Radiotherapy Treatment Areas

Radiotherapy for symptom relief

Radiotherapy can be given to treat symptoms that are causing you problems. This can be used for brain tumors that start in the brain (primary brain tumors) or cancers that have spread to the brain   (secondary brain tumors — also known as brain metastases). These symptoms are caused when the growth of the tumor presses

on nerves and surrounding tissues. Radiotherapy helps to relieve symptoms by controlling the growth of the tumor(s), and sometimes, the tumor(s) may shrink for a while. However, short-course radiotherapy is a type of palliative treatment and will not  be able to ‘cure’ the tumour(s). Short-course radiotherapy involves 5 to 15 treatments over 1 to 3 weeks. Each treatment will last for about 10 to 15 minutes. You will be able to go home after every treatment.

Prophylactic Cranial Irradiation (PCI)

Some patients with cancers such as lung cancer or leukaemia are offered radiotherapy to the brain to try and reduce the chance of the cancer spreading to the brain in the future. You will normally  have this treatment over 2 to 3 weeks.

Radiotherapy planning

Before you start your course of radiotherapy, you will be asked to attend the radiotherapy department for your radiotherapy planning appointment so the team can begin to prepare your treatment.

At the planning appointment, you will go to the mold room, where we will make a mask for you. The mask is individually made to fit you and needs to be worn at each stage of your radiotherapy planning and treatment. The mask will keep your head still during  the radiotherapy treatments to make sure the treatment is delivered accurately to the area the doctor has planned to treat.

To make the mask, the therapeutic radiographer will warm a flat piece of plastic until it is soft and then lay it onto your head so it shapes to your face exactly. It may be a little warm, but this process isn't uncomfortable. There are holes in the plastic so you can breathe  comfortably. Once the plastic has cooled and hardened (which takes a few minutes), the radiographer takes it off. The mask is then ready to  be used. Any marks to guide the therapeutic radiographer can be drawn on the mask.

 

 

 

You will then have a planning CT scan. This scan will provide  accurate information for your radiotherapy team so that they can plan your treatment.

During these scans, you may need to have an injection of contrast (a type of dye) to help show up the tumor more clearly. If you have ever had an allergic reaction to dye given during a scan  before, please let the radiographer know when you come to this appointment.

Treatment

On the first day of your radiotherapy treatment, a therapeutic radiographer will collect you from the waiting room and take you to a sideroom where there will be an opportunity for discussion before your treatment starts. We would encourage you to let us know about any particular problems or worries you may   be experiencing so that we can best support you.

During your treatment, you will need to lie on your back on the treatment couch, wearing your mask.

The therapeutic radiographers will move the couch and the treatment machine into position. They will use lights and lasers to position you accurately. Your treatment will be specific to you and may not be like the treatment of a fellow  patient. The treatment machine may come close to you, but it will not touch you.

When you are in the correct position, the therapeutic radiographers will leave the room to start your treatment. You will have to lie still and breathe normally. The team will be watching you on cameras from outside the treatment room. If you want them to come back in, just raise your hand. You will not feel any pain or discomfort during  treatment

 

 

Possible short-term side effects 

Radiotherapy treatment is painless. However, there are some side  effects that are associated with radiotherapy, and you may notice one  or more of them gradually developing over the course of treatment.

Please note that it is rare for one patient to experience all of these side effects.

If anything is worrying you, however small, during your treatment, please tell your therapeutic radiographer or radiotherapy specialist nurse, either at your visit or by phoning the radiotherapy   department.

Tiredness (fatigue)

You may feel a buildup of tiredness during your radiotherapy treatment and for a few weeks after the treatment has finished. This can often be made worse by a combination of other things, such as recovering from surgery, chemotherapy, or other medications and travelling for hospital appointments. Patients often notice that this tiredness worsens and is at its most severe at around 6 to 8 weeks after finishing the treatment.

Tiredness is the most common side effect of radiotherapy. You can  help yourself by keeping well hydrated and taking frequent rest. We encourage  you to maintain a healthy, balanced diet and continue with your usual activities and light exercise if you are able. Please do tell us if you are experiencing tiredness or any other side effects. It will help us to provide you with the correct advice and support.

Skin reaction

Radiotherapy may cause the skin around the area being treated to  become red, itchy, and dry. Your treatment team can advise you on where this is likely to happen, as skin reactions can differ from person to person.

