RADIOTHERAPY

( By JASCAP )

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Being Treated

Where do you have your radiotherapy treatment?

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 departments have varying types of equipment and are organised according to local needs, so they are run in different ways. While most of the information in this booklet is fairly general, and will apply to most departments, you may find that there are some differences at the hospital where you are treated.

You can usually have external radiotherapy as an outpatient, but if you are unwell, or having chemotherapy at the same time, you may need to stay in hospital and will be taken to the radiotherapy department each day from the ward. If you are having internal radiotherapy, you may have to stay in hospital for a few days.

Staff in the radiotherapy department

  • Clinical oncologist
  • Radiographers
  • Physicist
  • Mould room technician
  • Nursing staff
  • Other members of the cancer support team

Clinical oncologist

Although you will continue to be in the care of your GP during and after your radiotherapy, you will be under the care of a clinical oncologist while you are having the treatment itself. A clinical oncologist is a doctor trained in the use of radiotherapy and chemotherapy. The clinical oncologist will be responsible for prescribing and supervising your course of treatment.

You may see your oncologist before, during, and after your course of radiotherapy treatment, so that the effect of the treatment can be monitored. If you have any problems before or after your treatment, the nurses or radiographers can arrange an extra appointment for you.

If you are having chemotherapy as well as radiotherapy, this treatment may be supervised by your clinical oncologist or may be organised by a different doctor, called a medical oncologist. Medical oncologists specialise in chemotherapy treatment.

Medical oncologists and clinical oncologists work as part of a team. The team includes all the other health care staff who look after people having treatment for cancer. This multidisciplinary team (MDT) will have regular meetings to co-ordinate and plan care and treatment.

Radiographers

Radiographers are specially trained in using x-ray equipment. There are two main types of radiographer: therapy radiographers and diagnostic radiographers.

Therapy radiographers are the people who operate the machines that give you your radiotherapy treatment. They are highly trained in giving radiotherapy and patient care.

Diagnostic radiographers use x-rays and scans to diagnose illness – you may have x-rays or scans from time to time during and after your treatment to check the effect of your radiotherapy treatment.

Therapy radiographers work closely with your specialist and physicist to plan your treatment. Where possible, you will see the same radiographers throughout your course of treatment so you get to know each other quite well. They can give you help and advice about any aspect of your treatment, and you can discuss any of your concerns or anxieties with them. You can ask to be treated by a radiographer of the same sex as yourself, if you prefer.

Some radiographers, known as information radiographers, specialise in giving information to patients and their relatives.

Physicist

Working with the clinical oncologist is a physicist – a radiation expert – who will help to plan your treatment, assisting your specialist in decisions about the best way of giving the prescribed amount of radiation. The physicist is also responsible for maintaining the accuracy of the equipment used. Although you may meet the physicist at your initial planning appointment, they usually work behind the scenes.

Mould room technician

If you need to have a mould made of part of your body to keep it still during treatment, this will usually be done by technical staff in the mould room.

Nursing staff

Like hospital wards, the radiotherapy clinic has nursing staff – usually a sister or charge nurse and a team of nurses. They ensure that the clinic is running smoothly and look after any general needs you have, such as dressings and medicines. The nurses in the radiotherapy department can also give information and advice about the treatment and they give practical support.

Many cancer centres also have specialist cancer nurses (sometimes called clinical nurse specialists) who will have expert knowledge of your type of cancer. They can be a good source of support and information during your treatment.

Other members of the cancer support team

Dietitian

A dietitian can give you advice if you have any problems eating and drinking because of your radiotherapy, such as difficulty swallowing or a dry mouth.

Social worker

Social workers can give advice about any non-medical problems that you may have. This includes practical and financial help: for example, some patients can claim travelling expenses and others may be eligible for a grant from a charity.

Social workers can also give or organise counselling and emotional support for you and your family. If necessary they will refer you to local support services that can help you at home. You can ask to see a social worker if you think that this would be helpful.

