Radiation therapy uses penetrating beams of high-energy waves or particles in the treatment of cancer. The treatments are painless and you will not be radioactive during or after treatment. A beam of radiation will be directed to the tumor site from a machine called a linear accelerator.

The goal of radiation therapy is to kill the cancer cells with as little risk as possible to your normal cells. To protect your normal cells, your doctor will carefully plan your dose of radiation, spread out the treatment over time, and shield as much normal tissue as possible. This planning will start before your radiation therapy begins, during a visit called a simulation.

SIMULATION

In order for your simulation to be performed effectively, your bowel must be emptied of stool. Your nurse will review the specific instructions with you before your simulation appointment. On the day of the simulation, you will be asked to drink several cups of barium, a liquid that will allow your doctor to see your intestines on the x-rays that will be taken. Your nurse will give you instructions about when to drink the barium.

You will be given an appointment for a CAT scan at South Nassaus Radiology Department. Please report to the out-patient cashier fifteen minutes before your appointment time to register. A therapist from our department will meet you there and a CAT scan will be performed to plan out your radiation treatment. Markings will be made and a clear tape will be used to cover them until your permanent tattoos are done.

SKIN MARKINGS (TATTOOS)

Tattoos are made with a small sterile needle and a drop of ink. They will feel like a pinprick. Tattoos are permanent and will not wash off when bathing. The therapists will then take pictures of you in the simulation position. The pictures, tattoos, and a body mold are used to make sure that you are positioned correctly on the table during each of your treatment sessions.

THE BODY MOLD

An immobilization device called a body mold will be made of your lower body. The therapists will make this out of plastic, custom shaped to fit your body. During the simulation, and every day of treatment, this mold will be placed over your lower body and attached to the table.

SETUP AND BEAM FILMS

After the simulation is complete, you will be asked to return for an 'initial set-up' or 'dress rehearsal'. You will be positioned on the treatment table as you were during the simulation. X-rays of each of the radiation beams will be done to ensure that your treatment matches the prescription ordered by your oncologist. The beam films will be done weekly during the course of your therapy to determine the accuracy of your position. They are not used to monitor the size of your tumor or your response to therapy.

TREATMENTS

Radiation treatments will be delivered daily, Monday through Friday for about eight to nine weeks. The treatments are the same whether you receive conventional radiation, 3-dimensional conformal radiation, or intensity modulated radiation (IMRT). You should plan on being in the department for about one hour. When the therapists are ready for you, you will be asked to go to a dressing room, undress from the waist down, and put on a gown. During treatment you will be positioned on the table as you were during your initial set-up.

You will be alone in the room during treatments but the therapists are watching you on a monitor and can hear and speak to you through an intercom. It is important that you do not move during treatment, so please let your therapists know if you are uncomfortable.

While you are receiving treatment, your physician and nurse will see you weekly. During this time they will talk with you about any side effects from treatment that you may be experiencing. Please contact your nurse if you have any concerns between these visits.

POSSIBLE SIDE EFFECTS

SKIN REACTION

Most patients do not notice any changes in the skin in the area being treated. It is possible that you may lose some or all of your pubic hair; this hair will usually grow back in two to four months after radiation is completed.

Wash the pelvic area daily with warm water and a mild, unscented soap such as Dove®.

If you develop anal itching, a tub or sitz bath will be helpful. Your nurse will discuss other measures to make you feel more comfortable.

URINARY CHANGES

Your prostate gland may swell and your bladder lining may become irritated during radiation therapy. Symptoms such as: increased frequency of urination during the day or night, difficulty starting a stream of urine, urgency, and burning with urination may begin after about two weeks of treatment. Measures to help you handle these symptoms include:

Drink six to eight glasses of water (or other liquids) during the day. Your do not need to force additional fluids.

Try to avoid drinking fluids after 8 PM.

Avoid bladder irritants such as caffeine, alcohol, spices, and tobacco. Some men find that acidic juices or cranberry juices will also increase burning.

Please inform your doctor or nurse of any urinary changes. Medications can be prescribed to increase your comfort.

BOWEL CHANGES

Radiation to the prostate may irritate the wall of your rectum. Symptoms such as: softer, smaller, or more frequent bowel movements, hemorrhoid or rectal discomfort, rectal cramping or fullness, mucous discharge, a small amount of rectal bleeding, increased gas, or an increased urgency to have a bowel movement may begin about two weeks after starting treatment. You should follow your usual diet when starting treatment. If you develop any changes in your routine bowel pattern, please inform your nurse. She can discuss any diet changes which will help you lessen these symptoms. Medication may be prescribed by your doctor if you are still uncomfortable.

SEXUAL ISSUES

You may be sexually active unless advised otherwise by your doctor. The booklet, Sexuality and Cancer, can be obtained through the American Cancer Society (1-800-ACS-2345).

If your partner is fertile when your radiation therapy starts, contraception should be used during treatment. It is usually recommended that you do not conceive a child for a two year period after your radiation treatments are completed. If you wish to conceive a child in the future, please discuss this with your oncologist. If a decision is made to arrange for sperm banking, this must be done before treatment begins.

Your radiation oncologist will discuss sexual changes that may occur after treatment is completed. These may include: changes in your ability to achieve or maintain an erection, a change in the sensation of orgasm, a change in the amount or consistency of the ejaculate, or burning on ejaculation. These changes may occur many months or years after treatment is completed. Please discuss any concerns you may have concerning your sexuality.