If you have had surgery in this area less than 6 weeks ago and your wound has not completely healed, we advise that you do not use any skincare products on this area at all.

If you have had surgery in this area more than 6 weeks ago and your wound is completely healed, you may wish to gently apply a moisturizer on this area to relieve the dryness or itching caused by your radiotherapy.  

During your radiotherapy and until 3 months after your radiotherapy has finished:

Wash your hair with your normal shampoo and lukewarm water. Do not  use hair dye or any styling products such as hairspray, and avoid excessive heat from styling equipment such as hair dryers.

During your radiotherapy and in the future:

The skin in the area receiving radiotherapy will always be more sensitive to the sun, even many years after your treatment has finished. We recommend that you wear a hat or cover up in the sun and/or use a high-factor sunscreen on the area. Do not apply

sunscreen if you have had surgery in this area less than 6 weeks ago or if your surgical wound has not completely healed.

It is very important that if you notice any discharge, swelling, or redness at the site of your surgical wound, you tell your treatment team as soon as possible.

Hairloss

There is a possibility that you may lose some hair close to the area that is receiving the radiotherapy treatment.

Your doctor or therapeutic radiographer will explain where to expect some hair loss. Hair loss starts around 3 weeks after the start of radiotherapy. Any hair regrowth usually starts 4-5 months after you have finished treatment. It is unlikely you will have significant permanent hair loss, although hair regrowth after treatment may be patchy or a different color or texture than the hair that was there  before.

Your nurse or therapeutic radiographer can give you information on how to cope with hair loss after radiotherapy. You may wish  to arrange to wear a wig, and your team can help to organize this. Your team can also talk you through other options, such as headscarves, which you may like to consider.

Other side effects

You may have already experienced headaches, nausea, and changes to your vision or limb weakness, and you may have been given a   course of (steroid) tablets to help these symptoms.

However, radiotherapy may cause some of these symptoms to return or to become worse. This is because radiotherapy can cause some temporary swelling of the brain.

If you experience these side effects during the treatment, then please tell your therapeutic radiographer or contact the oncology nurse service outside of the radiotherapy department opening hours.

They may arrange for you to see a doctor. Your medication may need to be adjusted to control these symptoms during your   treatment.

Psychological wellbeing

The radiotherapy team is here to support you with the psychological and emotional impact of your diagnosis and treatment.

A member of the team would be happy to chat to you about your emotional well-being at any time.

After treatment

4-6 weeks after completing your treatment, you will be reviewed by your clinical oncologist or a member of their team. Radiotherapy takes time to work, and so it is at this appointment your doctor will assess and discuss your progress and how you have been feeling since your treatment finished. Your doctor will also plan future  appointments with you, if needed.

Who will I see during my treatment?

You may regularly see other professionals during your treatment; these may include:

• Specialist Therapeutic Radiographers

• Dosimetrists and Medical Physics Experts

• Mould Room Technicians

• Clinical Oncologists

• Oncology Doctors/Registrars

• Clinical Nurse Specialists

• Dietitians

• Speech and Language Therapists

• Cancer Support Workers

 

Radiotherapy planning 

There are several stages involved in getting you ready for your radiotherapy and getting your radiotherapy ready for you.

 

Dental

If your jaw bone will be in the treatment area, you will need an X-ray and dental assessment before your radiotherapy planning can begin. 

You may need to have some teeth removed before your radiotherapy planning; the dentist will let you know if this is the case.

Even if you do not have any teeth, you may still need an assessment to check for any remaining roots.

The swelling from any extractions will need to have settled before the next stage can begin, and all dental sockets from extractions should be well healed.

 

Feeding tube (gastrostomy)

Having radiotherapy to the head and neck area may make swallowing very painful for you.

Your oncologist and dietitian may recommend that you have a gastrostomy tube inserted before your treatment begins to help support your nutrition. Not all patients will need one; your oncologist will discuss this with you.

A gastrostomy is a way of delivering food, fluids, and medicines directly into the stomach by inserting a thin tube through the skin and into the stomach. This procedure may involve an overnight stay in the hospital. The tube can be hidden underneath your clothing but will require some daily care and attention.

