Radiotherapy for young people

Radiotherapy is used as part of treatment to help destroy cancer cells within a targeted area of the body. It can be given as a treatment by itself, or it can be given before or after surgery. It may also be given with or after a course of chemotherapy. Sometimes it is necessary to treat the whole body with radiotherapy, for example, in preparation for a stem cell transplant.

Radiotherapy can be used to relieve symptoms such as pain or bleeding and improve quality of life when a cure is not possible. Your medical team will discuss this with you.

You will have radiotherapy at a specialist treatment centre, which has the skilled radiotherapy staff needed for young people. It may be necessary to travel further away for radiotherapy treatment.

Doctors who specialise in radiotherapy are called clinical oncologists. They are responsible for deciding the mount (dose) of radiotherapy that you need and over how many days. They will talk to you about your treatment and the possible side effects.  

How much radiotherapy is given depends on the type of cancer and where in the body it is, what other types of treatment are planned as well as general health. A course of radiotherapy may last a single treatment or could last for six weeks or more. Each treatment is called a fraction. The treatment is given in separate daily fractions to reduce the damage to normal cells and hopefully cause fewer side effects.

Radiotherapy treatment is usually given once a day (and occasionally twice a day) from Monday to Friday. It is very important to follow the treatment plan and avoid any unnecessary interruptions. If there are any interruptions to treatment then these have to be compensated for, possibly with treatment at a weekend or by having an extra treatment on one day.

Radiotherapy from outside the body does not make you radioactive. You do not need to worry that you will harm anyone during your treatment. 

Your oncology or haematology consultant will continue to be involved with decisions about treatment and support care throughout the radiotherapy part of treatment. The multi-disciplinary team (MDT) who are already involved in your care, such as physiotherapists and occupational therapists, will continue to support with treatment related side-effects or any other issues that may arise. Radiotherapy care will be carried out by a team of specialists including some or all of the below:

Consultant clinical oncologists - doctors specialising in radiotherapy. They are responsible for prescribing and supervising radiotherapy treatment. You will meet your clinical oncologist when you come for an appointment to find out about radiotherapy. They will go through your medical history before explaining about the different types of radiotherapy and what the treatment options are. Once treatment begins, they will see you regularly to discuss how it is going and answer any questions you may have.

Therapeutic radiographers - trained in all aspects of radiotherapy and patient care. You will meet them when you come for the pre-treatment (also called radiotherapy planning) appointment and at every visit. They can provide support, advice and information. They also liaise with other healthcare professionals such as doctors, specialist nurses, play specialists, dieticians, physiotherapists and clinical psychologists.

Specialist radiographers/nurses - many radiotherapy departments will have specialist paediatric radiographers or nurses who are skilled in treating children and young people and have access to a wide range of support.

Radiotherapy students or trainee assistant practitioners - students or trainees work alongside the radiographers and are under supervision at all times.

Physicists, planning technicians or planning radiographers - physicists or planning radiographers work with the clinical oncologist to draw up a personalised treatment plan.

Your specialist doctor plans your radiotherapy carefully. This is to make sure the treatment works well and causes as little damage as possible to normal cells nearby. You might have to go to the radiotherapy department a few times to plan your treatment. Planning can take a little while, but it is an important part of your treatment.   

Planning scans

Scans are taken to help plan the treatment. These scans usually happen on a CT scanner, which uses x-rays to produce images. These images are then used alongside other scans previously done to plan the best position for the radiotherapy machine. Some types of radiotherapy will use MRI scans for planning.

During the scan, you lie very still in the same position that you will be in for your radiotherapy so that the radiographers get the correct images. The radiographers will explain what position is needed, depending on the area of the body to be treated. They may use cushions or specially shaped supports to help. Clothing over the area to be treated will need to be removed.

Masks and moulds

If radiotherapy is going to be given to the head, neck or a limb, then a special mask or mould may be needed. The mask keeps your head and neck in exactly the right position during your radiotherapy. You only need to wear it during your radiotherapy sessions. You can breathe normally while the mask is on, and it shouldn’t feel uncomfortable. You might feel claustrophobic as it is on your face, but the radiotherapy team will talk to you about ways of coping with this.  

For other parts of the body, the radiographers may use foam blocks or special bags (‘vac-bags’) that are formed around the body and moulded to shape.

Masks and moulds are usually made from a material which is heated to make it very soft and then placed over the appropriate area of the body. This feels like a warm flannel and takes about 5-10 minutes to cool down and become hard again.

Some departments will use a plaster cast to take an impression of the relevant part of the body and then make a clear plastic mask or mould from that. A vac-bag is a bag full of polystyrene balls (like a large bean bag) that is wrapped around the relevant part of the body and then the air is sucked out so that it moulds to the exact shape.

Masks, moulds or vac-bags help to keep the body in the correct position while the radiotherapy treatment takes
place. They help to ensure that the same position is used every time.

Skin markings 

Once the radiographers are happy with positioning, they will draw some marks on the skin or mask and then stick some special markers over the top that will show up on the CT scan. During the scan, the couch will
move in and out of the scanner for a few minutes. The scanner doesn’t touch the body at all and cannot be felt
although it will make noises as it is working.