Symptom control team (palliative care team)

Many hospitals have a symptom control team to give additional help and support for people whose symptoms or treatment are causing problems. There may be other staff, such as dietitians or physiotherapists, who can help with any specific questions you may have.

Counsellors

Counsellors are available in some hospitals. If you feel that speaking to a counsellor would be helpful, ask the staff looking after you to arrange an appointment.

Secretaries and clerical staff

The secretaries and clerical staff in the radiotherapy department help to keep the appointment system running smoothly.

External beam radiotherapy

  • About your treatment
  • Getting to your appointment
  • Giving your consent
  • Planning your treatment
  • Molds
  • First Planning Visit
  • Skin markings
  • Having your treatment

About your treatment

External radiotherapy is normally given as a series of short, daily treatments in the radiotherapy department, using equipment similar to a large x-ray machine.

The treatments are usually given from Monday to Friday, with a rest at the weekend. Each treatment is called a fraction. Giving the treatment in fractions ensures that less damage is done to normal cells than to cancer cells. The damage to normal cells is mainly temporary, but is the reason why radiotherapy has some side effects.

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 or hormonal therapy 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.

A course of curative (radical) treatment may be given every weekday for two to seven weeks. Instead of having one treatment a day or having a rest at the weekend, some people will have different treatment plans. They may have more than one treatment daily, or treatment every day for two weeks. Sometimes treatment may only be given on three days each week (for example, Mondays, Wednesdays and Fridays).

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.

Don't be afraid to ask for help, whether it's from your employer, family or friends, social services, or the staff in the radiotherapy department. As your treatment progresses, you will have a better idea of how it makes you feel, so you can make any necessary changes to your daily life.

Where possible, the radiotherapy staff will try to give you an appointment for the same time each day. This allows you to get into a regular routine.

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.

If you rely on your own or public transport you can sometimes arrange a radiotherapy appointment which suits you. However, due to the large numbers of people having radiotherapy, it's not always possible to get an appointment exactly when you want it.

Some hospitals in the UK provide transport and, if necessary, this can be arranged for you. The hospital’s transport department will assess your needs and make all the arrangements if they are able to provide transport for you.

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 or nearby. Sometimes it is possible for the hospital to organise local accommodation while you are having radiotherapy.

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.

Patients often feel that the hospital staff are too busy to answer their questions, but it is important for you to be aware of how the treatment is likely to affect you. The staff should be willing to make time for you to ask questions.

You can always ask for more time to decide about the treatment if you feel that you can’t make a decision when it is first explained to you.

You are also free to choose not to have the treatment. The staff can explain what may happen if you do not have it. It is essential to tell a doctor, or the nurse in charge, so that they can record your decision in your medical notes. You do not have to give a reason for not wanting to have treatment, but it can be helpful to let the staff know your concerns so that they can give you the best advice.

Possible pregnancy

Women of childbearing age will be asked whether they could be pregnant, as x-rays given during pregnancy could harm a baby. If you think that you may be pregnant, let the doctors and radiographers know immediately and you will be offered a pregnancy test.

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 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.

Sometimes you may also need to go to the hospital’s scanning department to have an MRI scan.

This uses powerful magnetic fields to give a detailed picture of part of your body, which can give additional useful information.

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.

Some special procedures may be necessary to make sure the radiographers get a clear picture. The radiographer will explain these to you. For example, to plan treatment to the pelvic area, a liquid that shows up on x-ray may be passed into your back passage or into your bladder, or a tampon may be used to show the exact position of the vagina. These procedures may be slightly uncomfortable but are not painful and take only a few minutes. They are used only for planning the treatment, and not during the treatment sessions.

It is important for you to feel that you are involved in your treatment, so feel free to ask as many questions as you like.

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.

Moulds

To help you stay very still and keep your position during your treatment you may need a device called a 'mould'. This will be made before planning starts and is used to stop you moving so that the treatment is as effective as possible. Moulds are often used for treatments to the head and neck area. Sometimes a mould of your leg, arm or other body part is used to keep the area still during treatment. Marks can be made on the mould instead of your skin.

Moulds are commonly used for children having radiotherapy.