Alternatively, if you are unsuitable for a gastrostomy or choose not to have one and it becomes too difficult to swallow during your treatment, it may be recommended that you are admitted to the hospital for the placement of a nasogastric tube (NGT)

A NGT is a soft tube that is placed through your nostril, down the back of the throat, and into your stomach. It can provide nutrients and medication while you are finding swallowing difficult. It is less invasive than a gastrostomy, but it can be seen and requires more care and attention.

 

Mask - treatment planning appointment

 

 

A shell or mask will be made to help you keep your head still during treatment. You will be placed in the treatment position, usually on your back, with your arms by your sides. 

If you find this uncomfortable, please do not hesitate to tell one of the team, as they may be able to change your position.

The plastic sheet of material used to make your mask will have been warmed in a water bath, so it becomes very flexible. It will then be laid across your face and neck and gently pressed into position around your facial features.

The plastic will feel warm and damp against your skin, but it should not feel uncomfortable. Your mouth and nose will be covered, but you will be able to breathe normally through the holes in the plastic.

A well-fitting shell can be difficult to make if you have long hair, a beard, or a moustache, so you may be asked to tie your hair back. You may also be asked to shave any facial hair before your planning appointment.

Once the shell or mask has been made, you will then have a CT scan while wearing the shell. This scan is used to plan your treatment accurately.

Depending on the area being treated, you may also need a ‘mouth bite.' This is a mould of your teeth with a tube through the middle that you can breathe through. This is to keep your mouth open and your tongue in the same place every day while you have your treatment.

CT Scan

 

 

 

To plan your treatment, a CT scan is needed. This is usually done on the same day that the mask is made. Depending on the area being treated, the radiographers may need to inject a dye (contrast) into a vein in your hand or arm that shows up on the scan.

The radiographers will get you in the same position as when you had your mask made and take a scan. This scan is for the sole purpose of planning your radiotherapy, and there will not be any results available.

Please bring a list of any medicines you are currently taking to this appointment.

 

Radiotherapy treatment

The first day of treatment is usually a little longer than the others, as the team has to do extra checks to make sure that everything is correct. 

The radiographers will place you on the treatment couch in the same position you were scanned in. They will put your mask on, which is then clipped to the bed in the same way as when you were scanned.

 

 

Your mask may be a little tighter than it was originally, as it can shrink slightly as it sets in the days following it being made. 

If you feel you need to come out of the mask at any time, wave your hand to alert the radiographers.

 

Once you are in the correct position, the radiographers will check some measurements and then leave the room, where they will operate the machine from outside. They are watching you at all times on CCTV cameras.

When the machine is on, you may hear some noises coming from it, but the treatment itself will be painless.

Over the course of your treatment, X-rays will be taken regularly to confirm your position and to evaluate any potential weight loss or change in shape that may affect your treatment plan. 

 

Side-effects of radiotherapy to the head and neck

Most side effects from radiotherapy are predictable, expected, and temporary (short-term side effects), while other side effects can be chronic (long-term). Everyone is different, so you may find that you experience some or all of these symptoms. Likewise, you may recover very quickly, or it may take a while longer.

 

Short-term side-effects

Radiotherapy has a delayed effect; this means that you usually do not notice any side effects until the end of the second week of treatment. Side effects usually start off mild and slowly build up during the course of your treatment. They most commonly include:

Tiredness/fatigue

Some patients may find that they feel more tired than usual during treatment (often after 2 to 3 weeks).

Travelling to your radiotherapy appointments may also add to this. It is important that you continue with your normal activities and routines as much as possible. Try to find a sensible balance between rest and activity.

Sore skin in the treatment area 

Your skin in the treated area will become pink or red as your treatment progresses. It is also likely that the skin will get very sore and may peel or blister, which will become painful and uncomfortable. Please read the ‘Self-care during radiotherapy’ section for information on how to care for your skin.

Hair loss in the treatment area 

Hair loss is anticipated during most types of radiotherapy to the head and neck area.  This usually happens after 2 to 3 weeks of treatment. Hair regrowth usually begins a few weeks after treatment. Sometimes, new hair can be different in colour or texture than it was before. Occasionally, hair loss can be permanent.

Dry mouth

If all your salivary glands have been treated with radiotherapy, there is a risk of a permanently dry mouth. Most people find sipping water and chewing sugar-free gum can help. Dryness can increase the risk of developing oral thrush, so it is important to keep the oral cavity moist. Other products to help relieve dryness are available; speak with your radiographers or specialist nurse for further advice.

