Radiotherapy

Radiotherapy is the use of high energy x-rays to treat cancer.

Many people with cancer will have radiotherapy as part of their treatment.

Radiotherapy destroys cancer cells in the treated area by damaging its DNA. Although normal cells can also be damaged by the radiotherapy, they can usually repair themselves.

Radiotherapy treatment can cure some cancers and can also reduce the chance of a cancer coming back after surgery. It may be used to reduce cancer symptoms.

For some types of curative radiotherapy treatment, you may need to go to the hospital each weekday for between two and seven weeks. In this situation, a small dose of radiotherapy is given each time. This is because as well as damaging cancer cells, radiotherapy can also cause damage to healthy cells in the treatment area. If a very high dose of treatment was given all in one go, it could cause too much damage to the healthy cells, so small doses are given to allow them to recover in between.

Radiotherapy equipment is very complex and takes up a lot of space, as well as support from specially trained staff, so radiotherapy departments tend to be in the larger regional and teaching hospitals. Often you will have your initial cancer treatment (such as surgery) at your local hospital and will then be referred to your nearest specialist cancer treatment hospital for radiotherapy.


Radiotherapy patient info part 1


Radiotherapy patient info part 2

External beam radiotherapy

The treatments are usually given from Monday to Friday, with a rest at the weekend. Each treatment is called a fraction.

The number of treatments you have depends on several factors, including:

  • your general health
  • the type of cancer being treated and where it is in the body
  • whether or not you have had, or are going to have, surgery, chemotherapy as part of your treatment.

For these reasons, treatment is individually planned for each patient, and even people with the same type of cancer may have different types of radiotherapy treatment.

 

External radiotherapy does not make you radioactive, and it is perfectly safe for you to be with other people, including children, throughout your treatment.

 

Palliative treatment (for symptom control) may involve only one or two sessions of treatment, or up to ten sessions.

There are several different types of radiotherapy machines that work in different ways. Radiotherapy treatment for most cancers, apart from skin cancers, is given by machines called linear accelerators (LinAcs).

The type of radiotherapy machine used will be carefully chosen by your specialist and physicist to give you the most appropriate treatment. Some machines are quicker than others and may give treatment in a very short time, such as a few seconds. Usually, radiotherapy treatment (including the time taken to position you) takes 10–15 minutes or less on any type of machine.

The radiotherapy machine does not normally touch you, although for some types of cancer it may press against your skin. If you have a specific type of radiotherapy known as electron treatment, a small applicator may be used, which touches a small area of skin.

The treatment itself is painless, although it may gradually cause some uncomfortable side effects.

Radiotherapy affects people in different ways; some find that they can carry on working, only needing time off for their treatment, while others find it too tiring and prefer to stay at home. If you have a family to look after, you may find that you need extra help.

Getting to your appointment

If you have to do a lot of travelling each day to get to your appointment you may feel very tired, particularly if you are feeling some side effects from your treatment.

If the treatment makes you feel tired, you could ask a family member or friend to drive you to the hospital, or ask for hospital transport if friends or family can't easily drive you there.

Some local support groups and charities also provide hospital transport. If transport is very difficult, or you live a long way from the hospital, you may need to stay in a ‘hostel’ ward in the hospital (The Simon Hotel). Sometimes it is possible for the hospital to organise local accommodation while you are having radiotherapy.

If you have difficulty meeting the cost of travelling to the radiotherapy clinic each day, you may be able to get a grant towards your travel expenses. People on a low income may be able to claim the costs from the Department of Work and Pensions or through the Hospital Travel Costs Scheme. Some charities (such as Macmillan) provide travel grants, and so do some local support groups.

Giving your consent

Before you have your radiotherapy, your doctor will explain the aims of the treatment to you. They will usually ask you to sign a form saying that you give your permission (consent) for the hospital staff to give you the treatment. No medical treatment can be given without your consent, and before you are asked to sign the form you should have been given full information about:

  • the type and extent of the treatment you are advised to have
  • the advantages and disadvantages of the treatment
  • any other treatments that may be available
  • any significant risks or side effects of the treatment.

If you do not understand what you have been told, let the staff know straight away so that they can explain again. Some cancer treatments are complex, so it is not unusual for people to need repeated explanations.

It is often a good idea to have a friend or relative with you when the treatment is explained, to help you remember the discussion more fully. You may also find it useful to write down a list of questions before you go to your appointment.