The mould is made of clear Perspex or a plastic mesh. The Perspex mould is made using a plaster cast that is first taken of the body part. This involves using strips of wet plaster bandage that are laid across the body. The plaster takes about five minutes to set. Some people may find this claustrophobic or a little frightening, especially if the mould is of the face and neck, but it only feels like this for a few minutes. After you leave the department, Perspex is moulded onto the cast to form a mask.

Some hospitals use a plastic mesh instead. The plastic mesh becomes soft in warm water and can be moulded to your body. It hardens after a few minutes and is then ready to use. Moulds covering the face will have holes cut for the eyes, nose and mouth.

A radiotherapy mask

Your mould should fit snugly and will be ready to wear at your first planning or treatment session. It may feel claustrophobic, but it can help to remember that you will only have a mould on for a few minutes at a time.

First Planning Visits

On your first visit to the radiotherapy department you may 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. Sometimes you may also need to go to the hospital’s scanning department to have an MRI scan. This uses powerful magnetic fields to give a detailed picture of part of your body, which can give additional useful information.

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

Some special procedures may be necessary to make sure the radiographers get a clear picture. The radiographer will explain these to you. To plan treatment to the pelvic area, for example, a liquid that shows up on x-ray may be passed into your back passage or into your bladder, or a tampon may be used to show the exact position of the vagina. These procedures may be slightly uncomfortable but aren’t painful and take only a few minutes. They are used only for planning the treatment, and not during the treatment sessions. It is important for you to feel that you are involved in your treatment, so feel free to ask as many questions as you like.

For some conditions, like many skin cancers and for palliative treatment, 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.

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. The staff will explain how to look after these markings. If the marks begin to rub off, tell your radiographer. Do not try to redraw them yourself. Since they can rub off onto clothing, some people choose to wear older clothes next to the skin during their treatment.

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.

The sight of large radiotherapy machines can be frightening, especially for children. Don't be afraid to talk about any fears or worries to the staff; they are there to help you, and the more you understand about your treatment the more relaxed you will be.

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.

Some treatment rooms have tape or CD players so that you can listen to music while having your treatment, to help you to relax. 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, either through a window or 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. At first, this and the sound of the machine can be unsettling.

Positioning the radiotherapy machine

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.

Making a radiotherapy mask

This information is about the process of making a radiotherapy mask. Perspex and plastic masks are often used when radiotherapy is given to the brain, or the head and neck area. It may be helpful to read this with our information on brain tumours or head and neck cancer, as well as our information on radiotherapy. You may also want to discuss it with a nurse or doctor involved in your treatment.

Radiotherapy masks

  • How the mask is made
  • Perspex mask
  • Mesh plastic mask
  • Treatment planning

Radiotherapy masks

Radiotherapy is the use of x-rays (and other rays) to treat cancer. Radiotherapy has to be aimed very precisely to make sure that exactly the right area of the body is treated each time.

It is important that a person having radiotherapy lies still for a few minutes while the treatment is in progress. However, when radiotherapy is given to treat tumours of the head and neck area or brain tumours, it is even more important to be as still as possible. This is because even a tiny movement could effect how well the radiotherapy works.

To help with this, a radiotherapy mask (which is sometimes called a mould, a head shell or a cast) is made to be worn during the treatment. The mask is fixed to the radiotherapy treatment

table. This ensures that your head and neck are held in exactly the right position for the treatment. Wearing a mask reduces the possibility of any movement whilst the radiotherapy is given. The mask is only worn during the treatment planning procedures and during the treatment itself, ie, for only a few minutes at a time each day. You will not have to wear the mask at any other time.

How the mask is made

The mask is made in the mould room of the radiotherapy department by a mould technician or radiographer. The process of making the mask can vary slightly between hospitals and usually takes around 30 minutes. One technique uses wet plaster bandages and the finished mask is made of perspex. The other technique uses a type of mesh plastic, which is moulded to fit the shape of your face.

Perspex mask

If you are having a perspex mask you may be given a swimming cap or some other covering to wear, to protect your hair from the mould mixture.

