What is radiotherapy?
Radiotherapy is the treatment of cancer
(malignant disease) using exact, carefully measured doses of radiation.
Usually, several beams of radiation are carefully and accurately directed
to a specific area of the body. Each beam is called a radiotherapy "field".
The point at which all the beams (fields) meet is
where the highest dose of radiotherapy is given. You will hear the radiographers
and doctors talk about fields.
Radiotherapy is painless and is similar to having
an x-ray picture taken. A similar radiation is used, but in radiotherapy
it is more penetrating.
Radiotherapy may be used for:
Curative (radical) treatment
In radical cases the aim is to cure the cancer so higher doses of
radiotherapy are given, aiming to completely eradicate the tumour. This
has to be spread over a longer period, often four to six weeks, to allow
normal healthy cells to appear.
Palliative means that radiotherapy is given to
relieve local symptoms such as pain or bleeding. It is usually given
over a short period of time, either on one day or one to three weeks.
Radiotherapy is given before surgery to shrink
the tumour or reduce the risk of spread during surgery.
Adjuvant or "post-operative" treatment
Radiotherapy is given after surgery to destroy
any tiny amounts of tumour cells that may have been left after surgery.
Total body irradiation
Radiotherapy is given to the whole body to destroy the bone marrow
cells prior to having a bone marrow transplant.
Total skin electron radiotherapy
Radiotherapy is given to the whole body to treat certain superficial
Radiotherapy works because tumour cells are more
sensitive than normal cells, and so are damaged by the radiation. The normal
healthy cells are also damaged, and this is what causes side effects , but
they are able to repair and heal themselves.
External beam radiotherapy DOES NOT make you
radioactive and it is quite safe to be with other people including children,
during your course of treatment.
What is Radiotherapy Treatment Planning?
Treatment planning identifies the exact area to be
treated and the most effective dose of radiation you should receive. The
radiation is restricted to the tumour so healthy tissue is exposed to as
little radiatin as possible. Planning sessions may last up to an hour and
you will need to lie still.
Planning takes place in either a Simulator or
CT Sim Scanner. A simulator is an x-ray imaging machine which can
imitate the radiotherapy treatment machine. You will lie on a couch in the
chosen treatment position. The simulator is moved around you to take pictures,
but it does NOT touch you.
Lights are dimmed so that laser lights and field
lights (indicating the area to be treated) can be seen. Exact, careful measurements
are taken and recorded. This record means the treatment radiographers can
chek you are lying in the correct position each time you have treatment,
and that the radiation is directed to the same exact area each day.
Once the treatment area for radiotherapy has been
finalised, temporary ink marks will be drawn on to your skin. You will be
asked not to wash these marks off whilst you are having treatment. They
may fade, but the radiographers will re-mark them when necessary. Do
not try to redraw them yourself.
Permanent dots (tattoos) will also be made
on your skin, with your permission, by putting a pin prick of ink under
the skin. Then, if the pen marks are washed off your skin, the treatment
radiographers will have an exact reference mark to set up to, to deliver
Some patients will need to have a plastic mould made
to fit the part of the body being treated. The moulds are made to ensure
that you are in the correct position for treatment, and allow pen marks
to be made on the mould rather than on your body. You will only wear the
mould for a short time during your treatment.
They are made of clear, lightweight plastic and fit
closely, but comfortably over the area being treated.
Your First Day of Treatment
It is quite normal to feel anxious on your first
day of treatment. If you are worried about the radiotherapy, please tell
the staff, they are there to help you. Once treatment starts, you will be
Once in the treatment room, you will see the LINAC
machine (linear accelerator). You will need to lie on the couch as
before when you had planning. The radiographers use laser lights to align
you on the couch, then darken the room to see another light which indicates
the area to be treated.
When the radiographers are satisfied that everything
is correct and they have completed their checks they will leave the room,
and you will hear a buzzing noise as they leave. This is only an interlock
alarm which informs the machine that it is safe to switch on. You are in
the room on your own whilst treatment is on, but the radiographers are watching
you all the time on a closed circuit television. If you need them, just
wave your hand and they will interrupt the treatment and come in to you
They return to the room after each treatment beam
and move the machine to set up the next one. In some cases the radiographers
do not enter the room until all treatment beams have been completed, and
they control the movement of the machine
After a few minutes your treatment will be over for
that day. This routine will go on each day until your course of treatment
The Effects of Radiotherapy
Any side effects will depend on several factors:
The area of the body to be treated
The radiation dose used and timescales over which
it is delivered
Any previous or concurrent chemotherapy
The condition of the patient
Side effects tend to become more evident as treatment
goes on and will probably be at a peak just after the course has finished.
