Radiotherapy

What is Radiotherapy?

Radiotherapy is the treatment of cancer and other non-cancerous conditions using radiation. Radiotherapy may be given on its own, or it may be used alongside other treatments such as surgery or chemotherapy.

Radiotherapy treatment for most cancers is delivered by treatment units called Linear Accelerators (Linacs) but can also be given on superficial units, this is different depending on the type of treatment you require. 

Each patient's treatment is different and planned individually.

How does it work?

Cancer cells are more sensitive to radiotherapy than normal cells. It works by destroying cells in the area that is treated.

Normal healthy cells can also be damaged by radiotherapy which causes treatment side effects however, healthy tissue will repair but cancer cells cannot.

Radiotherapy uses high-energy x-rays or electrons to treat disease.

How is it given?

External radiotherapy is normally given as a series of short, daily treatments in the radiotherapy department.

Most patients come to the hospital for a course of daily appointments (also called fractions) Monday to Friday (five days a week). Radiotherapy treatment can be anything from one treatment, to a course lasting seven weeks or more. Some treatments may be delivered twice a day.

Each treatment session takes between 15 to 30 minutes. More complex treatment delivery may take up to an hour in the treatment room.

Side effects

There will be some side effects, and these are grouped into early and late side effects. These will be specified on your consent form, a copy of which will be provided to you at the start of your treatment course.

The most common side effects often occur during the course of radiotherapy treatment and may continue for a few weeks after treatment has finished. Side effects which occur six months or longer after treatment has finished are called late side effects. The doctor will explain all the potential side effects, even if they are quite rare.

Any member of the treatment team can be approached with questions about side effects.

Most side effects of radiotherapy will continue for about 10 – 15 days after treatment has finished and then gradually begin to get better.
However, symptoms of tiredness may continue for longer.

Fatigue

Not everyone feels tired during radiotherapy treatment, but many people do. For example, some people are able to continue working, but others need to take time off work.

Tiredness (fatigue) can continue for weeks to months after treatment has finished. It can often be made worse by having to travel to hospital each day, or by other treatments such as surgery or chemotherapy.

Skin reactions

Radiotherapy can make the skin sore in the treated area. To minimise the skin reaction extra, specific care is needed. Not all skin care products (soaps, moisturisers, shower gels) can be used.

Some people develop a skin reaction while having external radiotherapy. If this happens, it may begin after about 10 days and will settle down 2 to 4 weeks after the treatment has finished.

Hair loss

Radiotherapy will only cause hair loss in the treatment area. The clinical oncologist or radiographers can indicate exactly where hair loss may occur.

Hair usually begins to fall out after 2–3 weeks. It should grow back after treatment finishes. This may take several months, depending on the dose of radiotherapy received. Occasionally, hair loss is permanent. The radiographers can advise if any hair loss is likely to be permanent.

Long term side effects of radiotherapy

Long term side effects are classed as those that are present more than 3 months after radiotherapy. They can last long after treatment has finished. The consultant’s team will have discussed any possible long term side effects with the patient, when they consent for treatment. 

These are specific to the area where treatment is given.

We are here to support you through this part of your journey. At any time during your visit, if you feel unsure about anything, please let us know. The better we understand how you’re feeling, the more we can help make the process as comfortable and simple as possible.

If you have any special needs or requirements, please let the department know in advance so we can offer assistance.

Initial Consultation

Your initial consultation will either be face to face or over the telephone with a Consultant Oncologist where you will discuss your treatment options.  

They will review your medical information and may perform a physical examination to ensure the best management for you. The Oncologist will also discuss the benefits and potential risks of radiation therapy and answer all of your questions.

If you and your Oncologist decide that you are to have radiation therapy, all potential side effects will be discussed with you, and you will be asked to sign your consent form (Verbal Consent will be taken if your consultation is by telephone).

