Radiotherapy is given in specialist treatment centres. The specialist doctor who is in overall charge of your radiotherapy is called a consultant clinical oncologist or radiotherapist. Most clinical oncologists also prescribe chemotherapy. Therapy radiographers work in radiotherapy departments and are the main people you will come into contact with when you have radiotherapy treatment. They work closely with the clinical oncologist and help plan and give your treatment. They will be able to answer many of your questions.
Radiation therapy can be given in one of two ways: external or internal. External radiotherapy is usually given as a course of several treatments over days or weeks while internal treatment may only happen once or a small number of times.
External radiotherapy
External radiotherapy is usually given during outpatient visits to a hospital cancer centre. A machine directs the high-energy rays, usually x-rays, at the cancer site and a small area of normal tissue surrounding it. You will be positioned carefully on a treatment couch and then the machine will be directed exactly at the area to be treated, often from different angles. Treatment takes several minutes and is painless. Before you start your course of radiotherapy you will usually need to attend the hospital for treatment planning. External radiotherapy doesn’t make you radioactive and you can safely mix with other people, including children, at anytime.
Internal radiotherapy
Internal radiotherapy can be given in several ways either as an outpatient or inpatient. Brachytherapy is a treatment, in which solid radioactive sources are placed inside a body cavity or needles are placed in the tumour. This usually involves staying in hospital for a few days until the radioactive source has been removed.
Another type of internal radiotherapy involves using a liquid source of radiation and is called radionuclide (or radioisotope or unsealed source therapy). It can either be taken by mouth or given as an injection into a vein. For this type of treatment you will need to stay in hospital for a few days until most of the radioactivity has disappeared from your body. If you are going to have internal radiotherapy, your doctor will discuss this with you and give you further information.
Occasionally, with radioactive treatment or with treatment with radioactive ‘seeds’, you will be made radioactive for a few days. You may then have some temporary restrictions on your social life. This will be carefully explained to you.
What will happen during treatment?
When you have radiotherapy, your treatment needs to be planned carefully. This is to make sure that the treatment area or treatment field includes all of the cancer and avoids healthy tissues.
Planning usually takes place in a simulator, which is a special x-ray machine. This provides an exact “mock-up” of treatment positions. Radiographers operate the simulator and run the planning suite. They will explain what will happen during planning and carry out any preparation you may need. The radiographers and physicists (who are specialists in the subject of radiation) calculate the dose of radiation you will be given. This is usually carried out with the help of computers.
The doctors will use your previous x-rays or scans to help them plan your treatment. Sometimes you may be asked to have more tests, for example a CT scan lying in the treatment position. Any extra preparation or procedures will be explained to you.
You may have a single treatment or a course of treatments, called fractions, over several weeks. This will depend on why radiotherapy is recommended for you. Lower doses are given for palliative treatment than for curative treatment and usually over a shorter period of time. If you want more information about this or your treatment machine, ask your doctor or radiographer.
Most patients attend the hospital for treatment daily, Monday to Friday. However, radiotherapy is sometimes given only once or twice a week. Treatment may also be given more than once a day. A course of radiotherapy may last for about six weeks. Ask your doctor or radiographer how long your course of treatment will be. Most people receive radiotherapy as outpatients, travelling to the department each day. You might like to ask a friend or relative to come with you. You will usually be able to book all your appointments at the same time to allow you to plan ahead.
When you arrive for your treatment, the radiographers, who carry out your treatment, will explain things to you. If there is anything you don’t understand or you have questions, ask them. You may be asked to change into a gown before treatment, and then the radiographers will position you on the couch. Using the temporary tattoos or marks which were put on your skin during treatment planning, they will line up the radiotherapy machine. It won’t usually touch you. The preparation may take some time, often longer than the treatment itself. It will probably take even longer on the first day. When the radiographers are satisfied that you and the treatment machine are both in the correct position, they will leave the room and switch on the radiation beam. You won’t feel anything during the treatment.
The radiographers will watch you using closed-circuit television or through a window. You can speak to them, or vice versa, by an intercom. You should keep very still during the few minutes it takes to give your treatment but you can breathe and swallow normally.