How to Choose the Best Radiation Oncology Treatment: A Patient’s Step-by-Step Guide

Facing a cancer diagnosis and choosing the best radiation oncology treatment can feel overwhelming for anyone. Nearly 60% of cancer patients receive some form of radiation therapy during their treatment journey, making it one of the most common approaches to fighting cancer.

However, understanding your options doesn’t have to be intimidating. From traditional external beam therapy to advanced techniques like IMRT and IGRT, radiation therapy for cancer has evolved significantly. Under the guidance of specialists like Dr. Manoj Sharma, radiation oncologist, patients in India and worldwide are accessing personalized treatment plans that balance effectiveness with minimizing side effects of radiation therapy.

Whether you’re just beginning your cancer treatment journey or seeking a second opinion, this step-by-step guide will help you navigate the complex decision-making process. We’ll walk you through understanding different radiation approaches, working with your medical team, preparing for treatment, and managing potential side effects—all to help you make informed decisions about your care.

Understanding Radiation Therapy

Radiation therapy stands as a cornerstone of modern cancer treatment, utilizing high-energy particles or waves to destroy or damage cancer cells. Understanding how this powerful tool works can help you make informed decisions about your treatment options.

What radiation therapy does

At its core, radiation therapy works by damaging the DNA inside cancer cells. This genetic damage prevents cancer cells from growing and dividing, ultimately causing them to die. The treatment creates small breaks in the cellular DNA that cancer cells cannot repair. While nearby healthy cells may also be affected by radiation, they typically recover and return to normal function.

The destruction of cancer cells doesn’t happen instantly. After radiation damages the DNA, it takes days or weeks before cancer cells begin to die. Furthermore, cancer cells continue dying for weeks or months after radiation therapy ends. This gradual process explains why patients often receive multiple treatment sessions over an extended period.

For patients seeking the best radiation oncology treatment, understanding this cellular mechanism helps explain why precision and personalization are essential in radiation planning. Treatment plans are specifically designed for each individual based on their cancer type, location, and other factors.

When it is used in cancer treatment

Radiation therapy serves multiple purposes in cancer treatment, making it versatile for various stages and types of cancer. Specifically, doctors may recommend radiation therapy to:

• Cure or shrink early-stage cancers that are particularly sensitive to radiation

• Prevent cancer recurrence after surgery (adjuvant therapy)

• Shrink tumors before surgery (neoadjuvant or pre-operative therapy)

• Treat symptoms like pain caused by advanced cancer (palliative treatment)

• Target areas where cancer might spread, even when not yet detected

• Treat cancer that has returned after previous treatment

Additionally, radiation can be given alone or combined with other treatments such as chemotherapy or surgery. When radiation and chemotherapy are administered together, they often help each other work more effectively, although side effects may increase. This combined approach is called chemoradiotherapy.

The decision to use radiation therapy depends primarily on the type and stage of cancer, along with other health factors the patient might have. More than half of all people with cancer receive radiation therapy as part of their treatment, underscoring its significance in comprehensive cancer care.

Types of radiation therapy: external, internal, systemic

There are three primary types of radiation therapy, each with distinct delivery methods and applications:

1. External beam radiation therapy (EBRT) is the most common type. A machine outside the body, typically a linear accelerator, directs high-energy beams at the cancer. These beams can include X-rays, electrons, or protons. Modern external radiation techniques include 3D conformal radiation therapy (3D-CRT), intensity-modulated radiation therapy (IMRT), and image-guided radiation therapy (IGRT). Notably, patients receiving external radiation are not radioactive and can safely interact with others, including children.

2. Internal radiation therapy (brachytherapy) involves placing a radioactive source inside or near the tumor. Seeds, ribbons, or capsules containing radiation are positioned directly at the cancer site. This approach allows for higher doses of radiation to be delivered to specific areas while limiting exposure to surrounding healthy tissues. Brachytherapy is commonly used for cancers of the prostate, cervix, endometrium, vagina, and breast.

3. Systemic radiation therapy uses radioactive substances that travel through the bloodstream to find and destroy cancer cells throughout the body. Patients receive this treatment by swallowing radioactive material, through an IV line, or via injection. After systemic radiation, body fluids may be radioactive for a period, requiring certain safety precautions.

Each type of radiation therapy offers distinct advantages depending on the cancer’s characteristics and location. Consequently, your radiation oncologist will carefully consider these factors when recommending the most appropriate approach for your specific situation.

