Definition and Overview
Radiation oncology is one of the methods used in cancer treatment, the other two being surgical and medical oncology. Radiation oncology involves the use of radiation therapy to focus on and kill cancer cells. With multiple, regulated doses of radiation over a given period, this treatment therapy can (1) directly kill cancer cells and (2) affect the chromosomes and change the DNA of the cells to prevent them from dividing and making tumors.
A radiation oncology consultation is a process where the patient and the radiation oncologist (the doctor who specializes in radiation therapy) meet, discuss, and plan the treatment.
Who Should Undergo and Expected Results
Radiation therapy may be prescribed as a curative, adjuvant, or palliative treatment for cancer patients. It is recommended as a curative treatment for patients with tumors with the goal of killing the cancerous tissue and preventing cancer from spreading to nearby organs. This treatment applies to patients with small tumors or with early stages of cancer.
Adjuvant treatment means that radiation therapy is a part of a multi-treatment plan, which may include surgery and chemotherapy. For instance, in neo-adjuvant therapy, it may be used to reduce the size of a tumor prior to surgery. It may also be used in adjuvant systemic therapy, where radiation and chemotherapy are undertaken at the same time.
Radiation therapy is used as a palliative treatment when cancer can no longer be cured. Radiation therapy is then performed to alleviate pain, provide symptomatic relief, and retain the quality of life for the patient.
How Does the Procedure Work?
Radiation oncology consultation is conducted upon the diagnosis of cancer. Once radiation therapy is decided on as a treatment, whether solely or as a part of adjuvant therapy, the patient and ideally a family member or a relative, need to meet with the radiation oncology team for a consultation.
The first meeting or consultation with the radiation oncologist or radiation oncology team usually takes one to two hours. It begins with the nursing staff putting together a patient record based on his general personal information, medical history, and medications taken. It will be beneficial if the patient brings with him all his medical records (with photocopies) so that they may be attached to his patient record for future reference. This includes diagnostic imaging scans like CT scans, X-rays, and other laboratory test results.
Next, the radiation oncologist will review all these information as he meets with the patient. He may also ask questions such as if the patient has had previous surgery or is currently undertaking chemotherapy. This will enable him to formulate a treatment plan that is suitable to the patient’s needs. The doctor will then discuss possible treatment options, explaining each one in detail including possible side effects. The patient and/or a family member can take this opportunity to ask questions and alleviate their concerns regarding the procedure.
Once it has been decided that radiation therapy will begin, the next step is called “simulation” or radiation planning. This process involves the programming of radiation sessions into the computer so that it will be loaded and activated every time the patient has his radiation session. This involves several steps that are outlined below:
The patient will be asked to lie down on the treatment table and, with the help of computed tomography (CT) scanning, the radiation oncologist will accurately identify the target areas with the goal to minimize harm to adjacent and surrounding sections.
The radiation therapist (assists the radiation oncologist) will position the patient on the treatment table and will make sure that the patient remains in the exact same position for all of his radiation sessions. To ensure that the patient always stays in the exact spot for his treatments, he may be marked with small, dot-sized permanent tattoos or the radiation therapist may outline the treatment area with a permanent marker. If the outline becomes faded (from bathing or sweat), the radiation therapist will simply draw it again. If necessary, a custom-built mask and other immobilization devices may be utilized to keep the patient still during the sessions.
Once all this information is taken, the radiation oncologist and the dosimetrist (calculates and determines the radiation dosage) will work together toward formulating the treatment plan. The planning usually takes one to two weeks.
The radiation oncology consultation ends with the patient receiving his treatment schedule and any other instructions.
Possible Complications and Risks
There are hardly any complications or risks during radiation oncology consultations. The only problem that may arise may involve the breakdown of equipment, which may prolong the treatment period.
- Perry MC. Approach to the patient with cancer. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 182. Zeman EM, Schreiber EC, Tepper JE. Basics of radiation therapy. In: Niederhuber JE, Armitage JO, Doroshow JH, Kastan MB, Tepper JE, eds. Niederhuber: Abeloff's Clinical Oncology. 5th ed. Philadelphia, PA: Saunders Elsevier; 2013:chap 27.