Radiation Oncology

The Tammy Walker Cancer Center's Radiation Oncology Department, under the direction of Claudia Perez-Tamayo, M.D., has earned the reputation of offering technology normally available only in large, research medical centers.

In 1993, the Radiation Oncology Department was distinguished as the first in the state to offer "conformal three-dimensional" treatment planning and continues to be a leader in treatment planning.

It was also one of the first facilities in the nation to offer IMRT, a highly sophisticated and precise radiation treatment.

And in 2010 the Radiation Oncology Department at the Tammy Walker Cancer Center is proud to offer the newest version of the Varian Trilogy machine. The Trilogy is the world's firstimage-guided radiation therapy system optimized for both conventional and stereotactic approaches to treating cancer. In addition, Trilogy offers respiratory gating technology, which allows treatment delivery in tandem with a patient's breathing, minimizing treatment volumes. This technology allows the treatment team at Tammy Walker to provide precise, high dose delivery to very small areas of the body while sparing healthy tissue. Learn more about the benefits of Trilogy.

Patients throughout the area have found that they can receive excellent cancer care close to home. The Tammy Walker Cancer Center is committed to the fight against cancer and brings the best treatments available nationwide to north central Kansas.

What happens before, during, and after treatment?

Before you can begin treatment, your doctors must first run tests to determine what type of cancer you have and if it has spread to other parts of the body. Once the diagnosis has been made, you will probably talk with your primary care physician along with several oncology specialists, such as a surgeon, a medical oncologist and a radiation oncologist, to discuss your treatment choices. Often, these specialists will work together to help recommend the best treatment for you. In some cases, your cancer will need to be attacked by using more than one type of treatment. For example, if you have breast cancer, you might have surgery to remove the tumor (by a surgeon), then have radiation therapy to destroy any remaining cancer cells in or near your breast (by a radiation oncologist). You also might receive chemotherapy (by a medical oncologist) to destroy any remaining cancer cells that have traveled to other parts of the body.

Your radiation treatment pathway; an illustrated guide to understanding what to expect

Before Treatment

Consultation With a Radiation Oncologist
If you are considering radiation therapy, you must first schedule a visit with a radiation oncologist to see if radiation therapy is right for you. During your initial visit, the doctor will evaluate your need for radiation therapy and its likely results. This includes reviewing your current medical problems, past medical history, past surgical history, family history, medications, allergies and lifestyle. The doctor will also perform a physical examination to assess the extent of your disease and judge your general physical condition. After reviewing your medical tests, including CT scans, MR scans and positron emission tomography scans (PET scans), and completing a thorough examination, your radiation oncologist will fully discuss with you the potential benefits and risks of radiation therapy and answer your questions.

Simulation and Treatment Planning
To be most effective, radiation therapy must be aimed precisely at the same target or targets each and every time treatment is given. The process of measuring your anatomy and marking your skin to help your team direct the beams of radiation safely and exactly to their intended locations is called simulation.

During simulation, your radiation oncologist and radiation therapist place you on the simulation machine in the exact position you will be in during the actual treatment. Your radiation therapist, under your doctor's supervision, then marks the area to be treated directly on your skin or on immobilization devices.

Immobilization devices are molds, casts, headrests or other devices that are constructed and placed on a certain part of your body to help you remain in the same position during the entire treatment. A special treatment planning CT scan is done to help with the simulation and treatment planning. The radiation therapist marks your skin and/or the immobilization devices either with a bright, temporary paint or a set of small permanent tattoos. Although simulation is typically only one session, your physician may schedule more than one session depending on the type of cancer you have and the type of radiation therapy that is being used.

Once you have finished with the simulation, your radiation oncologist and other members of the treatment team review the information they obtained during simulation along with your previous medical tests and use sophisticated treatment-planning computer software is used to help design the best possible treatment plan. After reviewing all of this information, your doctor writes a prescription that outlines the exact course of your radiation therapy treatment.

During Treatment

Treatment Administration
When you undergo external beam radiation therapy treatment, each session is painless, like getting an X-ray. The radiation is directed to your tumor from a machine located outside of your body. One of the benefits of radiation therapy is that it is usually given as a series of outpatient treatments and you may not need to miss work or experience the type of recuperation period that can follow other treatments. Treatments are usually scheduled five days a week, every day except Saturday and Sunday, and continue for 3 to 10 weeks. Some patients receive hyperfractionated radiation therapy, in which radiation treatments are given more than once a day. Other times, only one or a few treatments are required, such as for the treatment of cancer that has spread to the bone.

