Consultation
At
the time of initial consultation, your radiation oncologist
first will review your medical history and perform a
physical examination. Once this information has been
obtained, your radiation oncologist will discuss the
treatment options available for your particular situation.
These options will depend on a number of factors, including
the type of tumor, the extent of the disease at the time of
diagnosis, your age and general health, and your medical
history. Your personal feelings about the treatment, your
self-image, and your lifestyle also will be important
considerations. An overview of some of these treatment
options is provided below. Radiation therapy is an effective
way to treat many kinds of cancer in almost any part of the
body.
Half of all people with cancer are treated with radiation,
and the number of cancer patients who have been cured is
rising every day. For many patients, radiation is the only
kind of treatment needed. Thousands of people are free of
cancer after having radiation treatments alone or in
combination with surgery, chemotherapy, or biological
therapy. Doctors can use radiation before surgery to shrink
the tumor and facilitate resection. After surgery, radiation
therapy may be used to stop the growth of any cancer cells
that remain. Your doctor may choose to use radiation therapy
and surgery at the same time. This procedure is known as
intraoperative radiation therapy (IORT). In some cases
doctors use radiation therapy in combination with anticancer
drugs, instead of surgery; other tumors require surgery in
addition to chemotherapy and radiation therapy. Radiation
therapy is recommended for some patients even when cure is
not possible. Many of these patients find the quality of
their lives improved when radiation therapy is used to
shrink tumors and reduce pressure, bleeding, pain, or other
symptoms. This is called palliative care.
Clinical Team
A medical doctor who has had
special training in using radiation to treat disease--a
radiation oncologist--will prescribe the type and amount
of radiation treatment that best suits your needs. At
Emory, all of the radiation oncologists are board certified
and have special areas of interest.
The radiation oncologist works closely with other
physicians involved in your care and also heads a highly
trained health care team within our department. Your
radiation therapy team may include:
·
the
resident physician (radiation oncologist in training),
who assists the radiation oncologist with all aspects of
your care
·
the
radiation physicist, who ensures that the equipment is
working properly
·
the
dosimetrist, who performs calculations with the
treatment planning software and develops the plan for your
radiation therapy
·
the
radiation therapy nurse, who provides nursing care and
helps you learn how to manage side effects
·
the
radiation therapist, who positions you each day for
treatment and operates the equipment that delivers the
radiation
·
the
social worker, who provides counsel and assistance in
solving the social problems that often arise during long
courses of treatment
Simulation
After the consultation, the
radiation oncologist may need to do some special planning to
define the exact radiation treatment area. In a process
called simulation, you will be asked to lie very
still on a table while the radiation oncologist and
radiation therapist use a special x-ray machine to define
your treatment ports or fields. This is the
exact place on your body where the treatment will be aimed.
You may have more than one treatment port. Simulation
usually requires 30 minutes to one hour.
At
Emory University we use an advanced simulation process
called CT simulation. This method is superior to
conventional simulation that is performed with fluoroscopy.
The CT simulation system offers high-resolution imaging and
short examination time for the full range of oncologic
procedures including volumetric localization, simulation and
verification for conformal, high-precision and stereotactic
radiotherapy planning.
Planning
Using
the information from the simulation, other tests, and your
medical history, your radiation oncologist will meet with
the radiation physicist and the dosimetrist.
Your radiation oncologist then decides how much radiation is
needed, how it will be delivered, and how many treatments
you should have. This process often takes several days.
At Emory University, we use a process called
three-dimensional (3-D) treatment planning to design and
optimize the radiation therapy. This treatment planning
software allows doctors to view a patient's tumor
three-dimensionally, enabling them to judge the most
effective strength and shape of the radiation beams used
while minimizing damage to the healthy tissues surrounding
the tumor. With this approach the beams are designed first,
and the resulting dose distribution then is reviewed to
ensure that it is satisfactory. This technology
revolutionized radiation treatment planning. Intensity
Modulated Radiation Therapy (IMRT) is even more advanced
than conventional 3-D conformal therapy, but is not suitable
for all patients. With IMRT, "inverse planning" is used.
This approach involves first defining the desired radiation
dose to the tumor and surrounding organs; the dosimetrist
then uses the planning software to obtain the optimal
radiation beam arrangement.
Treatment Delivery
The radiation used in radiation therapy can come from a
variety of sources. Your radiation oncologist may choose to
use x-rays or electron beam. Choosing which
type of radiation to use depends on what type of cancer you
have and on how deeply into your body the radiation
oncologist wants the radiation to penetrate. High-energy
radiation is used to treat many types of cancer. Low-energy
x-rays are used to treat more superficial diseases.
After you have started the treatments your radiation
oncologist will follow your progress, checking your response
to treatment and your general state of health at least once
a week. The treatment plan may be revised by your radiation
oncologist if necessary. It's very important that you have
all of your scheduled treatments to get the most benefit
from your therapy. Unnecessary delays can decrease the
effectiveness of your radiation treatment.
The treatment delivery process is performed daily (generally
Monday-Friday). It involves lying on a treatment couch with
a body immobilization system. The linear accelerator is
properly positioned and the radiation therapist uses the
computer-controlled interface to deliver the treatment.
On-line imaging verification is performed to ensure the
correct delivery of radiation dose to the tumor site.
Follow-up Care
Once your entire course of
radiation therapy is finished, it is important to have
regular exams to check the results of your treatment. No
matter what type of cancer you've had, you will need regular
checkups and perhaps lab tests and imaging studies. Your
radiation oncologist will want to see you at least once
after your treatment is complete. The physician who referred
you for radiation therapy will schedule additional follow-up
visits as needed. Follow-up care, in addition to checking
the results of your treatment, might also include more
cancer treatment, rehabilitation, and counseling.
