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Radiotherapy

The Spire Specialist Care Centre use the latest advances in technology in order to provide the most accurate radiotherapy treatment tailored to your specific needs

What is radiotherapy

External beam radiotherapy is the use of high energy X-rays used to treat cancer or sometimes benign disease. It can be delivered as a stand-alone treatment option or before or after surgery, before, during or after chemotherapy and alongside hormone treatment. The body is made up of building blocks called cells, the radiotherapy works by damaging the cancer cells. Although, some normal cells will be in the treatment area, most are able to repair and recover from the radiotherapy.

External beam radiotherapy is delivered by a linear accelerator (Linac). The Spire Specialist Care Centre has the latest in state-of-the-art Linac Technology.

Radiotherapy treatment can be given over a number of days (fractions) this can enable a larger dose of radiation to be given whilst helping to minimise the treatment to the surrounding normal tissue. This approach can help to minimise side effects from the radiotherapy. The treatment can also be given in a single treatment or a shorter course dependent on the purpose of radiotherapy. Your doctor will discuss with you the intended number of treatments and the reasoning why.

The Purpose of Radiotherapy

Radiotherapy treatment is given with two different intentions:

Radical (Curative) Intent: The aim of this is to give long term benefit from the radiotherapy treatment. 

Palliative treatment aims to shrink tumours and relieve cancer symptoms and pain.  It can also help to prolong life.

What treatments are available

Treatments that will be routinely offered in the centre:

 

• Stereotactic Radiosurgery/Stereotactic Ablative Radiotherapy (SRS/SABR) - The Specialist Care Centre at Chelmsford is the first Spire site with the capability to provide stereotactic radiosurgery (SRS)/stereotactic radiation therapy (SRT) for cranial/brain treatments, as well as stereotactic ablative radiotherapy (SABR)/stereotactic body radiation therapy (SBRT) to other body sites. Both SRS and SABR are highly targeted forms of radiation therapy where the tumour receives a very high (ablative) dose of radiation whilst surrounding tissues receive a low dose. SRS is delivered in 1 to 5 fractions whilst SABR is generally delivered in 1 to 8 fractions. SRS and SABR are performed on an outpatient basis.

Intensity Modulated Radiotherapy (IMRT) – Allows treatment to be shaped around structures that need to be avoided whilst the intensity of a radiation beam can be varied to produce areas of high and low dose within a treatment beam dependent on the patient’s tumour and location.  This variation optimises the effectiveness of the radiotherapy treatment.  To enhance the precise planning and treatment using IMRT daily image guided radiotherapy (IGRT) is used.

Volumetric Modulated Arc Therapy (VMAT) – This is an IMRT treatment technique that utilises the linear accelerator moving in an arc rotation to reduce the time the patient is on the treatment machine, whilst ensuring optimal dose to the tumour and reducing the dose normal tissues receive.

• Image Guided Radiotherapy (IGRT) – A planning CT scan is used to tailor, design and plan patient specific treatments.  The images acquired from the initial CT scan are used to provide baseline reference images. This ensures treatment accuracy and positioning, daily images are taken and compared to the original planning CT scan. IGRT can be achieved by a number of techniques from two dimensional X-ray images to three dimensional cone beam images acquired on a radiotherapy treatment machine pre to and during daily treatments.  IGRT offers the benefit of using advanced imaging systems to precisely position the radiotherapy treatment and target the tumour. 

• DIBH - Deep Inspiration Breath Hold (DIBH) is a new cardiac sparing technique used when treating leftsided breast cancer patients. It allows us to further minimise the amount of radiation potentially received by the heart therefore reducing long term cardiac toxicities

• 4D CT - Four dimensional CT scanning methods are used to achieve highly conformal radiotherapy in the presence of respiratory-induced motion of tumours and normal tissue and requires a 4D CT image in which the internal motion as a function of the respiratory cycle can be quantified

Additional Services:

• Dupuytrens service – A benign hand contracture condition which can cause a person to have limited hand mobility. Radiotherapy treatment options for Dupuytren’s are currently only available privately due to the demand on the NHS. At SSCC we can provide a quick, smooth and pain free treatment option for patients in the early stages of Dupuytren’s Contracture

 

 

 

Treatment planning

You will be asked to attend a radiotherapy planning appointment this is to enable an individual treatment plan to be designed specifically for you. You will require a Computed Tomography (CT) scan in the position that you will be for your radiotherapy treatment. A CT scan uses radiation to take a 3D map/picture of the area of the body intended for treatment. The radiographers performing the scan may want to put some very small permanent skin marks on the area for treatment. These are only the size of a pin head and aid the positioning and the accuracy of radiotherapy. This CT scan will then be used by the Clinical Oncologist, Dosimetrist and Physicist to plan the optimum treatment for you. The doctor may use previous scans and X-rays to help plan the radiotherapy treatment.

Treatment planning sessions normally take approximately 30 minutes, occasionally you made need an injection of contrast media with the CT scan. The radiographers will inform you if this is required and if it is safe to do so. 

If you are having you head or neck area treated you may need a mask made.

What is a mask?

For treatment of the head or neck area you will need to wear a special mask which stabilises your head during treatment. The mask is made of a perforated sheet of thermoplastic and any markings to guide the radiographers can then be drawn on the mask rather than your skin. The process will be explained by the radiographers.   You will be asked to lie on a couch and a sheet of thermoplastic will be warmed in a water bath until it is malleable. Once the thermoplastic is warm it will be applied to your face and an impression will be made by gently pressing the mould onto your features.  You will be able to breathe normally through the perforations covering the mouth and nose.

