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.

What are the benefits of radiotherapy?

The benefits of radiotherapy are due to its effect against any residual cancer cells remaining in the area being treated. Radiotherapy uses high-energy x-rays to kill cancer cells.

After surgery for breast cancer there remains a risk of a recurrence of the cancer in the breast over subsequent years, even when the surgeon has completely removed the cancer that can be seen. Giving a course of radiotherapy after surgery reduces this risk. (If chemotherapy is also recommended then radiotherapy is usually given after the chemotherapy has been completed.) Without radiotherapy, trials have shown a risk of recurrence in up to 40% of patients by 12 years after surgery. 

When recommending radiotherapy, your oncologist will have taken into account the risks and benefits of the treatment. Although there are risks and side effects, it is felt that the advantages for you outweigh the disadvantages.

Depending on the results of your surgery, you will have been prescribed between 5 and 18 treatments. You may have radiotherapy treatment daily or less frequently—your oncologist will discuss this with you and will also discuss if they wish to prescribe three further treatments at the end of your course. These ‘boost’ treatments will be to the area around where the lump was removed, but these boost treatments are not usually required for patients who have had a mastectomy.

A member of the radiotherapy staff will telephone you with an appointment to attend the department to have your treatment planned. If you have any problems with travel or appointment times,

Pregnancy

Patients with child-bearing capacity must not be pregnant or become pregnant at any time during a course of radiotherapy as radiation can be harmful to the unborn child. It is important to let the radiographers know if you have missed a period or suspect that you may be pregnant, before you are exposed to any radiation.

Patients with child-bearing capacity will be asked to confirm their pregnancy status prior to planning the radiotherapy and again on the first day of radiotherapy treatment. This applies to all those with child-bearing capacity between the ages of 10-56 years and is a legal requirement.

Planning your treatment

When you first arrive in the department, book in at the reception desk, and they will explain where you need to go. Your first appointment is for a CT scan. This can be used to plan your radiotherapy, and there will be no results from it.

Everyone is a different shape, and your planning can be used to make a personalized treatment plan for you. Radiographers will carry out the scan, explain the procedure to you, and answer any questions.

We will ask you to lie on a sloping board with both of your arms resting above your head on armrests. Your radiographers will help get a suitable position on the board. This position will be used for both planning and treatment. It is therefore important to let us know if you feel you are unable to hold this position for around 10-15 minutes.

Your radiographers will put some pen marks on your skin.

And small markers will be taped to your skin, which will show up on the scan. These markers will be removed when the scan is finished. 

When the scan is complete, we will tattoo three or four dots on your skin. These are tiny permanent marks the size of a freckle. These are important marks that help us make sure you are in the same position each day for treatment. The CT scan only takes 15-20 seconds.

Radiotherapy Treatment

Treatment to the left breast/chest wall

Radiotherapy to the left breast/chest wall may increase your risk of heart disease by a small amount. This is because your heart is near the area we want to treat and therefore may receive some of the radiation dose.  For some people, taking a deep breath in and holding it during their radiotherapy can help to reduce this risk. This is called deep inspiration breath hold (DIBH).

If DIBH is appropriate for you, your radiographers will explain the procedure and get you to practice holding your breath before they carry out the CT scan. You would need to be able to hold your breath for no more than 20 seconds. Your breathing will be monitored by placing a very small box on your chest during the CT and when you have treatment.

Although DIBH is one of our options for treatment, treatment without it is still safe and effective

• If you are having DIBH, the small positioning box will be placed on your chest as it was at CT.

Your radiographers will let you know when they are ready to begin the treatment and when to take a deep breath in and hold it. They will talk to you throughout to guide you with your breathing pattern. The treatment machine will only switch on when you are holding your breath correctly.

• The machine will be on for a few minutes, and we will be watching you the whole time on a monitor in our control area.

• The treatment is painless. You should not feel any different immediately after your treatment is finished. If you have any questions or concerns, please speak to your radiographers.

You will need to report to the receptionist at the Radiotherapy Department every day when you arrive. The receptionist will let the radiographers working on your machine know that you have arrived.  on your first visit, the radiographers will set aside some time to talk you through the treatment and answer any extra questions you may have, so please arrive twenty minutes before your treatment time on that day.