Strips of plaster of paris are applied to the face to make a mould

Firstly, the mould technician will apply a cool cream or gel onto your face. Then, they will put strips of plaster of paris bandage on top of this. You will still be able to breathe, as holes are left around your nose and mouth.

Plaster of paris gets warm while it is setting. This is normal and may make the process uncomfortable. Do not worry: it will not burn you. Once the plaster of paris has set (which will take about five minutes) the mould is taken off. A perspex mask is then made from this mould.

A finished perspex mask

Mesh plastic mask

This technique uses a special kind of plastic. The plastic is heated in warm water so that it becomes soft and pliable.

It is put onto your face so that the plastic gently moulds to fit your face exactly. It feels a little like having a warm flannel put onto your face. You can still breathe easily, as the plastic will not cover your nose or mouth.

Once the mesh has moulded and become hard (which takes a few minutes) the mask is taken off. It is then ready to be used when you have your treatment.

A warm plastic mesh is put onto your face so that the plastic gently moulds to fit your face

Treatment planning

Once the mask is ready, you might need to visit the mould room again so that adjustments can be made to position the mask correctly on the radiotherapy treatment table.

You may also have your treatment planned during this visit. Treatment planning ensures that the radiotherapy is aimed very precisely at the cancer. You may be positioned on a machine called a simulator (which helps the radiographer to work out the exact position you need to be in).

Sometimes scans or x-rays are necessary to help with planning. The doctor or radiographer may make a few ink marks on the mask; this makes it easier to position you correctly each time you come in for treatment. Radiotherapy planning can take more than one visit.

When you have the radiotherapy you will be lying down on a table below the radiotherapy machine. The mask is placed on your face and fixed to the table so that your head doesn’t move while the radiotherapy is being given. Treatment usually takes only a few minutes and is not painful. The staff will be close by to answer any questions that you may have.

Specialised external radiotherapy techniques

Some newer ways of giving radiotherapy are being assessed to see whether they give better results than standard radiotherapy. Research studies are being carried out to see whether the new techniques can control the cancer better while causing fewer side effects. Some of the techniques are described below.

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.

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)

High-resolution intensity-modulated radiotherapy, which is sometimes called three-dimensional IMRT (3D-IMRT) 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. However, it is possible that by shaping the treatment area so precisely, microscopic cancer cells just outside the treatment area may not be destroyed. This means that the risk of the cancer coming back in the future could be higher with these specialised radiotherapy techniques. Research studies currently being carried out should show whether this is the case.

TomoTherapy

This is a specialist form of IMRT. The radiotherapy is given by a machine that rotates, much like a CT scanner rotates when taking a scan. Before each treatment the TomoTherapy machine takes a scan to locate the tumour. It then plans treatment to deliver the radiation precisely to the tumour, minimising radiation to healthy tissue. It’s a very new treatment and not widely available in the UK.

Total body irradiation

This type of radiotherapy is used much less commonly than the other types of radiotherapy, but may be given to people who are having a stem cell transplant as part of their treatment.

A large single dose, or six to eight smaller doses of radiation is given to the whole body to destroy the cells of the bone marrow. Very high doses of chemotherapy are also given. This treatment is followed by giving stem cells by a drip into a vein, to replace the bone marrow that has been destroyed.

This type of radiotherapy is described in our booklet on stem cell and bone marrow transplants.

Proton therapy

Proton therapy is only used to treat cancers affecting the eye, such as melanoma. It is given using a machine called a Cyclotron. The cyclotron uses proton radiation rather than x-rays to kill the cancer cells. The proton beam is aimed directly at the cancer and causes very little damage to surrounding healthy tissues. Some very rare cancers may be treated with high-dose proton therapy. This treatment is not available in the UK but the Department of Health can arrange for people who need this type of radiation to have it at centres in the USA or Europe, paid for by the NHS.

Stereotactic radiotherapy

Stereotactic radiotherapy is used to treat brain tumours.

