Intensity-Modulated Radiation Therapy (IMRT) Treatment Process
IMRT is delivered or given by a machine called a linear accelerator. The machine directs high-energy x-rays at the cancer and some normal surrounding tissue from outside the body. Patients receive IMRT during outpatient visits to a hospital or treatment center. IMRT involves a series of daily treatments to target and accurately deliver radiation to the prostate.
Who Gives Radiation Treatments?
During your radiation therapy, a team of medical professionals will care for you.
Radiation Oncologist: A doctor specially trained to treat cancer patients with radiation. He or she makes the decisions about your treatment plan and leads the team of medical professionals in the cancer center.
Medical Physicist: An individual with an advanced degree (Masters or PhD) in physics. The medical physicist ensures the treatment plan prescribed by the radiation oncologist is prepared properly, to deliver the appropriate dose of radiation. Additional the medical physicist is responsible for the safety of the radiation equipment, ensuring that it is working properly.
Dosimetrist: Takes the prescription for treatment written by the radiation oncologist and through the use of physics, creates a computerized treatment plan that will run the radiation equipment.
Radiation Therapist: Operates the radiation equipment and positions you for treatment.
What happens during/after my initial meeting with the cancer doctor?
On your first visit to our cancer center, you will have an initial meeting/consultation with a physician specializing in radiation oncology. The process of IMRT will be discussed and any questions or concerns that you may have will be addressed. You will be given more information about what to expect during each step of your treatment. The radiation oncologist will be responsible for your radiation treatment and will manage any symptoms you may develop during the course of treatment. If you consent to treatment, the process will be started for insurance authorization.
How Does Your Doctor Plan your Radiation Therapy Treatment?
After a physical exam and a review of your medical history and test results, including CT simulation, your doctor will pinpoint the treatment area. In a process called simulation, you will be asked to lie still on a table while the radiation therapist uses a special diagnostic CT machine to define your treatment field. This is the exact place on your body where the radiation will be aimed. To ensure the radiation beam is aimed correctly, special molds or casts of parts of your body will be made to help you remain still during your treatment. A radiation therapist will mark the field with semi-permanent ink. These marks will be used to properly align you on the treatment table during your course of therapy. The marks will fade away over time, but they need to remain until your treatment is completed.
Avoid using soap or scrubbing these marks. Sometimes the area will be marked with permanent dots like a tattoo.
By using the information from the simulation, other tests, and your medical background, your doctor will decide how much radiation is needed, how it will be given, and how many treatments you should have.
What is Implantable Fiducial Marker Placement?
Implantable fiducial markers involves implanting gold markers, sometimes called Fiducial markers, in the prostate or prostate bed to target the treatment area and focus the radiation beam. The markers are placed in the prostate utilizing the same procedure as was used to obtain the biopsy samples. These markers do not need to be removed at the end of treatment and provide us with a target to align your daily treatment. We will give you specific instructions when we schedule your appointment.
Instructions for the Placement of Trans-rectal Ultrasound Guided Fiducial Markers with or without SpaceOar
Prior to your procedure:
- There are no dietary restrictions.
- Discontinue any medication that may thin your blood 1 full week prior to your procedure. These medications include: Aspirin, Coumadin, Warfarin, Plavix, Ibuprofen (Motrin), Naproxen (Aleve), Lodine, Toraol, Celebrex, Fish Oil, Vitamin E, etc.
- You MUST have a driver to and from your procedure.
- You will take an antibiotic beginning the day prior to your procedure, and continue said medication the following 3 days as prescribed. Typical preprocedure antibiotics are Levaquin or Cipro. Please call the office if you have not received a prescription for this medication of if you have questions about the dosing schedule.
- An enema MUST be used approximately 1.5 hours prior to your procedure. This product (Fleets Enema) is available at most drug stores and/or pharmacies. Simply followthe directions on the label.
After your procedure:
- You may experience blood in the urine and/or stool for a few days.
- Visible blood in the ejaculatory fluid is not uncommon.
- You should refrain from heavy lifting the day of your procedure. Otherwise, there are no restrictions.
- Please call the office, 815-409-4930, if you develop a fever (temperature >100.3), difficult urination, or upon heavy bleeding from the rectum, with a bowel movement, or in the urine.
Instructions for your Radiation Treatment Planning Session and Daily Treatments For CT Simulation
Prior to your procedure:
- Eat light twelve hours prior to your procedure. You may have clear liquids such as soup, juice, jello, etc.
- An enema MUST be completed 2 hours prior to the CT. This product (Fleets Enema) is available at most drug stores and or pharmacies. Simply follow the directions on the label.
- Drink 3 cups of water (24 oz) 45-60 minutes prior to your appointment. Try not to urinate until after procedure is completed.
After your procedure:
Once the CT simulation is complete, you will meet with a therapist to discuss when your next appointment will be and when you treatments will begin. This appointment is set up approximately 7-10 days following your CT simulation. You will be given instructions from the therapist at that time on how to prepare for your daily treatments.
Should you have any questions or concerns between these appointments, please contact the Prostate Cancer Center at 815-409-4957.
What Happens During Each Treatment Visit?
