RADIOTHERAPY

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 treatment
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.
Neoadjuvant treatment
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 skin lesions.

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 your treatment.

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 more relaxed.

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 immediately.

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 is finished.

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.

Sore Skin
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.
Fatigue
is the most common side effect of radiation. The likelihood 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 completely gone.
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.
Throat irritation
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.
Dry mouth
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.
Nausea
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.
Hair loss
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 Radiotherapy

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 speak to your medical team, or the nurses or doctors at the hospital. They will do all they can to help you.