The effects will start to subside a few weeks later. Side effects are carefully
monitored during treatment and advice and medication will be available from
the staff of the radiotherapy team. There are also precautions you, as the
patient, can take to minimise these side effects. (See How
to Help Yourself section).
Some people feel quite emotional, upset or anxious
- this is normal. Fear of the unknown is common, so find out as much as
possible about your treatment to reduce these feelings. Remember that you
are not alone, there are people to help you, talk to your medical team,
or family and friends.
Some of the side effects you may experience are as
follows. You will be advised by your radiographers abour treatment side
effects and how to minimise them.
your skin in the treatment area can become red,
dry, itchy and inflamed, especally towards the end of your course of
treatment. This may even increase for a week or two after your treatment
has finished (your tissues continue to be affected by the x-rays for
several weeks). The radiographers and nurses will advise you on skin
care and provide you with leaflets. It is important to follow their
advice even if you are not experiencing discomfort.
is the most common side effect of radiation. Thehood that you will experience fatigue is based in part on your
illness, in part on the frequency of radiation treatments, and in part
of the specifics of your radiation therapy. Fatigue should go away after
treatments are finished but it can take weeks or months until it is
Loss of appetite and taste
you may find that foods you once liked are no
longer appetising, but eating well will help your body heal and help
maintain your energy levels. Eating four or five small meals during
the day may be more comfortable for you than eating two or three large
ones. Your doctor and medical team can provide you with booklets and
other ideas to help you maintain your nutritional status.
if you receive radiation to the neck, throat or
chest you may experience a sore throat, dry mouth, nausea or cough.
You may have difficulty eating and swallowing, especially toward the
end of the treatment. Let your doctor know if you have difficulty swallowing.
There are treatments that can help with the discomfort. Difficulty in
swallowing will usually go away in the months following therapy.
a temporary decrease in the production of saliva
during radiation therapy may cause patients to experience dry mouth.
This condition is called xerostomia. Saliva helps prevent cavities,
so you may be advised to visit the dentist before radiation.
may occur after the first radiation treatment,
especially in patients who have radiation to the abdomen. Some people
can avoid nausea if they do not eat in the hours before radiation, especially
sweet, spicy or fatty foods. You may also want to schedule your radiation
visits to the end of the day so you can be home if nausea develops.
If nausea should become a problem, ask your doctor about taking a medication
that prevents nausea (an antiemetic) before each session of radiotherapy.
may occur through radiation. Unlike chemotherapy,
hair loss occurs only on the specific area of the body that receives
radiation. This hair loss is generally temporary, but my be permanent
(specially with higher doses of radiation).
How to help yourself during
You are likely to receive written instructions on
skin care and other precautions from your medical team whilst on radiotherapy.
Be sure to follow these instructions carefully and always ask if there is
anything worrying you regarding your treatment.
Apply the recommended cream gently to the area
treated and make sure there isn't a layer of cream on your skin when
having your treatment.
Use a mild or baby soap in the treatment area
and tepid water. Don't rub your skin, but gently pat the area dry with
a soft towel.
DO NOT USE any perfume, deodorant, powders,
soaps, lotions, shower creams on the radiotherapy site during your treatment
and until any skin reaction has subsided.
DO NOT use sticking plasters or micropore
in the radiotherapy area.
Only use electric shavers in the treatment area,
and only if shaving is necessary. Try to avoid if possible.
Use loose clothing and natural fibres next to
your skin to minimise skin irritations.
Avoid exposing the treated area to sunlight during
and after treatment.
Avoid temperature extremes, such as ice packs
and heat pads.
Try to keep the treated area covered. If you
are exposing the area to sunlight use a high factor sunscreen.
Further tips you may find useful are:
Ensure your fluid intake is at least 2-3 litres
a day to help your body function normally.
Avoid spicy and coarse foods (e.g. nuts and raw
vegetables) if your mouth is sore. Alcohol will also make your mouth
sting, as will hot and cold foods.
If eating large meals fills you with dread, try
smaller meals more frequently instead.
If your blood count lowers due to radiotherapy,
you will increase your risk of catching infections until it recovers.
Continue with your daily routine as much as possible.
Make sure you plan a rest period during the day though. Tiredness will
build up towards the end of treatment.
If anything worries or concerns you, please seak
to your medical team, or the nurses or doctors at the hospital. They
will do all they can to help you.