RADIATION ONCOLOGY.

"My joy is giving the patient a complete understanding of the role of radiation oncology in the treatment of cancer. That knowledge is powerful and pays forward as my patients can teach others."

- Ramji Rajendran MD, PhD
Radiation Oncologist

Why

I was very nervous about my radiation treatment. I had no idea what was going to happen, but I knew that this was a very important step towards ensuring all cancer cells would be gone. The anxiety of the unknown was overwhelming to me. I am honored to have Learn Look Locate Medical Advisor, Ramji Rajendran MD PhD, Radiation Oncologist dedicate his expertise and knowledge to empower you about your upcoming radiation treatment. We both hope you find this page to be comforting and a great resource.

xxoo, Cynthia

Meet the Radiation Team

Understanding Radiation and the Different Types

How to Care for Yourself and Questions to Ask Your Doctor

From a Patient’s Perspective

Cynthia, Founder of Learn Look Locate

Advanced Radiation Treatment-Cutting Edge

Ramji Rajendran MD PhD
Radiation Oncologist

Dr. Rajendran primarily practices at AMITA Health’s Alexian Brothers Medical Center and Illinois Gamma Knife Center. He has also conducted research in the areas of prostate organ motion, proton radiation therapy, and radiation therapy for breast and thoracic tumors. He has written numerous papers and made presentations nationally and internationally. He is trained in the use of 3 dimensional conformal radiation therapy, intensity modulated radiation therapy (IMRT), stereotactic body radiation therapy (SBRT), gamma knife radiosurgery, high dose rate brachytherapy and permanent interstitial brachytherapy.

He has interest in treating a broad range of cancers including breast cancer treatment, lung cancer treatment, brain cancer, genitourinary (prostate cancer, testicular cancer, bladder cancer), head and neck cancer and gynecologic malignancies. He is also interested in cancer survivorship issues and empowering cancer patients and their caregivers. Dr. Rajendran enjoys spending his leisure time with his wife and three children camping, hiking, playing tennis, gourmet cooking and wine tasting. Learn more

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Tomotherapy

Tomotherapy is a dedicated IMRT treatment (intensity-modulated radiation therapy) machine with tremendous precision and unique capabilities. Tomotherapy offers two primary advantages over previous radiation therapies: better targeting and better delivery. Physicians can plan, verify and deliver treatment with a single system.

This enhanced precision helps minimize the impact of radiation on adjacent healthy tissue. Tomotherapy is ideal to treat tumors that are next to important normal structures that should be spared from radiation, such as treating prostate cancer while sparing the rectum and bladder; head and neck cancer while sparing the salivary glands; and brain cancer while sparing as much normal brain as possible.

The tomotherapy system is well suited for stereotactic radiation. Specifically, ROC physicians have been using the precision and power of tomotherapy to treat small lung cancers in patients who are unable to undergo lung surgery. This treatment is delivered over 5 sessions and has achieved local control rates of over 90 percent. Learn more

Seek out emotional support.

There are many emotional demands that you must cope with during your cancer diagnosis and treatment. It is common to feel anxious, depressed, afraid or hopeless. At times, it may help to talk about your feelings with a close friend, family member, nurse, social worker or psychologist. To find a support group in your area, ask your radiation oncology nurse.

What is a Radiation Oncologist?

Radiation oncologists are the doctors who will oversee your radiation therapy treatments. These physicians work with the other members of the radiation therapy team to develop your treatment plan and ensure that each treatment is given accurately. Your radiation oncologist will also monitor your progress and adjust the treatment as necessary to make sure the radiation is hitting its target while minimizing side effects. Before, during and after your radiation therapy treatments, your radiation oncologist works closely with other cancer doctors, such as medical oncologists and surgeons, to maximize the radiation’s effectiveness. Radiation oncologists have completed at least four years of college, four years of medical school, one year of general medical training, and four years of residency or specialty training in radiation oncology. They have extensive training in cancer medicine and the safe use of radiation to treat disease. If they pass a special examination, they are certified by the American Board of Radiology. You should ask if your doctor is board certified.