After the scan, the radiographers will remove the special markers and, if the markers were on the skin, they will ask permission to make some permanent dots (like tiny tattoos, about the size of a pinpoint) so that they don’t wash off before or during your treatment.

The marks are important for the radiographers to make sure the scan position matches to the radiotherapy
machine position each time treatment takes place.   

Pregnancy

It is important for patients not to become pregnant during radiotherapy treatment. If a person is sexually active, it is important to use contraception such as condoms, the pill or coil to avoid pregnancy. The radiotherapy team might ask some questions relating to this at the planning appointment and at the start of radiotherapy treatment. Please speak to a member of your team if you have any questions or need advice.

Consent

Before radiotherapy can begin, consent must be given. Parents or carers will need to give consent for children.
In the UK, teenagers and young adults between 16-18 years or their parents can consent for treatment. Young
adults over 18 years can consent themselves.

It is important to understand all the information about the radiotherapy treatment and have the opportunity to
ask questions before a consent form is signed.

The form is a written record that you have agreed to the radiotherapy and give permission to carry on with
planning and treatment.

Remember, radiotherapy treatment is an ongoing process so don’t be afraid to ask questions at any time. There is no such thing as a silly question!

Preparing for treatment

After the radiotherapy planning appointment, your clinical oncologist will work with the planning team to produce a personalised treatment plan. This may take several days or weeks depending on the complexity of the treatment and the area of the body that is being treated.

Before treatment begins, your radiographer will be able to give you a good idea of how long each treatment will take. They are usually quite short.

While you wait for your radiotherapy to start, it might be helpful to practice lying still at home for short periods. Most radiotherapy departments have facilities for music or audio (using phones, iPods or MP3 players). To pass the time and provide some distraction while the treatment takes place, choose something you would like to listen to during the sessions.

During treatment sessions, staff and family members can talk via the CCTV system to help reassure and encourage. Talk about what would be helpful for you in advance, so that you can be prepared.

Your radiographer will explain what will happen during treatment. 

In the treatment room, you will need to lay on the treatment couch in the same position as set up in the planning appointment. The radiographers will check the position and help with any masks, moulds and vac-bags.

The couch can also be moved to help make sure all marks made at the planning appointment match the treatment machine. When the radiographers are happy that the position is correct, they will leave the treatment room while the treatment is being delivered. They will watch all the time on their monitors.

You will need to lie still under the radiotherapy machine. Radiotherapy machines look like large x-ray machines. You can usually bring music or audio to play if you want to.

The machine comes close but does not touch the body and the treatment does not hurt.

There is nothing to see or feel when the machine is switched on, but there will be noises from the machine and a warning sound. Sometimes the machine may stop and move into a new position. This is so you can have radiotherapy from different directions. For at least the first few days, the radiographers will take some images of the treatment area during treatment. This is to ensure that exactly the same body position is used each day and that treatment goes in exactly the right place.

External beam radiotherapy treatment does not make you radioactive.

Tests and appointments during radiotherapy treatment

Normally blood tests will be done before radiotherapy starts and possibly once or twice a week during treatment.

The number of blood tests will depend on the area of the body being treated. The tests will include a full blood count to monitor haemoglobin, neutrophil and platelet counts, to ensure that the radiotherapy treatment is as effective as possible.

Your clinical oncologist will want to have a catch up during treatment. This will help them monitor how treatment is going and discuss any questions or problems you may have.

Depending on your individual plan, after radiotherapy finishes there may be other treatment planned or follow-up assessments to find out how well the treatment has worked. Your doctor will want to see you regularly and will discuss the plan in detail with you.

When all treatment has finished, your doctors will decide how frequently follow-up appointments should be and who will oversee follow-up. This will depend on several things, including diagnosis and what other treatments have been given.

To start with, follow-up appointments will be fairly regular but after a while clinic appointments will become further apart. If you have any queries or concerns about the radiotherapy follow-up, please talk to your radiotherapy team.

Proton therapy uses protons rather than x-rays to treat a tumour. But it is given in a very similar way to standard radiotherapy. 

If you have proton beam therapy (PBT) recommended, treatment will either be at The Christie Hospital in Manchester, or at University College London Hospital.  

For further information visit:

UCLH, London

The Christie, Manchester

Your doctor will give you more information if they think proton therapy might be helpful for you.  

Total body irradiation (TBI) is radiotherapy to the whole body. You may have TBI if you need a donor stem cell (allogeneic) transplant. It can be given as part of the treatment to get you ready to receive the donor’s cells.  

You may have TBI twice a day over several days, or as one or two sessions. You have it to the front and back of your body. Your radiotherapy team will explain everything and help you to change position when you need to.  

Stereotactic radiotherapy (SRT) can be used to treat certain brain tumours. SRT uses many small beams of radiation that target the tumour. The beams cross over at the tumour. This means that the tumour gets a high dose of radiation and nearby areas only get low doses. This helps to reduce the side effects of treatment.  

SRT is sometimes called Gamma Knife™ or CyberKnife™ because of the names of the different machines used to give this type of treatment.  

You might only need one session of treatment. Or it might be given over several sessions of treatment. A session can take from about 15 minutes to a few hours, depending on the type of machine. Your radiotherapy team will tell you what to expect. 

You may need a mask or a head frame made to help keep you in position during treatment. Your radiotherapy team will talk to you about this and give you lots of support.