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Your Treatment Team

What to Expect from Your Treatment

Prior to Treatment

When you schedule your initial appointment you may be asked to bring records, especially pathology reports, X-ray and scan reports, and often the original films or a CD of the films to be reviewed by our physician at your first visit. With some referring physicians we are able to obtain the appropriate information ourselves, and we won’t need to ask for your help. If we do need you to request the records, please be aware that it can take up to 15 days for medical offices to supply you with copies of your records, so filing a timely request is important. It is important to have this information readily available so that the start of your treatment is not delayed.

Upon Arrival

Our receptionists will guide you in completing the necessary paperwork, answering your questions regarding insurance, and getting you in to see the physician in a timely manner. 

Detailed consultation with your physician

Your initial consultation appointment will take about one hour.  Our physicians will go over your previous medical records, examine your x-rays and lab work, and perform a physical examination.  They will be especially interested in how your diagnosis was established and will want to see the pathology reports from your biopsies or surgeries.  They will provide you with their impression and recommendations. 

The physician will spend time with you in order to fully explain the benefits and potential side effects of the treatment.  He or she will most likely speak with your referring physician to ensure the continuity of your treatment, especially if you will be receiving chemotherapy at some point in your treatment.  During this consultation appointment, you will have the opportunity to begin scheduling your radiation therapy.

Treatment Planning

If you and the physician are in agreement, then a CT scan for planning purposes will be scheduled in most cases.  This scan will allow the physician, physicist and dosimetrist to determine how best to treat your particular tumor.  It will typically be scheduled 1-5 days after the initial consultation, depending on insurance restrictions.

Your CT Scan

No injections of contrast are required for this scan. At the time of the scan, tiny tattoos or marks probably will be placed on your skin to allow precise replication of the CT position when actual treatments are given. Certain tumor locations require a mesh facial mask or other immobilization devices to be fitted to ensure perfect immobilization so that we treat tumors near vital structures (such as the spinal cord or salivary glands) with a better chance of avoiding damage to the normal structures nearby. For some tumors of the head and neck region, a dentist may have made plastic molds for your teeth; these molds should be brought and put on for the CT scan and left in our office so they can be used at subsequent appointments.

After the CT scan is completed, the information is fed into a computer and a dosimetrist or physicist works with the physician to create a plan which delivers the most radiation to the tumor, and the least to surrounding tissues. This planning requires 5-7 working days. You will be given a tentative start date for your radiation treatment at the time of the CT scan. Mesh mask or other immobilization devices should be left in our office so they can be used at subsequent appointments.

The Next Step: Simulation

When the treatment plan is completed and approved by the physician, you will return and be placed on the actual treatment table (linear accelerator).  Marks will be made by either pen (which washes off) and/or tattoos (little tiny dots), so that you will be in perfect alignment every day for your therapy. If a mesh mask or other immobilization device was made, it will be put on as well. For some tumors of the head and neck region, a dentist may have made plastic molds for your teeth; these molds should be brought and put on for the CT scan and then left in our office so they can be used at subsequent appointments. At this time X-ray exposures will be taken to make sure the actual treatment position is exactly the same as the CT position, so the radiation goes exactly to the tumor. These exposures will be reviewed by the physician, and if approved the treatments will begin, usually the next day.  

Treatment

In a typical treatment regime, you should expect to be treated daily, Monday through Friday for approximately 5-8 weeks (except for Mammosite which requires just 5 consecutive days).  You will usually be in and out of the office in about half an hour, barring any unforeseen scheduling problems.  The actual treatment only takes a minute or two, but we need to make sure you are in the exact same position each day.  For some complicated cases, special radiation treatments called "IMRT" or "IGRT" will be used, and these may take 20-30 minutes to complete. Ask the technologist who gives the treatments if you have questions.

As you continue through your therapy, the physician and physicist will be monitoring your treatment dose and will be made aware of any side effects that you might experience.  Normally you will leave right after treatments, but at least once a week, you will be seen by a physician to review your treatments, answer questions, check for side effects and conduct an exam. The doctor can give advice on skin care, prescribe or renew medications and try to relieve concerns you may have. However, if you have problems at other times during the week, notify any office staff personnel, and you can be seen by the physician then as well.

Follow Up

Once you have completed the treatment course, we will ask you to come back in approximately two weeks, so that the physician can check your progress, make sure your skin is healing appropriately and talk to you about any future treatment that might be required.  You will then come back for additional follow-up visits.