Nancy Collot, a Cleveland Clinic patient, shares her story.
Radiation oncology is a form of cancer treatment that uses strong beams of energy to kill cancer cells or keep them from growing and dividing. Small doses of radiation may be administered daily over a period of several days to several weeks. The radiation oncologist will select the type of therapy best suited for your particular type of cancer. Radiation therapy may be used in conjunction with surgery or chemotherapy.
Cleveland Clinic Florida offers patients state of the art radiation oncology services for nearly all types of cancers. Our new developments in external beam radiation therapy include the use of the Varian Trilogy image-guided radiation therapy system. This machine allows for treatment to be delivered with real-time image guidance for the most accurate radiation delivery.
Cleveland Clinic Florida’s multidisciplinary approach to cancer care coupled with our physicians’ dedication to research and the use of cutting edge technologies, allows us to provide better outcomes for our patients.
Internal Radiation (Brachytherapy)
In some instances, internal radiation therapy, also called brachytherapy, is more effective than external radiation. Brachytherapy involves implanting the source of radiation in and/or around a tumor. The source may be a seed, ribbon or wire and will emit a high dose of radiation to the area to kill cancer cells. Implants can be temporary, remaining for minutes, hours or days, or they can be permanent.
External Beam Radiation
External beam radiation therapy (EBRT) is the most common form of radiation therapy and it is administered through a machine, which targets a specific area of your body with the radiation. External radiation therapy is usually given five days a week for one to eight weeks, depending on the disease. The daily treatment usually takes only a few minutes.
Types of external radiation therapy include:
- Image Guided Radiotherapy (IGRT)
Image guided radiation therapy (IGRT) involves the use of imaging technology such as X-ray, ultrasound, or optical imaging to direct the delivery of radiation during radiation therapy treatment. This allows highly precise radiation delivery to a tumor, while sparing nearby organs.
- A non-invasive radiosurgical option
This is offered to patients with certain brain tumors which provides results comparable to or better than conventional surgery in many cases.
- 3-D Conformal Radiation Therapy
This therapy uses CT scans and special computer software to deliver beams of radiation shaped to match the tumor and minimize exposure to surrounding healthy tissue.
- Intensity-Modulated Radiation Therapy (IMRT)
Intensity-Modulated Radiation Therapy (IMRT) uses sophisticated computer software to deliver different dose intensities of radiation directly to the tumor or to specific areas, minimizing exposure to surrounding healthy tissue.
- Calypso 4D Target Localization System
Also known as “GPS for the Body®”, this therapy is used to treat prostate cancer. This unique radiation targeting technology, determines the exact position and movement of the prostate during radiation therapy treatment - optimizing radiation targeting and minimizing side effects.
Cleveland Clinic Florida’s cancer program has earned Three-Year Approval with Commendation from the Commission on Cancer (CoC) of the American College of Surgeons. This means patients are assured access to:
- Comprehensive care, including a range of state-of-the-art services and equipment
- A multidisciplinary, team approach to coordinate the best treatment options
- Information about ongoing clinical trials and new treatment options
- Access to cancer-related information, education and support
- A cancer registry that collects data on type and stage of cancers and treatment results and offers lifelong patient follow-up
- Ongoing monitoring and improvement of care
- Quality care close to home
A Radiation Oncology Department Social Worker is available during daytime hours to discuss emotional issues or concerns you may have about your treatment or your personal circumstances. The social worker also can assist with housing and transportation, as well as provide information about support groups.
Cleveland Clinic Florida offers several support groups for patients dealing with cancer.
Frequently Asked Questions
Below, find frequently asked questions (FAQs) about Radiation Oncology.
How long does a course of radiotherapy treatments usually last?
Most radiotherapy treatments are daily, 5 days per week, for a specified period of 1 to 8 weeks, depending on the disease and the course that your physician prescribes.
Will I be able to drive after my radiotherapy treatment?
Almost all radiotherapy patients are able to drive while receiving radiotherapy treatment. However, with some types of cancer, driving may NOT be recommended due to fatigue or strong pain medication. Your physician will be able to address your specific case.
Will I feel anything after my radiotherapy treatment?
Many patients continue with most of their normal activities during radiotherapy treatment, working, golfing, gardening, etc. Depending on the area being treated, there may be side effects including fatigue, nausea, "sun-burned" skin, or diarrhea. Your physician can discuss the likely side effects and prescribe medication for some conditions. Making certain that you are taking care of your body’s needs is very important. Maintaining your weight and getting adequate fluids and rest are important goals to consider.
How long does each radiotherapy treatment take?