You will usually be given radiotherapy treatment every day, Monday to Friday (except for bank holidays). Sometimes this is changed to treatment once, twice or three times a week depending on the clinical situation. Your doctor will discuss this with you.

The radiographers will take you into the treatment room and position you on the treatment couch as you were for the planning scan. The radiographers will explain what they need to do and may ask you to make small movements so that the marks that were put on your skin during the planning stage line up with laser lights in the treatment room. When they are happy with the position, the staff will leave the room to deliver the treatment.

You will be alone in the room for a short time while the radiotherapy machine is switched on. The radiographers can always see you when you are in the treatment room. If you have any problems, they will advise you to call out for attention and they will come in to help you.

All treatment machines have background music playing to help you feel more comfortable although you can request that this is turned off if you wish. The radiotherapy machine will move around you into different positions, but it will not touch you. You will hear a buzzing noise during treatment, but you will not feel anything.

Care during your course of treatment

The radiographers who you see each day can give you advice if you have any problems. They can also contact someone from the radiotherapy team e.g. CNS or registrar to come and see you for specialist advice.

Smoking will increase the side effects of radiotherapy. Please ask your CNS or GP if you want help to give up smoking during your treatment.

If you have a breast implant, you may also be at risk of internal scarring (fibrosis) leading to replacement or removal of the implant. Your clinical oncology doctor will explain all the side effects that may apply to your specific case.

Early side effects (during and immediately after your course of treatment)

• Tiredness (fatigue) - is common. The tiredness will slowly improve after your treatment has finished.

• Skin reaction - the skin in the treatment area may become pink or, if you have brown or black skin, it may become darker. It may also feel dry and itchy; this is common and nothing to be concerned about. Your skin reaction is likely to reach a peak 10-14 days after the treatment has finished. You can use a light moisturiser on the skin in the treatment area. Avoid using very thick or medicated creams. We will give you skin care advice when you start treatment.

• Skin blistering - this can happen in areas of friction, such as under your breast and under your arm. This may occur after you have finished your treatment. These moist areas may become sore, and you will need specialist skin care advice.

• Hair loss - if you are having treatment under your arm, you may experience loss of any hair in that area. The hair will usually regrow after three to four months.

• Swelling and tenderness - the area receiving treatment may feel sore.

• Sore throat or pain on swallowing - this happens rarely in a small proportion of patients undergoing radiotherapy to the lymph nodes behind the breastbone. You will have been advised if this is the case.

All these symptoms will settle within a few weeks of completing the treatment.

Late side effects (usually from three months after treatment)

• Change in skin texture and colour - the skin may be darker after treatment and may also feel less supple.

• Change in breast size - if you have had breast conserving surgery, the breast may be smaller after treatment. There can be a change in firmness, or you may have some swelling, tenderness, or increased sensitivity.

• Lung fibrosis - Radiotherapy to the area directly behind the chest wall may cause some scarring in the lung tissue. This may cause a cough or shortness of breath but only very rarely causes such symptoms. Usually there are no symptoms at all related to the scarring, but it will be visible if you have future scans of your lungs.

• Fluid retention and swelling (lymphoedema) of the arm - this can happen after surgery under the arm (axilla) but there is an increased risk if the radiotherapy treatment includes this area. Your clinical oncology doctor will discuss this side effect if we are including your axilla.

• Rib tenderness or fracture - you may experience some rib tenderness; however, a fracture is a very rare side effect.

• Cardiac (heart) damage - Your doctor will discuss this with you if you are at risk. This is only if the left side of your chest is treated, or if a larger field encompassing lymph glands behind the breastbone is used for right sided cases.

• Shoulder stiffness - this is only a risk if this area has been included in the treatment. Remember these are possible side effects and you may not experience any of them.

Contact details 

If you have any questions or concerns about your treatment, you can contact your Clinical Nurse Specialist (CNS). Please let us know before you finish treatment if you don’t know who your CNS is.

What is the aim of radiotherapy treatment?

Depending on the kind of radiotherapy you are having, the aim of radiotherapy may be to

• cure the lung cancer

• shrink your tumour or control its growth

• manage symptoms caused by your tumor, improving your quality of life and potentially prolonging your life

How do doctors decide on the best treatment for you?

