The treatment process outlined here is for traditional radiation therapy. The
University of Maryland Marlene and Stewart Greenebaum Cancer Center offers many
advanced types of radiation treatment for patients who may not be candidates
for traditional radiation therapy. Ask your physician or nurse for more information.
Step 1 – Consultation
The first step of the treatment process is a consultation, during which you
will be interviewed and examined by a radiation oncologist, and in some cases,
a resident (a physician who has graduated from medical school but is still in
training) and/or a nurse practitioner. A nurse may assist in both the interview
and exam. Family members may be asked to remain in the waiting area during the
physical examination but are strongly encouraged to participate in the consultation
visit with your approval.
You may be asked to bring reports from referring doctors, especially x-rays,
CT scans, MRI scans, nuclear medicine scans, operative notes and pathology reports
pertaining to your diagnosis. Our staff will use this information to evaluate
your medical condition and assess the role of radiation therapy in the treatment
of your specific disease. An overall plan will be outlined, including potential
benefits, side effects, opportunities to initial consultation. We will be available
to answer your questions at any time before, during or after treatment.
After the initial consultation, our physicians may confer with your referring
physician. If treatment is recommended and you agree to proceed, an appointment
will be made for simulation. In some cases, additional diagnostic tests may
be requested prior to your simulation.
Step 2 – Simulation
Your initial appointment in the Radiation Oncology Department will be used
to create a treatment field. This is known as simulation. A custom set of "blocks"
will be designed that allow us to treat your cancer while protecting your healthy
tissue & organs. These blocks will be placed between you and the radiation
machine during each treatment session. You will not feel the radiation while
it is being delivered, and the actual treatment will take less than 5 minutes.
Expect to be in the department for 15 to 30 minutes once or twice each day,
though, so that the machine can be properly set up for your individual needs.
Once the radiation treatment area has been identified, the radiation therapist
will then make pen marks on your skin as a reference to pinpoint the location
of treatment. You will be instructed by the radiation therapist to keep these
marks and not to wash them off. The marks will be used as a map to duplicate
the treatment position each day. The radiation therapist may also mark the skin
with tiny permanent tattoos (these look like very tiny dots on your skin). These
are actual pinpricks made under the surface of the skin using India ink. This
procedure feels like a bee sting or needle stick to most patients. The radiation
therapist will also take digital photographs for identification purposes and
to document your treatment position.
Step 3 – Computerized Treatment Planning
Customized information from the simulation is directly transferred to the
treatment-planning computer. This system displays your body shape and shows
how the radiation will enter and exit your body. It will also show how the radiation
dose will be distributed around the tumor or treatment volume. Your physician
will work with the dosimetrist to select single or multiple beams for treatment
Step 4 – Treatment Verification
On the day of your simulation the radiation therapist or nurse will give you
a time to come back for verification films. This day is a “dress rehearsal”
and is used to verify treatment fields and check positioning. This is done before
any radiation is delivered. The radiation therapist will assist you back to
the treatment room and reproduce the position used the day of your simulation.
The therapist will take port films to verify beam placement and accuracy, based
on the customized treatment plan (see Step 3).
Port films are actual films taken on the treatment machine that allow the therapists
and your physician to verify that the radiation is being delivered according
to the treatment plan. These films are compared to films obtained during the
simulation and treatment planning process. Port films are taken at the beginning
of treatment and weekly thereafter or as requested by your physician. These
are not diagnostic x-rays and do not allow your physician to evaluate changes
in your tumor or the success of the treatment.
Step 5 – Radiation Treatment
Before you begin treatment, you or a family member will be asked to read and
sign an informed consent form. We cannot administer treatment without your signed
consent. Treatments are usually given daily, Monday through Friday, at the same
time every day. The treatment often begins a day or two following the treatment
How radiation affects normal tissues varies greatly. Your physician will advise
you during and after your radiation treatment regarding the potential side effects
of your treatment. You may feel very tired, particularly during the last several
weeks of therapy. Your body is working hard to fight the cancer, give it what
it needs - REST! While you may continue most activities during therapy, do not
overdo it. Depending on your job, you may continue to work full time, part time
or you may need to take some time off. Your skin may become dry, irritated and
red within your treatment field. Treat this area gently. Avoid using powders,
lotions or creams not prescribed by your doctor on this area. Your physician
will also talk with you about how to manage and control these side effects.
It is essential that you arrive promptly for your treatment. You can help maintain
our schedule by arriving on time. The radiation therapists do their very best
to keep appointments on time for all patients. Occasionally a very sick patient
or a problem with a machine will cause deviations in the schedule. Every effort
will be made to advise you of these inconveniences.
If you know you cannot keep an appointment, please call and let the radiation
therapist know and every accommodation will be made to change your appointment.
Your treatment course can take 1-8 weeks depending on your diagnosis and treatment
plan. You will be scheduled to see your physician once a week (or more if necessary)
to evaluate progress, manage your side effects and address any concerns you
may have. The clinical and administrative staff are here to assist you at anytime.
Remember that staff members are trained to deal with you or your family’s
concerns. Just ask!
Step 6 – Last Day of Treatment
The radiation nurse and/or your physician will meet with you on the last day
of treatment to give you discharge instructions and answer any questions you
may have. The receptionist will schedule a follow up appointment for you to
come back and see your physician. Follow up appointments are usually the last
day of treatment. You scheduled two to four weeks after the last day of treatment.
You should feel free to contact us with questions at any time even after treatment
Follow up appointments will continue for up to, and sometimes beyond, a one-year
period. Your physician will determine the frequency of these visits.