What to Expect During Treatment

External Beam Radiation Therapy Treatments

When you undergo external beam radiation therapy treatment, you will be positioned on the treatment table of a radiation therapy machine, usually a Linear Accelerator or “Linac.” Radiation therapists may refer to the treatment table as a “couch.” The treatment head of the Linac directs a radiation beam at your tumor. Radiation therapy is painless, like an X-ray or CT scan. As such, patients usually don’t need to stay in the hospital and may even work throughout treatment.

A radiation therapy course usually consists of short, daily treatments delivered by your radiation therapists. Each treatment, the therapist will bring you in to the treatment room. Once you are positioned correctly, the therapist will leave the treatment room and begin your treatment. During your treatment, your therapist will closely monitor you on a television screen. There is a microphone in the treatment room so you can always speak with the therapist if you have any concerns. Before the treatment begins, the radiation therapists may move the treatment machine and treatment table to deliver your personalized radiotherapy plan. The machine might make noises during treatment that sound like clicking, knocking or whirring, but the radiation therapist is in complete control of the machine at all times. The machine can be stopped at any time for any reason, such as if you are feeling sick or uncomfortable. Time spent in the treatment room will vary depending on the type of radiation. After treatment, the radiation therapists will help you off of the table and out of the treatment room.

Your radiation oncologist monitors your daily treatments and may alter your radiation dose based on these observations. Also, your doctor may recommend blood tests and imaging to see how your body is responding to treatment. If the tumor shrinks or if your body changes significantly, a change to the treatment plan may be required based on the changes to the tumor or your body.

It is best not to miss scheduled treatments, but sometimes a course of treatment may need to be interrupted for a day or more. This may happen if you develop side effects that require a short treatment break. Unscheduled machine maintenance may also cause a missed daily treatment. These missed treatments may be made up by altering the schedule.

Treatment courses for sarcoma can vary, from a single treatment up to even 35 treatments. The number of radiation treatments you will need depends on the size, location and type of cancer you have, the goal of treatment, your general health and other medical treatments you may be receiving. If brachytherapy is used (which is radiation that is inserted into the body), the treatment length can be shorter. Treatments are usually scheduled five days a week, Monday through Friday.

In some cases, you may receive chemotherapy and radiation therapy at the same time. The chemotherapy may be delivered daily, weekly, every three weeks or at an alternate schedule determined by the medical oncologist together with the radiation oncologist. The chemotherapy may work to make the radiation therapy more effective at killing cancer cells. Chemotherapy also travels throughout the body to help destroy or reduce microscopic cancer cells that are too small to see. This may help keep the cancer from having a chance to spread. Your treatment team will help coordinate these therapies and care for potential side effects.

Weekly Checkups

During radiation therapy, your radiation oncologist and nurse will see you regularly to follow your progress, determine whether you are having any side effects from treatment, recommend treatments for those side effects (such as medication) and address any concerns you may have. Your doctor may also make changes in the schedule or treatment plan depending on your response or reaction to the therapy. Your radiation oncology team will gather on a regular basis with other health care professionals to review your case to ensure your treatment is proceeding as planned. During these sessions, all the members of the team discuss your progress and any concerns.

Quality Assurance During Treatment

During your course of treatment, correct positions of the treatment beams will be regularly verified with images made using the treatment beam itself. These images represent an important quality check but do not evaluate the tumor itself. Depending upon what kind of treatment you receive and what your doctor thinks will work best, the type of images used (e.g., X-ray, CT scan, ultrasound, etc.) may vary. These images assure your radiation oncologist that the treatment setup accurately matches the intended target. A medical physicist may also review your treatments every week to ensure they are being delivered correctly.