The Treatment Process: Today, radiation is delivered using highly sophisticated technologies that require a significant amount of preparation and planning, involving the physician, physicist and entire Radiation Oncology Team.
After being referred to Advanced Radiation Centers of New York, our office staff will work with you to provide a consultation appointment with one of our Radiation Oncologist's and one of our facilities. We will ask for basic information by phone, including your referring physicians name(s) if any as well as demographic and billing information (or if being referred from an IMP physician, your demographic information may be accessed through our IMP computer systems). So that our physicians can best understand your medical health and status, a full Health History Questionnaire will be immediately mailed to you for you to complete at your own schedule and in the comfort of your home. Please return the completed Questionnaire when you arrive for your consultation. If your appointment date will not allow enough time for you to receive this Questionnaire by mail, please request to receive the Questionnaire via fax or e-mail, or you may arrive an additional 30-40 minutes before your consultation time to complete these comprehensive forms .Otherwise, please arrive for your appointment 10-15 minutes prior to confirm insurance information and to complete any other paperwork.
Our staff will endeavor to obtain all relevant tests, studies, pathology reports, surgical reports, etc. from your referring physicians. You do not have to bring any studies or x-rays/scans unless requested to do so by our staff. However, if you have copies of these studies, please feel free to bring these for review.
During the Initial Consultation, you will meet with your Radiation Oncologist who will review your current case and health history. An examination will be performed, either before or after a thorough discussion of your treatment options. If radiation therapy is a treatment option for your particular situation and disease stage, the details of this treatment including how many treatments will be prescribed, as well as side effects, risks and benefits which will also be detailed. You will have an opportunity to ask any questions.
In addition to providing a thorough discussion of treatment options and details, another goal of the consultation at ARC is to provide our patients with the piece of mind that comes through understanding the process and knowing “what comes next”, We are very aware that when something is an “unknown” (like Radiation treatments to most people), it can be frightening or anxiety-provoking. Gaining a thorough understanding of the process and having the opportunity to ask questions can sometimes feel like a huge weight has been lifted of your shoulders (remember, there is no such thing as a bad or stupid question! – so feel free to ask away!).
If the decision to undergo external beam radiation therapy has been made, your next appointment will be to return for a Simulation, or Treatment Planning Session”. Prior to returning for your Simulation, there may be several procedures that need to be performed or other synergistic treatments to start – we refer to these as Pre-Simulation Procedures.
The Simulation is the “Planning Session” where all the necessary information that the Radiation Oncologist needs to create an individualized course of radiation is gathered. As part of this process, a virtual “model” of your internal anatomy will be created, enabling a plan of treatment that perfectly matches your internal and external anatomy. Of course, since everyone’s internal anatomy is different, every plan of therapy must be different. This plan takes into consideration which areas will be targeted based on the area of the body where cancer is or may be, while at the same time avoiding tissues or organs that are not at risk. The level of sophistication of radiation delivery at ARC requires a dedicated and highly individualized collection of information related to your specific anatomy and cancer risk.
The Simulation appointment is typically a 30-60 minute process where measurements of your body are taken, a scan of the region of treatment is taken, and small ink marks may placed on your skin to aid in daily set-up reproducibility. In certain types of cancer treatments, special immobilization devices are created to ensure that the anatomy will be accurately reproduced each day. For example, a special thermoplastic mask is made when treating cancers of the brain, and head & neck areas. Any other specific preparation instructions will be given to you by phone when your are called day or two prior by our office as we confirm this appointment.
Appointment Scheduling at Simulation: Finally, prior to leaving your Simulation appointment (or by phone within 24 hours), our staff will help you to make your future treatment appointments, taking into consideration the window of time that you most prefer. We will endeavor to give you a schedule that bests fits your normal daily routine, as the physicians and staff at ARC understand the importance of maintaining a close-to-normal daily activity schedule, including working, exercising or other daily activities, when your are getting radiation. You will be given a print-out of all of your daily scheduled treatment appointments. Should you need to modify your schedule at any time, please speak to your Therapist and they will do their best to accommodate you.
After you leave your Simulation appointment, your Radiation Oncologist will spend the next few weeks working with the images of your anatomy and other pertinent information during the Treatment Planning process.
Prior to your Simulation appointment, your Radiation Oncologist may have you perform one or more of the following in preparation for the Simulation:
1. Scans or blood work to complement other studies that may have previously been ordered by your Urologist, however it is often not necessary to order initial or further scans.
2. Placement of Gold-Markers to facilitate IGRT – one of the foundations of IGRT is the placement of “fiducial” gold-makers into an organ which serve as a beacon or “GPS” to help locate the precise location of the prostate, allowing for highly accurate Image Guided Radiation Therapy.