The radiation therapists, who are under the direction of your radiation oncologist, will be taking all the time necessary to ensure that you are accurately positioned for your radiotherapy treatment. The actual time when the radiation is "on" is generally only about a minute or two for each treatment field. Most of the time, radiotherapy patients are in and out of the treatment center in less than 30 minutes. The staff attempts to arrange the schedules to ensure that appointments are kept on time, but on some days, there may be delays because of unforeseen circumstances or emergencies.
What is the difference between chemotherapy and radiation therapy?
Chemotherapy involves medications given by injections or pills for cancer. This type of treatment is circulated throughout the entire body and is generally prescribed by a medical oncologist. Radiotherapy is produced by a linear accelerator or a radioactive source, and is prescribed by a radiation oncologist. The radiotherapy beams are focused on a very specific area of the body, and thus the effects are highly localized.
How does the physician know how much radiation to give me?
Through years of research and experience, there are ranges of doses that are recommended for each specific type of cancer. Your case will be thoroughly reviewed by the radiation oncologist, and a customized dose and radiotherapy treatment field will be prescribed based on the cancer diagnosis, the cell type, and the location and stage of the disease.
Can I take vitamins and/or medications while receiving treatment?
Good nutrition is important during your radiotherapy treatments, and taking a multivitamin at this time is acceptable. Your physician will, however, need to be aware of all medication and/or herbal products that you are currently taking, including large doses of any one vitamin. In some cases, mega-vitamins may be harmful.
Can I be out in the sun?
As a general rule, the area that is being treated with radiation should NOT be exposed to much direct sunlight for up to a year after treatment. Sunscreen is highly advisable for these regions. Sunscreen may not be applied on treated area while undergoing treatment.
How long will I have to come for follow-up visits?
Most patients are seen by their radiation oncologist for some period of time after their treatments are completed. Your specific schedule will be determined by your radiation oncologist, in collaboration with your other physicians.
Is it a problem if I miss a treatment?
If you miss an appointment during your prescribed treatment, it will extend your treatment course by a day. We strongly recommend that you attempt to make all appointments as prescribed by your radiation oncologist. Keep in mind that the treatments are generally given Monday through Friday. Weekend treatments are given in emergency cases.
Will I feel any pain from the radiation treatment?
There is usually no pain associated with the radiation treatments. It is very much like having an x-ray taken. Sometimes a sunburn effect may cause the area to be tender.
Can I get a second opinion?
Getting another opinion is your decision and prerogative. It is important to us that you are aware of all of your options before starting a course of treatment.
Are side effects the same for everyone?
The side effects of radiation treatment vary from patient to patient. You may have no side effects or only a few mild ones through your course of treatment. Some people do experience serious side effects, however. The side effects that you are likely to have depend primarily on the radiation dose and the part of your body that is treated. Your general health also can affect how your body reacts to radiation therapy and whether you have side effects. Before beginning your treatment, your doctor and nurse will discuss the side effects you might experience, how long they might last, and how serious they might be.
What are the most common side effects?
The most common early side effects of radiation therapy are fatigue and skin changes. They can result from radiation to any treatment site. Other side effects are related to treatment of specific areas. For example, temporary or permanent hair loss may be a side effect of radiation treatment to the head. Appetite can be altered if treatment affects the mouth, stomach, or intestine.
Fortunately, most side effects will go away in time. In the meantime, there are ways to reduce discomfort. If you have a side effect that is significant, the doctor may prescribe a change in your treatments or even give you a temporary break.
How are skin problems treated?
You may notice that your skin in the treatment area is red or irritated. It may look as if it is sunburned, or tanned. After a few weeks, your skin may be very dry from the therapy. Ask your doctor or nurse for advice on how to relieve itching or discomforts. Do not use any skin creams that you have not discussed with your treatment team.
With some kinds of radiation therapy, treated skin may develop a "moist reaction," especially in areas where there are skin folds. When this happens, the skin is wet and it may become very sore. It’s important to notify your doctor or nurse if your skin develops a moist reaction. They can give you suggestions on how to care for these areas and prevent them from becoming infected.
During radiation therapy, you will need to be very gentle with the skin in the treatment area. The following suggestions may be helpful:
- Avoid irritating treated skin.
- When you wash, use only lukewarm water and mild soap, pat dry.
- Do not wear tight clothing over the area.
- Do not rub, scrub, or scratch the skin in the treatment area.
- Avoid putting anything that is hot or cold, such as heating pads or ice packs, on your treated skin.
- Ask your doctor or nurse to recommend skin care products that will not cause skin irritation. Do not use any powders, creams, perfumes, deodorants, body oils, ointments, lotions, or home remedies in the treatment area while you’re being treated and for several weeks afterward unless approved by your doctor or nurse.
