Appointments and Support Services

Appointments for Radiation Oncology
can be made by calling (812) 238-7504.

Oncology Support Services
can be obtained by calling Kathy Bannon at (812) 238-7394.

After hours phone numbers
for patients with radiation oncology problems is (812) 238-7000.

Location
Hux Cancer Center is located at
1606 North 7th Street Terre Haute, IN 47804
Click here for driving directions to Hux Cancer Center
Click here for driving directions to Union Hosptial

Parking
Convenient patient parking for radiation oncology is located immediately adjacent to the Hux Cancer Center. Radiation oncology is on the northwest corner of the hospital building and parking is accessed from Beech Street.

About Radiation Therapy

Radiation therapy is the medical science that employs various types of radiation or x-ray to treat disease. Doctors who are especially trained in the use of radiation for treatment of disease are called radiation oncologists. Oncology is the science of cancer and oncologists are specially trained physicians who treat cancer. Radiation oncologists have 4 or 5 years of training after medical school during which they are specially trained in the safe and proper use of x-ray for the treatment of disease. The radiation oncologists at the Hux Cancer Center are board-certified in radiation oncology by the American Board of Radiology.

Uses of Radiation

Radiation can be used to treat cancer or benign disease. Radiation therapy plays a role in the treatment of 60 to 70% of all patients who have cancer. About 40% of all patients who receive radiation therapy are cured of their disease by radiation. Like surgery, radiation therapy is used for treatment of disease in a particular location. The benefits and side effects of the radiation are related to the area of the body in which it is used.

X-ray treatment is usually given in a number of small doses called fractions. By giving a moderate dose of radiation in a number of fractions over an extended period of time, side effects from radiation are minimized. When radiation is given to try and cure a cancer usually 25 to 40 fractions of radiation are given. When radiation is used to try and eliminate symptoms due to a cancer a smaller number of fractions, are frequently employed.

The ability of radiation to cure a cancer is dependent upon the location and type of the cancer. Some cancers are very resistant to radiation therapy; these cancers include brain tumors, tumors that arise in muscle and bone and tumors of the kidney and pancreas. In some cases cancers are very difficult to treat curatively with radiation because the normal surrounding tissues are very easily injured by radiation. An example of this is cancer in the upper abdomen where the adjacent bowel and kidneys cannot tolerate high doses of radiation. Some cancers are frequently cured by radiation. As a general rule cancers that are very small and localized to their site of origin fit in this category. An example of this is a small tumor of the vocal cord where radiation can result in cure rates in excess of 95% with excellent preservation of voice quality.

Side effects from radiation therapy are directly related to the location that is treated and the dose of radiation that is given. Acute side effects are problems related to treatment that occur during the course of radiation. These problems typically resolve within a few weeks after the radiation has been completed. Examples of this would be hair loss from treatment to the brain, a sore mouth or throat from treatment of the head and neck area, difficulty swallowing from treatment of the chest and diarrhea or bladder irritation from treatment of the pelvis. Long-term side effects are problems due to radiation that occur months after the radiation has been completed. Long-term side effects are predominantly related to the total dose of radiation that is given. The frequency of long-term side effects is also increased if high daily doses of radiation are given.

Individual radiation treatments typically last only a few minutes. Most of the time is taken to reposition the body part being treated so that the treatment is given in an identical manner each day. On average the treatment machine is administering the dose for 1 to 2 minutes per patient. Individual treatments are painless. Patients do not experience any sensation during the administration of the radiation.

Benign disorders can also be treated by radiation therapy. An example of this is the treatment of incisions after removal of excessive amounts of scar tissue called keloid to try and prevent the recurrence of this painful and disfiguring condition.

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Radiation Oncologists

Radiation oncologists are physicians who are especially trained in the proper and safe use of radiation therapy for the treatment of medical conditions. Radiation oncologists are consultants. They are asked to see patients by other physicians. Since they are experts in the treatment of malignancy, patients with cancer are frequently referred to radiation oncologists for recommendations regarding the use of radiation for the treatment of cancer. Radiation oncologists are specially trained to follow patients after they have received radiation therapy to be especially watchful for recurrence of the cancer and for late side effects of treatment. They are specially trained in dealing with these side effects should they occur.