What are Radiation Oncology Nurses?

Radiation oncology nurses work together with radiation oncologists and radiation therapists to care for you and your family during your radiation treatments. They will explain the possible side effects that you may experience and describe how you can manage them. They will assess how you are doing throughout treatment and will help you cope with the changes you may experience. They will also provide support and counseling to you and your family. Radiation oncology nurses are licensed registered nurses or licensed practical nurses. Many registered nurses in radiation therapy have additional accreditation in the specialty of oncology nursing. Advanced practice nurses, including clinical nurse specialists and nurse practitioners, have completed a master’s degree program.

What are Radiation Therapists?

Radiation therapists work with radiation oncologists to administer the daily radiation treatment under the doctor’s prescription and supervision. They maintain daily records and regularly check the treatment machines to make sure they are working properly. Radiation therapists go through a two- to four-year educational program following high school or college. They take a special examination and may be certified by the American Registry of Radiologic Technologists. In addition, many states require radiation therapists to be licensed.

What are Medical Radiation Physicists?

Qualified medical physicists work directly with the radiation oncologist during treatment planning and delivery. They oversee the work of the dosimetrist and help ensure that complex treatments are properly tailored for each patient. Medical physicists are responsible for developing and directing quality control programs for equipment and procedures. Their responsibility also includes making sure the equipment works properly by taking precise measurements of the radiation beam and performing other safety tests on a regular basis.

What are Dosimetrists?

Dosimetrists carefully calculate the dose of radiation to make sure the tumor gets enough radiation. Using computers, they work to develop a number of treatment plans that can best destroy the tumor while sparing normal tissue. Since treatment plans are often very complex, dosimetrists work with the radiation oncologist and the medical physicist to choose the treatment plan that is right for you. Many dosimetrists start as radiation therapists and then, with very intensive training, become dosimetrists.

Others are graduates of one- to two-year dosimetry programs. They are certified by the Medical Dosimetrist Certification Board.

Understanding Radiation

Studies have shown that women with early stage breast cancer who have a lumpectomy to remove the cancer followed by radiation live just as long as women who have a mastectomy and may be preferred by many women. The standard of care after breast-conserving surgery is external beam radiation therapy. Often, this follows chemotherapy. Your surgeon will perform an operation called lumpectomy, also called a partial mastectomy, excisional biopsy or tylectomy, to remove the tumor. In some cases, a second operation called a re-excision may be needed if microscopic examination finds tumor cells at or near the edge of the tissue that was removed (called a positive or close margin). To see if your cancer has spread, your doctor may remove several lymph nodes from under your arm (axilla). If any of these nodes contain cancer cells, more nodes may be removed. Breast-conserving surgery is not suitable for all breast cancer patients. Talk with your surgeon to see if this is the best procedure for you. Learn more

External Beam Radiation Therapy

External beam radiation therapy involves a series of daily outpatient treatments to accurately deliver radiation to the breast. Painless radiation treatments are delivered in a series of daily sessions. Each treatment will last less than 30 minutes, Monday through Friday, for five to seven weeks. The usual course of radiation treats only the breast, although treatment of the lymph nodes around the collarbone or the underarm area is sometimes needed. 3-dimensional conformal radiotherapy (3D-CRT) combines multiple radiation treatment fields to deliver very precise doses of radiation to the breast and spare surrounding normal tissue.

Intensity modulated radiation therapy (IMRT) is a form of 3D-CRT that further modifies the radiation by varying the intensity of the radiation beams. It is currently being studied for treating breast cancer. Side effects might include skin irritation, like a mild to moderate sunburn, mild to moderate breast swelling and fatigue.

