What to Expect Before Treatment

Your sarcoma diagnosis will be reviewed by a cancer care team, called a multidisciplinary team, including a radiation oncologist, surgeon, medical oncologist, pathologist and radiologist. Together they will determine the best treatment recommendation for you.

If your care team recommends you consider radiation therapy as part of your treatment plan, you will meet with a radiation oncologist, or radiation doctor. They will design your radiotherapy plan and lead the treatment team. You may also be seen by a medical student, a resident physician (radiation oncology doctor in training), a nurse practitioner or a physician’s assistant. You may also have a nurse coordinator who will help you with appointments, next steps, side effects and anything else you may find helpful through treatment. Many other team members participate in creating and delivering radiation therapy including a dosimetrist (like a pharmacist for radiation) and a medical physicist, who helps with the safety and quality of the radiation treatments. Radiation therapists are technical specialists in positioning patients so they can receive accurate daily radiation treatments in a comfortable way. All of these team members are here for you and are committed to your success.

During your first visit, your doctor will talk with you about whether radiation therapy will be helpful in treating your disease. This includes reviewing your current medical history, past medical history, past surgical history, family history, medications, allergies, lifestyle and current symptoms. A physical exam will help to assess the extent of your disease and assess your general physical condition. Your medical record will be reviewed including any medical images and blood work. During your visit, the radiation oncologist will explain important details about your sarcoma, the recommended treatment, the radiotherapy process, and the expected side effects. If you decide to receive radiation therapy, you will sign a consent form and undergo a preparatory step called a CT simulation, or “mapping.”

Simulation and Treatment planning

Radiation therapy plans are very precise and each treatment must be very accurate. During CT simulation, radiation therapists will position your body and tumor so that you are comfortable holding still for daily radiation treatments. Radiation therapists may make marks on your body with temporary ink or a set of tiny, permanent tattoos. Additionally, they may create body casts, masks, headrests, or other devices to help get you in to the same position for each radiation treatment. They may also create blocks (shields) that can be used to protect parts of your body during treatment.

Once you are positioned, a CT scan (“CAT scan”) is performed. Other scans such as an MRI may also be performed. Since they are just used for radiation treatment planning, there is usually no report from these scans. The radiation oncologist and his/her team then use a sophisticated treatment-planning computer to design the best possible personalized radiation plan. After reviewing the plan, your radiation oncologist will write a prescription that outlines exactly how much radiation you will receive, how often, and to what parts of your body.

Quality Assurance Before Treatment

After your radiation oncologist approves the radiation therapy plan and prescribes treatment, medical physicists and their team review the plan for safety and quality. They may also perform a "dry run" on the radiotherapy machine to ensure that the treatment can be delivered precisely and accurately. Once all of this is confirmed, treatment can begin.