We look forward to providing you with coordinated, compassionate care.

As a patient of Central Alabama Radiation Oncology, you have more than likely just received a cancer diagnosis from your oncologist and been prescribed radiation treatment. We want you to know that we understand your fears and concerns and want to make your radiation treatment experience as pleasant as possible.

Central Alabama Radiation Oncology has special Patient Education Nurses trained to answer any questions that you may have about radiation treatment. You may want to prepare a list of questions to ask during your initial consultation with your Patient Education Nurse. If you forget to ask something or think of another question later, that is very common. No one can remember everything, especially when they are in difficult circumstances. We will be happy to cover it next time you visit.

If you would feel more comfortable having a family member or friend come to your consultation session or treatment appointments, we encourage them to do so. Please don’t bring anyone with a cold or flu, or any other contagious illness because they could expose others who have a weak immune system. We do not allow children under the age of 12, unless they are accompanied and remain in the lobby.

What to Expect

At Central Alabama Radiation Oncology, we believe that each patient is unique and deserves the best in patient care. We go to great lengths to ensure your experience is as comfortable as possible and that you are given individualized care and consideration. Here is a brief overview of what you can expect during your visits to Central Alabama Radiation Oncology.

INITIAL CONSULTATION WITH YOUR DOCTOR OR NURSE

The consultation is critical to both you and your physician. During the consultation, the radiation oncologist performs a physical examination and obtains your medical history. It is helpful to prepare for the consultation by bringing x-rays, medical records, a list of medications, insurance information, and referral forms. There will be a great deal of information communicated during the consultation, so we recommend that you prepare a list of questions prior to the consultation to ensure they are all answered. You may also want to bring a family member or close friend with you to the consultation to help understand all of the information exchanged. After the consultation, the radiation oncologist will typically communicate with any other treating physicians to determine the appropriate course of treatment. Once a final decision is made to use radiation therapy, your team will discuss the treatment plan and alternatives with you and will present a consent form for you to sign prior to treatment. It is important to read and understand the consent form prior to signing it.

SCHEDULE SIMULATION APPOINTMENT

Next, we will schedule a planning session, or simulation. Simulation is used to determine how the radiation will actually be delivered. A CT simulator will allow the radiation oncologist and technologists to obtain images which are transferred to the planning system.

PATIENT SIMULATED ON CT SCANNER TO CUSTOMIZE THEIR RADIATION TREATMENT PLAN

At this point, the treatment delivery plan is finalized using a virtual 3-D image created by the CT simulator. Once the aspects of the treatment fields are set, you will be given multiple “tattoos,” which mark the treatment fields. These tattoos are not elaborate and consist of no more than tiny pricks which look like a small freckle. Tattoos enable the radiation technologists to set up the treatment fields precisely, while allowing you to wash and bathe without worrying about removing the marks. Each patient at Central Alabama Radiation Oncology receives a customized individual radiation treatment plan. The plan is unique to each patient depending on the size and location of their cancer.

PATIENT LEAVES SIMULATION TREATMENT WITH RADIATION APPOINTMENT

After simulation and prior to actual treatment, several steps occur behind the scenes without the patient present. The simulation x-ray may be used to design special lead alloy blocks that are used to minimize the amount of radiation delivered to normal tissues, while maximizing the dose to the cancer site. Sophisticated computer software performs calculations to help ensure the proper radiation dose will be delivered. It may take several days for treatment planning to be completed. After treatment planning is complete, you are ready to begin radiation therapy.

PATIENT BEGINS RADIATION TREATMENT

During treatment, you must lie very still while the radiation beam is targeted to the exact area of the tumor. The machine and treatment table may rotate up to 360 degrees. The technologists will not be in the room during the treatment, but they will be monitoring the treatment via a video camera and an audio connection with the treatment room. You will not feel the radiation as it is being delivered.

WEEKLY TREATMENT MANAGEMENT VISITS WITH DOCTOR AND NURSE

Radiation therapy is generally given once a day, five days per week, usually at the same time each day. The number of treatments depends upon multiple factors and varies from 5-10 to 40 or more. While the first few visits might last for an hour or more, typically a daily radiation treatment requires only about 15-30 minutes in the treatment room. The delivery of the radiation treatment depends on the type of cancer.

PATIENT FINISHES TREATMENT

FOLLOW-UP APPOINTMENTS

Radiation Treatments

Radiation therapy applies high levels of radiation to kill cancer cells or keep them from growing and dividing while minimizing damage to healthy cells. Radiation therapy is delivered in many different ways depending upon the type of cancer and the stage of treatment. The following are the types of radiation treatment we provide:

EBRT or External Beam Radiation Therapy uses machines known as linear accelerators to beam radiation, which delivers a dosage deep into the area of the body where the cancer is located. The use of EBRT machines has significantly reduced side effects, and modern state-of-the-art equipment has vastly improved the ability to deliver radiation. EBRT is usually given for approximately 6 to 8 weeks on an outpatient basis.

