Radiation Therapy · Radiation Therapy (IMRT), an advanced technique in radiation treatment...

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Radiation Therapy Radiation Therapy AT THE C ANCER C ENTER AT L EHIGH V ALLEY H OSPITAL THE CANCER CENTER

Transcript of Radiation Therapy · Radiation Therapy (IMRT), an advanced technique in radiation treatment...

Radiation TherapyRadiation TherapyAT T H E C A N C E R C E N T E R

AT L E H I G H VA L L E Y

H O S P I TA L

THE CANCER CENTER

The Cancer Center at

Lehigh Valley Hospital

was created to make

quality cancer care

as comfortable and

convenient as possible

for our patients and

their families.

When you receive radiation therapy at the Cancer Center at

Lehigh Valley Hospital, you have the security of knowing

that you are cared for by experienced physicians, nurses, therapists

and other professionals who are specialists in their field and who

have helped thousands of patients confront cancer.

As your care progresses, you will learn more about the resources

of our department and our Cancer Center, including our specialists

and the availability of the finest state-of-the-art technology.

This guide is designed to help you understand radiation therapy

and explain what you can expect during and after your treatment.

We will do all we can to treat the cancer and help you and your

family achieve the best results possible.

The Right Place for

RadiationTherapy

The Right Place for

RadiationTherapy

R A D I A T I O N T H E R A P Y A T T H E C A N C E R C E N T E R A T L E H I G H V A L L E Y H O S P I T A L

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AboutRadiation

Therapy

AboutRadiation

TherapyRadiation therapy uses X-rays, electrons and other types of radiation to

treat cancerous and some non-cancerous areas of the body in a variety ofways. It usually involves focusing beams of radiation on cancerous cells.Radiation, by itself or in conjunction with other kinds of treatment, canoften cure cancer.

If a cure is not possible, it may help relieve the symptoms of cancer,such as pain, through palliative care. Radiation therapy may be the onlytreatment necessary or it may be used in combination with surgery orchemotherapy (drugs).

For example, radiation therapy may help shrink a cancerous tumor before surgery or stop the growth of remaining cancer cells after surgery. When used with chemotherapy, it may help destroy cancer or prevent its reappearance. If you are receiving radiation therapy andchemotherapy, your doctors will work as a team to ensure that you receive the most appropriate care.

About Your Radiation Therapy TeamRadiation therapy involves many specialists from the Department of Radiation

Oncology at Lehigh Valley Hospital, all of whom are certified by their respective boards.

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Radiation Oncologists areboard-certified doctors with specializedtraining in the use of radiation for thetreatment of cancer and other diseases.You will see the same radiation oncologist(referred to as “your doctor” throughoutthe rest of this guide) as your treatment progress-es. Radiation oncologists are skilled in assessing thelong-term effects of the therapy and monitoring the cancer.

Radiation Therapists are certified therapists trained to use radiation treatment machines. They assist your doctor with treatment planning and deliveryour daily treatment.

Radiation Oncology Nurses are registered nurses with certification in the care of oncology patients. Trained in radiation, they assist you in preparing for treatments and help you with any problems you may have during your care.

Radiation Physicists are individuals trained in measuring and deliveringradiation doses. They make sure the machines are delivering the right doses and performing properly. The physicists work closely with your doctor to plan yourtreatments.

Medical Dosimetrists work closely with the radiation oncologists, physicistsand radiation therapists to calculate your radiation doses and plan your treatment.

Clerical Staff members arrange your first appointment and assist you withyour daily arrival.

Cancer Support Team members are available to support you and your family members. Social workers, a psychologist, a dietitian, a financial coordinator, achaplain and others are here for you and ready to help.

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Our Equipment and ResourcesA number of methods are used to treat the many types of cancer. We have the

following equipment and resources available to help with your care.

Our principal external beam treatment machines, called high-energylinear accelerators, offer the most powerful beams of radiation available on the EastCoast and make an enormous difference in how well we can treat deep-seated tumors. We are able to target the treatment precisely with only minimal effect on adjacenthealthy tissue. Our equipment is capable of delivering Intensity ModulatedRadiation Therapy (IMRT), an advanced technique in radiation treatment delivery.IMRT uses high-energy linear accelerators, equipped with multi-leaf collimators, todeliver tiny beamlets of radiation to the tumor site with a high degree of precision.

Radiation therapy is planned on simulators, conventional X-ray machines configured in the same design as the linear accelerators. We have two simulators that allow for precise mapping of the tumor for radiation delivery. In certain cases,planning is performed on a dedicated CT scanner. In conjunction with these planning tools, we have sophisticated three-dimensional computer treatment planning

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systems that allow us to deliver concentrated doses of radiation to cancerous tissuewith minimal effect to surrounding healthy tissue.