Step 1: Meet Your Radiation Oncology Team

Your cancer treatment journey begins with meeting the specialists who will guide your radiation therapy. The expertise of a well-coordinated radiation oncology team is vital to achieving the best radiation oncology treatment outcomes.

Who is on your care team

A comprehensive radiation oncology team typically includes several highly trained professionals working together to provide your care:

• Radiation Oncologist: The doctor who specializes in treating cancer with radiation, prescribes your treatment plan, and oversees all aspects of your radiation therapy.

• Medical Physicist: Ensures radiation equipment works properly, performs safety tests, and helps develop precise treatment plans. These specialists often hold doctorate or master’s degrees, with additional clinical physics training.

• Dosimetrist: Calculates the exact dose of radiation needed to target your tumor while minimizing exposure to healthy tissue. Many dosimetrists begin as radiation therapists and undergo additional specialized training.

• Radiation Therapist: Positions you for treatment and operates the machines that deliver radiation. These professionals complete a two-to-four-year educational program and are typically certified by the American Registry of Radiologic Technologists.

• Radiation Oncology Nurse: Explains your treatment, answers questions, helps manage side effects, and provides overall support throughout your radiation journey.

Beyond these core team members, you may interact with dietitians, physical therapists, social workers, and patient navigators who provide additional support services.

Role of the radiation oncologist

The radiation oncologist leads your radiation therapy team and plays a crucial role in your treatment. After completing medical school, these specialists undergo one year of general medical training followed by four years of residency training in radiation oncology.

Your radiation oncologist will:

• Develop and prescribe your personalized treatment plan

• Ensure treatments are delivered precisely

• Monitor your progress and adjust treatment when necessary

• Identify and help manage side effects

• Work collaboratively with other physicians involved in your care.

Radiation oncologists are the only doctors with the expertise and training to safely prescribe and oversee radiation therapy treatments. They meet with you initially for consultation, then for planning sessions, and conduct weekly visits throughout your treatment course to evaluate your progress.

Importance of multidisciplinary planning

Cancer care has evolved from a disease-focused approach toward patient-centered treatment, with multidisciplinary management as a fundamental aspect of high-quality care. Rather than working in isolation, specialists from various fields collaborate to determine the optimal treatment strategy for each individual patient.

Studies demonstrate that multidisciplinary approaches in cancer care increase the use of guideline-based treatments and reduce time to treatment. This collaborative model ensures that every treatment decision is thoroughly considered and grounded in the latest scientific evidence.

The multidisciplinary approach offers several key advantages:

1. Comprehensive evaluation: Different specialists bring unique insights that influence treatment strategies.

2. Streamlined process: When physicians collaborate in real-time, treatment plans can be established more efficiently, often during or immediately after your first appointment.

3. Improved outcomes: Research shows that patients who receive multidisciplinary care may experience better survival outcomes compared to those who don’t.

4. Coordinated care: Regular communication among team members ensures everyone remains informed about your treatment progress.

By meeting your radiation oncology team early in your treatment journey, you gain clarity about each member’s role and establish the foundation for successful therapy aimed at fighting your cancer effectively.

Step 2: Planning Your Treatment

The foundation of effective radiation therapy lies in meticulous planning that begins after your initial consultation. This critical preparation phase ensures your treatment targets cancer cells precisely while minimizing damage to surrounding healthy tissues.

Simulation and imaging scans

Following your decision to pursue radiation therapy, you’ll undergo a procedure called simulation. This 1-2 hour session serves as a “trial run” that maps the exact area to be treated. During simulation, you’ll lie on a flat table in the position that will be used throughout your treatment course. The radiation therapist will take detailed images using a specialized CT scanner designed specifically for treatment planning.

Medical imaging forms the backbone of this virtual planning process. Though CT scans are typically the primary imaging method, your doctor might order additional scans for more complete information:

• Magnetic resonance imaging (MRI) provides excellent detail of soft tissues

• Positron emission tomography (PET) may be used in specific cases where uptake studies enhance target delineation

• Contrast agents might be administered orally or intravenously to improve image quality

Modern treatment planning systems include tools for multimodality image matching, essentially creating a detailed three-dimensional map of your anatomy. This fusion of images allows for extremely precise targeting.

