How is Radiation Therapy planned for an individual patient?

  1. When your radiation oncologist determines that radiation therapy will benefit you, our treatment center will submit a request for authorization from your insurance to treat you.  After 3-5 business days, our treatment center will call you to return to our department for a CT simulation scan.
  2. During simulation, detailed imaging scans show the location of a patient’s tumor and the normal areas around it. These scans are usually computed tomography (CT) scans, but they can also include magnetic resonance imaging (MRI), positron emission tomography (PET), and ultrasound scans.  CT scans are often used in treatment planning for radiation therapy. During CT scanning, pictures of the inside of the body are created by a computer linked to an x-ray machine.During simulation and daily treatments, it is necessary to ensure that the patient will be in exactly the same position every day relative to the machine delivering the treatment or doing the imaging. Body molds, head masks, or other devices may be constructed for an individual patient to make it easier for a patient to stay still. Temporary skin marks and even tattoos are used to help with precise patient positioning.Patients getting radiation to the head may need a mask. The mask helps keep the head from moving so that the patient is in the exact same position for each treatment.
  3. After simulation, the radiation oncologist then determines the exact area that will be treated, the total radiation dose that will be delivered to the tumor, how much dose will be allowed for the normal tissues around the tumor, and the safest angles (paths) for radiation delivery.
  4. The staff working with the radiation oncologist (including physicists anddosimetrists) use sophisticated computers to design the details of the exact radiation plan that will be used. After approving the plan, the radiation oncologist authorizes the start of treatment. On the first day of treatment, and usually at least weekly after that, many checks are made to ensure that the treatments are being delivered exactly the way they were planned.
  5. The area selected for treatment usually includes the whole tumor plus a small amount of normal tissue surrounding the tumor. The normal tissue is treated for two main reasons:
  • To take into account body movement from breathing and normal movement of the organs within the body, which can change the location of a tumor between treatments.
  • To reduce the likelihood of tumor recurrence from cancer cells that have spread to the normal tissue next to the tumor (called microscopic local spread).

How is Radiation Therapy given to patients?

Radiation can come from a machine outside the body (external-beam radiation therapy) or from radioactive material placed in the body near cancer cells (internal radiation therapy, more commonly called brachytherapy). Systemic radiation therapy uses a radioactive substance, given by mouth or into a vein, that travels in the blood to tissues throughout the body. The type of radiation therapy prescribed by a radiation oncologist depends on many factors, including:
  • The type of cancer.
  • The size of the cancer.
  • The cancer’s location in the body.
  • How close the cancer is to normal tissues that are sensitive to radiation.
  • How far into the body the radiation needs to travel.
  • The patient’s general health and medical history.
  • Whether the patient will have other types of cancer treatment.
  • Other factors, such as the patient’s age and other medical conditions.

Why is radiation therapy given in small doses?

Patients who receive most types of external-beam radiation therapy usually have to travel to the hospital or an outpatient facility up to 5 days a week for several weeks. One dose (a single fraction) of the total planned dose of radiation is given each day. Occasionally, two treatments a day are given. Most types of external-beam radiation therapy are given in once-daily fractions. There are two main reasons for once-daily treatment: to minimize the damage to normal tissue and to increase the likelihood that cancer cells are exposed to radiation at the points in the cell cycle when they are most vulnerable to DNA damage.

What is external beam radiation therapy (EBRT)?

External-beam radiation therapy is most often delivered in the form of photon beams (either x-rays or gamma rays). A photon is the basic unit of light and other forms of electromagnetic radiation. It can be thought of as a bundle of energy. The amount of energy in a photon can vary. For example, the photons in gamma rays have the highest energy, followed by the photons in x-rays. Many types of external-beam radiation therapy are delivered using a machine called a linear accelerator (also called a LINAC). A LINAC uses electricity to form a stream of fast-moving subatomic particles. This creates high-energy radiation that may be used to treat cancer. Patients usually receive external-beam radiation therapy in daily treatment sessions over the course of several weeks. The number of treatment sessions depends on many factors, including the total radiation dose that will be given. One of the most common types of external-beam radiation therapy is called 3-dimensional conformal radiation therapy (3D-CRT). 3D-CRT uses very sophisticated computer software and advanced treatment machines to deliver radiation to very precisely shaped target areas.

What is Intensity Modulated Radiation Therapy (IMRT)?

IMRT uses hundreds of tiny radiation beam-shaping devices, called collimators, to deliver a single dose of radiation. The collimators can be stationary or can move during treatment, allowing the intensity of the radiation beams to change during treatment sessions. This kind of dose modulation allows different areas of a tumor or nearby tissues to receive different doses of radiation. Unlike other types of radiation therapy, IMRT is planned in reverse (called inverse treatment planning). In inverse treatment planning, the radiation oncologist chooses the radiation doses to different areas of the tumor and surrounding tissue, and then a high-powered computer program calculates the required number of beams and angles of the radiation treatment. In contrast, during traditional (forward) treatment planning, the radiation oncologist chooses the number and angles of the radiation beams in advance and computers calculate how much dose will be delivered from each of the planned beams. The goal of IMRT is to increase the radiation dose to the areas that need it and reduce radiation exposure to specific sensitive areas of surrounding normal tissue. Compared with 3D-CRT, IMRT can reduce the risk of some side effects, such as damage to the salivary glands (which can cause dry mouth, or xerostomia), when the head and neck are treated with radiation therapy. However, with IMRT, a larger volume of normal tissue overall is exposed to radiation. Whether IMRT leads to improved control of tumor growth and better survival compared with 3D-CRT is not yet known.

What is Image Guided Radiation Therapy (IGRT)?

In IGRT, repeated imaging scans (CT, MRI, or PET) are performed during treatment. These imaging scans are processed by computers to identify changes in a tumor’s size and location due to treatment and to allow the position of the patient or the planned radiation dose to be adjusted during treatment as needed. Repeated imaging can increase the accuracy of radiation treatment and may allow reductions in the planned volume of tissue to be treated, thereby decreasing the total radiation dose to normal tissue.

What is Stereotactic Body Radiotherapy (SBRT)?

Stereotactic body radiation therapy (SBRT) delivers radiation therapy in fewer sessions, using smaller radiation fields and higher doses than 3D-CRT in most cases. By definition, SBRT treats tumors that lie outside the brain and spinal cord. Because these tumors are more likely to move with the normal motion of the body, and therefore cannot be targeted as accurately as tumors within the brain or spine, SBRT is usually given in more than one dose. SBRT can be used to treat only small, isolated tumors, including cancers in the lung and liver. Many doctors refer to SBRT systems by their brand names, such as the CyberKnife®.

Can I receive additional radiation if I have already received radiation in the past?

If an area of the body has previously been treated with radiation therapy, a patient may not be able to have radiation therapy to that area a second time, depending on how much radiation was given during the initial treatment. If one area of the body has already received the maximum safe lifetime dose of radiation, another area might still be treated with radiation therapy if the distance between the two areas is large enough.

Does external beam radiation therapy make a patient radioactive?

When you receive external beam radiation, you will not become radioactive and not endanger anyone around you.