Radiation Oncology

What to Expect: External Beam Radiation

The goal of external beam radiation is to aim radiation directly at your cancer. You'll get radiation only on the part of your body that has cancer tumors.

Most of the time, you will get external beam radiation therapy as an outpatient. You'll have treatment at a Riverside radiation therapy center and will not have to stay in the hospital unless recommended by your doctor.

Most people get therapy 5 days a week, Monday through Friday. Treatment lasts for 2 to 10 weeks, depending on the type of cancer you have and the goal of your treatment. The time between your first and last radiation therapy sessions is called a course of treatment.

To help you understand the process, our staff is offering this information on what you can expect during:

Your first visit to our radiation therapy center usually does not involve treatment. The appointment should take about an hour.

What to bring to your first appointment

Our staff needs your medical history and other information before you see the doctor. There are two options for completing the necessary paperwork:

  • Complete the forms at home. You can download and print out the forms at home and bring the completed paperwork with you. Click here to download forms.
  • Complete the forms at our office. Plan to arrive 45 minutes early for your appointment. You can complete the paperwork in the waiting room. You will need to know the Social Security number of the primary holder of your health insurance. (For instance, if you are covered through your wife's policy from her workplace, then your wife is the primary insurance subscriber and you will need her SS#.) We'll also want you to provide your personal health history, so making notes beforehand may help recall.

What to expect

At this first visit, you will:

  • Meet and talk with your radiation oncologist, who will review your records prior to seeing you. He or she will explain the treatment and answer any questions that you may have.
  • Have a physical exam.
  • Meet the radiation oncology nurse. The nurse will review the treatment procedure and routine with you.
  • Receive instructions for your next visit. For instance, you may be given a prep instruction sheet to follow before your second appointment, the CT appointment and before each radiation therapy treatment.

At your second visit you will go through a process called. "CT Simulation". This appointment takes approximately one hour. Here's what to expect:

  • You may be asked to change into a gown or shorts.
  • Next you will be asked to lie still on a table while the therapist and radiation oncologist take measurements and scan the area of the body needing treatment.
  • The therapist will place you in the position that you will be in for your daily treatment.
  • The therapist will also mark your skin with semi-permanent ink to ensure the radiation is directed to the same body area for each treatment. These small, semi-permanent marks are referred to as "tattoos."
  • You may shower as usual.
  • Do not wash marks off until treatment is finished.

Treatment areas

Your radiation preparation and treatment will vary depending on the area treated. Here's what to expect for head and neck patients, prostate patients and breast patients:

Head and neck patients

For a head and neck patients, your head will have to be immobilized in preparation for your daily treatments. This part of the procedure will involve making a mask to form around your face. This mask will be used in your daily treatments. The physician may require a "bite block", a device that is held in the mouth to protect the tongue during treatments. This position may be uncomfortable but its important for the planning process. This is the position you will be in for your daily treatment. The therapist will also place marks on the mask to ensure the radiation is directed to the same area for each treatment. If a mask is not used, then the skin will be marked with semi-permanent ink.

Prostate patients

You may be asked to follow prep instructions before this appointment, including drinking water to fill your bladder. During this appointment you may be asked to remove all clothing from the waist down and put on disposable shorts. You will lay on a table as we make a special mold that your lower body will fit into; this is the position you will be in daily for treatment. The therapist will mark your skin with semi-permanent marks or with tattoos that they will use daily to line you up under the machine.

Breast patients

During setup and treatment, your arms may be positioned above your head on what is called a wing board, and a mold for your head and arms will be made just for you. This is the position that you will be in daily for treatment. It may be uncomfortable for your arms to be up, however it is important for the planning process. The radiation therapist will also mark your skin with semi-permanent ink or tattoos that they will use to line you up under the machine.

Your third appointment will be in a few days or up to two weeks after your CT stimulation appointment. This allows the team to customize a plan of radiation specifically designed for you.

When the planning is completed in the background, you will come for your third visit; the verification stimulation appointment. During this appointment, images will be taken in the treatment position, to verify the plan that was made custom for you. The radiation oncologist will review these images to ensure that the equipment and treatment plan are adjusted accurately. In most cases you will not receive a treatment during this visit.

Here's what to expect during the third visit verification stimulation:

  • You may be asked to change into a gown or shorts.
  • In the treatment room, you will lie on the table in the same position used for the CT simulation.
  • The therapist will move you until your marks line up with the machine flight field and lasers.
  • A scan, with the machine moving around you, is often done during this visit, and done during treatment visits.