This technique directs the radiotherapy from many different angles so that the dose going to the tumour is very high and the dose affecting surrounding healthy tissue is very low. Before treatment, several scans are analysed by computers to ensure that the radiotherapy is precisely targeted, and the patient's head is held still in a specially-made frame while having the radiotherapy. Several doses are given.

This treatment is available only in some specialist hospitals and isn't suitable for all patients with brain tumours. Your clinical oncologist can discuss whether it may be appropriate in your case.

Stereotactic radio-surgery (gamma knife)

In fact, this type of radiotherapy, again for brain tumours, does not use a knife but very precisely targeted beams of gamma radiotherapy from hundreds of different angles. Only one session of radiotherapy, taking about four to five hours, is needed.

For this treatment you will have a specially-made metal frame attached to your head. Then several scans and x-rays are carried out to find the precise area where the treatment is needed. During the radiotherapy, you lie with your head in a large helmet, which has hundreds of holes in it to allow the radiotherapy beams through.

This treatment is available only in specialist hospitals and is not suitable for all patients with brain tumours. You can discuss with your clinical oncologist whether it may be appropriate for you.

Internal radiotherapy

Internal radiotherapy is used mainly to treat cancers in the head and neck area, the cervix, womb, prostate gland or the skin.

  • How it is given
  • Safety measures
  • Your feelings

How it is given

Treatment is given in one of two ways:

  • by putting solid radioactive material (the source) close to or inside the tumour for a limited period of time
  • by using a radioactive liquid, which is given either as a drink or as an injection into a vein.

If you have internal radiotherapy, you may have to stay in hospital for a few days and special precautions will be taken while the radioactive material is in place in your body. Once the treatment is over there is no risk of exposing your family or friends to radiation.

The process of putting solid radioactive material close to or inside the tumour is called brachytherapy.

Giving a radioactive liquid, either as a drink, a capsule, or as an injection into a vein is called radioisotope treatment. Your specialist will discuss your particular treatment with you.

Before having your treatment you will be asked to sign a form to say that you give your permission (consent).

Safety measures

Certain safety measures will be taken to prevent unnecessary radiation exposure to the hospital staff and your friends and relatives. Depending on the type of treatment you are having, the restrictions may be needed for a few days – but sometimes it is only for a few minutes.

The staff looking after you will explain the restrictions to you in more detail before you start your treatment. Each hospital has different routines, and it is worth visiting the treatment area beforehand to discuss with the nursing and medical staff what will happen.

You may be admitted to the ward the day before your treatment so that the staff can go over the procedure with you. This is a good time to ask questions and it may help to make a list beforehand so you don't forget something important.

While the radioactive source is in place, or after treatment with a liquid radioisotope:

  • You will be nursed in a side room, away from the main ward.
  • You may be nursed alone or with someone else having similar treatment.
  • Lead screens may be put on either side of your bed to protect other people from any radiation given out.
  • The doctors and staff on the ward will only stay in your room for short periods at a time.
  • Children and pregnant women will not be allowed to visit.
  • An instrument called a Geiger counter may be used to monitor the level of radiation in the room. The nurses may wear a small radiation counter.
  • Visitors will be restricted, and only allowed to stay in the room or sit at the end of the bed for a short time, if at all. They may be able to talk to you from outside the room through an intercom.
  • Staff and visitors will be asked to keep away from you, to reduce their exposure to the radiation.

The safety measures and visiting restrictions might make you feel very isolated, frightened and depressed at a time when you may want people around you. If you have these feelings it is important that you let the staff looking after you know. It might also be helpful to take in plenty of reading material and other items to keep you occupied while you are in the single room.

Brachytherapy

If you are having brachytherapy, you only need to stay in isolation while the radioactive source is in place. Once it is removed, the radioactivity disappears and it is perfectly safe to be with other people.

Radioisotope

If you are having treatment with a radioisotope (liquid), the radioactivity will disappear gradually and you will only need to stay in isolation until the radiation in your body has broken down. Before you leave hospital, the staff will check that most of the radioactivity in your body has gone, and that your belongings are free from any signs of radioactivity. After you leave hospital you should be able to carry on your life almost as normal, but there may be a few restrictions about contact with people – especially children and pregnant women – for a few more days.

