Radiation therapy

TomoTherapy combines an advanced form of intensity modulated radiation therapy (IMRT) with the accuracy of computed tomography (CT) scanning technology in one machine.

This advanced technology can create powerful and precise radiation plans that treat hard to reach and complex tumours. It uses a built in CT scanner to confirm the shape and position of the tumour prior to each treatment. It also expertly reduces radiation exposure to healthy and critical tissues and organs.

SABR is a type of radiation therapy delivered to small, well-defined tumours using very high doses of radiation
(significantly higher than conventional radiation therapy).

It is typically used in the treatment of inoperable tumours and well-defined secondary tumours.

It offers a non-invasive treatment with a high probability of eradicating the targeted sites of disease.

Volumetric Modulated Arc Therapy is an advanced form of radiation therapy that delivers a precisely focused treatment plan in a significantly shorter time.

VMAT delivers a continuous beam (arc) of radiation as the linear accelerator rotates around you. Unlike conventional IMRT treatments, during which the machine must make repeated stops to treat the tumour from a number of different angles, VMAT can deliver the dose to the entire tumour in a 360 degree rotation.

IMRT is an advanced mode of high precision radiation therapy that uses computer controlled linear accelerators to deliver precise radiation doses to a tumour.

It allows for the radiation dose to conform more precisely to the three dimensional shape of the tumour by modulating (controlling) the intensity of the radiation beam, whilst minimising the dose to surrounding normal cells.

Also known as internal or sealed source radiotherapy, brachytherapy is a form of radiation therapy where a sealed radiation source is placed inside or next to the area requiring treatment.

It is commonly used in our department as an effective treatment for gynaecological and prostate cancers.

Brachytherapy can be used alone or in combination with other therapies such as surgery, external beam radiation therapy (EBRT) and chemotherapy.

TBI is a form of radiation therapy used primarily as part of the preparative regimen for bone marrow transplantation.

As the name implies, TBI involves irradiation of the entire body.

The technique serves to destroy or suppress the recipient’s immune system, preventing rejection of the transplanted donor bone marrow or blood stem cells.

It can also eradicate residual cancer cells in the transplant recipient, increasing the likelihood of transplant success.

TSET is a technique used to treat mycosis fungoides, the most common type of cutaneous T-cell lymphoma.

The technique involves treating the entire skin surface using low energy electron beams generated by a linear
accelerator.

Because electrons only penetrate the skin, this therapy spares deeper tissues and organs from radiation.

Four-dimensional computed tomography represents (4DCT) the next step in imaging.

4DCT takes images that not only capture the location of your tumour, but also its movement and the movement of your body’s organs over time.

This is valuable for accurately treating tumours located on or near organs that move, such as those in the chest or abdomen.

4DCT allows us to design more accurate treatments for moving tumours, better target them, and reduce the risk of side effects.

IGRT is the process of frequent two and three-dimensional imaging during a course of radiation therapy.

Examples of IGRT include cone beam CT (CBCT), kilovoltage (kV) radiographs or megavoltage (MV) images.

Some prostate patients will have gold seeds implanted which are used in conjunction with IGRT to precisely target the tumour each day.

Radiation therapy can cause skin changes because it can damage healthy skin cells in the area that is being treated.

The changes depend on:

• the part of your body being treated
• how much radiation you are given
• whether you are having certain medicines at the same time
• whether you have other illnesses or conditions such as diabetes

Skin changes may begin about 10 to 14 days after radiation therapy starts and possibly worsen during your treatment and up to about a week or so after your treatment finishes. After this your skin usually starts to improve. By 4 to 6 weeks after finishing radiation therapy your skin should have healed.

Types of skin changes may include:

• colour changes (pink to bright red)
• feeling warm to touch
• dry, itchy, flaky or sensitive skin
• pain or swelling
• moist areas

Caring for your treatment area

• Clean the area with warm water and a mild unscented soap
• Rinse well and gently pat the skin dry, rather than rubbing
• Take short, lukewarm or cool baths and showers
• Apply products recommended by your treatment team

Avoid these products on damaged skin:

• deodorants on broken or irritated skin
• talcum powder
• aftershave
• makeup
• dressings and creams containing petroleum
• sunblock

Talk with your treatment team if you are not sure.

Also avoid:

• rubbing the skin
• wearing tight-fitting clothing
• shaving with a razor blade (use an electric shaver)
• using wax or hair removal creams
• using adhesive tape or patches
• letting the area get very hot or cold (e.g. hot or cold packs)

Sun protection

Protect yourself from the sun during and after your treatment.