After a patient is referred to a radiation oncologist the physician will discuss the patient's symptoms and medical history with the individual patient and family members. A careful physical examination is done to determine the extent of the problem and the suitability of the illness for treatment with radiation therapy. After careful review of all of the data and any additional tests that have had to be done, the radiation oncologist will discuss their opinion with the patient and family. The radiation oncologist will typically discuss whether or not the patient's illness could be improved by the administration of radiation therapy and will review with the patient and their family all of the potential risks and benefits of radiation therapy.

If a course of radiation therapy is prescribed and the patient opts to proceed, the radiation oncologist will then work with the other members of the radiation oncology team to design appropriate treatment fields and protective devices to properly position the patient and administer the dose of radiation safely. During the course of the radiation the oncologist will meet with the patient at least weekly to observe the progress of the treatment course and intervene to try and relieve any side effects that are occurring from the radiation. The radiation oncologist is responsible for supervising the course of treatment. The oncologists meet frequently with the other members of the treatment team and the patient's other oncologists and primary doctors to discuss the patient's response to treatment and any additional treatment that will be necessary. The radiation oncologists, Cancer Care group, at the Hux Cancer Center are part of a large group of radiation oncologists and most patients' treatment plan and clinical course will be discussed by a number of radiation oncologists. This offers the patient the benefit of having several doctors available for consultation and review of their disease management.

The radiation oncologists attend several review conferences each year to update their clinical skills and are also involved in teaching cancer medicine to other doctors. The radiation oncologists are members of the Union Hospital Cancer Committee and are active in the Union Hospital tumor conferences and present tumor conferences at several area hospitals. The Cancer Committee oversees the cancer program at Union Hospital to be sure that the care our patients with cancer receive is state of the art therapy. At tumor conferences individual patient cases are discussed in a multidisciplinary manner so that a wide variety of physicians can have input into the management of patients' disease processes. Tumor conferences also serve as an educational form for family physicians and other specialists who are not specifically trained in cancer care.

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Steps in your treatment

• Simulation: After the patient has been evaluated by the radiation oncologist and a course of treatment with radiation has been decided upon, the area to be treated needs to be outlined so that the daily treatment can begin. This process is called simulation. Simulation can be done by fluoroscopically visualizing the area to be treated and outlining on the body surface, the area chosen by the radiation oncologist for treatment. Some tumors cannot be seen with fluoroscopy. Patients may have special marks placed on the surface of their body and then a CT scan is done through the area that has been marked. The CT scan images are then placed in the treatment planning computer so that a 3-dimensional reconstruction of the area to be treated can be made. The radiation oncologist will outline on the CT images the portion of the body that needs to be treated. Structures to be protected from radiation are also outlined. The physicist and medical dosemetrist then will develop a treatment plan to deliver the radiation to the tumor while avoiding those areas that the oncologist does not want to receive radiation. Once the plan has been developed and approved by the radiation oncologist the patient comes back into the treatment planning room and the plan is transferred from the computer back onto the patient's surface.
  
  As part of the simulation process the proper positioning of the patient on the treatment table is decided upon. It will be important for the patient to be in a comfortable position that can be reproduced each day so that the treatment can be reproduced exactly day after day. Sometimes the patient will just lie flat on the table. At other times special masks and molds are placed over and around the patient so that their body can easily be repositioned on a day to day basis. Simulation room lasers are used to mark body positions on the skin's surface where the radiation will be given. Each day in the treatment room these laser marks will be used to position the patient in the same way for treatment as they were for simulation.
  


• Blocks: Once the simulation has been completed any portion of a treatment field that the oncologist wants to be excluded from the treatment volume are eliminated from the volume by blocking. Radiation therapy blocking at the Hux Cancer Center is done by the manufacture of customized Cerrobend blocks. These blocking devices are placed into the beam each day prior to treatment in order to exclude radiation from the blocked area. In addition to customized blocking devices, beam shaping devices called tissue compensators are also fabricated for our patients. Tissue compensators take into effect the various curves in the normal body outline. The compensator acts to even out the surface of the body so that the radiation beam will be more uniform as it goes through the body's tissue. Using specially made compensators the physicists and oncologists are able to distribute the radiation within the patient in a manner that minimizes dose to normal structures and maximize, the dose to the tumor area.