This third appointment will take about 15 to 30 minutes.

On your fourth visit, treatment will begin. During your treatments, you will be cared for by your radiation therapist. Using the marks that have already been made on your skin, the therapist will carefully position you on the treatment table beneath the machine. If a mold was made, it will be used to help you hold still. Remaining still during treatments ensures that the proper area is treated.

The treatment machines are large and can be intimidating when you first encounter them. They can make noises similar to a vacuum cleaner and during your treatment they move up and down and around you so that radiation can be directed at the tumor from different angles.

It is normal to be a bit anxious during your first few treatments, but we will be watching you and help you through this treatment. Rest assured that the machines are checked regularly by the radiation physics staff to ensure proper operation.

During treatment, your radiation therapist will be in another room monitoring you on a close-circuit TV screen. You will be able to talk to each other via an intercom. Even though you may feel alone, remind yourself that your treatment is constantly being checked.

The treatment period usually takes a very short time - a few minutes at most. Often, the waiting and preparation take longer than the treatment.

Once a week, a doctor and nurse will check in to see how you're feeling. Tests may be ordered, if you are having specific problems. Since therapy can affect non-cancerous, normal cells in the area treated, its possible that you may have side effects. Your nurses and oncologists can answer any of your questions about possible side effects.

The number of radiation treatments will vary according to the location and the type of cancer you have. Some things to remember:

  • Treatments are usually given five days a week (Monday—Friday). Because it is so important for you to have all of your treatments, we urge you not to miss any of them.
  • You will be given an appointment to come in each day. Because patients are scheduled every 15 minutes, please keep your appointment time as assigned.

On occasion, you may find yourself waiting because of unavoidable delays. For this, we offer our apologies in advance. We will always get you into the treatment room as quickly as possible.

During treatment

Once a week, a doctor and nurse will check in to see how you're feeling. Tests may be ordered, if you are having specific problems. Since therapy can affect rapidly dividing normal cells in the area being treated, you may have some complaints about side effects that will require special tests. Please expand the 'Side effects from your treatment' bar for more information.

Follow-up visits

You will be advised when you should have follow-up visits. You will usually be asked to return to the radiation oncologist for one or more visits. He or she will want to evaluate the effectiveness of your treatment and to know about any problems you may be having.

The doctor who referred you to the radiation oncologist will receive a complete report on your treatment and should review it with you as well.

What to Expect: Internal Radiation Therapy (Brachytherapy)

Brachytherapy is a special use of radiation in which a radioactive source is placed as close as possible to the cancer cells. This allows higher doses of radiation treatment in a smaller part of your body resulting in more cancer killing power at the site without extensive damage to healthy cells. You may also get internal radiation along with other types of treatment, including external beam radiation, chemotherapy, or surgery.

The radioactive source is delivered using a remote controlled afterloading device which briefly and precisely places the source within the affected tissue. The radioactive source may be delivered to the cancer cells through tubes using a special machine known as a remote afterloader.

In our department we do exclusively high dose rate Brachytherapy using iridium-192. By using internal radiation therapy, the radiation oncologist can give a higher total dose of radiation in a shorter time than is possible with external treatment.

Before your brachytherapy treatment, you will be given a handout describing the procedure (how to prepare, what to expect and side effects). Please discuss any questions or concerns with your radiation oncologist.

You will meet with your oncologist or nurse before you begin treatment. Your oncologist or nurse will discuss radiation therapy, its benefits for your situation, side effects and how to care for yourself during and after treatment. Your cancer team will develop a treatment plan for you. During this appointment you may undergo:

  • A physical exam
  • A review of your medical history
  • Additional blood work
  • CT scans to define the places in your body that will get radiation or treatment fields.

Treatment time depends on the type of brachytherapy procedure. Some treatments allow you to be treated within a few minutes either as an inpatient or an outpatient while other types of brachytherapy may last for one to three days requiring hospitalization.

  • The radiation source is in place for 3 to 40 minutes depending on simple vaginal or complicated skin.
  • Treatment frequency depends on your type of cancer. Typically, treatment is twice a day for 2 to 5 days or once a week for 2 to 5 weeks.
  • During the course of treatment, your catheter or applicator may stay in place, or it may be put in place before each treatment.
  • You may be in the hospital during this time, or you may make daily trips to the center to have the radiation implants.

The side effects of brachytherapy vary from patient to patient. The side effects you experience depend mostly on the part of the body that is treated. Before beginning your treatment, your radiation oncologist will explain the side effects you might experience, how long they might last, and how serious they might be.