Your feelings

People handle their fears in different ways; some want to know everything about their treatment, while others prefer to know as little as possible. If you need any explanations, the staff on the ward will be happy to help you. It often helps to talk to the staff or family and friends about any fears or worries you have. You will probably only be in the single room for a short time, perhaps only one or two days, during which you can read books and magazines, watch TV or listen to the radio.

Brachytherapy

  • Internal radiotherapy for gynaecological cancers
  • Selectron machine
  • Microselectron
  • After the treatment
  • Side effects
  • Possible long term side effects
  • Caesium or irridium wires
  • Brachytherapy for prostate cancer

Internal radiotherapy for gynaecological cancers

Internal (Intracavitary) radiotherapy (often called brachytherapy) gives radiation treatment directly to a particular part of the body. In women it is used for treating cancer of the cervix, womb (uterus) or vagina. It can be used on its own or combined with external radiotherapy. A piece of radioactive material, known as a source, is put close to the area of the cancer. The advantage of internal radiotherapy is that it gives a high dose of radiotherapy directly to the tumour, but a low dose to normal tissues.

The source is placed inside applicators (hollow plastic or metal tubes) which are positioned at the top of the vagina. (Sometimes only one tube is used). This keeps the source in place. The applicators are placed inside the vagina while you are under a general anaesthetic or sedation in the operating room. At the same time, a flexible tube called a urinary catheter may be put into your bladder to drain off urine. This means that during your treatment you won’t have to move around to pass urine (which could dislodge the applicators).

Once the applicators are in place, an x-ray will be taken to check that they are in the correct position. Sometimes the radioactive source is put into the applicators while you are in the operating room, but more commonly it will be put in place once you are back on the ward in your own room. The applicators are kept in place by a pack (cotton/gauze padding) inside your vagina. This can be uncomfortable but you can have regular painkillers to ease any discomfort.

Once the source is in place you have to stay in bed, so that the applicators don’t move out of position. If you need anything, you can call a member of staff by using the buzzer by your bed. If the source does move out of position, you should call the staff on the ward straight away.

Many women find the prospect of this treatment quite worrying. It’s important to talk things through with your specialist so that you understand as much as you need to about what your treatment involves. Some hospitals have specialist nurses who are trained to give advice and support to women having treatment for gynaecological cancer. Ask your specialist what help is available in your hospital.

Selectron machine

In many hospitals a machine called a Selectron, or similar name, is used to put the radioactive material into the applicators. The machine is attached by tubes to the applicators. When the machine is switched on, it passes small radioactive balls into the applicators. If the machine is switched off, the radioactive balls are pulled back inside the machine.

The machine is kept switched on throughout treatment, except when someone needs to go into your room. It can then be turned off, to reduce their exposure to the rays. However, safety measures and visiting restrictions are still necessary. The time you spend on the machine varies, but it is usually between 12–48 hours.

Microselectron

Sometimes a machine called a Microselectron is used for internal radiotherapy. It gives the radiotherapy more quickly, so the treatments last for only a few minutes and you can go home the same day.

After the treatment

Once the complete radiation dose has been given, the source and the applicators will be removed. This is usually done on the ward. As it can be a little uncomfortable, you will be offered some painkillers beforehand. Sometimes a few breaths of the gas Entonox will help you to relax. Staff on the ward will check that all the applicators and sources have been removed. Your catheter may be removed at the same time.

Your specialist may suggest that you use vaginal douches for a few days after the applicator has been removed to keep the vagina clean. Your nurse will tell you how to use these.

You will probably be able to go home the same day, or the following day. Once the radioactive sources are removed, all traces of radioactivity immediately disappear.

Many women are given both internal and external radiotherapy to ensure the cancer is treated in the most effective way.

Side effects

It is not unusual to have slight bleeding or discharge once the radiotherapy treatment has ended. If it continues or becomes heavy it is important to let your doctor or nurse know.