Stereotactic radiosurgery is a major advance in the treatment of certainbrain tumors and certain non-cancerous conditions of the brain. We are one of a few cancer centers in the country to offer this treatment. The treatment sends concentrated doses of radiation to cancerous cells from a series of different angles, so there is minimal effect to the surrounding healthy tissue.

Gamma Knife® radiosurgery is available in the Cancer Center at LehighValley Hospital–Muhlenberg, the area’s only hospital-based program. Patients withbrain lesions and other very complex problems benefit from this advanced technologythat aims highly focused gamma rays at the target with only minimal risk to surrounding normal tissue and involves no incisions. This non-invasive treatment is primarily for malignant and benign brain tumors, vascular malformations andtrigeminal neuralgia (facial pain). The Gamma Knife reduces surgical risk and patientdiscomfort, resulting in a shorter hospital stay and lower risk of complications.

Brachytherapy services enable us to place radioactive material in the body surgically. The radioactive source in the implant may transmit rays outside yourbody, so hospitalization in a private room may be required. For some patients, however, HDR (High Dose Rate) brachytherapy allows us to provide these serviceson an outpatient basis.

Prostate seed implants are performed at the Cancer Center. For this procedure, tiny radioactive seeds are permanently implanted into the prostate gland.The implant is typically an outpatient procedure allowing you to be discharged onthe same day.

Since our goal is to achieve the best possible results for you, we take a number ofsafety precautions to ensure your well-being. We use custom-made lead alloy shieldsand multi-leaf collimators to protect other parts of your body from exposure to radiation. Lead alloy shields are mounted on plates imprinted with a unique digitalcode for each patient to ensure that the correct shield is used every time.

About YourTreatment:

StepbyStep

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About YourTreatment:

StepbyStepRadiation therapy treatments usually extend over several weeks, requiring

daily visits Monday through Friday. The weekend time away from therapygives you and your body a chance to rest. Because you will receive individualmedical evaluation and treatment planning, your specific experience might differ slightly from the general process explained here.

Scheduling Your First AppointmentYou or your referring doctor may schedule your first appointment. Many people

find it helpful to have a relative or friend accompany them for their first visit and we invite you to ask anyone you wish to join you for your initial consultation.

Your First Appointment: A ConsultationYour first appointment will be a consultation with one of our radiation oncologists.

During this visit, the doctor will discuss your medical history and talk with you aboutyour condition. You will have a physical examination and your medical records and X-rays will be reviewed. You also will meet with a radiation oncology nurse. Thisvisit will last one to two hours.

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Our experienced staff of doctors, nurses and radiation therapists will do everything possible to make sure you have the best possible results.

The radiation oncologist will discuss your treatment options with you and explainthe possible side effects and the anticipated benefits of your therapy. If you decide to proceed with treatment you will be asked to sign an informed consent form priorto treatment and an appointment will be made to begin treatment planning and simulation.

Treatment Planning and SimulationBefore your radiation therapy begins we must plan a program to deal specifically

with your type of cancer.

We do this with the help of an X-ray machine called a simulator that looks like, or simulates, the treatment machine. In conjunction with simulation, a CT scan may be done to assist in treatment planning.

At the time of simulation, we will take your photograph for identification purposes. During simulation, X-rays are taken to determine the precise location ofthe cancer area. Since radiation affects all cells, both normal and abnormal, it isimportant to ensure that as little as possible of the normal tissue is treated. The skinover that area will be outlined with a special marking pen to identify exactly wherethe radiation will be directed. These marks will wash off easily, but since they mayrub off, you might want to wear older undergarments and clothing for this visit. Youwill not need to keep these marks on for the treatment.

We will also place tiny tattoos over the area to be treated. This helps us reproduceprecisely the treatment we have designed for you each time you receive your therapy.Once these marks are placed, pictures are taken of the area that will receive treatmentto further assure accuracy and safety.

An appointment will be made for your next visit, usually within one week after thissimulation. This time allows our staff and your doctor to make accurate computer calculations for the radiation treatment. It also gives us time to design shields to protect other areas of your body from receiving unnecessary radiation.

Because each patient is different, treatment plans will vary. The number or frequency of your appointments does not imply anything about the expected results of your care. Your schedule is planned specifically for you, to help you achieve thebest results, so we ask that you help by maintaining that schedule.

During the progress of your therapy, we may find it appropriate to use morethan one type of radiation treatment machine because each one performs differentfunctions in the course of therapy. Also, you may have a simulation more than once to make adjustments in your treatment plan as your cancer shrinks.

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Beginning TreatmentThis visit will take longer than later ones because your therapist and doctor must

verify your treatment set-up. For your convenience, there is a section at the back of this booklet to write down your treatment information and any questions you may have for us.