Partial Breast Irradiation. Available in a few clinics for a very select group of patients, these techniques are used after a lumpectomy to deliver radiation to the tumor site rather than the entire breast.

Breast brachytherapy involves placing flexible plastic tubes called catheters or a balloon into the breast. Over one to five days, the catheters or the balloon are connected to a brachytherapy machine so high doses of radiation can treat the nearby breast tissue.
Other techniques include 3-D conformal partial breast irradiation and intra operative radiation therapy (IORT).
The long-term results of these techniques are still being studied. Talk with your radiation oncologist if you would like more information. Learn more

After Mastectomy Radiation

In cases where the breast is surgically removed, your doctor may suggest radiation therapy for the chest wall and nearby lymph node areas. Whether or not radiation therapy should be used after removal of the breast depends on several factors, including the number of lymph nodes involved, tumor size and surgical margins. Learn more

Stereotactic Radiosurgery (SRS) and Stereotactic Body Radiotherapy (SBRT)

Stereotactic radiosurgery (SRS) is a non-surgical radiation therapy used to treat functional abnormalities and small tumors of the brain. It can deliver precisely-targeted radiation in fewer high-dose treatments than traditional therapy, which can help preserve healthy tissue. When SRS is used to treat body tumors, it’s called stereotactic body radiotherapy (SBRT).

SRS and SBRT are usually performed on an outpatient basis. Ask your doctor if you should plan to have someone drive you home afterward and whether you should refrain from eating or drinking or taking medication several hours before treatment. Tell your doctor if there’s a possibility you are pregnant or if you’re breastfeeding or if you’re taking oral medication or insulin to control diabetes. Discuss whether you have an implanted medical device, claustrophobia or allergies to contrast materials.

What is stereotactic radiosurgery and how is it used?

Stereotactic radiosurgery (SRS) is a highly precise form of radiation therapy initially developed to treat small brain tumors and functional abnormalities of the brain. The principles of cranial SRS, namely high precision radiation where delivery is accurate to within one to two millimeters, are now being applied to the treatment of body tumors with a procedure known as stereotactic body radiotherapy (SBRT).

Despite its name, SRS is a non-surgical procedure that delivers precisely-targeted radiation at much higher doses, in only a single or few treatments, as compared to traditional radiation therapy. This treatment is only possible due to the development of highly advanced radiation technologies that permit maximum dose delivery within the target while minimizing dose to the surrounding healthy tissue. The goal is to deliver doses that will destroy the tumor and achieve permanent local control.

SRS and SBRT rely on several technologies:

  • three-dimensional imaging and localization techniques that determine the exact coordinates of the target within the body
  • systems to immobilize and carefully position the patient and maintain the patient position during therapy
  • highly focused gamma-ray or x-ray beams that converge on a tumor or abnormality
  • image-guided radiation therapy (IGRT) which uses medical imaging to confirm the location of a tumor immediately before, and in some cases, during the delivery of radiation. IGRT improves the precision and accuracy of the treatment

Three-dimensional imaging, such as CT, MRI, and PET/CT is used to locate the tumor or abnormality within the body and define its exact size and shape. These images also guide the treatment planning—in which beams of radiation are designed to converge on the target area from different angles and planes—as well as the careful positioning of the patient for therapy sessions.

Although SRS commonly refers to a one-day treatment, physicians sometimes recommend multiple stereotactic delivered treatments. This is important for tumors larger than one inch in diameter as the surrounding normal tissue exposed to the single high dose of radiation must be respected and limited, and the volume of normal tissue treated increases proportionally to the tumor size. Delivering the radiation in a few sessions as opposed to one, can improve safety and allow the normal tissue to heal in between treatments. Therefore, fractionating the treatment allows for high doses to still be delivered within the target, while maintaining an acceptable safety profile. This procedure is usually referred to as fractionated stereotactic radiotherapy (SRT), and typically refers to the delivery of two to five treatments of focused radiation and are not always given on consecutive days.