Radiotherapy to the pelvic area can cause side effects such as tiredness, diarrhoea and a burning sensation when passing urine. These side effects can be mild or more troublesome depending on the strength of the radiotherapy dose and the length of your treatment. Your oncologist will be able to advise you what to expect.

Most of these side effects can be treated with medicines, which your oncologist can give to you. Any side effects should gradually disappear once your treatment is over.

It is important that you drink plenty of fluids and maintain a healthy diet during your treatment. If you have diarrhoea you can ask your doctor to prescribe anti-diarrhoea medicines. You may feel sick but this is not common. If you don't feel like eating, you can replace meals with nutritious high- calorie drinks, which are available from most chemists and can be prescribed by your GP. Our booklet on eating well has some helpful tips on eating when you are feeling ill.

Menopause

Unfortunately, radiotherapy for cancer of the cervix affects the ovaries, and brings on the menopause, usually about three months after the treatment starts. This means that your periods will stop and you will have menopausal side effects such as hot flushes, dry skin and possibly loss of concentration. Some women become less interested in sex and notice that their vagina is dry.

You can be protected from menopausal side effects by taking HRT (hormone replacement therapy) as tablets or skin patches. Your gynaecologist may suggest you start on these during the radiotherapy treatment or shortly after it has ended. It’s important to discuss the possible effects of menopause with your specialist so that you can be given appropriate advice and support. An organisation called The Daisy Network can help women who have experienced premature menopause.

Sometimes radiotherapy causes a narrowing of the vagina, which can make sex uncomfortable. This can be distressing but there are things that can be done to help. See our sections sexuality and fertility for advice on how to deal with the effects on your sex life and fertility.

Possible long term side effects

Radiotherapy to the pelvic area can sometimes cause long-term side effects (sometimes called 'late effects'). However, improvements in treatment planning have made these much less likely. In a small number of people, the bowel or bladder may be permanently affected by the radiotherapy. If this happens the increased bowel motions and diarrhoea may continue, or the person may need to pass urine more often than before. The blood vessels in the bowel and bladder can become more fragile after radiotherapy treatment and this can make blood appear in the urine or bowel movements. This can take many months or even years to occur.

If you notice any bleeding it is important to let your doctor know so that tests can be done and appropriate treatment given.

Our section on pelvic radiotherapy in women has information on coping with these side effects.

Some people also find that radiotherapy affects the lymph glands in the pelvic area and can cause swelling of the legs. This is known as lymphoedema. It is more likely if you have had surgery as well as radiotherapy.

Caesium or irridium wires

These can be used to treat a number of types of tumours including those in the mouth, lip, cervix and breast. Very thin radioactive needles, wires or tubes are inserted while you are under general anaesthetic in the operating room.

An x-ray may be taken to ensure that the needles are in the correct position. You will be in a room on your own, and the safety measures will be used until the wires are removed – usually after 3–8 days. Sometimes the wires are removed under a general anaesthetic.

Wires in the mouth can be uncomfortable, and can make eating and talking difficult. You will need to have a soft or liquid diet while they are in place. Your nurse will show you how to keep your mouth clean, using regular mouthwashes. If eating is a problem you may be fed through a thin tube (a nasogastric or NG tube), passed up your nose and down into your stomach.

The wires are removed once the correct dose of radiation has been given. This may be after two days if the treatment is given as a booster following external treatment or up to one week if it is the only type of radiotherapy treatment being given.

Once the wires have been removed, the area will feel sore for up to two or three weeks afterwards. Your specialist will prescribe painkillers that you can take regularly until this improves.

After caesium brachytherapy there is a slight risk of infection, but this is very rare. If you develop a high temperature or heavy bleeding after your treatment, contact your specialist as soon as possible. You will be prescribed antibiotics to treat the infection.

Brachytherapy for prostate cancer

Brachytherapy using radioactive seed implants is sometimes used to treat small tumours of the prostate gland.