Mouth ulcers/sore throat

The radiotherapy treatment will make your mouth and throat very sore, and you may develop ulcers. This can be relieved with pain relief medication, but the team looking after you will monitor and advise you.

Difficulty swallowing/oesophagitis 

Radiotherapy to the head and neck area often causes swelling and soreness of the throat. This can make swallowing and therefore eating more difficult and painful. Your radiographer or specialist nurse will be able to arrange pain medication for you to help with this. You will have support from a specialist Speech and Language Therapist and dietitian who can advise and help you. The Speech and Language Therapist can assess your swallowing function and recommend strategies to improve safety. It is important to use your swallow as much as possible during treatment to help reduce the chance of long-term swallowing problems.

Sticky saliva/excess mucus

Your saliva will become thicker and stickier leading to a dry mouth and throat. This can make eating, drinking, speaking and swallowing difficult.

Oral thrush

During treatment you will be at risk of developing oral infection (thrush). Your mouth will be regularly checked for this but you must tell a radiographer if you notice any changes.

Change/loss of sense of taste

Many patients suffer from changes in taste, sometimes alongside a metallic taste in their mouth. Your taste should gradually return but this can take 6 to 12 months after treatment has finished. Occasionally, your taste never completely returns to normal.

Change/loss of voice 

Your voice may change and lose some of its strength while having treatment. It can also become painful to speak. It is important to keep well-hydrated to protect your voice. Please make sure that you sip water regularly throughout the day.

Change/loss of hearing

Hearing can change while having treatment. This includes loss of hearing and tinnitus, which can take several months after treatment to return. Soreness, inflammation and swelling of the ear and in some cases weeping, may happen if it is within the treatment area. This will take a few weeks after treatment to improve.

Sore/watery eyes

You may develop sore, inflamed or watery eyes if the treatment area includes or is close to your eye(s). Let the treatment team know if you notice any changes.

Nasal crusting

Your nose may become sore, dry or develop crusting if it is in or near the treatment area.

Lymphoedema

Radiotherapy to the head and neck area may cause a build-up of fluid (lymphoedema) in the area being treated. If you notice any swelling it is important that you inform the radiographers or your specialist nurse. You may be referred to a lymphoedema specialist. Following the skin care guidance (later in this leaflet) can help minimise and manage any lymphoedema.

Other side effects may include a cough, loss of appetite, changes in or loss of smell, nausea and/or vomiting, anxiety or low mood, and dehydration.

The side-effects you experience will depend on the dose, area being treated, and whether you have had or are having chemotherapy and/or surgery. Your oncologist, radiographers and specialist nurse will go through what you can expect in more detail, and you will receive a copy of your consent form with all possible side effects listed.

Long-term side-effects

Some side-effects may occur months or years after treatment has finished. These are less common but often permanent and may include:

• Tiredness/fatigue - this may take up to a year to fully recover.

• Dry mouth - saliva production may never fully recover.

• Thick oral secretions.

• Difficulty swallowing, including an increased risk of food or drink ‘going the wrong way ‘(aspiration).

• Aspirating - food or fluid pass into the lungs rather than stomach.

• Damage to the jaw bone (osteoradionecrosis).

• Trismus - difficulty opening your mouth.

• Changes in the skin.

• Lymphoedema - fluid build up.

• Cataracts.

• Hypothyroidism.

• Increased risk of stroke.

• Brachial plexopathy - damage to the nerves leading to the arm. 

As the treatment involves using radiation, there is a very rare risk that it may cause another cancer within the area treated in the future. 

Other potential late effects include permanent taste changes, hair loss, dental problems, permanent dryness of the nose or nasal crusting, long term voice changes, dry eye and/or visual changes, loss of smell, hearing changes, pituitary dysfunction and delayed healing of the skin. It will be noted on your consent form which of these will apply to you. 

 

Self-care during radiotherapy

Skin care in the treatment area

Moisturise frequently; gently smooth it onto your skin until it is absorbed. Do not rub.

Continue to use the moisturiser you prefer and like to use - if you do not currently use one, speak with the radiographer or your Cancer Nurse Specialist (CNS) and they will be able to suggest some options.

• Do not apply moisturiser immediately before treatment.

• If a moisturiser is causing irritation, stop using it and discuss it with a radiographer or your CNS.