When you arrive in the reception area, please check in with our receptionist. Yourradiation therapist will call you to the treatment room. To verify accuracy of theplanned treatment, the therapist will take X-rays. These X-rays are taken to ensurethat your treatment matches what was designed during simulation. This visit maytake 30 to 45 minutes. You may or may not receive a treatment on this day.

Special cushions may be used to help you stay in position. It is important that you remain still so the radiation reaches only the area where it is needed and so thesame area is treated each time. You may breathe normally during the treatment.

The therapist will then control the treatment unit from outside the room andobserve you on closed-circuit television. You may talk to each other via an intercom.You may feel alone for the next few minutes, but remember that you are constantlymonitored and you can talk with your therapist at any time.

A radiation therapy machine looks like other X-ray equipment. You will not see orhear the radiation, and you probably won’t feel anything. Some patients say theynotice warmth or tingling in the area being treated, but you should not experienceany discomfort. You will not become radioactive from your therapy. If, for any reason, you feel ill or very uncomfortable during your treatment, please tell yourtherapist. Please do not hesitate to ask any questions you may have during your visit.

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Your Daily TreatmentsWithin a short time you will become familiar with your treatment routine and the

medical team that is helping you fight your disease. You will find your treatmentswill become routine after the first one.

For all regular visits, please sign in with our receptionist.

Your radiation therapist will call you to the treatment room. For each radiationtherapy visit you will be in the treatment room with the therapist about 15 minutes.You may need to change into a gown.

Administering the radiation takes only a few minutes during which time you will be alone in the room.

Once a week you may have a blood test to check your red and white blood cellcounts and platelets, and additional X-rays to assure the accuracy of the treatment.These X-rays do not usually show response to treatment; they are used to ensure that the treatment is being given as designed. You also will be examined regularly by your doctor and nurse to monitor your progress and to answer your questions. We care about your general health and well-being, so please let us know how you are feeling.

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Care FollowingRadiation

Therapy

Care FollowingRadiation

TherapyProfessional health care related to your cancer does not end when

your radiation treatment is completed.

You will need regular follow-up exams, laboratory tests and perhaps X-rays. Also, you may be seeing other cancer care specialists after your radiation therapy. We will send reports about your care to your referring doctor.

We will schedule a follow-up appointment for you after your final treatment session.

Managing Side EffectsWe will tell you about possible side effects and recommend how to deal with them.

Most are not serious and they usually disappear a few weeks after your treatment ends.We will suggest ways you can reduce the discomfort of any side effects and possiblyprevent their recurrence.

Many patients are able to work and enjoy normal activities during their radiationtherapy. Others find that they need more rest than usual and cannot do as much. You will be the best judge of how much activity you are able to handle.

There is no need to avoid being with other people during your radiation therapy.Your body will not contain any radioactive substance, so you are not a hazard to others, even in intimate contact. The only exception to this is for some patients

If you have any questions

or problems before returning

for your follow-up visit,

please call us at (610) 402-0700

at the John and Dorothy Morgan

Cancer Center or (484) 884-5818

at Lehigh Valley Hospital-

Muhlenberg.

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receiving internal radiation therapy, or brachytherapy. If you are receiving this therapy, you may need to be isolated while the radioactive material is within yourbody. As soon as this material is removed, however, there is no radiation hazard toanybody around you. Patients receiving prostate seed brachytherapy are dischargedwith permanent seeds in place and are given specific care instructions.

About Your Health CareEach patient responds to radiation therapy differently. We will give you specific

instructions for at-home care to fit your needs.

It is important that you take good care of yourself during the course of your treatment to protect your overall health and assure that you receive the greatest benefit from your radiation therapy.

Your radiation team works together to ensure you have the best possible chance for recovery.

OverallHealth

Guidelines

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OverallHealth

GuidelinesGet plenty of rest. Your body will use extra energy during the course

of your treatment. Sleep as much as you need. If you have extreme fatigue,please discuss the problem with your doctor.

Eat wisely. Good nutrition is essential and we will discuss your specialdietary needs. For patients receiving radiation therapy to certain parts of thebody, dietary restrictions may be given. Your doctor or nurse will discuss theserestrictions with you when the therapy starts. You should maintain a balanceddiet and try to maintain your weight. If you have problems eating or needextra help with nutrition planning, please let us know.

Be kind to your skin. You need to treat the skin in your treatment area with extra care since in some cases it can become “sun burned” from yourtreatment. Since we do not use marks during the treatment but rather rely on the tattoos, you are allowed to gently wash the area being treated. This issomewhat different than what you may read in some of the other booklets you will be receiving. We will give you specific instructions about proper skin care. Do not apply creams or lotions to the treatment area unlessapproved by your doctor.

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Tell us about any medication you are takingbefore treatment begins. In addition, do not take anymedication during treatment, even aspirin, without first discussing it with your doctor or nurse.

