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Radiosurgery Treatment Process

What to expect in radiosurgical treatment

Aria’s Cancer Center team can sometimes complete stereotactic radiosurgery treatments in one session, lasting one to four hours.  Most patients feel no pain during the treatment and are able to go home immediately afterward.Stereotactic radiosurgery is a carefully controlled process that, at Aria’s Cancer Center, consists of a series of well-planned steps:

Consultation.  A patient's first visit at the center will be with the Aria cancer specialist leading his or her treatment team, usually the radiation oncologist.  This physician reviews the patient’s medical history and reports, makes a recommendation about any further tests that may be required, discusses the options available (including whether stereotactic treatment is appropriate), and works with the patient to choose an optimal course of treatment.  If the treatment elected is stereotactic radiosurgery, the patient will receive full radiation treatment in one day; if it is stereotactic radiotherapy, the Aria team will schedule a series of appointments for the patient.

Positioning.  The Aria team will fit the patient with an immobilization device to ensure that he or she remains in the same position – as comfortably as possible – without moving during the procedure.  Aria’s radiation-oncology team may use different methods for positioning and immobilization, depending on the area to be treated.  These frameless systems range from a lightweight mesh mask (see photo right), individually formed to fit the patient’s face and head, to a bite block.  For the bite-block system, the team closely fits a bite tray (similar to a dental mold) to the patient’s upper jaw and then secures it to the treatment couch.For stereotactic treatments to regions of the body other than the head and neck, various types of body frames or cushioning systems are available for patient positioning.  The specialist discusses these options with the patient to determine which will work best, given each individual’s specific circumstances.

The department's CT scanner for treatment planning.

Imaging.  The patient undergoes a CT scan or MR imaging, or both, to generate images of the area to be treated.  This imaging – along with any other radiologic images the patient may have had – provides information required not only to create a treatment plan but to ensure that the patient is positioned correctly at the time of treatment.

Treatment planning.  With the information gathered during the positioning and imaging steps, a dedicated Aria medical team designs the best treatment plan for the patient’s situation. These specialists will use a sophisticated software program to generate a customized plan for the individual’s treatment.

Image-guided computer planning for treatment of a lung tumor.

Treatment delivery.  Radiosurgery treatments usually take about an hour.  In some cases the treatment time can be longer.  Most of the time is used to ensure that the patients is accurately positioned for treatment.  Laser lights in the room help the therapist assure that the patient is level and straight on the treatment couch.  The patient may see and hear the robotic arms of the imager as they extend from the linear accelerator and move into position.  Usually, the team will first use the machine to take two or more images from different angles, or use a complete rotation of the arms to generate a three-dimensional image.  The Aria team will use these images to guide adjustment of the treatment couch.  Patients may also notice a camera on the ceiling, part of an optical guidance system that monitors and corrects for any movement during the treatment.  In some cases, the team may also use a camera to monitor the patient’s breathing.

The patient is alone in the room during the treatment – that is, when the machine is actually delivering the radiation beams – but the therapy team can see, hear, and communicate with the patient at all times through audio-video monitoring.  The team will control the accelerator, imagers, and treatment table from outside the room.

The linear accelerator emits a buzz as it produces the radiation beams.  Although its effect on tissue, particularly cancer cells, is quite dramatic, the radiation produces no sensation for the patient.  They may hear the quiet whir of the beam-shaping device and see the movement of this unit’s collimator leaves.  The accelerator moves around the patient to deliver beams from different angles, according to the treatment plan.  The patient may also notice the couch moving as part of the treatment process.

Patients usually undergo the treatment as outpatients, and can return home immediately after the procedure.  If any swelling or fluid build-up takes place at the site of the treatment, the radiation oncologist may prescribe a mild course of steriod medication.  In rare cases, particularly of treatment for larger tumors,
the tissue destroyed may need to be removed.

Follow-up care.  After patients complete their treatment, their Aria cancer specialist will monitor their progress with a series of follow-up visits.  Blood tests, diagnostic x-rays, and sometimes additional CT scans and MR imaging may be needed at these appointments.  The visits give patients an opportunity to review any questions or concerns and discuss ongoing follow-up, self care, and wellness.