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Radiation therapy is a treatment used for many forms of childhood cancer.
This therapy uses beams of radiation, either X-rays or protons, to shrink tumors and kill cancer cells. Radiation works by damaging the DNA inside cancer cells.
The radiation oncologist is the doctor in charge of radiation therapy. The radiation oncologist works with the radiation therapy team to develop a treatment plan for each child’s case.
Radiation targets cancer but may damage nearby healthy tissue. This damage can cause side effects. Some side effects can affect the growth and development of children and adolescents. The medical team designs treatments to protect as much healthy tissue as possible.
The patient and family will meet members of the treatment team. The team will explain the treatment process and answer questions. Families should write down questions before this appointment and should feel comfortable asking the treatment team if something is not clear. Sometimes it’s helpful to bring a family member or friend along to help take notes. If families think of more questions after the appointment is over, they should contact the team for answers.
The doctor may talk to parents about whether patients should receive sedation. Doctors may recommend sedation for young children and other patients who have trouble staying still.
The treatment team will talk to parents about the goal of radiation treatment and side effects. This process is called informed consent. It is where a patient and the family gives permission before treatment can start.
Before the simulation, patients will have a customized mask or body mold made that will help them lie in the proper position for treatment.
Contrast for CT or MRI
In most cases, patients will receive a contrast agent for either CT or MRI simulation. The patient’s schedule will contain directions about not eating or drinking before receiving the contrast. It is very important to follow the guidelines exactly. Notify the therapy team of any history of allergies to contrast.
If contrast is used the patient will need an IV. If the patient does not have a port, central line, or other IV device, a nurse will need to start an IV.
The CT scan is an X-ray study that is needed to help calculate the radiation treatment plan. The patient lies in their mask or body mold on a flat table (called a couch) and the table automatically slides (or moves) through the scanner that looks like a large ring or donut. This process is how the images are made. It takes about an hour.
When an MRI is used to help with radiation treatment planning the patient lies in their mask or body mold and the area to be imaged is placed inside the magnet (inside the round opening in the MRI device). The MRI device makes loud noises, so either ear plugs or headphones are used to protect the ears. The MRI usually takes 30 minutes to an hour.
The patient should wear loose, comfortable clothing that does not contain metal such as snaps, buttons, and zippers. The best clothing choices may include T-shirts with sweat pants, pajama bottoms, or other elastic waist pants. The treatment team will often have the patient wear a hospital gown.
During the simulation several steps will be followed to make sure the radiation is delivered in the precise treatment location each time.
After the simulation, the radiation oncologist will work with dosimetrists and physicists to develop a treatment plan.
The team will plan the amount and frequency of radiation and map the radiation beams.
The radiation oncologist will write a prescription that outlines exactly how much radiation is to be given, how often, and where. Not all cancers are treated with the same amount of radiation. The treatment plan depends on many factors, including the type of tumor and the age of the child.
Before the first treatment begins, the radiation therapy team will take X-ray images on the treatment machine of the patient and check that all of the treatment machine settings are correct. These images confirm the area being treated is the precise location the doctor planned. The doctor will approve the images before the first radiation treatment begins.
The radiation oncologist will explain the patient’s treatment plan to the family before treatment sessions begin. This is an excellent time for families to ask questions. A child life therapist may work with the patients to explain the treatment process using child-friendly language and medical play.
The radiation oncologist will explain:
Most patients receive radiation treatment as an outpatient. The scheduler will work with families to make radiation appointments. If the patient is receiving sedation, there will be a separate appointment for this procedure.
Patients and families should always follow the registration procedure of their pediatric center.
Typically the schedule will be similar to the following:
The patient will have regular follow-up visits with the radiation oncologist. During follow-up visits, patients will have diagnostic imaging tests, usually CT, PET or MRI scans to monitor how well the cancer is responding to treatment.
Reviewed: June 2018