3. Chemotherapy or Hormone Therapy - in certain situations, your treatment may require chemotherapy or hormone therapy. In certain types of cancer treatment, such as Breast Cancer, Chemotherapy is typically given before Radiation Therapy begins. In certain cases of Prostate Cancer, Hormone Therapy maybe given as well prior to begriming Radiation Therapy (and this treatment usually continues during and sometimes after radiation).
After the Simulation, the Radiation Oncologist and Physics team that helped to create a perfect modeled radiation plan for your anatomy. Your next visit to the office will be a few weeks later to begin therapy. However your first day is not an actual treatment, but will be where we will run-through the plan to provide confirmation and verification of the precision of the planning which had previously been confirmed on a computer model This “dry-run” or “dress-rehearsal” will take place with you in the actual treatment room. The Radiation Therapists will run through each step of an actual treatment, but will take films rather than give the actual treatment – films that are taken for review by the Radiation Oncologist. Any fine-tuning of the planning can be made prior to treatment, which can then proceed once is has been deemed “perfect” by the physician.
Treatment Planning: Dosimetry:
The next step is perhaps the most important, and occurs “behind the scenes”. Once we have your anatomy on the computer (from the Simulation), the images from the scan will then be reviewed by the Radiation Oncologist with the aid of the Physicist and Dosimetry team. A 3-Dimensional representation of your anatomy will be made allowing for a careful and exacting look at the organs, structures and tissue density of your internal anatomy. Using sophisticated computers, the shape and angles of the radiation beams are optimized using state-of-the-art mathematical algorithms such as Inverse Planning. The results of this dosimetric work, which takes place over the next few weeks following your Simulation, is a precise “modeling” of the Intensity Modulated Radiation Therapy (IMRT) plan that will be used to deliver conformal, or “shaped” radiation to those areas that need to receive treatment, while at the same time avoiding to the best degree tissues and organs that do not. Targeting confirmation via Image Guided Radiation Therapy and or Rapid Arc planning is also performed and verified.
Daily Treatments: What to expect:
The typical course of radiation is given on a Monday through Friday basis, and can last for 15-50 daily treatments, pending on the type of cancer that is being treated and whether or not other types of treatment have been or will be used, such as surgery. Please arrive 10-15 minutes prior to your scheduled treatment time, and expect to be with us for approximately 30-45 in total (although the radiation treatment itself is only about 5 minutes!). You will be given a Daily Scan-In & ID Card. By scanning the bar-code on the back of this card at the scanner located near the reception desk, the treatment console will be notified that you have arrived. you may be asked to change depending on the area that is being treated. The Radiation Therapist will escort you into the treatment room, and will get you into a comfortable position and make some basic adjustments using marks on your
skin or immobilization device matched to external lasers in the room.
The Therapist will then step out of the room, where they can still see and hear you via audio and video at the treatment console. In most cases, they will utilize radiation technologies for further precision, most specifically Image Guided radiation technology such as On-Board Imaging, Cone-Beam CT or Stereoscopic kV Imaging to find the exact and precise location of the targeted region. You may feel the table move slightly in various directions as the Therapist moves you into an exacting position for treatment. Once positioned perfectly, the linear accelerator will rotate around you, with radiation treatment delivered over about the next 5 minutes. The treatments are “invisible”, and you will not feel any pain or discomfort when being treated. Once completed, the Therapist will re-enter the room and help you from table, and you are then able to leave and get on with the rest of your day!. The entire time that you will be in the treatment room, including the treatment itself, is no more than 15 minutes in most cases.
Your first day and even first few weeks of treatment are likely to be without any side effects at all! Side effects that occur during radiation (“acute side effects”), are cumulative, in other words, as the days and weeks of treatment go by you may begin to experience some effects as the cumulative effect of the radiation causes an irritation of the normal tissues. Your Radiation Oncologist will explain these possible side effects to you during your Initial consultation.You will arrive and receive your treatments each day by the Radiation Therapist. However, on a weekly basis, you will be seen by the nursing staff as well as by one of our Physicians. During this weekly brief exam and discussion, the Radiation Oncologist will assess your response to treatment, assess any side effects you may be experiencing, and prescribe any necessary medications or treatment modifications that may be warranted.
Once Radiation Therapy is completed, instructions for follow-up will be discussed with you by your Radiation Oncologist and our staff. Typically, you will be seen back in our offices one month following completion of treatment, and then on an on-going basis. During these follow-up visits, assessment of your response to treatment and disease status can be made, as well as review of any studies or tests that have been performed since your last visit, or requisitions for future studies or tests will be given. You will also continue close and careful follow-ups with your referring physician team, to ensure a collaborative multi-disciplinary monitoring of your case.