with Intensity Modulated Radiation Therapy (IMRT)

Radiation therapy is a form of cancer therapy using high-powered x-rays to kill cancer. A specialized treatment machine known as a linear accelerator produces the treatment x-rays. The most common use of radiation therapy is external beam radiation therapy (EBRT). During a course of EBRT, a unique treatment plan is developed specifically for you (see Treatment Process below). A radiation therapist, who is a specially-trained technologist, administers the treatment plan outlined by your doctor. In conjunction with the linear accelerator that is carefully programmed with your specific treatment information, the radiation therapist ensures that you are receiving the precise treatment intended just for you.

During each daily treatment, the therapist will help you into a gown and position you on an x-ray table according to the pre-determined plan. You must lie very still during the treatment, which is painless and lasts only a few minutes. During that short time, you will be alone in the room; however, the therapist watches you the entire time on a monitor located just outside the treatment room. At the completion of each daily treatment, you should not feel any differently than you did at the beginning of the session. The therapist will then help you up from the table, assist you in getting dressed and escort you back to the waiting room. Most patients drive themselves to and from their daily treatment without difficulty. You and the therapist will confirm your appointment time for your treatment the following day. A typical course of EBRT is delivered Monday through Friday for several weeks, depending on the circumstance. Your doctor will review the plans with you in detail.

3D Conformal Radiation Therapy and Intensity Modulated Radiation Therapy (IMRT)

The main goal of external beam radiation therapy (EBRT) is to deliver a dose of radiation that is strong enough to kill the cancer but not so strong that damage is done to the surrounding healthy organs. Killing the cancer translates into the possibility of curing you of the disease. Sparing the normal organs means you will experience fewer side effects. Over the years, significant technological advances have been made in radiation oncology. Both 3D Conformal Radiation Therapy (3D-CRT) and Intensity Modulated Radiation Therapy (IMRT) are examples of the advances used to realize the goal of EBRT.

Today, the radiation oncologist uses many x-ray tools to help visualize a cancer within the body. Sophisticated treatment planning computers allow your physician to carefully outline the cancer and its relation to the healthy organs. The computer then designs radiation beams that actually conform to the shape of the cancer and minimize radiation to the area around the cancer. After your physician decides upon the best treatment plan, the information is transferred to the linear accelerator to be used for your treatment. The process of imaging the cancer, designing a specially shaped radiation beam, and delivering a precise dose of radiation forms the basis for both 3D-CRT and IMRT. Both are radiation therapy techniques that represent variations on the same theme: Radiation to the cancer and minimal radiation to everything else. Your radiation oncologist decides which technique is best for you.

Most cancers are treated with 3D-CRT. However, some cancers require higher doses of radiation. In addition, certain organs, like the spinal cord, are very sensitive to radiation. For example, if a cancer is located next to the spinal cord, great care must be taken to design multiple radiation beams to conform to the shape of the cancer while excluding the spinal cord from the path of the radiation. In such a situation, the radiation oncologist may prefer to use an IMRT technique, a more complex form of 3D-CRT. A sophisticated IMRT computer system allows the physician to specify the radiation dose to the cancer and simultaneously set limits on the dose to the healthy organs (i.e., the spinal cord). The result is an IMRT treatment plan that carefully paints the cancer with a high dose of radiation.

The Prostate Cancer at Saint  Joseph's offers an highly-trained staff , board-certified physicians with expertise in the use of 3D-CRT and IMRT. In addition, our team consists of board-certified medical physicists, dosimetrists and therapists who are integral in the safe delivery of radiation on a daily basis.

The Treatment Process

Consultation

Radiation therapy is successfully used in the treatment of most cancers often in conjunction with surgery and/or chemotherapy. There are several steps in the radiation therapy treatment process. The first step is the consultation which usually occurs at the request of the surgeon or medical oncologist. During the consultation, a radiation oncologist reviews all the medical information about your diagnosis of cancer. A physical examination then follows. Afterwards, you and your family meet with your radiation oncologist to discuss the rationale, benefits, and side effects of radiation therapy. If treatment is indicated, your physician will explain all about the next step: Simulation.

Simulation

The treatment of cancer is unique to the specific type of cancer. The use of radiation therapy varies based on the individual situation. It is during the simulation process that your radiation oncologist “simulates” or decides upon how best to treat your cancer. A computerized tomography (CT) scanner facilitates the process by obtaining special x-ray pictures of the cancer in your body. Your radiation oncologist then maps out the cancer as well as the organs that surround the cancer. Distinguishing between the cancer and the normal organs is very important because the goal of radiation therapy is to treat the cancer and minimize the radiation received by the adjacent organs. The simulation and mapping information is then used in the next step in the treatment process: Treatment Planning.

Treatment Planning

Once the simulation x-rays are obtained, the complex process of treatment planning begins. Unlike simulation, treatment planning is the behind-the-scenes work that does not require your presence. The treatment planning team consists of your radiation oncologist, medical physicist and dosimetrist. The team is specially trained to analyze various radiation therapy techniques in order to treat your cancer in the best way possible. Radiation oncologists with the PCC use state-of the-art treatment planning computers to customize a unique plan for each individual patient. The medical physicist tests the plan for precision and accuracy. Once your physician approves the final plan, you can be assured that the most optimal plan is ready to be used in the next step of the treatment process: Treatment.

Treatment

Through the efforts of the simulation and treatment planning processes, you can be confident that your treatment plan is tailored to your specific needs. There are many different ways to deliver radiation therapy, and your radiation oncologist will discuss which is best for you. Your treatment may involve external beam radiation therapy, brachytherapy, or the combination of both. Your physician and nurses will review exactly what you can expect from treatment and the anticipated side effects. You and your family are encouraged to ask questions along the way. Remember, our goal is to care for you with compassion and state-of-the-art cancer care; thus, it is important that we address all your questions and concerns about your treatment.

Follow-up

The period of time following cancer treatment, known as the follow-up, is just as important as the treatment itself. In addition, the follow-up period is the time to assess the status of your cancer and its response to the treatment. It is also the time that your physicians care for any side effects that may have resulted from the treatment. Your radiation oncologist often alternates follow-up visits with your other cancer doctors. Your team of doctors will jointly decide when and what type of x-rays/blood tests you may need. It is our hope that you will return to your normal routine as soon as possible after therapy.

Prostate cancer patients must be actively involved in choosing between several equally effective treatment methods. Patients should be encouraged to research the various options and make their decision taking into account their quality of life concerns along with their work and home life schedules. Although a diagnosis of cancer can be an intimidating experience, the more you are informed about the options available to you, the more equipped you will be to make the decision that is best for you.

We encourage you to contact our Patient Navigator at (678) 843-5665 or rsevy@sjha.org with any questions regarding EBRT and IMRT at Saint Joseph's. We're here to help.

Information on this page is provided collaboratively by the team at the Prostate Cancer Center at Saint Joseph's and has been medically reviewed by Nancy Wiggers, MD, Radiation Oncologist, 2010. Claims regarding treatment are based on years of clinical experience and industry reported data. The PCC follows American Urological Association and  National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines for the treatment of prostate cancer.

Last Updated: October 14, 2010 (RSH)