Radiotherapy
2. What happens after the decision to proceed with radiotherapy?
3. How is your radiotherapy applied?
4. Monitoring During Radiotherapy
1. How is the decision for radiotherapy treatment made?
After a thorough review of your entire medical history (previous surgeries, chemotherapy, radiotherapy information), pathology reports, and all your radiological images by your radiation oncologist, a decision will be made regarding the treatment. A detailed examination (including endoscopic and gynecological exams if necessary) will be conducted, after which your treatment plan will be outlined. After the treatment decision, your radiation oncologist will explain the goals of the radiotherapy, how and over what period it will be applied, and the potential effects and side effects of the treatment.
2. What happens after the decision to proceed with radiotherapy?
After the decision is made to proceed with radiotherapy, a series of procedures are required before the treatment can begin. This entire process is referred to as “radiotherapy planning,” and since it is tailored specifically to the patient, it may take some time depending on the complexity, location, and stage of the disease. In some cases, planning steps may need to be repeated. The planning process can take anywhere from a few days to 10 days.
The stages of the radiotherapy planning process are as follows:
2.a. Acquisition of computed planning images (CT Imaging):
Before beginning radiotherapy, a computerized tomography (CT) scan is performed to determine the location, type, and extent of your tumor. This will help to create a personalized treatment plan, define the radiation techniques, and ensure the radiation is directed to the correct target. It is essential that you remain still in the same position during treatment, so various support devices (such as a custom head-neck mask, vacuum bed, or knee support) are used to position you comfortably. In some cases, intravenous contrast agents may be used for better visualization, and a urinary catheter may be inserted. After determining your correct position and preparing the support devices, the CT scan will be completed in a few minutes. During this process, the area to be treated is marked, sometimes with tattoos or small dots to ensure the accurate delivery of radiation.
2.b. Identification of Tumor, At-Risk Areas and Healthy Tissues (Contouring):
In radiotherapy planning, computer-assisted planning software is used. With this software, the goal is to deliver the highest radiation dose to the tumor and at-risk areas while protecting surrounding healthy tissues.
With computer-aided planning, it is crucial to be able to deliver the highest doses to the tumor and areas at risk for tumor spread, while optimally protecting the surrounding healthy tissues from radiation. The radiation oncologist will draw and define the tumor, surrounding at-risk areas, and healthy tissues on each CT slice. In some cases, additional imaging techniques (such as MRI or PET) may be combined to obtain more detailed images. This three-dimensional model of your anatomy will be created to tailor the treatment specifically to you. This step of the planning process is crucial in determining your treatment plan. The expertise, attention to detail, and care of your radiation oncologist are essential in this phase.
2.c. Determining Treatment Radiation Fields, Techniques, and Doses (Physics Planning):
After the radiation oncologist identifies the tumor and healthy tissue, a medical physicist works on the technical aspect of radiotherapy planning. Using three-dimensional computer models, the radiation physicist determines the appropriate radiation angles and techniques for the treatment. Together, the radiation oncologist and the physicist will choose the most suitable plan for your tumor and healthy tissues. Afterward, quality control tests and necessary measurements are made to ensure the accuracy of the radiotherapy plan.
3. How is your radiotherapy applied?
Once your treatment plan is ready, you will need to arrive at your scheduled appointment for radiotherapy. Before the treatment, you will need to remove your clothing to expose the area to be treated and wear a gown. After preparing, you will be escorted into the treatment room, where you will lie on the treatment table, using the same position and support devices as during the initial planning CT. Once your position is confirmed, the radiation therapist will leave the room, and the treatment will begin. Each treatment session (fraction) usually lasts between 15 to 30 minutes. During the treatment, images are taken to ensure the correct tumor location and proper positioning of surrounding healthy tissues. If necessary, adjustments may be made to ensure the best possible treatment accuracy.
You will not feel any pain, discomfort, or smell during the treatment. If you feel unwell or uncomfortable during the session, the therapist can stop the treatment and assist you.
4. Monitoring During Radiotherapy:
It is crucial to receive your radiotherapy treatment on schedule to ensure its effectiveness. Delays in treatment can reduce its expected efficacy. Therefore, after your treatment begins, your doctor will closely monitor your general condition, your disease’s response to treatment, and any early side effects. These checks are typically done once a week, but the frequency may vary depending on the patient’s needs. Early side effects can usually be managed with timely interventions. Missing follow-up appointments can affect your treatment and its success, so it is important not to skip any during your radiotherapy course.