- Do not apply any skin lotions within 4 hours of a treatment.
- Avoid exposing the radiated area to the sun during treatment. If you expect to be in the sun for more than a few minutes, you will need to be very careful. Wear protective clothing (such as a hat with a broad brim and a shirt with long sleeves) and use a sunscreen. Ask your doctor or nurse about using sun blocking lotions. After your treatment is over, ask your doctor or nurse how long you should continue to take extra precautions in the sun.
The majority of skin reactions to radiation therapy are mild and go away a few weeks after treatment is completed. In some cases, though, the treated skin will remain slightly darker that it was before and it may continue to be more sensitive to sun exposure.
What can be done about hair loss?
Radiation therapy can cause hair loss, also known as alopecia, but only in the area being treated. For example, if you are receiving treatment to your hip, you will not lose the hair from your head. Radiation on your head may cause you to lose some or all of the hair on your scalp. Many patients find that their hair grows back again after treatments are finished. The amount of hair that grows back will depend on how much and what kind of radiation you receive. You may notice that your hair has a slightly different texture or color when it grows back. Other types of cancer treatment, such as chemotherapy, also can affect how your hair grows back.
Although your scalp may be tender after the hair is lost, it’s a good idea to cover your head with a hat, turban, or scarf. You should wear a protective cap or scarf when you’re in the sun or outdoors in cold weather. We can help arrange for wigs or hairpieces for those desiring this.
How are side effects on the blood managed?
In some cases, radiation therapy can cause low levels of white blood cells and platelets. These blood cells normally help your body fight infection and prevent bleeding. If large areas of active bone marrow are treated, your red blood cell count may be low as well. If your blood tests show these side effects, your doctor may wait until your blood counts increase to continue treatments. Your doctor may check your blood counts regularly and change your treatment schedule if it is necessary.
Will eating be a problem?
Sometimes radiation treatment causes a loss of appetite and interferes with eating, digesting, and absorbing food. Try to eat enough to help damaged tissues rebuild themselves. It is not unusual to lose 1 or 2 pounds a week during radiation therapy, though we will try hard to help you maintain your weight. You will be weighed weekly to monitor your progress.
It is important to eat a reasonable diet. You may find it helpful to eat small meals often and to try to eat a variety of different foods. Your doctor or nurse can tell you whether you should eat a special diet, and a dietitian will have some ideas that will help you maintain your weight.
The list below suggest ways to perk up your appetite when it’s poor and to make the most of it when you do feel like eating.
- Eat when you are hungry, even if it is not mealtime.
- Eat several small meals during the day rather than three large ones.
- Use soft lighting, quiet music, brightly colored table settings, or whatever helps you feel good while eating.
- Vary your diet and try new recipes. If you enjoy company while eating, try to have meals with family or friends. It may be helpful to have a radio or television on while you eat.
- Ask your doctor or nurse whether you can have a glass of wine or beer with your meal to increase your appetite. Keep in mind that, in some cases, alcohol may not be allowed because it could worsen the side effects of treatment. This may be especially true if you are receiving radiation therapy for cancer of the head, neck, or upper chest area including the esophagus.
- Keep simple meals in the freezer to use when you feel hungry.
- If other people offer to cook for you let them. Don’t be shy about telling them what you’d like to eat.
- Keep healthy snacks close by for nibbling when you get the urge.
- If you live alone, you might want to arrange for "Meals on Wheels" to bring food to you. Ask your doctor, nurse, social worker, or local social service agencies about "Meals on Wheels." This service is available in most large communities.
- If you are able to eat only small amounts of food, you can increase the calories per serving by adding butter or margarine; mixing canned cream soups with milk or half-and-half rather than water; drinking eggnog, milkshakes, or prepared liquid supplements (such as "Boost") between meals; adding cream sauce or melted cheese to your favorite vegetables.
Will radiotherapy affect me emotionally?
Nearly all patients being treated for cancer report feeling emotionally upset at different times during their radiotherapy. It’s not unusual to feel anxious, depressed, afraid, angry, frustrated, alone, or helpless. Radiotherapy may affect your emotions indirectly through fatigue or changes in hormone balance, but the treatment itself is not a direct cause of mental distress.
You may find that it’s helpful to talk about your feelings with a close friend, family member, chaplain, nurse, social worker, or psychologist with whom you feel at ease. You may want to ask your doctor or nurse about meditation or relaxation exercises that might help you unwind and feel calmer. We have a social worker available to help you work through some of these issues, as well as support groups.