Once the mask is made you will have a CT scan to plan the radiotherapy treatment, you will be required to wear the mask for the CT scan as well as each radiotherapy appointment. 

How will I feel

Side effects of the radiotherapy can vary from person to person and can be dependent on many factors relating to the type of cancer, the area being treated, the type and number of treatments, other treatments being given alongside the radiotherapy and whether the aim is to cure or manage the cancer.

Radiotherapy side effects normally occur as the treatment progresses and normally for a few weeks after the treatment finishes. They are caused when the normal tissue in the treatment area is damaged, causing inflammation. The therapy radiographers caring for you will help you manage any radiotherapy side effects you may experience.

At the Spire Specialist Centre our use of Intensity Modulated Radiotherapy (IMRT) and Image Guided Radiotherapy (IGRT) techniques help to minimise the dose to the surrounding normal tissue in the treatment area, therefore helping to minimise side effects.

What side effects should I expect?

Below is a list of some common side effects from radiotherapy, you will be given more in depth information on side effects related to the area you are having treated:

Fatigue

Some people can experience tiredness during their course of radiotherapy. It is important to rest when necessary. Drinking plenty of fluids can also help; drink caffeinated drinks in moderation as too much caffeine can dehydrate you.

Sore or Discoloured Skin

Radiotherapy can sometimes cause a skin reaction because the radiation beam passes through the skin. Some people experience some reddening or discolouration of the skin towards the end of their treatment, others find their skin might be itchy and can sometimes break down. You will be given advice by the Therapy Radiographers on how to look after your skin during radiotherapy before you start treatment.

Hair Loss

Radiotherapy can cause hair loss in the treatment area, this normally occurs where the radiation beam enters and exits the body. This may occur towards the end of the radiotherapy treatment. Hair may not always, but should normally grow back in the treatment area a few months after the radiotherapy has finished. Your Clinical Oncologist and Therapy Radiographer can discuss this in more detail and arrange a wig to be made if you are having your head treated.

Soreness and Difficulty Swallowing

If the mouth, throat or oesophagus is being treated some people may experience soreness or difficulty swallowing. This is due to the inflammation caused by the radiotherapy. Therapy Radiographers will be able to advise on how to manage these side effects and help with any pain management if required. Some people find it helpful to adopt a diet of softer foods, eating little and often can also be helpful, avoid foods that are particularly spicy or hot in temperature and avoid strong alcohol. A Therapy Radiographer will be able to organise dietician input if required.

Nausea/Vomiting

Radiotherapy to the stomach can cause nausea or vomiting, it can also occur as a result of treatment to other areas of the body. Your Therapy Radiographer will be able to advise you on how to manage these symptoms and anti-sickness medication can be prescribed.

Change in Urinary or Bowel Habits

Radiotherapy to the pelvis/ abdomen area can result in some change to urinary habits; this can sometimes result in increased urinary frequency, the need to pass urine during the night, or difficulty or pain when passing urine. It is helpful to drink plenty of fluids during your treatment; the radiographers will be able to give further advice if you experience any of these symptoms. Radiotherapy to the pelvis/ abdomen can also cause diarrhoea, there is advice we can give you regarding diet and medication if required.

The radiotherapy team

The Radiotherapy team are here to make your journey from diagnosis to treatment as smooth as possible. You will meet a dedicated, dynamic and specialist team who have specialist expertise in different areas of radiotherapy. Their welcoming and friendly approach, coupled with advanced theoretical and practical knowledge of treatment, side effects and their management, means you can rest assured that you are in highly skilled hands. The team of professionals will all work together to provide a radiotherapy experience that is tailor made to you. We hope to provide a personal approach to your radiotherapy treatment from a small familiar team that will follow you through the whole radiotherapy journey.

Oncologist

The Clinical Oncologist is the doctor who will be responsible for prescribing and helping to plan your radiotherapy treatment. He/she will see you at your initial consultation to discuss radiotherapy as a treatment option. The Clinical Oncologist works alongside the Physicist, Dosimetrist and Therapy Radiographers to design the best radiotherapy treatment for you.

Clinical Scientist/Physicist

The Clinical Scientist/Physicist work behind the scenes to ensure the safe operation of the Linac. They are involved in the commissioning, calibration and quality assurance of the radiotherapy treatment. They are also involved in the complex process of planning the radiotherapy treatments.

Dosimetrist

They use complex technology to calculate radiation doses and work closely with the Clinical Scientist/ Physicist to plan your radiotherapy treatment. They are also involved in the Quality Assurance of the Linac and equipment maintenance.

Therapy Radiographer

Therapy radiographers are the professionals you will see on a daily basis when you attend for treatment, they operate the radiotherapy equipment. The radiographers are there to support you through the radiotherapy treatment and will give help and guidance on side effects and any concerns you have.

Centre Administrator

The Centre Administrator will be there to greet you when you attend your radiotherapy appointments. They will help make your time at the Spire Specialist Care Centre as comfortable as possible. They will also be able to help you with any appointment queries. The centre administrators will coordinate your payments and liaise with your insurance company. 

A complimentary therapist will also visit the Spire Specialist Care Centre, access to physiotherapy, psychological support, dieticians and Clinical Nurse Specialists will also be available