Deciding whether radiotherapy is right for you depends on three factors:

• the type (pathology) of lung cancer you have

• the size and position of your lung cancer and if it has spread (stage)

• your general health, fitness (performance status) and how you cope with treatment

Types of lung cancer

There are two main types of lung cancer:

• small cell lung cancer (SCLC)

• non-small cell lung cancer (NSCLC)

NSCLC makes up most of the cases of lung cancer (around 87% in the UK). The treatments used for SCLC and NSCLC are different.

What happens next?

Your cancer doctor, usually a clinical or radiation oncologist, is the person who is responsible for prescribing and supervising your course of treatment.

The treatment recommended for you will be the one that offers you the most benefit, is likely to keep you well for the longest, and has lower risks or fewer side effects.

Your case may be discussed by a group of health care professionals, known as a multidisciplinary team (MDT). They will talk through treatment options. The team may include an oncologist, surgeon, lung cancer nurse specialist, palliative care team, chest physician, radiologist, pathologist, and radiographer, among others.

Consent to treatment

You can bring a relative or friend with you for support, particularly to your first appointment. They will be able to sit and wait in the waiting room while you have your CT scan. The appointment will

last approximately an hour, and after the planning session you will be able to go home.

Planning CT scan

You will be taken to the room with the CT scanner, where you will spend 15-20 minutes. You will have a private space to remove clothing and jewelry from your waist up to your chin.

Sometimes, an intravenous injection is given during the scan. This will be discussed with you if it applies to you. This is a contrast dye, which allows blood vessels to be seen more clearly on the CT scan to help your cancer doctor plan the treatment. If you are going to have contrast dye, you will be cannulated before you go on the scanner—a little needle will be inserted into a vein in your arm in preparation for the dye to be injected. It is important to inform the radiographer if you have had a reaction to IV contrast previously.

You will be asked to lie on the 'couch' part of the CT scanner, usually with your arms above your head. This couch, which looks more like a narrow table than a couch, has a hard surface, but most people don’t find it particularly uncomfortable.

Because the treatment delivery is very precise, it is important for you to be comfortable and try to keep as still as possible. For this reason, there are rests for your knees and elbows and a bar for you to hold on to.

Very occasionally, an immobilisation cast is required, depending on where the lung is being treated. This ensures that your shoulders and neck are kept in the correct position during treatment. A cast is a form of plastic netting that can be stretched over your upper chest and neck when warm and then hardens when it cools down.

A breathing monitoring device may also be used to give a 4D (four-dimensional) CT scan. It’s called 4D because the scan can determine the position of the tumor over time (with breathing). If you require a 4D scan, a small box will be placed on your chest when you are scanned, and this monitors breathing motion.

After the scan, radiographers will need to put up to four tiny dots on your skin using a felt-tip pen. At the end of the session, you will be asked for permission to make these marks permanent by tattooing very small dots.

These tattoo dots are used during treatment to ensure that you are in exactly the same position every day. As felt-tip pen marks can smudge and wash off, permanent marks are recommended so you can wash normally before and during the treatment.

How soon radiotherapy treatment starts after planning appointments varies. Some palliative or urgent treatments may start within a few days. Others, including more complex treatments, may start after a week or two. There is no need to worry that your tumour will change significantly during this time. A gap of two to three weeks between the planning stage and actual treatment is normal and will not be to your disadvantage.

If you have been given the contrast dye injection, you will be asked to wait about 30 minutes after the scan in the waiting area. This will be discussed with you before the injection is administered.

Radiotherapy Treatment of the Abdomen

Introduction

Your doctor has recommended radiotherapy to treat a cancer or tumour in your abdomen. This area may include the stomach, pancreas, kidneys, liver, lymph nodes, gall bladder or spleen. Your treatment may be given on its own or alongside chemotherapy.

Giving Your Consent

Before treatment begins, your doctor will explain the aims of your radiotherapy, the potential benefits, any risks or side effects, and the alternatives available. You will be asked to sign a consent form confirming you agree to receive treatment.

You have the right to ask questions and to take time to decide. You may also withdraw your consent at any time. We strongly recommend completing a full course of treatment once started, as interruptions can reduce its effectiveness.