The number of radiation treatments you will need depends on the size, location and type of cancer you have, your general health and other medical treatments you may be receiving. The radiation therapist will administer your external beam treatment following your radiation oncologist's instructions. It will take about five to 15minutes for you to be positioned for treatment and for the equipment to be set up. If an immobilization device was made during simulation, it will be used during every treatment to make sure that you are in the exact same position every day.

Once you are positioned correctly, the therapist will leave the room and go into an adjoining control room to closely monitor you on a television screen while administering the radiation. There is a microphone in the treatment room so you can always talk with the therapist if you have any concerns. The machine can be stopped at any time if you are feeling ill or uncomfortable. The radiation therapist may move the treatment machine and treatment table to target the radiation beam to the exact area of the tumor. The machine might make noises during treatment that sound like clicking or whirring. These noises are nothing to be afraid of, and the radiation therapist is in complete control of the machine at all times. The radiation therapy team carefully aims the radiation to decrease the dose to the normal tissues surrounding the tumor. Still, radiation will affect some healthy cells. The time in between daily treatments allows your healthy cells to repair much of the radiation damage. Most patients are treated on an outpatient basis, and many can continue with normal daily activities. Sometimes a course of treatment is interrupted for a day or more. This may happen if you develop side effects that require a break in treatment. These missed treatments may be made up by adding treatments at the end. Try to arrive on time and not miss any of your appointments. Your radiation oncologist monitors your daily treatment and may alter your radiation dose based on these observations. Also, your doctor may order blood tests, X-ray examinations and other tests to see how your body is responding to treatment. If the tumor shrinks, another simulation may be done. This allows your radiation oncologist to change the treatment to destroy the rest of the tumor and spare even more normal tissue.

Weekly Status Checks
During radiation therapy, your radiation oncologist and nurse will see you regularly to follow your progress, evaluate whether you are having any side effects, recommend treatments for those side effects (such as medication) and address any concerns you may have. As treatment progresses, your doctor may make changes in the schedule or treatment plan depending on your response or reaction to the therapy. Your radiation therapy team may gather on a regular basis with other healthcare professionals to review your case to ensure your treatment is proceeding as planned. During this session, all the members of the team discuss your progress, as well as any concerns.

Depending on your situation, your team will routinely use the treatment machines to take special CT scans or x-rays called port films. This imaging may occur daily or weekly. Your treatment team reviews these images to be sure that the treatment beams remain precisely aimed at the proper target. This imaging is not diagnostic and is not used to evaluate your tumor.

Brachytherapy Treatments
Brachytherapy is the placement of radioactive sources in or just next to a tumor. The radioactive sources may be left in place permanently or only temporarily, depending upon your cancer. To position the sources accurately, special catheters or applicators are used. There are two main types of brachytherapy: intracavity treatment and interstitial treatment. With intracavity treatment, the radioactive sources are put into a space near where the tumor is located, such as the cervix, the vagina or the windpipe. With interstitial treatment, the radioactive sources are put directly into the tissues, such as the prostate. Often these procedures require anesthesia and brief hospitalization. Patients with permanent implants may have a few restrictions at first and then can quickly return to their normal activities.

Temporary implants are left inside of your body for several hours or days. While the sources are in place, you will stay in a private room. Doctors, nurses and other medical staff will continue to take care of you, but they will need to take special precautions to limit their exposure to radiation. You may be able to go home shortly after the procedure.

After Treatment

Follow Up
After treatment is completed, follow up appointments will be scheduled so that your radiation oncologist can make sure your recovery is proceeding normally and can continue to monitor your health status. Your radiation oncologist may also order additional diagnostic tests. Reports on your treatment can be sent to your other physicians. As time goes on, the frequency of your visits will decrease. However, you should know that your radiation oncology team will always be available should you need to speak to someone about your treatment.

Are there any Side Effects?
Patients often experience little or no side effects from the radiation therapy and are able to continue their normal routines. However, some patients do feel some discomfort from the treatment. Be sure to talk to a member of your radiation oncology treatment team about any problems you may have. Many of the side effects of radiation therapy are related to the area that is being treated. For example, a breast cancer patient may notice skin irritation, like a mild to moderate sunburn, while a patient with cancer in the mouth may have soreness when swallowing. These side effects are usually temporary and can be treated by your doctor or other members of the treatment team.

