Stereotactic Radiosurgery to the Pelvis

Stereotactic radiosurgery is a special form of radiation therapy— it is not surgery. Stereotactic radiosurgery allows precisely focused, high dose X-ray beams to be delivered to a small, localized area of the body.

The surgeon, radiation oncologist, and nurse will talk with you about the procedure. Before your procedure can be done, you will need to have certain tests. These tests may include blood work, urine testing, a CT scan (sometimes called a CAT scan), an MRI, or a PET scan. You may also require placement of tiny gold markers known as fiducials.

Your team will talk with you about the treatment. Be sure to ask any questions you have. You will then be asked to sign the consent form for your treatment.

Placing the Markers (Fiducials)

A fiducial (fih-DOO-shul) is a small piece of gold sometimes referred to as a seed or marker. It is about the size of a grain of rice. The fiducial(s) marks the tumor. It can be seen on an x-ray and acts as a tracking device for the radiosurgery system to follow. The fiducial(s) will be placed in the appropriate area under ultrasound guidance by a urologist. This is an outpatient procedure and most patients return home within a few hours. You can have from 2 to 4 fiducials placed. You cannot feel them. They are not magnetic or radioactive and cannot be removed.

Fiducials will be placed 1 to 3 weeks before your radiosurgery treatment. You will need to stop any blood-thinning medicine such as Coumadin® and Plavix®, aspirin, and aspirin products at least 5 days before the fiducial placement. You will be told not to eat or drink anything after midnight the night before the fiducials are placed. You will need to have someone ready to drive you home after the procedure.

Treatment Planning

About 1 week after the placement of the fiducial markers, you will return to the radiation oncology department for a treatment-planning CT scan. At this appointment, a custom-molded “cradle” is made for you to lie on during treatment. The cradle will help you stay in the right position. At this appointment you may also have a catheter placed into your bladder to allow the radiation oncologist to see it better thus preventing any unnecessary radiation to that area.

The CT scan is done with you in the cradle. The CT images are sent to the planning computer. Once the CT scan is complete, the radiation oncologist and surgeon develop a custom plan according to information in the computer regarding your tumor. Planning your treatment may take 1 to 2 weeks.

Scheduling your Radiosurgery Treatment

After a plan has been made, you will be contacted by phone to schedule a date and time for treatments. You may receive 1 to 5 treatments over a 2-week period of time.

The Day of Your Treatment

• You should wear loose-fitting, comfortable clothing for the procedure. Please do not wear any jewelry.
• Do not use moisturizers within 2 hours before your treatment.
• You can take all of your regular medicines before your procedure.
• If you think that you will be uncomfortable lying on the treatment table, please take pain medicine before you arrive that day. The day of your treatment, tell your nurse if you are having pain. We can give you medicine before starting treatment.
• It is not necessary to avoid eating before the treatment or restrict any normal activities.
• You are welcome to bring a family member or friend with you on the day of your treatment but it is not required. He or she will stay in the waiting area while you are receiving your treatment.

During the Treatment

• The therapist will position you on the treatment table in the body cradle that was made specifically for you and adjust the table several times in order to ensure you are lined up perfectly for the treatment.
• Even though you will be alone in the room during the treatment, the radiation therapists will watch you closely and a microphone in the room allows you to communicate with them freely.
• The treatment can take up to 45 minutes.
• For most patients radiosurgery treatment is a pain-free experience.

What to Expect After Treatment

Once all your treatments have been completed, the radiation oncologist or nurse will speak with you and your family member and schedule your return follow up visit.

Side Effects

There have been minimal side effects associated with stereotactic radiosurgery treatment for pelvic tumors. The most common side effect is fatigue. Follow these tips to deal with side effects you may have.

Fatigue

• Take frequent rest periods and pace your activities.
• Save time for activities you enjoy. Plan them as part of your day.
• Plan a short period of activity, such as a walk each day. Inactivity may actually make you more tired.
• Tell your nurse or doctor if you become extremely tired.

Bowel Changes

• Loose, frequent bowel movements may occur
• Eat a low residue diet.
• Avoid spicy foods that will irritate the lining of your GI tract.
• Eat several small meals a day.
• Ask to speak with the dietitian about your nutritional needs and for examples of a low-fat diet.
• Ask your doctor or nurse for medications that you may use to help to decrease the frequency of bowel movements.

Urinary Changes

• Difficulty urinating or urinating more often than usual may occur
• Drink at least six to eight 8-ounce glasses of water daily throughout your radiation therapy, unless your doctor has restricted the amount of fluids you can drink because of another medical condition. This should be continued for two or three weeks after your last treatment. Avoid drinking liquids in the evening and before bedtime, so you can rest comfortably at night. Alcoholic beverages and beverages containing caffeine may irritate your bladder and increase the sensation to pass your water more often.
• Cranberry juice and vitamin C supplements may help relieve bladder irritation. Ask your doctor or nurse for specific recommendations.

Things to Report Immediately

Call immediately if you have any of the following symptoms:

• Painful, burning or absence of urinary flow
• Sharp, consistent pain uncontrolled with pain medication
• Changes in bowel habits
• Bloody, black or tar like stools
• Temperature of 100.5 F (38 C) or above

Things to Report to Your Nurse or Doctor

• Skin redness, tenderness, itchiness, or rash
• Any new or unusual symptoms

To report these symptoms, or if you have any questions or concerns, please call the UPMC Hillman Cancer Center at UPMC Shadyside’s Radiosurgery Program Office at 412-623-2061.