SRS and SBRT are important alternatives to invasive surgery, especially for patients who are unable to undergo surgery and for tumors and abnormalities that are:

  • hard to reach
  • located close to vital organs/anatomic regions
  • subject to movement within the bodySRS is used to treat many types of brain tumors including:
  • benign and malignant
  • primary and metastatic
  • single and multiple
  • residual tumor cells following surgery
  • intracranial, orbital and base-of-skull tumors
  • arteriovenous malformations (AVMs), a tangle of expanded blood vessels that disrupts normal blood flow in the brain and sometimes bleeds.
  • other neurological conditions like trigeminal neuralgia (a nerve disorder in the face), tremor, etc.

SBRT is currently used and/or being investigated for use in treating malignant or benign small-to-medium size tumors in the body and common disease sites, including the:

  • lung
  • liver
  • abdomen
  • spine
  • prostate
  • head and neck

SRS fundamentally works in the same way as other forms of radiation treatment. It does not actually remove the tumor; rather, it damages the DNA of tumor cells. As a result, these cells lose their ability to reproduce. Following treatment, benign tumors usually shrink over a period of 18 months to two years. Malignant and metastatic tumors may shrink more rapidly, even within a couple of months. When treated with SRS, arteriovenous malformations (AVMs) may begin to thicken and close off slowly over a period of several years following treatment. Many tumors will remain stable and inactive without any change. Since the aim is to prevent tumor growth, this is considered a success. In some tumors, like acoustic neuromas, a temporary enlargement may be observed following SRS due to an inflammatory response within the tumor tissue that overtime either stabilizes, or a subsequent tumor regression is observed called pseudoprogression. Learn more

Get plenty of rest.

Many patients experience fatigue during radiation therapy, so it is important to make sure you are well rested.

Eat a balanced, nutritious diet.

A nutritionist, nurse or physician may work with you to ensure you are receiving the right calories, vitamins and minerals from the foods you eat and that you are eating the proper type of foods. With certain types of treatment, it may be necessary to modify your diet to minimize side effects. You should not attempt to lose weight during radiation therapy, since you require more calories due to your cancer and treatment.

Treat the skin that is exposed to radiation with extra care.

The skin in the area receiving treatment may become red and sensitive. Your radiation oncology nurse will review specific instructions for caring for your skin with you. Some guidelines include:

  • Cleanse the skin daily with warm water and a mild soap recommended by your nurse.
  • Avoid using any lotions, perfumes, deodorants or powders in the treatment area unless approved by your doctor or nurse.
  • Try not to use products containing alcohol and perfumes.
  • Avoid putting anything hot or cold on the treated skin. This includes heating pads and ice packs.
  • Protect the treated area from the sun by using a sunscreen with an SPF of at least 15. If possible, avoid exposing the treated area to the sun altogether.

Moisturize and massage.

The area where the skin is radiated can get very dry and irritated, make sure you use plenty of lotion and massage the area as much as possible.

TrueBeam®

TrueBeam® is the latest innovation from Varian in linear accelerator technology. It employs many improvements to the standard linear accelerator that not only make treatment more efficient, but also improve patient comfort, and treatment tolerability.

TrueBeam® accelerates patient treatment by “intelligent” automation, imaging, positioning and reduction of the number of steps needed for treatment up to 5-fold. It enhances patient convenience by shortening treatment periods because of higher dose rates. For example, a standard IMRT treatment that normally lasts 10-15 minutes can be completed in less than 2 minutes. The machine can be fitted to perform radiosurgery and complex procedures, which typically last hours, in 5 to 20 minutes. The improved efficiency and faster treatments have the important advantage of decreasing the probability of tumor movement during treatment.

The integration of image guidance, high dose rates, precision and accuracy makes TrueBeam® an excellent choice for your radiation needs. Learn more

Side effects.

