Radiation Oncology at NHRMC

Expert Cancer Care

The providers at New Hanover Regional Medical Center Radiation Oncology are members of your cancer treatment team, offering radiation therapy for all types of cancer. MEET THE TEAM

Radiation oncology is one of the therapies used to kill cancer cells by precisely targeting them with high-energy X-rays. It is an important cancer treatment, and you may have it alone or in combination with other treatments.

Radiation oncology is one of the tools along with surgery, chemotherapy, hormonal therapy, and immunotherapy, that oncologists use to treat cancer. Radiation therapy can be used by itself (definitive); used to shrink a tumor before surgery (neoadjuvant), or given after surgery to prevent a tumor's regrowth (adjuvant). Sometimes radiation therapy and chemotherapy are combined (chemoradiation). In more advanced stages of cancer, radiation may be used to reverse symptoms caused by the disease.

Radiation oncology may be use for:

  • Prostate cancer treatment
  • Breast cancer treatment
  • Bone cancer treatment
  • Lung cancer treatment
  • Skin cancer treatment
  • Head and neck cancer treatment
  • Brain and spinal cord cancer treatment
  • Stomach cancer treatment
  • Pancreatic cancer treatment
  • Rectal cancer treatment
  • Bladder cancer treatment 
  • Cervical cancer treatment
  • Endometrial cancer treatment
  • Anal canal cancer treatment
  • Lymphoma treatment
  • And more

Radiation therapy is also used for some benign (non-cancer) conditions.

Your Radiation Therapy Care Plan

Radiation therapy is administered by a Radiation Oncologist, a board-certified/eligible oncologist who has extensive specialized training in the use of radiation therapy for the treatment of cancer. A radiation oncologist will consult with you and your other physicians to determine whether radiation oncology is right for you.

If it is determined that radiation is the appropriate treatment for your cancer, your radiation oncologist will lead a team of healthcare providers in the development of a customized care plan for you. Because every patient and every cancer are different, your radiation will be specifically prescribed depending upon your individual circumstances. Your radiation oncologist will oversee the planning and delivery of your radiation, communicate with your other oncologists (if you are seeing any) and primary care provider, and meet with you regularly for an “on treatment visit” to answer any questions you may have and assure that everything is going as planned.

How Radiation Therapy Is Delivered

Modern radiation therapy is delivered with precise targeting toward areas known or suspected to have cancer, while avoiding normal tissues whenever possible.

Radiation therapy is delivered by different methods:

  • External beam radiation therapy - radiation is delivered from outside the body, much like getting an X-ray. The following types of external beam radiation therapy are available at NHRMC:
    • Intensity-Modulated Radiation Therapy (IMRT)
    • Volumetric Modulated Arc Therapy (VMAT)
    • Image Guided Radiation Therapy (IGRT)
    • Stereotactic Body Radiation Therapy (SBRT)
    • Stereotactic Radiosurgery (SRS)
    • Hypofractionated Radiation Therapy
  • Internal Radiation Therapy or Brachytherapy- radiation is delivered from inside the body, which can either be temporary or permanent. The following types of brachytherapy are available at NHRMC:
    • Prostate brachytherapy
    • Gyn brachytherapy for cervical, uterine and vaginal cancer

How Often You Have Radiation Therapy Treatments

Radiation oncology schedules vary widely depending upon the site of your cancer and the type of radiation being delivered. Your radiation oncologist will discuss your treatment schedule with you at the time of consultation. Some radiation therapy schedules involve daily treatment over weeks, while some schedules involve only a single treatment. Each treatment may last only minutes.

Radiation Therapy Treatment Steps

 

Step 1: Initial Consultation

At the time of initial consultation, you will meet your radiation oncologist and he or she will review your history, relevant imaging, and pathology. 

During your initial consultation, you may be asked to change into a gown so that the doctor may examine you. If your oncologist decides that you may benefit from radiation, they will discuss the reason for radiation, the part of the body that needs radiation, and the dose of radiation within a specified time frame. Your radiation oncologist may also recommend additional tests before being able to finalize a recommendation.

Your radiation oncologist will also review the possible short-term side effects, long term risks, and have you sign a consent form which acknowledges your understanding of the above. The consent form also gives us permission to treat you.

Multiple people may be directly involved in your care. Whenever these professionals are needed for direct interaction with you, they will introduce themselves and explain their role in your care.

Step 2: Radiation Treatment Planning

Prior to your radiation, you will likely need to have a “planning CT scan.” The planning CT scan is usually done on a different day than the consultation, but sometimes can occur on the same day. This differs from other imaging that you may have already had in that this CT scan is for the sole purpose of planning your radiation delivery. On the day of your planning CT, you may be required to change into a gown. 