Brachytherapy is available in some hospitals in the UK. It is carried out under a general anaesthetic, or sometimes a spinal anaesthetic. Small radioactive metal seeds are placed into the tumour within the prostate gland, and they release small doses of radiation very slowly over a period of time. The seeds are not removed, but stay in the prostate tissue. The radioactivity gradually fades away over approximately a year. The radiation affects only the area a few millimetres around the seeds, so there is no danger of it affecting other people.

Side effects

It is fairly common to feel some soreness and bruising after the seeds are implanted. Your doctor can prescribe painkillers to help.

Some men get blood in their urine, which is quite normal. If you notice a lot of blood you should let your doctor know. It can help to drink plenty of fluids to flush through any blood.

It may be painful to pass urine for a time, or you may need to pass urine more frequently, or have a weaker stream. Up to one in seven men will have difficulty passing urine after brachytherapy. Some men will need to have a catheter inserted for a while. Occasionally the tube that drains urine from the bladder (urethra) will narrow some time later. If this happens, the urethra can often be stretched.

Brachytherapy treatment may cause impotence, and some men may become infertile after treatment.

It’s important to discuss this with your specialist who can advise you about the likely impact of brachytherapy on your sex-life and fertility, and suggest ways of coping.

Our section on early (localised) prostate cancer explains this treatment in more detail. See also our information about the possible late effects of pelvic radiotherapy.

Radioisotopes

Radioisotopes are given as a drink, in capsules that are swallowed, or by injection into a vein (as an intravenous injection). The same safety precautions are taken with this type of treatment as for other types of internal radiotherapy.

Radioactive iodine

The most common type of radioisotope treatment is radioactive iodine. It is used to treat tumours of the thyroid gland, and is given as capsules.

Any radioactive iodine that is not absorbed by the thyroid will be passed from the body in sweat and urine. You need to drink plenty of fluids during your treatment as this helps to flush the iodine out of the body. The amount of radiation in your body will be checked regularly and as soon as it falls to a safe level, after about four to seven days, you will be able to go home. You may need to take some special precautions after going home – you may need to avoid young children and pregnant women for a short time. The hospital staff will explain this to you.

Radioactive iodine doesn't usually cause side effects, but you may feel very tired for a few weeks after having this treatment.

Treating secondary bone cancer

Radioisotope treatment can also be given if certain types of cancer have spread to the bones (secondary cancer in the bone). A radioisotope is injected into a vein. You can be given it as an outpatient. Before you go home you will be given some simple advice to follow, as your urine and blood will be slightly radioactive for a few days. You may feel tired for a few weeks, but this type of radiotherapy treatment does not usually cause any other side effects.

You can read more about these treatments in our booklets on thyroid cancer and secondary bone cancer.

Follow-up after radiotherapy treatment

After your treatment has finished you will have regular follow-up appointments. These may be at the radiotherapy department or at your original hospital. The positive effects of radiotherapy may take some time to show. People sometimes expect to be given an x-ray or a scan at the end of their treatment to see if it has worked. However, in many cases the tumour may take some time to shrink and the radiotherapy may cause some inflammation, which means that x-rays and scans may not be helpful at this time.

How often you have check-ups will vary depending on your type of cancer and from one hospital to another, but as time goes by they will become less frequent. Your specialist will keep in contact with your own family doctor so they will know about your progress. Follow-up appointments are a good opportunity to discuss any problems or worries you may have. It may help to make a list beforehand so that you don't forget anything important.

If you have any problems, or notice any new symptoms in between these times, let your doctor know as soon as possible. You don't have to wait until your next scheduled appointment – just ask for an earlier one.

Many people find that they get very anxious for a while before their appointments. This is natural and it may help to get support from family, friends or a support organisation.

Emotional effects

Sometimes the hardest time to cope with is when treatment is finished and you, and everyone else, see this as the time to get back to normal. Recovery time varies, and no one can say for sure how long you will take to get over the physical and emotional side effects.

The end of the visits to hospital for treatment can leave you feeling alone and neglected. Many people find that they feel very low and emotional at this time, when they had expected to be able to put the cancer and the treatment behind them. This may be the time when you need most support.

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