurance, reach out to support organizations or resources that can assist you in navigating financial issues.

Remember that your radiation oncology team is there to support you throughout your treatment journey. Don't hesitate to reach out to them with any questions, concerns, or needs that arise during radiation therapy.