Most patients return to the radiation oncologist for several
regular follow-up visits. Other patients are referred back
to their original doctor, to a surgeon, or to a medical
oncologist. Your follow-up care will depend on the kind
of cancer you have and on other treatments that you received
or may need.
Cancer Information Service (CIS)
Provides accurate, up-to-date information on cancer to patients
and their families, health professionals, and the general
public. Information specialists translate the latest scientific
information into understandable language and respond in English,
Spanish, or on TTY equipment. Toll-free: 1-800-4-CANCER (1-800-422-6237)
TTY: 1-800-332-8615
CancerMail
Includes NCI information about cancer treatment, screening,
prevention, and supportive care. To obtain a contents list,
send e-mail to
cancermail@icicc.nci.nih.gov with the word "help" in the
body of the message.
CancerFax
Includes NCI information about cancer treatment, screening,
prevention, and supportive care. To obtain a contents list,
dial 301-402-5874 from a fax machine handset and follow the
recorded instructions.
On-line journals
Cancer
International Journal of Radiation Oncology, Biology, Physics
(IJROBP)
Journal
of the American Medical Association (JAMA)
Journal of Clinical
Oncology (JCO)
Journal
of the National Cancer Institute (JNCI)
Lancet
New England
Journal of Medicine (NEJM)
MEDLINE search engines
Medicine
Online PubMed
National Library of Medicine PubMed
General Oncology Resources
American
Cancer Society
CancerNet
Eye Cancer
Network
Medicine Online
OncoLink
Radiation Oncology
Online Journal
Professional Societies
and Organizations
American Association
of Physicists in Medicine (AAPM)
American
Brachytherapy Society (ABS)
American College
of Radiology (ACR)
American College
of Radiation Oncology (ACRO)
American
Cancer Society (ACS)
American
Medical Association (AMA)
American
Radium Society (ARS)
American Roentgen
Ray Society (ARRS)
American Society
of Clinical Oncology (ASCO)
American Society
for Therapeutic Radiology and Oncology (ASTRO)
European Society
for Therapeutic Radiology and Oncology (ESTRO)
Radiological
Society of North America (RSNA)
World Health
Organization (WHO)
Emory Radiation Oncology actively participates in a various clinical trials. These trials are investigating topics such as more effective treatments for cancer and the prevention of side effects.
Clinical Trials at Emory Radiation Oncology
We are a member of the national clinical trials cooperative group specializing in radiation therapy, known as the Radiation Therapy Oncology Group (RTOG). Our department also supports the research efforts of these cooperative groups: Children's Oncology Group (COG), Eastern Cooperative Oncology Group (ECOG), and New Approaches to Brain Tumor Therapy (NABTT). In addition, the department is actively involved in pharmaceutical industry and independent clinical trials. All of these clinical trials are investigating new or additional treatment options which current research suggests may be better than the current standard treatments.
The department's participation in clinical trials provides our patients with leading edge treatment options and the best possible care.
Overview of Clinical Trials
Joining a clinical trial is one of the many important decisions faced by cancer patients. When considering a clinical trial, it is important to gather as much information as you need and to take the time necessaary to understand it. You need to weigh the possible benefits and risks for yourself. You may also find it helpful to talk to family or friends, your health-care providers, and anyone you know who has been in a clinical trial.
NCI Cancer Trials Information
The National Cancer Institute (NCI) provides additional information on clinical trials in radiation oncology. CancerTrials is a clinical trials information resource from the NCI.
The following online resources also provide information on clinical trials:
RTOG
NABTT
ECOG
GOG
NSABP
COG
CALGB
.
Emory Radiation Oncology provides a social worker that is available Monday through Thursday to assist you.
Social Worker:
Martha Giardina, BSW
(404) 778-4627
Emory Clinic, Room AT215
Mon & Wed (8:00 a.m. - 1:00 p.m.); Tue & Thu (12:00 p.m. - 5:00 p.m.)
Consultation with Patient and Families
- Life transitions that relate to new diagnosis, returning to work, disease recurrence and palliative care
- Locating support through groups or individual/family counseling referrals
- Issues regarding disability options
- Decision making/readiness for home care, assisted living, nursing home and hospice
- Financial issues
- Advance directives (living will and durable power of attorney for health care)
- Relaxation/stress reduction tapes and techniques
Information and Referrals
- Community resources
- Mental health services
- Internet and cancer links
- Stress reduction classes
Lodging and Transportation
Lodging is not available through Emory Healthcare. The Hope Lodge is available for all cancer patients who live more than 50 miles from Emory and meet certain requirements. The Hospitality House is a facility that provides housing for family members of patients in the hospital. Lodging also is available at several hotels, motels and apartments within five miles of Emory Healthcare.
Transportation is not available through Emory Healthcare. The American Cancer Society offers patients some transportation services.
Click here for more information on lodging or transportation.
Support Groups and Classes
The staff in the Department of Radiation Oncology are here to work with you and help make your time with us as comfortable as possible. You are very important and we want you to know that we are here to meet your needs. The staff is well trained and the facility is equipped with the latest technology available.
With the help of friends and former patients who care very much about your treatment experience, we have also developed programs to help you share some of your feelings with others. There are support groups and classes which many of our patients have enjoyed. A number of our patients enjoyed these programs so much that they chose to continue with them after they completed their radiation treatments.
Click here for more information on our support services program.