Your planning appointment

If your Oncologist advises that you are ready to start the treatment process straight away, one of our administration team will telephone you within a few days to arrange a date and time for a planning session (CT simulation).

We will discuss any specific instructions that need to be followed before attending this scan.
If your treatment pathway is to start at a future date, one of our administration team will contact you by telephone nearer to that date.

CT simulation

The purpose of the CT simulation is to determine the best position for your treatment and to locate the exact area to be treated in relation to the surrounding normal tissues.  Your simulation is performed on a CT scanner, and the images taken are used for your individualised radiation treatment planning.

When you enter the CT room, the staff will ask you to take off any clothes and jewellery from the area to be scanned.  Please inform the staff members if you have any mobility limitations. You will then be asked to lie down on the couch top which slides through the scanner. 

Depending on the treatment area and technique required, some people may need to have a mask made before having a planning CT scan to help keep the area still. This mask is often used for patients having treatment to their head/neck area.

Once you are properly positioned you will undergo the CT scan which usually takes just five minutes and is painless.  Small permanent tattoo dots may be given to assist in your positioning daily for your treatment.

The whole CT simulation process lasts approximately 30 minutes - 1hour.

Our administration staff will have anticipated your Radiotherapy treatment start date and you will be given a schedule of appointment dates and times at your planning appointment. (This occasionally can be subject to change). When scheduling appointment times, every effort is made to accommodate your travelling, work, and childcare needs etc.

You will receive a revised copy of your schedule on the first day of your treatment, in case any adjustments have had to be made.

Treatment planning

The next step in the radiation therapy process is Treatment Planning. 

We need to find out about the shape and size of the area of the body to be treated and then match it against images and reports from previous scans, knowledge of the disease process, and reports at the time of surgery. This information is then used to design an individual treatment plan, perform a dose calculation and finally, to allow a radiotherapy treatment prescription to be written.

Therefore, using the information obtained during CT, a ‘target volume’ is determined by your Oncologist on a computer planning system. Dosimetry staff will calculate the best method of delivering the treatment to the target, whilst at the same time avoiding as much normal tissue as possible. 

Construction of accessories, computer calculations, data input and planning checks must be completed before treatment can begin. This is a very important and complicated phase of your individualised treatment.
Depending on complexity, this process can take from a few days to a few weeks.

Treatment

Radiation Therapy treatment is delivered by a Radiographer using a treatment unit called a linear accelerator.  Treatment is usually given once a day, five times per week and takes around 20 minutes. A course of radiation therapy could be a single treatment or daily treatment for up to seven weeks or more. Your Oncologist will have advised you how many treatments you are to have at your initial consultation.

You will be required to lie in the same position as during the CT process, and we ask that you try to keep as still as possible during the procedure.

The Radiographers must leave the room during the treatment; however, they monitor you on CCTV cameras from outside the room. There is also an intercom system, so if you need assistance, call out or raise your hand. 

The direction of the beam is set by moving the treatment unit and the couch, on which you are lying, to the correct position. You will not see or feel anything while the radiation is being delivered but you will hear some buzzing noises from the unit.

While undergoing a course of radiation therapy, most patients are able to maintain their usual lifestyle at home or at work. However, it is normal for most patients to feel tired, so it is best to plan your days to allow for rest when you need it. By drinking enough water, maintaining a well-balanced diet and continuing with your usual level of physical activity you will be better able to maintain your energy levels.

You may find that your skin is affected by treatment. If necessary, you will be given skincare instructions. More information on the management of side effects is available, so please ask if you would like a copy.

You will meet with a member of our Review Radiographer team and/or your Oncologist once a week during treatment to discuss any concerns and to ensure you are handling the treatment well. If you are experiencing any side effects, medications may be prescribed to help reduce them and management strategies will be discussed.

If you are experiencing a problem at any stage during your treatment, please tell your Radiographer who will arrange appropriate care and support for you.