Planning your treatment

For most curative (radical) treatments, planning is a very important part of radiotherapy and may take a few visits. Careful planning makes sure that the radiotherapy is as accurate and effective as possible. It ensures the radiotherapy rays are aimed precisely at the cancer and cause the least possible damage to the surrounding healthy tissues.

The treatment is planned by your clinical oncologist, a physicist and sometimes by a radiographer. You may have your first treatment on the same day as your planning session, but usually it is necessary to wait a number of days, sometimes up to two weeks, while the physicist and the oncologist prepare the final details of your treatment.

On your first visit to the radiotherapy department, you will have a CT (computerised tomography) scan taken of the area to be treated. A CT scan takes lots of images from different angles to build up a three-dimensional picture of the area. At the same time, therapy radiographers will take measurements from you which are needed for treatment planning. This session will usually take about 45–60 minutes.


Tomotherapy explanation

The radiographer’s measurements and the information from the scans is fed into the radiotherapy – planning computer to help your doctors plan your treatment more precisely.

For some conditions, like many skin cancers and for palliative radiotherapy, radiotherapy may be planned and given in a very simple way. Your specialist may simply put marks on your skin, with a soft pen, where the treatment is needed.

Positioning

During the treatment planning you will be lying on a fairly hard couch that can be uncomfortable. If it is, let the radiographer know as you can often be made more comfortable by having foam pads put underneath you. You have to lie very still for a few minutes so that accurate measurements can be taken and your exact position recorded. The radiographer can then make sure that you are lying in the correct position each time you have treatment.

Skin markings

Once the treatment area has been finalised, ink markings are usually made on your skin to pinpoint the exact place where the radiation is to be directed.

Sometimes two, three or more tattoo marks are also made on the skin. These are permanent, but they are the size of a pinpoint and will only be done with your permission. It is a little uncomfortable while it is being done, but is a good way of making sure that treatment is directed accurately. The tattoo marks are also useful once treatment has finished, as they show where the radiotherapy was given and prevent further radiotherapy being given to that area in the future.

Having your treatment

Before your first treatment, the radiographers will explain to you what you will see and hear. It is quite normal to feel anxious about having your treatment, but as you get to know the staff and understand what is going on it should become easier.

Radiotherapy itself is painless and each session may take anything from a few seconds to several minutes. Because your positioning is so important, the radiographers may take a little while to get you ready (they may call this setting up). The radiographers will position you carefully on the table and adjust the height and position of the table itself. The room may be in semi-darkness while this is happening.

Try to relax as much as possible.

Once you are in the correct position the staff will need to leave you alone in the room, to prevent them from being exposed to any unnecessary radiation. Don't worry if the staff seem to rush out of the room once they have positioned you, this is just to keep your treatment time as short as possible. Radiotherapy units have many patients to treat and the staff need to keep appointments on time.

During treatment you will be alone for a few minutes but there will often be an intercom so that you can talk to the radiographers. They will be watching you carefully from the next room, on a closed-circuit television screen. To protect your privacy, no one else will be able to see you. If you have any problems, you can raise your hand to attract the radiographers attention and they will come in to help you.

Most radiotherapy machines will be able to rotate around your body to give the treatment from several different directions.

The radiographers may have to come into the treatment room to change your position slightly in the middle of your treatment. Also, small changes sometimes have to be made to your treatment plan. There may be various reasons for this. Your specialist and the radiographers can explain any changes to you.

Specialised external radiotherapy techniques

Some newer ways of giving radiotherapy are being assessed to see whether they give better results than standard radiotherapy.

Conformal radiotherapy

Many specialist hospitals now use a technique known as conformal radiotherapy. Conformal radiotherapy uses the same radiotherapy machine as normal radiotherapy treatment. However, a device called a multi-leaf collimator is used to arrange the beams to target the area of the cancer more accurately. This ensures that a higher dose of radiation is given to the tumour. Healthy surrounding cells and nearby structures receive a lower dose of radiation, so the possibility of side effects is reduced.

The multi-leaf collimator consists of a number of metal sheets which are fixed to the radiotherapy machine. Each sheet can be adjusted so that the radiotherapy beams can be shaped to the treatment area.

Precise positioning of the radiotherapy machine is very important for conformal radiotherapy treatment and a special scanning machine may be used to check the position of your internal organs at the beginning of each treatment.

Intensity-modulated radiotherapy (IMRT)

Intensity-modulated radiotherapy also uses a multi-leaf collimator. During this treatment the layers of the multi-leaf collimator are moved while the treatment is being given. This method is able to shape the treatment beams even more precisely and allows the dose of radiotherapy to be altered in different parts of the treatment area.