Each person can have different side effects from radiation treatment. I didn’t experience any until 4 weeks into my treatment. I developed a very strong sun burn with blisters and had an allergic reaction to the lotion I was using. Be mindful of any products you are using on your skin during your treatment. The body’s immune system is very sensitive due to radiation, so it is important to watch how your skin reacts during and after your treatment. If you see any strong blistering or strange reactions from any lotions or creams tell your radiologists team right away.

Does it hurt?

My radiation treatment did not hurt, except for allergic reaction to the lotion. The only uncomfortable part was having my arm up over my head for the time the machine was swirling around me. The tightens around the radiated area over time did become very stiff and uncomfortable, plus my range of motion on my radiated side is limited, but not painful.

What does your skin feel like?

It is like a VERY bad sunburn and over time the skin becomes VERY tight and hard-almost like cement! You must massage the area often (which I did not) in order to break up the tightness. When I get stressed, I do get headaches from the tightness due to the radiation.

Stay active.

I stayed active for all five weeks of my treatment.  I went to spin classes and tried to stay strong mentally and physically, it helped me get through my treatment.

Get to know your radiation team.

My team was fantastic! You will see your radiation team every day for about 10 minutes each day for 5 weeks (depending on your treatment) so, get to know them because I feel that they are special people doing what they do, all day long, so my advice is get to know them:)

Ask questions.

I asked many questions and wanted to understand how the machine worked to kill cancer cells. I wanted to understand what was happening while the machine was moving around me during my treatment.

Holding your breath.

They ask you to hold your breath while the machine is moving around your body. The reason for this, is to pull your heart back so that the radiation does not go near your heart. Radiation can be damaging to your heart so be ready to hold your breath for a few minutes while the machine moves around you. You will get used to it over time.

Be grateful!

I am grateful for modern technology and this incredible machine that hopefully killed all the cancer cells that might have been remaining in my body. I literally took my hand and kissed it and then placed it on the machine before my treatment because I was so grateful for what is was doing to help get rid of any cancer left behind in my body. I feel being grateful for my treatment helped my healing process mentally, physically and spiritually. I hope your radiation treatment is painless and you get to the other side with very few side effects.

Gamma Knife®

The Gamma Knife® is a very precise and sophisticated tool used to treat malignant and benign intracranial lesions and tumors. Gamma Knife® radiosurgery is “surgery without a scalpel” and employs 192 small radiation therapy beams functioning as a “virtual scalpel” to converge on and accurately treat small areas of the brain. There is no need for general anesthesia and no surgical incision when patients are treated with Gamma Knife® radiosurgery. Gamma Knife® radiosurgery is used to successfully treat conditions including brain metastasis, meningiomas, arteriovenous malformations, trigeminal neuralgia, pituitary adenomas and acoustic neuromas.

Gamma Knife® radiosurgery is jointly performed by a radiation oncologist and neurosurgeon. Gamma Knife® radiosurgery involves the delivery of a single treatment of radiation therapy and is performed in one outpatient visit. Patients typically come to the Illinois Gamma Knife® Center in the morning and have a stereotactic head frame placed under local anesthetic. The head frame is specially designed to very accurately localize intracranial areas in three planes (the X, Y, and Z planes). Once the frame is placed, we perform an MRI of the brain and this information is transferred to our treatment planning computers. We design a conformal treatment plan to precisely treat necessary areas of the brain while sparing the rest of the brain from high doses of radiation. Treatments typically take 1 to 2 hours and most patients go home before lunchtime.

Learn more

Proton Therapy

Proton therapy is an effective form of radiation therapy for many types of tumors. It destroys cancer cells by preventing them from dividing and growing, just like standard X-ray radiation, but offers many important benefits. The most significant one is that patients experience fewer short- and long-term side effects. Unlike Xrays, protons can be precisely controlled so that most of the radiation ends up directly in the tumor so less healthy tissue is damaged during treatment. Proton therapy also lowers the occurrence of secondary tumors, which can occur many years after receiving radiation treatment.