Follow up

Once you have completed your treatment, our administration team will book you an appointment for a follow up visit/telephone call as directed by your Oncologist.

Follow-up visits/calls are important for the Oncologist to monitor your progress as well as to address any side effects that you may be experiencing.

After your initial follow-up, visits are generally scheduled at 3 to 6-month intervals, depending on your case and how you are doing. All the information about your treatment will be sent to your GP and other doctors as necessary.

Pregnancy and Radiation Therapy
If you are pregnant or feel that there is any chance that you may be pregnant, it is important to discuss this with your Clinical Oncologist before Radiation Therapy begins (including before your planning CT scan) and during treatment if your pregnancy status changes.
You must try and avoid becoming pregnant during treatment.

Do I still need to use contraception?
Yes. It is still possible to become pregnant. Pregnancy should be avoided as radiation therapy can have a harmful effect on an unborn baby. Talk to your Clinical Oncologist about suitable contraception methods.

Who do I tell if I have a Pacemaker, ICD (heart device) or cochlear implant (hearing device)?
You must tell your Clinical Oncologist or Therapeutic Radiographer if you have a pacemaker, ICD or cochlear implant. Radiation Therapy can affect how these devices can work; therefore we need to plan your treatment around such devices.

What do I do if I’m a smoker?
Research has shown that if you stop smoking Radiation Therapy can be more effective and can also reduce the side effects of treatment.

Will I be radioactive?
You will not be radioactive during and after Radiation Therapy treatment is given to you. You can safely mix with other people, including children and pregnant women, at any time during and after your treatment.

Can I drive during treatment?
In general, most patients will be well enough to drive whilst they are receiving radiation therapy treatment, but please be aware that depending on the site of your treatment, you may not legally be allowed to drive. Your Clinical Oncologist will discuss this with you if necessary.

If you feel unwell or are on strong pain medication, please discuss with your Clinical Oncologist prior to driving a motor vehicle.

Who can I talk to if I am not coping?
We understand some patients may be anxious about Radiation Therapy. While this can be expected, our staff are here to assist you manage these concerns and provide you access to a number of support services to help you through treatment. Therefore, if you are feeling anxious, please speak to a member of the team.

How do you know if the treatment is successful?
It may not be possible to know if your treatment has been successful immediately after treatment. Your Clinical Oncologist will discuss your follow up arrangements with you at the completion of treatment.

Is it safe to take vitamin tablets and herbal medicines during treatment?
It is important you continue to take your medications as prescribed by your Clinical Oncologist. Before starting any new medicines, including prescription, over-the-counter medicines, vitamins and alternative, natural or herbal medicines, please inform Treatment Staff or your Clinical Oncologist.

What happens if I am late for an appointment?
If you are going to be late for your scheduled appointment time, please contact us to let us know in case we have to ensure there is staff to treat you, for example out of normal working hours. We will always treat you, but you may have to wait for a gap when we can treat you.

Why do I have to have a full bladder?
Some treatments require a full or comfortably full bladder. If this applies to you, the Radiographers will inform you. The full bladder acts like an internal balloon which pushes bowel out of the way of the treatment beam and can also mean less of the bladder itself is treated. Some treatments need an empty bladder and so it is very important that you know if your bladder needs to be full or empty.

Can I miss treatments if I don’t feel like coming?
Missing treatments should be avoided. Radiotherapy treatment is designed to be most effective when delivered according to a fixed schedule. In certain circumstances your oncologist may authorise a gap in treatment if you are very unwell, but these gaps usually have to be compensated for by extending the overall number of appointments or by giving two treatments in one day, at least 6 hours apart.

The Radiotherapy department is situated next to the Haematology/Oncology unit, Core B at Peterborough City Hospital. Please see our Radiotherapy Map for more information.

Our core opening hours are Monday to Friday: 08.00 – 18.00.

On arrival, please follow the signs to the Radiotherapy Department and book in at the Radiotherapy reception.