• Physics: Once the treatment plan is completed and calculated, the physicist will review it for appropriateness and accuracy. Behind-the-scenes the physicists will be diligently ensuring routine quality testing is being performed on the treatment machines and safety devices and measuring the radiation beams to ensure they are operating as intended. The physics team will check each patient's record weekly during the treatment course to ensure the patient is receiving "what the doctor ordered."


• Treatments: Once all of the dosages have been calculated and all of the paperwork completed the treatment is ready to begin. The radiation therapist will place the patient on the treatment table in exactly the same position as was used for simulation. The marks on the patient's skin and the lasers in the treatment room are used to position the body properly for treatment. If blocking devices, compensators or wedges are needed for the treatment the therapist will place these in the proper position in the treatment field. The therapist will then program the treatment computer so that the machine can deliver the radiation. While the radiation is being given the therapist and any family members will be outside of the treatment room. The radiation beam is extremely precisely columnated but there is some scatter radiation in the room and constant exposure to this small amount of radiation could eventually cause harm to the therapist. While the patient is being treated, two-way audio is available should any verbal communication be required and the patient is monitored by 2 special cameras.

Individual treatments take only a matter of 1 to 2 minutes. The entire positioning and treatment process typically takes 5 to 10 minutes. A curative course of therapy typically will take 25 to 40 treatments. Treatment to relieve symptoms due to cancer typically will take 5 to 20 treatments.

During the course of the radiation treatment the patient will meet with the radiation oncologist at least weekly to ensure that the treatment is progressing appropriately and to deal with any side effects of the treatment. Once a week the patient will be weighed by the dietician.

During a course of curative radiotherapy, the size of the area being treated may be decreased to allow for more specific direction of the beam to the tumor. This process is called a cone-down. During a cone-down there is a second simulation process and the physics work is repeated to make the changes to the smaller field.

Brachytherapy: The two main types of radiation therapy are teletherapy and brachytherapy. Tele is the Greek word for distance. Teletherapy is radiation given from a source that is at some distance from the patient. Teletherapy is also referred to as external beam radiotherapy and at the Hux Cancer Center this is given via linear accelerators. Brachy is the Greek word for short and brachytherapy is given by placing the radiation source very close to the tumor. Brachytherapy can be delivered by a number of means. At the Hux Cancer Center brachytherapy is given using radioactive cesium that is contained in capsules that are placed inside applicators that were previously placed inside the patient (often during a short surgical procedure) or by placing radioactive seeds inside tubes placed into the patient's tumor or directly into the tumor itself.

Cesium brachytherapy is typically used for gynecological tumors. Specially designed applicators are placed within the vagina or uterus in the Cancer Center or in the operating room depending upon the clinical situation. When the patient is in their room the cesium sources are placed within the applicators. This process is called afterloading. The advantage of brachytherapy is that a very large dose of radiation can be given directly to the tumor while any radiation to surrounding tissues is kept to a very minimal amount. A gynecological implant usually will remain in place for 1 to 3 days. While the applicators are in place radiation is present in the room and family and friends are not allowed to visit.

Radioactive seeds can be placed inside tubes and subsequently removed from the patient or they can be placed directly into the tumor and left permanently in the patient. In the former case a radioactive material called iridium is typically used. Iridium implants are used to give additional radiation to tumors that lie within the bronchus of the lung (a tumor within a windpipe), some sarcomas (tumors of the muscle or soft tissue), and occasionally in the head and neck area. The radioactive seeds that are left inside patients typically contain radioactive iodine, palladium or gold. Radioactive seeds are typically placed through needles that have been inserted into the tumor. As the needles are removed the seeds are left behind. Seeds can be placed directly into prostate tumors and can also be used for treatment of some tumors in the head and neck area, vagina and urethra.

Radioactive capsules and solutions can be administered orally or intravenously for treatment of some cancers. Radioactive iodine is given to treat thyroid cancers. Very few tissues in the body take up iodine and giving radioactive iodine is quite specific for the treatment of thyroid cancer. Radioactive samarium and strontium can be given to patients who have widespread bone metastases. These chemicals are taken up by the cells that deposit calcium in the bone and are placed, just like calcium, into the bone matrix where the radiation is delivered to tumor cells in the bone and bone marrow.

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