How radiotherapy is performed

Radio­ther­apy is only used if the bene­fits out­weigh the risks. Your treat­ment team will dis­cuss the risks of any radio­ther­apy pro­ced­ures that are recom­men­ded for you. Before hav­ing radio­ther­apy, you will be asked to sign a con­sent form to con­firm that you agree to the treat­ment. The con­sent form will also out­line any risks asso­ci­ated with the treatment.

First, a patient has to be pre­pared so that they can lie in the same pos­i­tion for treat­ment. Usu­ally, a patient has a scan in the treat­ment pos­i­tion and the doc­tor out­lines the tumour tar­get to be treated and also iden­ti­fies the body organs to avoid (the kid­neys or liver, for example). When treat­ment starts there are a lot of checks. 

For pal­li­at­ive treat­ment (to relieve symp­toms in patients with an incur­able dis­ease), it may be a short course over a week or a single attendance.

Rad­ical treat­ment that aims to cure the patient usu­ally goes on for four to seven weeks, involving treat­ment every day, and the patient will be on the treat­ment machine for about 10 minutes. 

Your radio­ther­apy will be care­fully planned. This is to make sure the radio­ther­apy des­troys as many can­cer­ous cells as pos­sible, while affect­ing as few healthy cells as possible.

The amount of radio­ther­apy you have will depend on:

• where the can­cer is in your body,
• the type and size of the can­cer, and
• your gen­eral state of health.

In plan­ning your treat­ment, a radio­ther­ap­ist (radio­ther­apy spe­cial­ist) will use all the inform­a­tion gathered dur­ing your dia­gnosis. They may also carry out some addi­tional tests to find out more about the size of the can­cer and to get a clearer under­stand­ing of the area of your body to be treated.

Once your radio­ther­ap­ist has all the rel­ev­ant inform­a­tion, they will cal­cu­late the total dose of radio­ther­apy you need and the num­ber of indi­vidual doses (fractions).

If you are hav­ing external radio­ther­apy, a sim­u­lator machine will be used as part of your treat­ment plan­ning. The sim­u­lator moves in the same way as the machine that will be used for your treatment. It uses X-rays to take pic­tures so that the radio­grapher (a health pro­fes­sional trained in tak­ing X-rays) knows how to pos­i­tion your body when you have your treatment.

After the exact area of your body to be treated has been estab­lished, the radio­grapher will put ink mark­ings on your skin. This is to ensure the same area is treated each time.

If you are hav­ing external radio­ther­apy to your head or neck or if you find it dif­fi­cult to keep the part of your body still, a plastic mould will be made for you to wear dur­ing treat­ment. In this case, the ink mark­ings will be made on the mould, not on your skin.

External radio­ther­apy

If you are hav­ing external radio­ther­apy, you will usu­ally receive your treat­ment as an out­pa­tient (you will not have to stay in hos­pital overnight). You may need to stay in hos­pital if you are hav­ing chemo­ther­apy in com­bin­a­tion with radio­ther­apy or if you’re unwell.

Dur­ing the pro­ced­ure, you will be posi­tioned on a treat­ment table and a radio­ther­apy machine will dir­ect high-energy rays at the area being treated. You’ll need to keep as still as pos­sible through­out the treat­ment. The pro­ced­ure only takes a few minutes and is com­pletely painless.

While you are receiv­ing treat­ment, you will be left alone in the treat­ment room. A radio­grapher will oper­ate the machine from an adjoin­ing room and will watch you through a win­dow or using closed cir­cuit tele­vi­sion. You can talk to them through­out the pro­ced­ure using an intercom.

The radio­grapher will not be in the treat­ment room with you because expos­ure to radi­ation over a num­ber of years could be damaging.

Internal radio­ther­apy

Internal radio­ther­apy can be given as an implant, drink or injec­tion. Depend­ing on the type of treat­ment being used, you may need a short stay in hospital.

If you are hav­ing a radio­act­ive implant, you will prob­ably need to stay in hos­pital for a few days until the radio­act­ive source is removed. Once the implant has been removed, you’re not a risk to others.

Per­man­ent implants don not present a risk because they pro­duce a very small amount of radi­ation which gradu­ally decreases over time.

After hav­ing liquid radio­ther­apy, you may be radio­act­ive for a few days. Although this will not cause any long-term harm to your body, you will prob­ably have to stay in hos­pital until the radio­activ­ity decreases. This is a pre­cau­tion­ary meas­ure to reduce other peoples expos­ure to radiation.

Once the level of radi­ation has fallen to a safe level, you can leave hospital. Your treat­ment team may give you some safety advice to fol­low for a few days when you get home.

If there is any­thing that you are not sure about or you do not under­stand, ask a mem­ber of your treat­ment team to explain it to you in more detail.

Recov­er­ing from radiotherapy

Most side effects only last a few days or weeks after radio­ther­apy. How­ever, some side effects, such as tired­ness or hair loss, can last for a few months.

Follow-up appoint­ments

After your radio­ther­apy has fin­ished, you will have an appoint­ment with your radio­ther­ap­ist to check on your pro­gress. Follow-up appoint­ments may con­tinue for sev­eral years but will be less fre­quent as time goes on.

The tim­ing of follow-up appoint­ments will depend on whether you are hav­ing fur­ther treat­ment and whether or not the radio­ther­apy has been successful.

Your doc­tor will be sent a report about your treat­ment and you will be able to con­tact a mem­ber of your treat­ment team if you have any ques­tions or issues in between your follow-up appointments.

Effects of radiotherapy

The pos­it­ive effects of radio­ther­apy usu­ally take some time to show. Res­ults depend on the con­di­tion you have and the stage it was at when treat­ment began.

The effect­ive­ness of your treat­ment may depend on whether you are hav­ing other treat­ment along­side radio­ther­apy, such as chemo­ther­apy or surgery.