Treatment Process

Radiation Oncology

The treatment process outlined here is for traditional radiation therapy. The University of Maryland Marlene and Stewart Greenebaum Comprehensive 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

Treatment Planning

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 delivery.

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 verification process.

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 is complete.

Follow up appointments will continue for up to, and sometimes beyond, a one-year period. Your physician will determine the frequency of these visits.