Proton therapy is particularly beneficial when a tumor is located near critical organs structures, such as the brain, heart or spinal cord. It is also an important treatment for children because their bodies are still growing and are more sensitive to the undesirable effects of radiation. The precision of protons reduces the risks of developmental and growth problems, as well as a potential reduction in IQ in pediatric patients. Proton therapy is effective in treating many types of cancers as well as non-cancerous tumors. Tumor types that could often benefit from proton therapy include:

• Brain cancer
• Head and neck cancer
• Base of skull tumor
• Central nervous system
• Lung cancer
• Breast cancer
• Prostate cancer
• Pediatric tumor
• Tumor near the spine

Learn more

RapidArc®

RapidArc® radiation therapy is a new technique that combines the sophistication of intensity-modulated radiation therapy (IMRT treatment) with dynamic arc-based therapy. The marriage of these two techniques has resulted in improvements in the precision and speed with which advanced treatments are delivered.

RapidArc® is a volumetric arc therapy that delivers precise, three-dimensional treatment with a single 360-degree rotation of the linear accelerator gantry. This is possible because the treatment algorithm simultaneously changes the rotation speed of the gantry, the shape of the treatment field, and the delivery dose rate. Treatment is delivered to the whole volume rather than slice-by-slice. This combination allows treatments to be two to eight times faster than standard IMRT treatment. Learn more

CyberKnife®

CyberKnife® radiosurgery is an exciting, novel approach to stereotactic radiation. As the name implies, this technique employs surgical precision without the actual knife. Stereotactic radiation utilizes special equipment to deliver cancer-destroying doses of radiation while reducing the normal tissue included in the treatment field. Using special equipment to position the patient and localize the tumor allows precise delivery of radiation therapy to the tumor. This has been used for many years for benign and malignant brain tumors. CyberKnife® radiosurgery expands our ability to deliver this type of precision therapy to anywhere in the human body.

CyberKnife® is unique in its approach to stereotactic therapy. It has adapted a robotic arm that can move in any direction. This arm is equipped with a linear accelerator mounted at its end. We can use infinite angles to deliver treatment allowing for improved tumor coverage with high doses of radiation and better tumor control. Such treatment also employs live tracking of tumor movement during delivery, with automatic correction for such movement during the treatment delivery, thereby ensuring the high level of accuracy and limiting exposure to the normal surrounding tissues.

CyberKnife® radiosurgery can be used for tumors and benign conditions of the brain as well as the body. Most often, treatments are delivered in one to five fractions. The CyberKnife® System is the world’s first and only robotic radiosurgery system designed to treat tumors throughout the body non-invasively. It provides a pain-free, nonsurgical option for patients who have inoperable or surgically complex tumors, or who may be looking for an alternative to surgery. Learn more

Intraoperative Radiation Therapy

Intraoperative radiation therapy (IORT) is currently a breast cancer treatment technique that delivers radiation treatment at the same time as lumpectomy surgery. The radiation dose is delivered to an exposed tumor bed while surrounding healthy tissue is moved aside and spared from high dose radiation. The entire dose of radiation needed often can be given in one treatment, which may take from 20 to 60 minutes. This technology is being used in Europe, Asia, and in United States. Patients who participated in trials of breast IORT had low-grade, invasive or intraductal, early-stage breast cancer, with no lymph node involvement and clear surgical margins treated with lumpectomy. Most participants were 50 years and older.

The advantages of IORT may include fewer patient appointments and decreased risk of skin affected by treatment. The challenges of IORT include complex workflow during surgery needing careful coordination between surgeons and radiation oncologists. We have had excellent results in hundreds of well selected patients that mirror outcomes in the international trials. Longer term results are being awaited. Other cancers that may benefit from IORT include rectal cancer, head and neck cancer, pancreatic cancer, prostate cancer and soft tissue sarcomas. Learn more