By Car:

Post code for Sat Nav: PE3 9GZ
Please follow signs to car parks F & G.

The Haematology/Oncology unit has its own entrance close to these car parks.

Your car parking will be free. Please hand your car parking ticket to our receptionist who will validate your ticket for you.

By Public transport:

There is a regular bus service to the Hospital site. You will be dropped off at the main entrance to the Hospital. On entering the Main Atrium, a volunteer will be able to sign post you to our department.

By Hospital transport:

You may be eligible for free hospital transport.
Please ask a member of staff for a leaflet on how to book this.

 

What do I need to bring with me?

If you are diabetic, please ensure you bring your insulin and some food each time when attending for radiotherapy treatment in case there are any delays.

You should eat and drink normally before your treatment (unless advised otherwise).

If you are on regular medication, please bring enough to cover your travel and treatment time.

If you need pain relief, please bring this with you. You may need to take a dose whilst in the department.

Consultant Clinical Oncologists

A Consultant Clinical Oncologist is a doctor who specialises in treating cancer, with both radiotherapy and chemotherapy. They identify the different treatment options including the benefits and side effects of each option available for the patient. This enables the patient to make an informed choice for their cancer treatment. They also oversee the patient’s treatment plan and that it is optimised for each patient. The Consultant Clinical Oncologist also manages the patient’s post-treatment care.

Therapeutic Radiographers

The team of therapeutic radiographers are the professionals that define the most reproducible patient positioning for CT planning, they also acquire and interpret daily imaging to accurately position the patient and precisely deliver the radiotherapy treatment. The patient on treatment review service is undertaken by therapeutic radiographers where the patient is able to discuss any issues related to the radiotherapy treatment including side effects.  A therapeutic radiographer is a highly skilled allied health professional who has undertaken a specialist Degree to be able to deliver radiotherapy treatment. All therapeutic radiographers are state registered with the Health Professions Council (HCPC).

We also have student radiographers training in our department and are always supervised by a qualified member of staff.

Dosimetrists

We have a dedicated team of radiotherapy dosimetrists who plan patients' treatment. Each patient has a tailor-made plan. Under guidance from the Consultant, and using specific computer software, the dosimetrists place fields and modify them to get the optimal treatment. The Oncologist will then review this to ensure they have created an optimal treatment plan.

Radiotherapy Physics

The Radiotherapy Physics team provides scientific and technical support for the Radiotherapy service. Physicists commission new equipment and new treatment techniques, perform regular quality assurance (QA) checks on machines to ensure they are safe and accurate for clinical use, create and check patient treatment plans, and carry out measurements to verify patient dose, and advise on radiation safety for staff and patients. Radiotherapy Physicists are state-registered Clinical Scientists, under the HCPC.

Radiotherapy Nurse Specialist

A Nurse Specialist is available for nursing support at any point during your treatment, from the discussion with your Radiation Oncologist until you have had your review several weeks after completion of treatment. Your CNS will be your key worker if you have been referred to us from outside our institution. If you have been referred from within our hospitals, your site-specific CNS will liaise with the MDT on how best to provide the best shared care for you.

Consultant Palliative Radiographer

The Consultant Therapy Radiographer in Palliative Radiotherapy specialises in the treatment of secondary cancers from a range of tumour types and is the Trust Metastatic Spinal Cord Compression lead. They provide a Consultant Radiographer-led service acting as an autonomous practitioner and referrer for the radiotherapy service, running clinics, consenting patients, prescribing and managing a patient caseload whilst ensuring excellent clinical governance for this patient cohort.

 To provide a comprehensive therapeutic radiographer The Consultant Radiographer is state registered with the HCPC.

Administration and Clerical Team

Our admin team will book all of your Radiotherapy appointments and provide you with a detailed schedule of all of your appointments. The team will also deal with any queries you may have by telephone. If they cannot answer your questions, they will sign post you to the most relevant department/staff member who will be able to help you.