3D-CRT or Three-Dimensional Conformal Radiation Therapy is a method for delivering EBRT more precisely by using a special CT scan and computerized model. 3D-CRT promises to reduce the damage to tissues near the cancer. 3D-CRT is being tested to determine if higher doses can be given safely with higher outcomes.

IMRT or Intensity Modulated Radiation Therapy allows radiation oncologists to customize the dose, varying the amount of radiation given to different parts of the area being treated. It is an advanced form of 3-D conformal radiation therapy. Computer-controlled movable “leaves” adjust the radiation intensity so that more radiation can be delivered to the tumor while normal cells nearby receive less.

IGRT of Image-Guided Radiation Therapy involves imaging during the course of treatment allowing more accurate delivery of radiation. Images taken during the planning phase of treatment are compared to images taken during treatment. Sometimes the location of the cancer may shift in a patient’s body and this treatment allows better accuracy of the radiation delivery. IGRT is often used along with EBRT, 3D-CRT or IMRT.

Brachytherapy is internal radiation, sometimes referred to as “seeds” or “implants.” In brachytherapy, radioactive material is placed directly into or near the cancer. Brachytherapy may be used alone or along with external beam radiation therapy. The seeds or implants may be permanent or temporary. Brachytherapy has been effective in the treatment of several types of cancer such as prostate, cervix, uterus, vagina, head and neck and breast.

Women with breast cancer who choose breast conservation rather than a mastectomy may benefit from Breast Brachytherapy. After the removal of the tumor in a process called a lumpectomy, radiation may be administered using traditional EBRT which typically takes 5 to 6 weeks of treatment. Sometimes it is possible to reduce this treatment time down to as little as 2 to 3 days by using breast brachytherapy. Because of its short duration, women who do not wish to undergo 6 to 8 weeks of EBRT in breast conservation treatment find this an attractive option.

SRS or Stereotactic Radiosurgery is delivered on an outpatient basis and delivers a high dose of radiation to a highly defined target. It is a non-invasive procedure used for the treatment of brain tumors, arteriovenous malformation, and other conditions.

Optune is intended as a treatment for adult patients (22 years of age or older) with histologically-confirmed glioblastoma multiforme (GBM). Optune with temozolomide is indicated for the treatment of adult patients with newly diagnosed, supratentorial glioblastoma following maximal debulking surgery, and completion of radiation therapy together with concomitant standard of care chemotherapy.

Optune Lua is approved for the first-line treatment of adult patients with unresectable, locally advanced, or metastatic MPM to be used concurrently with pemetrexed and platinum-based chemotherapy. In a clinical study, MPM patients treated with Optune Lua plus chemotherapy experienced a median overall survival of 18.2 months.

SpaceOAR Hydrogel is clinically shown to minimize urinary, sexual, bowel side effects and protect quality of life for prostate cancer patients undergoing radiation therapy.

Side Effects

While the vast majority of patients do not experience side effects, there are a few things you should note.

Although patients do not experience any pain during the delivery of radiation therapy, effects of radiation do gradually build up as treatment continues. The vast majority of patients do not experience any side effects, although fatigue is common.

Should side effects or other complications occur, they are typically infrequent and are usually limited to the treatment area. In addition, the chance of encountering side effects depends upon various other factors such as age or other health conditions. During the same type of treatment, one patient may experience side effects while another may not. Any side effects should be brought to the attention of your nurses, therapists and radiation oncologists immediately because there are almost always ways to effectively treat the condition. Once radiation is completed, most side effects disappear.

The most common side effects are skin reaction and fatigue. In addition, patients with head and neck cancer may also experience soreness of the throat and mouth, dry mouth and a changed sense of taste or smell.

SKIN REACTION

Sometimes the area of the body being treated reacts to radiation therapy. The reaction ranges from mild redness and dryness, like a sunburn, to severe peeling or desquamation. Any reaction typically ends once treatment is complete although the area of skin may be slightly darker than before treatment and more sensitive to sunlight.

Any skin discomfort should be reported to your treatment team at once. There are topical medications that can be prescribed to counteract the skin irritation.

FATIGUE

One of the most common side effects of radiation therapy is fatigue. Patients experiencing fatigue will be tired, weary, weak or without energy. Although radiation does not require an alteration in normal daily activity, care should be given to plan for periods of rest. The fatigue disappears for most patients several weeks after treatment ends.

LESS COMMON SIDE EFFECTS

Hair Loss
Temporary loss of hair sometimes occurs at the site of treatment only. Regrowth of hair usually starts 6 to 8 weeks after therapy is complete.

Nausea/Vomiting
Nausea and vomiting may occur, especially when radiation is delivered to the abdominal area. Notify your nurse or physician if this occurs. Medication may be prescribed if the condition persists.

Diarrhea
Diarrhea also sometimes occurs when the abdominal area is being treated. Inform your treatment team if you experience diarrhea. They may recommend a change in diet or prescribe medicine to help.

Loss of Appetite
Loss of appetite is one of the most common reactions to any cancer treatment. Other side effects such as stomach discomfort can lead to a lack of desire to eat properly; however, it is important to maintain a healthy diet during treatment.