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In many cases, your child's cancer will need to be treated by using more than one type of treatment. For example, if they have lymphoma, they might receive chemotherapy or targeted therapy (by a pediatric oncologist) which can be followed by radiation therapy to destroy any remaining cancer cells (by a radiation oncologist). Certain types of lymphoma can be treated with either systemic therapy or radiation therapy on their own
After reviewing your child's medical records including imaging, as well as completing a thorough patient history and physical examination, the radiation oncologist will discuss with you the potential benefits and risks of radiation therapy and answer your questions. For a list of questions that you may want to ask, please see the Caring for Your Child section.
Before starting radiation therapy treatments, you will meet with your radiation oncology team in a consultation visit to evaluate the need of radiation therapy for your child’s condition. Your team may request further imaging studies or laboratory tests depending on the information they have so far. They may also discuss with other doctors to determine the best plan forward to help your child. Your doctor will discuss with you the different aspects of the radiation treatment process including the benefits, risks, logistics, and the potential short and long-term side effects of the radiation therapy.
Simulation is the set-up process for radiation therapy and is performed before starting radiation treatments. During the set-up process, the radiation oncology team will find a suitable position for your child such that the treatments can be accurately given each time. Your child will receive a CT scan and possibly other imaging in the decided position so that it can be used for radiation planning and treatment. The radiation therapist may also put some marks on the skin to help with the set-up (small ink dots or tattoos). There will be many members of the team present to help your child during the simulation including radiation therapists and possibly others including dosimetrists, physicists, and child life specialists . Sometimes they will provide a mask, body mold, or cushion to help keep your child in the same position for every treatment. Your team may also decide that your child may need to be given medicine to help them sleep during the set-up process and during treatments. This is commonly done for children who are too young to understand why they must hold still and would be discussed with you prior to the simulation. Your child will be monitored by members of the team the entire time during the simulation process.
After the simulation, your radiation oncology team will use the information gathered from the simulation and maybe other clinical studies to design an effective and safe radiation plan. Your child’s radiation plan will be created by a team of people including a dosimetrist who will use advanced computer programs to help create the plan. Your radiation oncologist will review and approve all the plan information prior to starting treatment.
Since radiation therapy is a complex treatment, quality assurance is performed prior to starting treatments. This involves other members of the treatment team such as medical physicist checking with special equipment to ensure that your child’s individualized treatment plan will work accurately and safely.
Your child’s doctor will discuss with you in regards to how many treatments your child will receive. Sometimes the number of treatments and also the exact timing of when radiation must start is determined by a protocol or clinical trial. The actual time on the treatment table each day may be relatively short, but the total appointment time required may be longer because of setup time and time for anesthesia (if required).
The radiation therapist and other members of the team may set up the treatment machine and move the machine before and during the treatment to target the treatment area of the body. If a mask, body mold, or cushion was used during simulation, it will be used during treatment as well to help keep your child in the same position for accurate treatment. Accurate positioning of the radiation beams to the target will be confirmed through images taken during the treatment. These images will be reviewed and approved by your child’s doctor.
Your child will also be monitored by members of the team the entire time while the radiation is being delivered. Your radiation oncology team will follow your child’s progress throughout the radiation treatment course. There may be weekly status checks of your child and you are encouraged to discuss any questions or concerns during those times or any time during treatment.
After treatment is completed, follow-up appointments will be scheduled so that your radiation oncologist can make sure your child’s recovery is proceeding normally. Your radiation oncologist, in concert with other members of your team, may order additional diagnostic tests. Reports on your child’s treatment may be sent to the other doctors helping treat your child’s cancer. Continued follow-up in the radiation oncology clinic is recommended to evaluate for long-term side effects of radiation therapy and to ensure that the cancer does not return. As time goes by, the number of times you need to visit your radiation oncologist throughout the year will decrease. However, you should know that your radiation oncology team will always be available should you need to speak to someone about your treatment.
Your team will also refer your child to appropriate specialists for short-term and long-term follow-up. Survivors of childhood cancers often receive survivorship care or care that is provided so that they can stay healthy and do well in their schoolwork or job. During these follow-up visits, your child’s healthcare provider can check for any problems that may happen after cancer and its treatment. These issues can vary depending on the type of cancer, where the cancer was located in the body, and the types of treatment your child received.
Some topics that long-term survivorship care may focus on can include dental and eye care, heart and lung health, and reducing the risk of second cancers. Childhood cancer survivors may also be recommended to receive follow-up with an endocrinologist, a doctor who specializes in endocrine or hormone problems. They may also be referred to follow-up with neurocognitive specialists who can help address issues with learning or memory. Some survivors may have also had cancer treatments that affect organs of the urinary tract (ex. kidneys, bladder, etc.) or affect reproductive organs. In those instances, the child may be referred to specialists who can help with urinary, sexual development or reproduction concerns.