Side effects usually begin by the second or third week of treatment, and they may last for several weeks after the final radiation treatment. In rare instances, serious side effects develop after radiation therapy is finished. Your radiation oncologist and radiation oncology nurse are the best people to advise you about the side effects you may experience. Talk with them about any side effects you are having. They can give you information about how to manage them and may prescribe medicines that can help relieve your symptoms.

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Who are the members of the Radiation Oncology Team?

While you undergo radiation therapy, a team of highly trained medical professionals will be working together to make sure you receive the best care possible.

Radiation Oncologists
A radiation oncologist is a doctor who specializes in using radiation to treat cancer, leads the team, and also oversees your radiation therapy treatments. The radiation oncologist works with the other members of the radiation therapy team to develop your treatment plan and ensure that each treatment is accurately given. Your radiation oncologist will also monitor your progress and adjust the treatment as necessary to make sure the radiation is hitting its target while minimizing side effects. Before, during and after your radiation therapy treatments, your radiation oncologist works closely with other cancer doctors, such as medical oncologists and surgeons, to maximize the radiation's effectiveness. Radiation oncologists have completed at least four years of college, four years of medical school, one year of general medical training, and four years of residency or specialty training in radiation oncology. They have extensive training in cancer medicine and the safe use of radiation to treat diseases and are board certified by the American Board of Radiology.

Radiation Oncology Nurses
Radiation oncology nurses work collaboratively with radiation oncologists and radiation therapists to care for you and your family at the time of consultation, while you are receiving treatment and during your follow-up care. They will explain the possible side effects you may experience and will describe how you can manage them. They will assess how you are doing throughout treatment and will help you cope with the changes you may experience. They will also provide support and counseling to you and your family. Radiation oncology nurses are licensed registered nurses or licensed practical nurses. Many registered nurses in radiation therapy have additional accreditation in the specialty of oncology nursing.

Radiation Therapists
Radiation therapists work with radiation oncologists to administer the daily radiation treatment under the doctor's prescription and supervision. They maintain daily records and regularly check the treatment machines to make sure they are working properly. Radiation therapists go through a two to four year educational program following high school or college. They take a special examination and are certified by the American Registry of Radiologic Technologists and licensed by the KS Board of Healing Arts.

Dosimetrists carefully calculate the dose of radiation to make sure the tumor gets enough radiation. Using computers, they develop a number of treatment plans that can best destroy the tumor while sparing the normal tissues. Since treatment plans are often very complex, dosimetrists work with the radiation oncologist and the medical physicist to choose the treatment plan that is right for you. Many dosimetrists start as radiation therapists and then, with very intensive training, become dosimetrists. Others are graduates of one- to two-year dosimetry programs. They are certified by the Medical Dosimetrist Certification Board.

Medical Radiation Physicists
Qualified medical radiation physicists work directly with the radiation oncologist during treatment planning and delivery. They oversee the work of the dosimetrist, and help ensure that complex treatments are properly tailored for each patient. Medical physicists are responsible for developing and directing quality control programs for equipment and procedures. Their responsibility also includes making sure the equipment works properly by taking precise measurements of the radiation beam and performing other safety tests on a regular basis. Qualified medical physicists have doctorates or Master's degrees. They have completed at least four years of college, and then generally two to four years of graduate school. They also typically have one to two years of clinical physics training. Medical physicists are certified by the American Board of Radiology or the American Board of Medical Physics.

During your treatment, you may work with a number of other healthcare professionals while undergoing radiation therapy. These specialists ensure that all of your physical and psychological needs are met during your treatment.

Additional members of the team

Nutritionists, also called dietitians, work with patients to help them maintain proper nutrition during their treatments. They will help you modify your eating plan if the side effects of treatment are affecting your appetite and what you can eat, and can provide recipes, menu suggestions and information on ready-to-use nutritional supplements. They address dietary issues and current developments that may affect cancer treatment outcomes.

Physical Therapists
Physical therapists use therapeutic exercises to ensure that your body functions properly while you are undergoing treatment. These exercises are used to help manage side effects, alleviate pain and keep you healthy.

Dentists may be involved in the care of patients who are receiving radiation for oral or head and neck cancers. They will help prevent the radiation from damaging the healthy areas of your mouth and oral cavity, and may recommend that you have preventive dental work prior to radiation. They will also help you manage oral complications of cancer therapy, such as dry mouth. A dental hygienist may also perform these services under the supervision of a dentist.

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