IMRT Radiation treatments are painless. The experience is just like having a regular x-ray taken. The treatment takes only a few minutes; but each session may last 15 to 30 minutes because of the time it takes to set up the equipment and place you in the correct position.
A rectal balloon is placed into the rectum to protect rectal tissue by reducing motion, removing rectal gas, and to provide a more reproducible set up throughout the course of radiation treatment. Insertion takes a few minutes by the radiation therapist. After insertion, the balloon is inflated to the prescribed amount. Most patients describe this as a light pressure sensation. After radiation, the balloon is removed and will be inserted with each radiation treatment.
Depending on the treatment area, you may need to undress, so wear clothes that are easy to take on and off. You will lie on a treatment table positioned under the radiation machine. You will be asked to remain still during the treatment. You do not have to hold your breath- just breathe normally.
Once you are in the correct position, the radiation therapist will go into a nearby room to turn on the machine and watch you on a TV monitor. You will be able to talk with the therapist over an intercom.
The radiation therapy machine will make clicking and whirring noises and sometimes sound like a vacuum cleaner as it moves to aim at the treatment area from different angles. The radiation therapist controls the movement and checks to be sure it is working properly. If you are concerned about anything that happens in the treatment room, ask your therapist to explain. If you feel ill or uncomfortable during the treatment, tell your therapist at once. The machine can be stopped at any time.
To help avoid rectal injury, the space between the prostate and the rectum can be increased by an absorbable gel spacer. The SpaceOAR system temporarily moves the rectum away from the high dose radiation area. The gel stays in the body for 3 months during radiation treatment and is naturally absorbed and cleared in the urine in about 6 months.
A balloon is placed into the rectum to reduce prostate motion, remove rectal gas, and provide a more reproduc- ible set up throughout the course of radiation treatment. Insertion takes a few minutes by the radiation therapist. After insertion, the balloon is inflated to the prescribed amount. Most patients describe this as a light pressure sensation. After radiation, the balloon is removed and will be inserted with each radiation treatment.
Hormone/Androgen-deprivation therapy (ADT)
(ADT) may be used in conjunction with radiation therapy if your cancer is more aggressive, with higher PSA, higher Gleason score, or if Prolaris results lean towards a more aggressive cancer. Male hormones, specifically testosterone, fuel the growth of prostate cancer. By reducing the amount and activity of testosterone, the growth of prostate cancer is slowed.
Learn More about ADT
How Long Does the Treatment Take?
Radiation therapy IMRT treatments to the prostate are given 5 days a week for 7 to 9 weeks. Weekend rest breaks allow normal cells to recover. But the total dose of radiation and the number of treatments you need depends on:
- The size and location of your cancer
- The type of cancer
- Your general health
- Any other treatments you are receiving
Instructions For Daily Treatment
It is important that you arrive for your daily treatment with a full bladder. This pulls your bladder up and away from your prostate area in order to limit the dose to this area. If required by your radiation oncologist, we will insert a rectal catheter and inflate a balloon every day. This allows us to keep as much of your rectum out of the treatment field as possible. We will position you in your “mold” daily. Once you are aligned in the treatment position, we will leave the treatment room. The machine will move around you in order to obtain images to finely target the treatment area. Once completed, the treatment will begin. Again, the treatment machine will move around you, it will not touch you, stopping periodically to deliver the treatment dose. During this process, you will be monitored by video and audio if communication is needed. It is important that you breathe normally and remain very still.
Please try to have a Bowel Movement prior to arriving for your treatment.
We prefer to have the rectum clear of any gas or stool fortreatment whenever possible.
About an hour before treatment, empty your bladder. Because it takes 45-60 minutes to fill your bladder for treatment, you must finish drinking 24oz (3 cups) of water one hour prior to your treatment time.
If you must urinate before you are treated, drink an additional 16 oz of water and notify the therapist
or staff that is was necessary for you to urinate. Before we start your treatment, we will check to be sure you have enough urine in your bladder. It may be necessary to allow some additional time for your bladder to refill. Since everyone is different, you may find you need to increase or decrease your water intake. The therapist or nurse can guide you. Caffeine is irritating to the bladder and will increase your urgency to urinate. Try to wait until after your daily therapy to have caffeine. Caffeine can be found in most soda, tea, coffee, chocolate and energy drinks.
Once a week, you will be seen by the nurse and your physician. You will be weighed, your vital signs will be taken and the nurse will perform an assessment of how you are doing with your therapy. Intermittently, during your therapy, lab work may also be drawn. If at any time, you have questions of concerns, please be sure to let the therapist or nurse know. We are happy to assist in any way we can. We look forward to working with you.
The Staff of the Prostate Cancer Center
Questions About IMRT Radiation Therapy Treatment?
If you have any questions about IMRT treatments, request an appointment or contact us today at 815.409.4930.
Understanding Radiation Therapy Guide for Patients and Families
This booklet has been created to help you understand your disease and how the treatment team at the Prostate Cancer Center collaborates with your urologist in curing your cancer. Additionally, the booklet is designed to answer your questions and those of your loved ones about the treatment of prostate cancer with radiation therapy.