Please tell us about:

• All medicines, supplements or herbal remedies you are currently taking

• Any chance you might be pregnant, as radiotherapy can harm an unborn baby

• Whether you smoke or drink alcohol, as both can increase side effects and reduce how well treatment works

Planning Your Treatment

CT Planning Scan

Before treatment begins, we carry out a CT planning scan. This is not used to assess your cancer; it maps the area we need to treat. The session typically takes 20 to 30 minutes.

You will lie on a flat couch in the same position used for every treatment session. It is important to stay very still. The radiographers will explain everything as they go.

In some cases, a contrast dye may be injected into a vein in your arm to help show structures more clearly on the scan. The radiographers will ask for your consent beforehand. You may notice a warm sensation, a metallic taste, or a sensation of a full bladder; these are normal. You will be monitored for around 15 minutes after the injection if needed.

You may be asked to avoid eating for two hours before the scan but to drink plenty of fluids. Specific instructions will be sent to you beforehand.

Skin Markings (Tattoos)

At the end of the planning scan, the radiographers will ask permission to make two or more small permanent tattoo marks on your skin. These are no bigger than a freckle. They are used at every treatment session to ensure you are positioned exactly the same way each time, so the radiation is delivered accurately. If you have any concerns, please discuss them with the radiographers at the time.

How Long Does Planning Take?

Radiotherapy treatment starts after planning appointments vary. Some palliative or urgent treatments may start within a f ew days. Others, including more complex treatments, may start after a week or two. There is no need to worry that your tumour will change significantly during this time. A gap of two to three weeks between the planning stage and actual treatment is normal and will not be to your disadvantage.

Important Advice Before Treatment

Fertility and Contraception

Radiotherapy to the pelvis is likely to cause permanent infertility in most people. If you are of reproductive age, please discuss this with your oncologist before treatment begins.

If there is any chance of you or your partner becoming pregnant during or after treatment, reliable contraception should be used. Radiation can affect reproductive cells and may harm a developing baby. Sperm banking is available before treatment starts—please ask your oncologist or CNS for a referral.

Medicines

Please bring a full and up-to-date list of all your medications to every appointment, including inhalers, supplements, and herbal products. Tell your team if you start any new medication during your treatment course.

Smoking and Alcohol

Smoking and drinking alcohol during radiotherapy can increase side effects and reduce how well treatment works. Please ask us if you would like support with either.

Planning Your Treatment

Your Planning Appointment

Your first radiotherapy appointment will be a planning session. This is used to gather all the information needed to design your individual treatment plan. You may also be asked to sign a consent form at this stage if you have not already done so.

• A list of any questions you have

• Your current medication list

• Any medication you may need during the visit

• Something to eat and drink, and something to occupy yourself — this first visit can take up to two hours

CT Planning Scan

Your treatment plan is designed using a CT planning scan. This is different from a diagnostic scan and will not be reported on as such. You will lie in the same position as you will for every treatment. The session usually takes 20 to 30 minutes.

A contrast dye may be injected into a vein in your arm to help certain structures show more clearly on the scan. If this applies to you, the radiographers will ask for your consent first. You may notice a warm sensation, a metallic taste or a sensation of a full bladder — all normal reactions that pass quickly. You will be monitored briefly after the injection.

Bowel and Bladder Preparation

Because the pelvis contains both the bladder and bowel, specific preparation is needed before each session. The exact preparation depends on which organ is being treated:

You will be given detailed written instructions and, where relevant, an enema leaflet. Please follow these carefully at every session as consistent preparation is essential for accurate treatment delivery.

Skin Tattoos

At the end of the planning scan, the radiographers will ask permission to make three or more small permanent tattoo marks on your skin. These are no bigger than a freckle. They are used at every treatment session to ensure you are in exactly the same position each day. If you have concerns about this, please discuss them with the radiographers at the time.

How Long Does Planning Take?

Your treatment plan is produced by your clinical oncologist, a medical physicist and specialist radiographers. This typically takes one to two weeks. You will usually be contacted by telephone to confirm your start date, and may receive only a day or two's notice. Please ensure we have your correct contact details.