During your planning session, our therapists will build a “mold” which will be custom made just for you, and will function to keep you in the same position for your treatment each day. We use different types of molds for different purposes. If you have a cancer above the shoulders, the mold may be a mask that fits tightly over your face. If your cancer is below the shoulders the mold may essentially be like a bean bag which forms around you. The mold allows us to position you in the same way for every treatment. In some cases, no mold is needed at all.

Once the mold is made, the doctor may need to place some marks on your body. For breast cancer patients, this involves drawing borders around the breast using a regular sharpie pen. With many cancer sites, the therapists may lay a wire or place “BBs” on scars or drain sites. Sometimes, a marker may need to be placed at the anus or within the vagina so that the doctor can more clearly identify these sites on the CT scan.

Once your mold is made and any markers placed, you will have your CT scan. A doctor will review the CT scan and make sure that your setup and imaging is correct.

Immediately following your CT scan, the therapists may take photographs of you to document your setup. This will help your therapists reproduce your planning position when you are on the treatment machine (also called a Linear Accelerator, or “Linac” for short). These photographs will be stored on a secure server which is only accessed by medical professionals directly involved in your care. If the photographs are required to include sensitive body areas (for example, breast or pelvic areas), the photographs will not include your face.

Also following your CT scan, you may have placement of tiny tattoos, about the size of a freckle. These tattoos are given by a small needle stick, and may feel similar to a bee sting when given. These tattoos are permanent.  Because they will not wash off, they will always be present, which allows the therapists to reproduce your daily setup as accurately as possible. If you do not want tattoos, you may refuse them, but you will need to keep stickers on your body in their place, and these must not come off until after your treatment is complete.

At the end of your planning session, you will either be given a time to return for a “dry run” session before your actual start date, or you will be given an appointment for your first day of treatment. Not all patients require a dry run.

Step 3: Dry Run or Virtual Simulation

Not all patients require a “dry run,” or “virtual simulation,” but if your radiation oncologist has indicated that you do, you will be taken to the treatment machine as if you are going to have radiation. Films will be taken to assure than your setup matches the planning setup as intended by your doctor.

Occasionally, changes will need to be made which may delay your start briefly. We will make every effort to minimize any delay, and please be assured that any delay is for the purpose of making sure you receive radiation as intended by your doctor.

Step 4: Radiation Treatment

On your first day of treatment, you will arrive and check in with the front desk. Treatment times are usually at the same time every day, but occasionally treatment times may be only once or twice a week.

Soon after check-in, a therapist will call you from the waiting area for your treatment. At this time, you may be asked to change into a gown. Once the therapists are ready for you, they will take you into the treatment room. You will be set up in a similar fashion as you were during your planning session. The therapists may darken the room and use lasers to make sure that your position is correct. You may hear the therapists call out numbers, and feel them make shifts to your setup.

When your setup is correct, they will leave the room for treatment. Sometimes they will take films before starting the treatment, in order to confirm that your setup is correct. It is important to lay still and not talk during this time unless absolutely necessary.

During your treatment the therapists will be able to see you and hear you. Although monitors are visible outside, they are shielded in order to protect bystanders from being able to see you on the screen. During your treatment you may hear the machine making sounds. These sounds will sometimes sound the same from day to day, but other times may vary. As a general rule, your primary treatment will be the same from day to day. A variance in sound is not indicative of a change in treatment time or dose. If your treatment includes a boost, the radiation will be different, generally to a smaller field than during your primary radiation treatment. Your radiation treatment is similar to getting an x-ray, and it is not possible to feel the radiation.

Over the course of your treatment, you may experience some of the side effects discussed at the time of initial consultation. Once a week, you will be seen by a physician. This is called an “On Treatment Visit”, or “OTV” for short. This is a brief visit lasting only a couple of minutes, so that your doctor can see how you are doing, and address any side effects that you may be having. If your doctor is not in town, you may see another doctor. If you have minor concerns or questions, we encourage you to write these down and discuss at your next scheduled OTV. If you have a major concern, there is always a nurse and physician available to meet with you.

As you finish your radiation, you and your doctor will discuss the time frame for any follow-up and any labs or imaging that may be required prior to that visit.

Your radiation oncologist will write a summary of your radiation therapy and send that to your primary care provider and other physicians involved in your care.

Step 5: Follow-Up

Follow-up appointments will be coordinated with your radiation oncologists and your other providers.

Follow-up care usually occurs within the first 6-12 weeks after completing your treatments. If you had significant side effects during your treatment, your radiation oncologist may wish to see you sooner. In many cases, your radiation oncologist will order labs or imaging to be completed prior to your follow-up visit.

You may see one of our physician assistants at the time of follow-up. If this is the case, your radiation oncologist will usually be available, if needed.