• If your skin blisters or peels, stop using moisturiser in that particular area and seek advice from a radiographer or your CNS.

• Avoid sun exposure to the treatment area - wear a brimmed hat and/or cover up with clothing.

• Please avoid rubbing the area, using sticky tape, wet shaving, wearing make-up and using wax, hair removal cream or lasers.

Health and wellbeing

• Keep well hydrated - aim to drink 2 litres (4 pints) of water a day, or put through your feeding tube.

• Avoid drinking alcohol.

• Eat a nutritionally well-balanced diet. If you are struggling to eat, a dietitian can advise you on how to add extra nourishment to your food, adapting the texture of your diet and high energy and high protein options. They can also arrange a prescription for nutritional supplements, such as high calorie drinks to help keep your weight up.

• It is important to try to maintain your weight during treatment. This will help to make sure that your mask fits well and should minimise any interruptions to your treatment.

• Keep active if you can - activity helps to improve outcomes and help you cope better with side-effects.

Mouth care

• Brush your teeth and gums regularly with a soft toothbrush - you may need to use high fluoride toothpaste; this will be provided for you if needed. Once treatment is complete, you will need to get this toothpaste from your dentist or GP on repeat prescription. The high fluoride toothpaste is likely to be required for life.

• You may be provided with mouth wash or mouth care products - use these regularly to help keep your mouth moist and clean.

• Pay attention to what is happening in your mouth; let your treatment team know if you begin to get ulcers or notice any changes.

Smoking

• Smoking can reduce the effectiveness of your treatment and make your side-effects worse.

• It is advised that you try to stop smoking before your treatment. If you would like help with this, please speak to your treatment team who can put you in touch with your local support.

 

Treatment reviews

You will be reviewed regularly throughout your treatment. This may be by your oncologist, dietitian, speech and language therapist, clinical nurse specialist or radiographer. The frequency of reviews will vary.

Your progress will be monitored to make sure you have everything you need to get you through the treatment.

You DO NOT need to wait for these appointments to report any problems - please keep your radiographers updated of any issues.

 

After radiotherapy

Radiotherapy has a delayed effect in which the side-effects will continue even after your treatment has finished. They tend to reach their peak around 7 to 14 days after your last radiotherapy session, so do not be alarmed if they worsen.

Recovery times vary from person to person but side-effects should gradually improve over the following 6 to 12 weeks.

Your skin may develop a shiny appearance, sometimes with the appearance of broken blood vessels (telangiectasia). It is likely to be drier than it was before treatment so continue to moisturise regularly.

Your skin in the area treated will be more sensitive to the sun than it was previously. Make sure that you keep the area covered or use SPF 50+ sunscreen for at least a year after treatment.

In the weeks following your treatment, you will be reviewed by the specialists that have been looking after you. This will vary depending on your diagnosis and treatment regimen, but you will be advised about this by your treatment team.

Although all patients are glad to have finished their course of radiotherapy, it is quite normal to feel anxious as to what happens next. Please do not feel abandoned; if at any time between appointments you are concerned about anything, please contact your CNS, the radiotherapy department or your GP. They will be able to advise about any concerns you may have or arrange to see you if needed.

If you need urgent help out of normal working hours, please contact NHS 111 for advice.

 

 

Radiotherapy for breast cancer after surgery

Common conditions:

• Early breast cancer

• Locally advanced breast cancer

• Post-mastectomy treatment

Common side effects:

• Skin redness and irritation

• Breast swelling

• Fatigue

• Breast firmness or shrinkage

Radiotherapy for lung cancer and chest metastases

Common conditions:

• Non-small cell lung cancer

• Small cell lung cancer

• Chest metastases

Common side effects:

• Fatigue

• Chest pain or discomfort

• Difficulty swallowing

• Cough

Radiotherapy for abdominal cancers including liver, pancreas, and stomach

Common conditions

• Pancreatic cancer

• Liver cancer

• Stomach cancer

• Bile duct cancer

Common side effects

• Nausea and vomiting

• Loss of appetite

• Fatigue

• Diarrhea

Radiotherapy for prostate, bladder, cervical, and other pelvic cancers

Common conditions:

• Prostate cancer

• Bladder cancer

• Cervical cancer

• Rectal cancer

Common side effects:

• Bladder irritation

• Diarrhea

• Fatigue

• Changes in sexual function