Radiotherapy

Radiotherapy (or radiation therapy) is a form of X-Ray treatment and is one of the main methods of treating cancer. In fact, half of all cancers are treated with radiotherapy at some point along the treatment course.

Radiotherapy can be used in early stage disease and in selected cases of oligometastatic disease to help cure or maximally control a cancer. It is also used in more advanced disease which cannot be cured to improve pain and other symptoms. In addition, radiotherapy can be used in the treatment of some benign or functional conditions.

You may receive radiation as your only form of treatment, or it may be combined with surgery and/or chemotherapy. Your exact treatment plan will be determined based on your type and stage of cancer and will be discussed with you at your clinic appointment.

The most common form of radiotherapy is called External Beam Radiation Therapy (EBRT), which is delivered by a sophisticated machine called a linear accelerator (linac). The linac produces high energy X-Rays which are precisely targeted to shrink and kill tumours by damaging their DNA. Our stereotactic radiotherapy treatments are so precise that we can target a tumour with submillimeter accuracy.

Following your consultation with your Radiation Oncologist, you will receive an appointment for a radiotherapy design scan. This is a CT scan which is done in the radiotherapy department and is used to precisely target the tumour and design a personalised treatment plan.

Design scans usually take 1-2 hours to complete depending on preparation procedures and scan specifications which will be discussed with you prior to the appointment.

Designing the radiotherapy treatment is a highly technical, complex, and meticulous process, and can take up to 3-4 weeks to complete. You will be contacted by the radiotherapy department to confirm your start date once the treatment plan is finalized. If your treatment is ready earlier than originally scheduled, the treatment team will contact you and offer an earlier start date.

Treatments schedules range from a single treatment, to three to five treatments, to multiple weeks of daily treatment (Monday to Friday or on alternate days) depending on your type and stage of cancer. Your Consultant Radiation Oncologist will discuss the expected schedule with you at your initial consultation but may occasionally need to adjust this following analysis of the design scans. Treatment appointments vary from 20-60 minutes depending on the type of treatment.

At Beacon Hospital we offer advanced radiation therapy as standard and in line with international evidence-based gold standards. These advanced techniques have been shown to improve cancer control outcomes and at the same time reduce side effects from treatment. During treatment, you will be lying on a treatment couch, and the machine (linear accelerator) rotates around you to deliver the radiation therapy – nothing touches you, you do not feel anything, and you are not radioactive during or after external beam radiation treatment.

Some terms you may hear include:

• 3D Conformal Radiation Treatment (3DCRT):
  • 3D conformal radiation therapy is a type of radiotherapy in which the shape of the radiation beam matches the precise contours of the tumour.
• Intensity-Modulated Radiation Therapy (IMRT):
  • Intensity-Modulated Radiotherapy is a type of radiotherapy in which the both the intensity and shape of the radiation beam is adapted to match the precise contours of a tumour and minimize the damage to surrounding healthy tissue.
• Volumetric Modulated Arc Therapy (VMAT):
  • VMAT is a type of IMRT which is delivered as a continuous arc (up to 360 degrees) as the treatment machine rotates around you.
• Image Guided Radiation Therapy (IGRT):
  • Image-guided radiation therapy is the use of imaging during treatment to improve the precision and accuracy of treatment delivery.
• Surface Guided Radiation Therapy (SGRT):
  • Surface-guided radiation therapy is the use of surface scanning technology to provide real-time monitoring of your position during treatment, which improves the precision and accuracy of treatment delivery. It also allows us to treat you without the need for tattoos.
• Stereotactic Radiosurgery (SRS):
  • Stereotactic radiosurgery is not actual surgery. Instead it is a non-invasive precise radiotherapy technique used to deliver highly concentrated doses of radiation to small tumours or functional lesions in the brain. Treatment is delivered in 1, 3, or 5 sessions.
• Stereotactic Ablative Radiation Therapy (SABR):
  • Stereotactic ablative radiotherapy (SABR), also known as stereotactic body radiation therapy (SBRT), it is a non-invasive precise radiotherapy technique used to deliver highly concentrated doses of radiation to small tumours in the body, outside of the brain. It can be used to target and treat tumours in many different locations including lung, liver, kidney, adrenal gland, lymph nodes, prostate, and bones. Treatment is often delivered in 3, 5, or 8 sessions.
• Deep Inspiratory Breath-hold (DIBH):
  • Deep inspiration breath hold is a radiation therapy technique where patients take a deep breath and hold this breath while the radiation is delivered. When your lungs are filled with air, your heart moves away from the chest and the radiation dose to the heart is minimised. Inspiration breath hold can also be used when delivering stereotactic ablative radiotherapy (SABR) to tumours within the base of the lungs.
• End Expiratory Breath-hold (EEBH):
  • End-expiratory breath hold is a radiation therapy technique where patient’s breath out and then hold their breath. The radiation is delivered while the breath is held. This is used when delivering SABR to tumours in the upper abdomen (liver, kidney, or adrenal gland).

While radiotherapy has immediate effects on a cancer cells DNA, it’s anti-tumour effects continue for weeks to months before the full effect of treatment is seen. You will have a follow up after treatment with your doctor to assess how well the radiotherapy has worked.

With modern radiotherapy techniques, the radiation exposure of nearby healthy cells and organs is minimized, however as with any treatment, there are still side effects that you may experience.

Radiotherapy side effects are limited to the area of the body being treated and include:

• Fatigue
• Skin reaction and inflammation
• Swelling and build-up of fluids
• Hair loss in the treatment area which may be temporary or permanent
• Stress and other coping issues are also common

You will be seen weekly during your radiation treatment by your Radiation Oncologist or/and specialist nurse to assess and manage side effects. If you have any queries or concerns during treatment please let us know.

You can find information booklets regarding specific cancers and radiotherapy treatment in our Patient Information Leaflets.

While we occasionally delivery radiotherapy for inpatients, the majority of our treatments are delivered on an outpatient basis.

Radium-223 (brand name Xofigo) is a radioactive radio-isotope used to treat cancers in the bone that began in the prostate and can help to reduce pain. It is an outpatient treatment delivered intravenously through a drip once a month, usually for 6 treatments.

You will be mildly radioactive for a short time after treatment, but this radioactivity reduces quickly and leaves your body through the urine and faeces. You will be given advice on general care and hand washing after treatment. Side effects are very mild and can include diarrhea and mild nausea.

Radium-223 is for men who have prostate cancer involving the bones and:

• Had hormone treatment that is no longer working
• Had or are not suitable for docetaxel (chemotherapy)
• Cancer in the bones but not other organs
• Are not having abiraterone treatment

Birth control is strongly recommended during treatment, since radiation therapy may pose risks to an unborn child. Please discuss this with your doctor. Women under the age of 50 will be asked to sign a pregnancy waiver form prior to the design scan.

External beam radiation therapy uses high energy X-Rays (or beams) targeted at a tumour and is focused on a specific area of your body.

Chemotherapy is a type of medicine designed to kill or control cancer cells or help the immune system to kill cancer cells and can be given in tablet form or through a vein (intravenously). For more information on chemotherapy treatment at Beacon Hospital please click here.