Research studies have shown that conformal radiotherapy and intensity-modulated radiotherapy have less side effects than traditional radiotherapy treatment.

General side effects of radiotherapy

While radiotherapy can destroy cancer cells, it can also have an effect on some of the surrounding normal cells.

Years ago, in the 1950s and 60s, radiotherapy often caused very severe side effects, especially skin burns and scarring. There have been huge improvements in the machines that give the treatment, and severe side effects are now very rare.

As radiotherapy affects people in different ways, it is difficult to predict exactly how you will react to your treatment. Before you start, the staff will discuss with you any likely side effects of the particular treatment you are having. They can also give tips on how to deal with them and how they can be treated. Being aware of side effects in advance can help you to cope with any problems that occur.

Most side effects of radiotherapy disappear gradually once the course of treatment is over. However, for some people, they may continue for a few weeks.

Tiredness

You may feel tired during your radiotherapy. This can often be made worse by having to travel to your treatment each day. Listen to your body, and if necessary, allow yourself extra time to rest, perhaps by taking a nap in the afternoons.

Skin care

Some people develop a skin reaction while having external radiotherapy. If this effects you, it will normally happen after 3–4 weeks. People with pale skin may find that the skin in the treatment area becomes red and sore or itchy. People with darker skin may find that their skin becomes darker and can have a blue or black tinge. The amount of the reaction depends on the area being treated and the individual's skin.

Some people have no skin problems at all. Your radiographers will be looking for these reactions, but you should also let them know as soon as you notice any soreness or change in skin colour.

It’s important not to use any creams or dressings unless they have been prescribed or recommended by your specialist or the radiographer.

Occasionally, if your skin gets very sore, your treatment may have to be delayed for a short time to allow the area to recover.

Staff at the radiotherapy department will be able to give you advice on how to look after your skin in the area being treated. Care of the skin will vary according to the part of the body that is being treated and the dose of radiotherapy that the skin is receiving

You may be advised to use only tepid water and plain soaps, without any perfume, to wash the area; and not to soak too long in the bath. You can dry your skin by patting it gently with a soft towel, but you shouldn’t rub the area as this may make it sore.

Perfumed soaps, talcum powder, deodorants and perfumes may also make your skin sore and should not be used. The staff at the hospital may suggest that you gently apply plain moisturisers, such as E45 cream or aqueous cream, to the area. After your treatment, plain soap and plain moisturisers are often recommended. Aloe vera cream can sometimes help the skin to heal. Always check with the radiotherapy staff before applying anything to your skin.

It is very important that any marks put on your skin to show the treatment area are not removed. If the marks do fade or disappear, do not try to replace them yourself but let the radiotherapy staff know.

These restrictions apply only to the treatment area, and the rest of your skin can be treated normally. Your skin may peel after the redness has faded, but it will gradually heal. Changes in the skin usually settle down two to four weeks after the treatment has finished, but the area may stay slightly darker than the surrounding skin.

You can swim as soon as any skin reaction has settled down, usually within a month of finishing treatment. However, if you are swimming out of doors, do not stay in the water too long, and remember to use a waterproof sun-cream.

Changes in your blood

Radiotherapy to some parts of the body may affect the bone marrow, which produces the different types of blood cells. If the doctors think this might happen to you, you will have regular blood tests during your treatment to check your blood counts (the number of cells in your blood). If your blood counts are low, you may feel tired and 'run down'. If your blood count becomes very low (which is unlikely), it may be necessary to have a short rest from treatment so that your blood cell levels can return to normal. You may also need to have a blood transfusion.

It is very important to let your doctors know if you feel very unwell, or if your temperature goes above 38ºC (100.4ºF), or if you start feeling cold and shaky.

Complementary therapies

These can help to improve your quality of life and well being and can sometimes help to reduce the side effects of radiotherapy. Many people find that complementary therapies or practices can help them to feel stronger and more confident in dealing with radiotherapy. These therapies can be used alongside conventional treatments and medicines.

Some complementary therapies, such as meditation or visualisation can be done by the person with cancer themselves and can reduce anxiety. Other therapies such as gentle massage can be carried out by relatives or carers and can help them to support the person with cancer.

Physical contact and touch can be among the most powerful forms of support for people who are faced with uncertainty, fear or pain, whether emotional or physical. Touching someone gently can express how much you care about them.

Some hospitals offer complementary therapies alongside conventional care. These may include:

  • aromatherapy
  • art therapy
  • colour and sound therapy
  • massage
  • reflexology
  • relaxation, visualisation or guided imagery techniques
  • acupuncture.