The journey begins with having a consultation with Prof Fogarty. A referral is needed. A new patient appointment can be made by ringing 9458 8050 and asking for an appointment with Professor Fogarty.The process of having radiation is that there needs to be an initial consultation with myself so that I decide if radiation is the best treatment based on experience and knowledge of the literature. If I think radiation is warranted, I will offer that to you. During the rest of the consultation, I will explain the rationale for treatment, the process and the possible side effects. This is necessary for you to give fully informed consent. You will need to show your consent by signing a treatment consent form. The consent form can be signed by another in charge of your affairs.
The rationale for radiation is the treatment of diseased cells that are mixed in with normal cells. Radiation allows for normal tissue repair of the normal tissue in the volume and yet sterilization of the diseased cells.
Then we get on with the process. First, we organize planning. Planning takes about 1-2 hours. Usually, we can do the planning on the same day as your initial consultation. Planning is aiming the radiation to where it has to go. Planning is not scheduling. Scheduling is when you have the radiation. This should fit your timetable as well as that of the centre.
During planning, you will meet nurses, administration people and our radiation planning staff. You may need a scan. This scan is for planning and not for a diagnosis. No contrast, either by mouth or vein, is needed. You can go home after the scan but we then do a lot of work on the scan. I contour different volumes on the scan. I prescribe radiation to the volumes that include tumour. I show the planners normal tissue volumes that need to be avoided. I approve the plan when there is enough dose going to tumour volumes to control the tumour but the dose to the normal structure is low enough to avoid long term side effects.
The next step in the process after plan acceptance comes treatment. On the Xstrahl machine can start almost immediately with a fractionation pattern that fits in with other responsibilities. The other machines need about a week to plan for. You may even need to come back for a second planning scan if we use a special technique called 3D printed bolus.
I will supervise the treatment and review patients regularly during the treatment in order to make sure the exact amount of radiation is delivered to achieve the best outcomes. During this time, short term side effects may arise eg redness of the skin, flakiness of skin, tiredness, that the doctor will prewarn you about and prescribe medication for any side effects if needed. The nurses will see you regularly and advise on skincare in consultation with me.
There will be a medical follow up a month or two following the treatments and then care will once again be continued by the original skincare doctor who, with the radiation oncologist, forms the skin cancer multidisciplinary team. Medical follow up will examine for disease recurrence or new cancers. We will also look for long term side effects. These are rare especially if we use adequate fractionation.