What to Expect with Radiation Therapy

What to know before, during and after radiation treatment

A middle-aged woman talks to a Scripps radiation oncology team, representing what happens before, during and after radiation treatment.

Dr. Kenneth Shimizu, Scripps Cancer Center, Scripps Clinic

What to know before, during and after radiation treatment

Radiation therapy is a powerful cancer treatment, but most patients tolerate it well. Advances in radiation therapy technology have resulted in much more precise targeting of cancer cells, with less impact on nearby healthy cells and fewer side effects as a result of treatment. If you’re receiving radiation therapy at Scripps Cancer Center, here’s what you can expect before, during and after treatment.

Preparing for treatment

Before you begin treatment, you’ll go through several steps to determine the most appropriate radiation treatment plan for your cancer type and stage, as well as your overall health and lifestyle.

Initial consultation and evaluation

Your initial consultation takes about an hour. During this time, you may:


  • Complete forms to provide medical history and important information
  • Have your weight and blood pressure taken
  • Discuss your medical history with the physician
  • Have a physical examination by the radiation oncologist


If radiation oncologists recommend treatment, they will:


  • Explain what type of radiation therapy you will have and how often you will need treatment
  • Set an appointment for a computed tomography (CT) simulation (see below)

Computed tomography (CT) simulation

The computed tomography (CT) simulation is a type of X-ray that uses imaging to create pictures of the area being treated with radiation therapy. This tells the radiation oncologist exactly which area to treat in order to maximize radiation to the tumor and minimize exposure to healthy areas around the tumor.


The CT simulation takes about 30 minutes to one hour. Here’s what to expect:


  1. You’ll complete a medical consent form.
  2. We’ll take your photo for identification purposes.
  3. If your treatment requires a custom-made mask or cast to ensure you remain in the correct position during treatment, we’ll create it for you.
  4. We may inject a contrast dye into your arm to provide more detail in your CT scans.
  5. We’ll perform the CT scans, which are fast, painless and non-invasive.
  6. The radiation oncologist will review your CT scans.
  7. If needed, pinpoint-sized marks may be made on your skin with semi-permanent ink to guide the radiation therapist during treatment.
  8. Your treatment start date and schedule will be determined.

Radiation therapy planning

A team of specialists works together to plan your radiation therapy and prepare for your treatment. Here’s what happens:


  1. The radiation therapy physics staff receives your CT scans.
  2. The physics staff creates a 3-D computerized treatment plan, targeting treatment areas to minimize radiation to nearby tissues and organs.
  3. The medical physicist, dosimetrist and radiation oncologist collaborate to design and finalize your individualized treatment plan.
  4. The radiation equipment is extensively tested and calibrated for quality assurance.


When all of these steps are complete, we’re ready to begin your treatment.

External beam radiation therapy

Most patients will receive external beam radiation therapy, which treats cancer from outside of the body. Radiation beams are delivered by powerful, precise equipment in one of our hospitals or radiation therapy centers. Most patients need several treatments per week. The number of weeks depends on the type and stage of cancer.

 

Scripps cancer specialists use several types of external beam radiation therapy:


  • Electron beams
  • 3-D conformal radiation therapy (3-D CRT)
  • Intensity-modulated radiation therapy
  • Image-guided radiation therapy
  • Stereotactic radiosurgery (SRS)
  • Stereotactic body radiotherapy/stereotactic ablative radiotherapy (SBRT/SABR)
  • Total body irradiation


Generally, each radiation treatment takes about 15 minutes. But this may vary based on the type of radiation therapy, the need for imaging scans and other factors. Your radiation oncologist can tell you more specifically how long each treatment will take.


Depending on your individual needs and the type of radiation therapy you’re having, you may have just a few treatments, or you may need multiple treatments over a number of weeks. Most patients have daily treatments Monday through Friday for five to eight weeks, but your schedule may be different.

During your treatment

Most patients can drive themselves to and from treatment, but if we feel you should have someone else drive, we’ll let you know well before your appointment.


Your personal experience may vary a bit, but in general, here’s what to expect at each treatment appointment:


  1. You’ll check in at the reception desk.
  2. You may be asked to change out of your clothes into a gown.
  3. Your radiation therapist will help you get into the correct position on the treatment table.
  4. If you have a custom-made immobilization device, your therapist will gently place it on you and try to make you as comfortable as possible.
  5. We may take imaging scans to confirm that you are correctly positioned for treatment.
  6. Your radiation therapist will activate the radiation delivery equipment.
  7. Through a closed-circuit monitor and intercom system, your therapist will monitor your treatment and talk to you as needed.
  8. You may hear a sound or see a red light that indicates radiation delivery, but the treatment itself is painless.


Should you have questions or concerns during your treatment, let your radiation therapist know right away. We can stop the equipment at any time, and we want you to feel comfortable and calm.

After your treatment

Following each treatment, most patients typically resume their daily activities. You may experience some side effects from radiation therapy. The most common side effect is feeling tired, and it’s important to get plenty of rest.


Your skin in the area being treated may become sensitive or feel burned. Your cancer care team will tell you how to treat this. Follow their instructions exactly and avoid using any soaps, lotions or other products on your skin unless they tell you it is okay to do so.

Internal beam radiation therapy

Internal beam radiation therapy, most commonly called brachytherapy or seed radiation, delivers radiation by placing radioactive substances directly into or near a tumor. Radioactive beads, wires or other sources are placed into the body through catheters or small plastic tubes. 


Scripps offers high-dose brachytherapy, which delivers a high dose of radiation internally for a very short time per treatment. The radioactive substance is placed into the body and removed after a few minutes. Treatments may be repeated for several days or weeks.

During your treatment

Scripps performs brachytherapy treatments as an outpatient procedure in our radiation therapy centers. The total number of treatments you have can range from three to 10, depending on your individual needs. 

 

Your personal experience may vary a bit, but in general, here's what to expect:


  1. You'll check in at the reception desk and be guided to the procedure area.
  2. If needed, we'll give you sedation and pain medication, but many brachytherapy treatments will not need either. For certain types of treatment, we use local anesthesia to numb the implant area.
  3. Your team will take you to a special room where the treatment is delivered. This room has cameras and an intercom, so your team can see and hear you while the treatment is being delivered. You can also talk with your team members.
  4. Your radiation oncologist or radiation therapist will place a device that will be used to deliver the radiation in or on your body.
  5. We’ll do imaging tests before the procedure to make sure the implant is inserted in exactly the right place.
  6. The physics team will carefully perform the calculations required to deliver the dose of radiation prescribed by your doctor, minimizing radiation exposure to nearby tissues. 
  7. High-dose brachytherapy treatment takes a few minutes to complete. Your team will be outside the room, watching and monitoring you the whole time. It’s unusual to feel pain while the treatment is being delivered, but there may be some discomfort.  
  8. Your team will enter the room and remove the radiation device. After the treatment is delivered, no radioactive material will be in or on you.
  9. Once we’re sure you’re feeling okay, we’ll give you discharge instructions and you can go home.

After your treatment

It’s unusual to have pain after the treatments have been delivered. Make sure to let your team know if you have pain or don’t feel well.

 

Following each treatment, most patients typically resume their daily activities. You may experience some side effects from radiation therapy. The most common side effect is feeling tired, and it’s important to get plenty of rest.


Should you have questions or concerns during your brachytherapy treatment, let your care team know right away. We want you to be comfortable and confident.