Radiation Therapy During Treatment
The Steps the Patient and Their Family Go Through During Radiation Therapy
Meeting with the Radiation Therapy Specialist:
This is the first step for the family when their child’s treatment plan includes radiation therapy. They discuss the role of radiation in the treatment, ask questions, and get answers. The family also gets to know the nursing staff responsible for assisting during the treatment period.
Simulation:
This involves taking measurements of the child’s body and marking their skin or mask to ensure the radiation is directed accurately at the same area throughout the treatment period, aiming for the best results in a safe manner. The treating doctor and the radiation therapy specialist ensure that the child is positioned accurately on the machine in the same direction each time during radiation exposure, and sometimes they might need to stabilize the child with another device.
Creating a Treatment Plan:
After completing the simulation, the treatment team reviews all the information gathered and the results of preliminary tests to devise a treatment plan. The doctor writes a complete treatment prescription to clarify the required amount of radiation, where it should be directed on the body, the dosage, and the duration of treatment, which depends on the type of tumor and sometimes the child’s age.
The First Day:
Before the first dose, the radiation therapy unit takes images to verify treatment accuracy (“treatment verification”) to ensure it’s targeting the tumor area and confirming that it’s the region to be treated. This must be approved by the specialist doctor before starting treatment, and this step is repeated frequently throughout the treatment period.
Daily Treatment:
The radiation therapy specialist checks daily to make sure the child is positioned in the same spot, ensuring the mask is placed correctly for radiation delivery. Sometimes, they use immobilization devices to ensure the patient’s position is precise if needed, then they leave the room and go to the opposite room (monitor room), which is the control room, to observe the child closely on a television screen. There is a microphone in the room so that the child can talk to the specialist at all times. The specialist can stop the machine at any moment if the child feels unwell or moves out of position.
The sessions are painless; the child doesn’t feel anything, but they might hear the machine operating, which is normal.
The session lasts about (15 to 45) minutes, with most of that time spent preparing the child for treatment.
Typically, treatment is given 5 days a week.
Weekly Follow-up:
The doctor and nurse regularly see the child to monitor progress, assess side effects, and how to manage them, so always make sure to ask any questions that are on your mind. The doctor can adjust the treatment plan and session times based on the body’s response to the treatment. The radiation therapy team meets with the rest of the treatment team from various specialties to review the child’s case and ensure that the treatment is proceeding according to the established plan.
During these meetings, progress and concerns are discussed.
Weekly Port Imaging:
The responsible doctor reviews the port image every week (and sometimes daily) to make sure that the radiation is aimed at the same spot on the child’s body each time. This is why there are days when the child stays on the machine longer than usual; that’s the day when the doctor reviews the port image or performs a confirming CT scan using the radiation therapy machine (Cone Beam CT).
Follow-up:
The radiation oncologist, in collaboration with the other doctors, ensures that the treatment steps are going in the right direction.
Tips for Parents:
If possible, visit the treatment unit with the child before starting therapy sessions to familiarize yourself with the environment and what to expect. Before treatment begins, make sure your doctor knows about any medications you’re taking and if you have any allergies, and don’t start taking any medications during treatment without consulting the doctor or nursing staff. The child should have a balanced diet. Review the treatment plan with the doctor and discuss the potential for side effects. Talk about how to handle these side effects. Notify the medical team of any side effects that occur in the child.
Side Effects
These occur as a result of radiation passing through healthy cells during treatment, causing damage to them. These healthy cells can rebuild themselves, but in the long term, side effects can appear two to three weeks later and usually fade away a few weeks after treatment ends. In rare cases, severe side effects may appear after treatment is completed.
The most common side effect is fatigue, but it’s usually not severe, and the child can continue all or some of their usual daily activities. Another side effect is a decrease in blood cell count, which occurs when treating large areas of the body. The radiation oncologist monitors this decrease. Skin changes are common and referred to as radiation dermatitis, where the skin in the treatment area may turn red and become very sensitive, and the child might lose hair in the area exposed to radiation.
Important note:
Side effects are often mild and go away after the radiation treatment is completed.