What to Expect During Stereotactic Radiosurgery Treatment

A former patient walks the reader through what is to be expected during stereotactic radiosurgery treatment:

Upon referral to our center, a senior neurosurgeon and radiation oncologist will review your case, assessing your medical and treatment history, medications and prior imaging studies to determine the best treatment course for your particular condition. Further diagnostic imaging studies such as MRI or angiography may be requested to complete your medical record. You will then have the opportunity to meet with the physicians to discuss their treatment recommendations.

Registration

Prior to receiving your treatment you must obtain a MGH patient number. You may obtain one at Patient Registration in the Cox Building Lobby or on the first floor of the Wang Building next to the outpatient pharmacy or the Yawkey Center for Outpatient Care, Monday through Friday from 8:00 am to 4:30 pm. Please arrive 15-30 minutes prior to your scheduled appointment if you need to register. Please have the following information available: name, address, date of birth, social security number, insurance information and emergency contact information. You may also register in advance by phone by calling Patient Registration at 617-726-9090 or toll free at 866-211-6588.

Your treatment day

For your support and comfort, we encourage you to bring someone with you to your treatment appointment. Upon arriving on the day of your treatment, please check in with the receptionist. You will then be greeted by a member of the proton radiosurgery team who will make you comfortable, provide you with an overview of your treatment day and answer any questions you may have.

For patients with lesions contained within the head, the treatment plan will require that several tiny beads, known as fiducials, be implanted in the surface of your skull. During proton therapy treatment, the fiducials help insure that the proton beam is very precisely aimed at the target. Using a small needle, a neurosurgeon will put the fiducials in place. Performed with a local anesthetic, the procedure is very simple and you should feel only a slight pressure from the needle.

For both a CT scan and later during your actual proton therapy treatment, it is crucial that you remain absolutely still. To insure this, we will need to fit you with an immobilization device. Some circumstances require a stereotactic head frame to remain in place from the time of the CT to the end of the treatment. If this is the type of immobilization which is indicated for you a physician will secure the frame to your head. While the head frame is a bit awkward, wearing it is not painful. You should feel only a slight pressure as the frame is attached. If at any time you are feeling concerned or uncomfortable please let your physician or nurse know.

When the frame is securely in place, an IV contrast will be injected in preparation for a CT scan. The CT scan will create a precise three-dimensional picture of the area to be treated. This becomes the framework for calculating the radiation dose and designing your treatment. For the CT scan, you will be laid on a treatment bed and your immobilization device secured to insure that you do not move.

Once the CT scan is completed your treatment plan will be finalized. This process takes several hours during which time you are free to move around the hospital or relax in a semi-private patient lounge, located in the Cox building. The lounge is equipped with small televisions and a refrigerator with beverages. Also a healing garden located in the Yawkey Center for Outpatient Care, provides a comforting, meditative and inspirational retreat. We encourage you to eat and drink plenty of fluids during this period. Members of the radiation oncology team will be available throughout the day to answer questions and provide any assistance you may need.

Treatment planning

The physicians will use the CT scan, in addition to other studies you have had, to outline the target and to note important normal structures. The size of the target, as well as its relationship to these structures, is critical in calculating the prescribed radiation dose. It also determines the directions from which the proton beam will be aimed through the body to the target. Once the treatment plan has been finalized, customized equipment is fabricated to shape the proton beam so that the radiation dose matches as closely as possible the shape of the target. This equipment is designed for each direction from which the beam will be aimed.

Proton radiation treatment

Once your plan is finalized, treatment will begin. You will be asked to lie on a treatment bed with the immobilization device secured. X-rays will be taken and adjustments in your position may be made based on comparison to the CT scan and the orientation of each treatment direction. The beam will then be turned on to deliver the precise radiation dose. This process may be repeated several times in order to aim the beam at the target from different directions. During the treatment, you will not feel, see or hear the radiation beam. In general the total time required for a typical treatment is one hour. As soon as your treatment is over, the immobilization will be removed. After a brief observation period you will be free to go home.

Follow up

After treatment, your physician will discuss further care with you, including any immediate precautions, follow-up recommendations and instructions in the event of further symptoms related to your illness and/or treatment.