Ask questions. Please don’t hesitate to ask questions atany time. We are here to help you and want to hear yourconcerns and answer your questions.

Taking good care of yourself and learning all you can aboutyour body and its response to your disease and treatment canbe helpful during radiation therapy. Maintaining good healthcare routines after your treatment program is essential.

We rely heavily on

technology and

professional skill,

while recognizing that

personal support is

a key component

in cancer care.

GeneralInformation

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GeneralInformation

Appointments. We try to schedule convenient appointments for you so youcan work, go to school, take care of your family and go about your usual activities.Please check with your therapist if you find it necessary to change your schedule.

Please be prompt for your appointments so we may give all patients the best care and minimize inconvenience for everyone. If you will be late please call us at 610-402-0700 at the John and Dorothy Morgan Cancer Center or 484-884-5818 at Lehigh Valley Hospital-Muhlenberg.

We try our best not to keep patients waiting, but occasionally delays are unavoidable due to the complexity of the equipment we use.

Family and Friends. We encourage you to bring loved ones and we welcomethem, especially during your first appointment. If you wish, family members orfriends may accompany you during your daily visits here. To protect the privacy ofall patients, we ask that they remain in the reception area. If you want other visitsbetween your family and doctor, please ask and they will be arranged promptly.

Parking. Please refer to the maps on pages 20 and 21 of this guide for the location of free parking.

Smoking. Smoking is not permitted.

Support Programs. We are dedicated to helping you maintain the best possible quality of life during and after your radiation therapy treatment. We understand the personal challenges you and your family face and offer special support services to help you deal with them. Please consult a nurse for more information about our programs.

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Time Expectations. It takes time for us to carefully analyze your particulartreatment needs, design your individualized radiation therapy program and provideaccurate and effective treatments each time you come for care. The table below liststhe average time required for each of your visits. Your individualized care mayrequire additional time.

Visit Average Time

Initial consultation 1– 2 hours

Treatment planning/simulation 1 – 1.5 hours

Verification/first visit 45 minutes

Regular treatments 30 minutes

Follow-up visits 30 – 45 minutes

AboutCancer

Services

Transportation. If you need help with transportation during the course of yourtreatment, please let us know and we will have one of our nurses meet with you tomake arrangements.

Billing. You will receive two separate bills for your care. One will cover yourdoctor’s services and the other, from Lehigh Valley Hospital, will cover the technicalcomponent of your care. Although we do not generate the bills in our office, we can provide you with the information and phone numbers you may need to makeinquiries about your bill. We will make every effort to minimize the concern associated with this aspect of your care.

AboutCancer

ServicesPatients who come to Lehigh Valley Hospital soon discover that they are not

alone when facing a diagnosis of cancer. We rely heavily on technology andprofessional skill, while recognizing that personal support is a key componentin cancer care. We will do all we can not only to treat the cancer, but also tocare for and heal the whole person.

The Cancer Center at Lehigh Valley Hospital was created to make quality cancercare as comfortable and convenient as possible for our patients and their families.We offer a full range of outpatient diagnostic and treatment services, doctors’ officesand education, rehabilitation and support services.

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We are a founding member of the Penn State Cancer Institute, enabling us to consult with their cancer care specialists and take part in the research activities and educational programming.

A central part of the care available at the Cancer Center is providing support forcancer patients and their families. Our Cancer Support Team offers help to ourpatients and their entire family. A variety of support groups and special programshelp patients and their families relate to others who have “been there.”

The Cancer Center also offers education and prevention programs including oursecond opinion service, the cancer consultative service, a resource room and outreachand screening programs for the community.

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Lehigh Valley HospitalCedar Crest Blvd. & I-78

Main Entrance

1230 1210

1240

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Medical Office

Buildings

MRI Parking

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Exit

Exit

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Morgan Cancer Centerentrance

Pool PavilionJaindl Pavilion Anderson

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1220 MRI

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Lehigh Valley HospitalMuhlenberg

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97

49

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Muhlenberg Behavorial

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Physical Therapy

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Cancer Center�Entrance

P

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P

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25

17 70

2626

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LVH—Muhlenberg

HealthWorks & �Rehabilitation Services

Lehigh Valley� Eye Physicians

Coordinated Health

PASU

Pediatric Specialties

Hospital Entrance �Route (blue)

Emergency Entrance �Route (red)

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Notes

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John and Dorothy Morgan Cancer Center1240 S. Cedar Crest Boulevard

Allentown, PA 18104Radiation Therapy: 610-402-0700

Lehigh Valley Hospital–MuhlenbergCancer Center

Route 22 & Schoenersville RoadBethlehem, PA 18017

Radiation Therapy: 484-884-5818

610-402-CARE • 888-LVH-CARE • www.lvh .org

THE CANCER CENTER

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