Marking the treatment area

To ensure consistent positioning throughout your treatment, the radiation therapist will mark your skin to identify the exact treatment location. These marks typically come in two forms:

First, temporary markings made with felt-tipped markers help guide initial positioning. Subsequently, permanent reference marks called tattoos are often applied. These tattoos—no larger than a freckle—are created using a sterile needle and a drop of non-toxic ink. Though small, these marks play a vital role in treatment accuracy.

Custom immobilization devices may likewise be created during simulation. These might include masks for head and neck treatments or body molds for chest, abdomen, or pelvic radiation. These devices help maintain the exact same position for every treatment session.

Creating a personalized treatment plan

Once simulation is complete, your radiation oncology team develops your personalized treatment plan. Medical physicists and dosimetrists work together to determine the optimal approach for delivering radiation to your tumor while protecting healthy tissues.

This complex process involves:

• Selecting appropriate beam types (photons, electrons, or protons)

• Determining optimal energy levels (measured in MeV)

• Calculating precise radiation dosages

• Configuring beam angles and intensities

For intensity-modulated radiation therapy (IMRT) or image-guided radiation therapy (IGRT), additional sophisticated planning ensures maximum precision. The team uses specialized treatment planning software that creates a “virtual model” of your anatomy based on your imaging scans.

Your completed treatment plan undergoes rigorous evaluation, often using dose-volume histograms that help clinicians assess how uniformly radiation will reach the tumor while sparing critical organs. This thorough planning process typically takes several days to a week before your actual treatment begins.

Step 3: Undergoing Radiation Therapy

The day of your first radiation treatment marks an important milestone in your cancer journey. Understanding what happens in the treatment room can help ease anxiety and prepare you for what lies ahead.

What happens during each session

Upon arrival for each session, you’ll change into a hospital gown and enter the treatment room. The radiation therapists will help position you on the treatment table using the tattoos or marks placed during your simulation. Immobilization devices such as masks or body molds might be used to ensure you remain perfectly still.

Once positioned correctly, the therapists will leave the room but remain connected with you via intercom and video monitoring systems. The machine, called a linear accelerator, will move around you without touching your body. Prior to delivering radiation, therapists often take imaging scans to verify your position, making adjustments if necessary.

How long treatment lasts

Most radiation therapy courses span 1-7 weeks for curative treatment, whereas symptom relief treatments might range from a single session to 2 weeks. Typically, patients receive daily treatments Monday through Friday, allowing healthy cells to recover during weekend breaks.

Each appointment generally takes 10-45 minutes, though most of this time involves setup and positioning. The actual radiation delivery typically lasts only 2-5 minutes. Your radiation oncologist will determine your specific schedule based on your cancer type, location, and treatment goals.

What you may feel during treatment

Despite its power, external beam radiation therapy is painless – you won’t feel the radiation entering your body. The experience resembles getting an X-ray. Nevertheless, maintaining the required position might cause discomfort for some patients.

Interestingly, certain patients occasionally report unusual sensory experiences. Some perceive flashes of light, particularly with head treatments. Others describe smelling chemical-like or metallic odors during sessions. These sensations, while harmless, should be mentioned to your care team.

Throughout treatment, communication with your radiation therapists remains vital. They can address concerns, adjust for comfort when possible, and provide guidance on managing the emotional aspects of regular treatments.

Step 4: Managing Side Effects and Risks

Managing the effects of radiation therapy is an essential part of your cancer treatment journey. Though side effects vary based on the treatment area, dose, and your general health, having proper information helps you prepare and respond appropriately.

Common short-term side effects

Most patients experience some side effects during or shortly after radiation therapy. Fatigue is the most common, typically beginning after a few weeks of treatment. This tiredness differs from everyday exhaustion and might not improve with rest.

Skin changes in the treatment area frequently occur, including:

• Redness, irritation, or tanning

• Dryness, flaking, or itchiness

• In some cases, blistering or peeling

Radiation to specific areas may cause localized hair loss, which typically grows back 3-6 months after treatment ends. Additionally, some patients experience digestive issues like nausea, appetite changes, or difficulty swallowing, especially when receiving radiation to the abdomen, chest, or pelvic region.

Long-term risks to be aware of

While most side effects resolve within weeks after treatment, some might persist or develop later. Radiation can make tissues less stretchy, a condition called radiation fibrosis. This may affect organs differently: