Radiation therapy: What to expect

Many cancer patients will need radiation therapy as part of their treatment. Radiation can be used alone or as part of a treatment plan. When radiation is used in combination with other treatments, it can help to reduce the size of the tumor so that it’s easier to remove during surgery or to make it more sensitive to chemotherapy. Some patients also receive radiation after surgery or chemotherapy to help destroy any remaining cancer.

We spoke with radiation oncologist Bouthaina Dabaja, M.D., for insight on what patients can expect when receiving  radiation treatment. Here’s what she had to say.

How will I know if I need radiation therapy?

Your care team will work with you to determine your treatment plan, including whether you might need radiation therapy. If your care team determines that you need radiation therapy, then we’ll decide the target, technique, dose and type of radiation to use.

What happens before radiation treatment begins?

First, you’ll meet with your radiation therapy team. This can include radiation oncologists, research nurses, registered nurses, radiation therapists, medical dosimetrists, physicists and other cancer professionals who work to create an individualized treatment plan for each patient’s cancer. The radiation oncologist will explain the process and your personalized treatment plan, including the number of treatments you will need. The radiation oncology nurse and care team will answer your questions and guide you through the process.

Before treatment begins, your care team will plan your radiation. This is done using a CT simulation machine. The CT simulation will produce a scan for your team to plan the angles and shapes of the radiation beams for treatment. These plans are designed by medical dosimetrists, who carefully plan and calculate the proper radiation dose for each treatment.

What happens during the simulation process?

Depending on the cancer type, the consultation and simulation are usually scheduled on the same day. Before you start the simulation process, the therapists will explain the procedure and position you on the table. Simulation often takes 30-45 minutes.

During simulation, you will feel the table move to different positions. The lights in the room will be turned on and off. You will see red laser lights on each wall. Do not look directly into the red beam as it may hurt your eyes.

While you are on the table, the staff will take imaging scans, such as MRI and CT scans. Your radiation oncologist will use these scans to pinpoint the exact treatment area to target during radiation therapy.

Here are some other things to expect during the simulation:

• Skin markings/tattoos. The therapist will draw on your skin with a felt marker to create a marking. These marks act as landmarks to help position you for treatment. If permanent markings are required, the therapist will use a sterile needle to deliver a pin-size drop of ink.
  
  
• Mask. A mask is required for patients receiving external radiation therapy to the head. While you lie on the table, the therapists will place a warm sheet of plastic mesh over your face that will shape around your head and shoulders. As the mask cools, it will harden as it forms to fit your face. The masking process takes about 15 minutes.
  
  
• Vac-Lock: If you are receiving radiation on a part of your body other than the head, a special body mold is made to keep you steady. This helps to make sure you are in the same exact position for each treatment.
  
  
• Breath-Hold or 4DCT technique: If you are receiving radiation near rapidly moving organs such as the diaphragm, your team will show you how to do the breath-hold or 4DCT technique. This is done several times during the planning process and treatment.

How soon after the simulation will I start radiation therapy?

Depending on the type of cancer being treated, your radiation therapy team will need 1 to 7 days after simulation to plan your treatment. For complex cases, more time is needed to minimize the radiation dose to vital healthy structures.

At MD Anderson, all treatment plans then go through our physics and departmental quality assurance to be reviewed before treatment begins.

The course of treatment and length of time per treatment varies based on each patient’s customized plan.

What happens during each radiation treatment?

Before you start receiving radiation therapy, the therapist will position you on the treatment table and make sure you are comfortable. You'll lie down on the table while the machine moves around you to deliver the radiation, so make sure you wear comfortable clothes. You will not see or feel the radiation, but you may hear the machine as it is turned on and off.

You will be in the treatment room 10 to 40 minutes, depending on the complexity of your treatment. Even though you are alone during treatment, the therapists can see you on the monitor and hear you through the intercom. If you are uncomfortable, ask the therapists for help. They can turn off the machine and come in to see you at any time.

If you are a patient at MD Anderson, you can ask your radiation therapist to play music to help pass the time during your treatment. We have music to choose from, or you can bring your own.

What should patients expect after treatment?

Most patients will experience some radiation therapy side effects, such as appetite changes, fatigue, insomnia and skin irritation. Often these are manageable. Side effects vary from patient to patient and depend on where radiation is delivered. appetite changes, insomnia and skin irritation. Often these are manageable. Side effects vary from patient to patient and depend on where radiation is delivered.

Many patients experience fatigue, stress and mood changes during treatment. Exercising during radiation therapy can help, even if you’re only able to go for a short walk. There are many benefits of physical activity for cancer survivors.

What should patients and caregivers keep in mind going into radiation therapy?

When a patient receives radiation, we expect to see some shrinkage of the tumor. This should also reduce symptoms the tumor is causing, such as pain, shortness of breath or neurological loss. It is important to keep your care team informed of all symptoms before, during and after treatment.

Your radiation oncologist will follow along with the rest of your care team to evaluate how the cancer is responding to treatment and monitor any long-term side effects.

Keep a copy of your radiation treatment plan in case you need radiation again in the future. This will be used to determine if you can receive radiation again to the same area or nearby.

Most importantly, call your doctor if you experience any unusual symptoms during or after radiation therapy. We’re here to support you throughout your radiation therapy experience. We want you to remember that you’re not alone.

Request an appointment at MD Anderson online or by calling 1-877-632-6789.