Having Your Treatment

Arriving for Your Appointment

Please check in at the Radiotherapy Department reception on arrival every day. On your first day you will be given your full appointment schedule . 

What Happens in the Treatment Room

Each appointment lasts approximately 10 to 20 minutes. A radiographer will collect you from the waiting room. You may be asked to change into a gown. The radiographers will position you carefully on the treatment couch using your tattoo marks and laser lights in the room.

When your position is confirmed, the radiographers will leave the room to begin treatment. You will be monitored on closed-circuit camera throughout. If you feel distressed at any point, raise your hand or call out and the treatment will be stopped immediately. There is also an intercom so staff can speak to you.

The machine will move around you during treatment. You will hear a buzzing sound but will not feel anything. Please stay as still as possible, though you should breathe and swallow normally. Do not try to get off the couch unassisted — the couch is raised during treatment.

On some sessions, the radiographers will take additional images to verify your position. This takes a few extra minutes and does not affect the treatment itself.

Music: We can play background music during your treatment to help you relax. Please let us know your preference.

Keeping Your Appointments

It is very important to attend every session. Missing treatments can reduce the effectiveness of radiotherapy. If you are unable to attend for any reason, please telephone us as soon as possible so we can explore your options.

Fluid intake: We recommend drinking approximately two litres (around eight glasses) of fluid every day throughout your treatment. If you have a kidney condition that makes this difficult, please discuss this with your radiographer, nurse or doctor.

Side Effects

Side effects for pelvic radiotherapy can be divided into short-term effects that occur during or soon after treatment, and late effects that may develop months or years later. Your clinical oncologist will discuss the side effects most relevant to your individual treatment before you consent.

Remember: these are possible side effects and you may not experience all of them. Please tell your team about any symptoms you develop.

Late Side Effects

Serious long-term side effects are uncommon, but it is useful to be aware of them. Your doctor will discuss any that are particularly relevant to your treatment.

Urinary and Bowel Changes

Most people return to near-normal function once acute side effects settle, though you may find a new ‘normal’ — slightly more frequent or urgent urinary or bowel activity. Occasionally, thin blood vessels may form in the bladder or bowel wall (telangiectasia), which can cause bleeding. This usually settles on its own, but any bleeding must be reported to your GP or oncology team so it can be investigated appropriately.

A small number of people (around 5-10%) experience more significant long-term urinary or bowel symptoms that may require specialist review.

Sexual Function

Radiotherapy to the pelvis can affect sexual function. In men, this may include erectile dysfunction or changes to ejaculate volume (including dry orgasm). In women, it may cause vaginal dryness or narrowing. These effects can develop months after treatment ends. There are treatments and therapies that can help — please speak to your CNS or oncologist.

It is safe to have sex during and after radiotherapy. You will not pass on radiation or cancer to your partner.

Lymphoedema

If the pelvic lymph nodes are included in the treatment area, some swelling of the legs (lymphoedema) is possible. Your clinical team will discuss this with you if it applies, and can refer you to a specialist lymphoedema service.

Pelvic Insufficiency Fractures

Radiotherapy can occasionally cause small stress fractures to the pelvic bone. These can cause pain but are manageable with appropriate pain relief and monitoring. Tell your team if you develop any new pelvic or hip pain after treatment.

Risk of Secondary Cancer

A very small increased risk of a secondary cancer in the pelvic area exists many years after radiotherapy. At 10 years or more after treatment this risk is approximately 1-2%. Your oncologist will discuss this with you as part of the consent process.

After Your Treatment Ends

Side effects may continue or temporarily worsen for 2 to 4 weeks after your final session before gradually settling. Continue following the advice given to you during your treatment until symptoms improve.

You will be seen in clinic approximately 4 to 6 weeks after completing treatment, and further follow-up will be arranged at that point. If you have concerns before then, please contact your CNS or the radiotherapy department.

Returning to work: If you feel fatigued after treatment, consider a phased return — shorter days or fewer days at first. Your GP can support this with a fitness-to-work note. Macmillan also produces helpful guides on working during cancer treatment.

Holidays: We recommend waiting at least 6 to 8 weeks after treatment ends before travelling, and checking with your oncologist before booking.