• Wear a hat.
• Wear loose fitting, cotton clothing.
• Use sunscreen with a high protection factor.
• Stay in the shade as much as possible.

Areas of your skin that react during radiation therapy will always be more sensitive and at risk of sun damage even when your treatment has finished. You will always need to protect them from the sun.

Download the fact sheet Skin changes and skin care during radiotherapy from eviQ for more information.

Cancer related fatigue is different to normal fatigue and 70-100% of patients with cancer experience fatigue. It may get worse as you progress through treatment and affect your normal everyday activities. Everyone may experience different levels of fatigue.

Strategies that may assist fatigue

• Plan your day around how much energy you have
• Rest between activities
• Gentle exercise/physical activity
• A referral to an Occupational Therapist can be organised.

Fatigue resources

• Fatigue management

Brain symptoms

Symptoms can include:

• Headaches
• Visual changes
• Seizures/fits
• Drowsiness
• Irritability
• Ringing in the ears (tinnitus)
• Change to your behaviour or mood.

If you experience any of these symptoms please tell your doctor or nurse.

Nausea and vomiting

Nausea and vomiting while having radiation therapy is usually well controlled. Receiving radiation therapy to certain areas of the body may make you sicker than others.

• Take regular anti-nausea medication as prescribed by your doctor
• Let your doctor know if nausea/vomiting continues for greater than 24 hours or if medication is not working.

Suggestions that may help control your nausea and vomiting

• Avoid preparing food when feeling sick.
• Small frequent meals rather than large meals.
• Eat slowly and chew food well.
• Avoid overly sweet, fatty or spicy foods.
• Drink plenty of fluid.

Hair loss

Hair loss may be temporary or permanent. This may begin 2–3 weeks after your first treatment and may occur if hair is within the radiation treatment area.

Use hats, wigs or turbans to protect scalp from the wind, cold and sun.

Cancer Council Queensland information booklets are available and Look Good Feel Better offers support programmes.

• • Cancer Council Queensland’s ESA Wig and Turban service brochure
  • Cancer Council Queensland’s Hair Loss – Practical and Support Information factsheet

Cancer related fatigue is different to normal fatigue and 70-100% of patients with cancer experience fatigue. It may get worse as you progress through treatment and affect your normal everyday activities. Everyone may experience different levels of fatigue.

Strategies that may assist fatigue

• Plan your day around how much energy you have
• Rest between activities
• Gentle exercise/physical activity
• A referral to an Occupational Therapist can be organised.

Fatigue resources

• Fatigue management

Lymphoedema

Lymphoedema is the swelling of a limb caused by a lymphatic system blockage.

It usually only occurs on the affected side in which lymph nodes were removed. Swelling may also occur if lymph nodes are in the treatment area.

Treatment includes:

• physiotherapy and exercises
• compression garments

Talk to your doctor about what additional treatment options may be suitable for you.

Nausea and vomiting

Nausea and vomiting while having radiation therapy is usually well controlled. Receiving radiation therapy to certain areas of the body may make you sicker than others.

• Take regular anti-nausea medication as prescribed by your doctor
• Let your doctor know if nausea/vomiting continues for greater than 24 hours or if medication is not working.

Suggestions that may help control your nausea and vomiting

• Avoid preparing food when feeling sick.
• Small frequent meals rather than large meals.
• Eat slowly and chew food well.
• Avoid overly sweet, fatty or spicy foods.
• Drink plenty of fluid.

A Dietician is available for advice if required.

Difficulty swallowing

Difficulty swallowing is known as dysphagia.

If you have symptoms your treatment team will organise an appointment for you with a Speech Pathologist and Dietician

Mouth care

The cells in the digestive tract grow quickly and radiation therapy can affect the cells lining the mouth and throat causing soreness, ulcers, bleeding and difficulty swallowing. Difficulty with chewing or swallowing may lead to loss of weight and this may slow down your recovery. Tell your doctor or nurse if you are unable to eat and drink.

Suggestions for mouth care hygiene

• Regular mouth washes after meals and before going to bed using salty water, sodium bicarbonate  (baking soda) or prescribed mouthwash.
• Use a soft toothbrush.
• Avoid flossing your teeth.
• Apply lip balm for dry lips.
• Inspect mouth daily and report mouth changes including coated tongue (thrush).
• Avoid foods or fluids that irritate your mouth if you have mouth ulcers.

Make sure you see a Dentist before you start and after you complete treatment.

Dry mouth

Radiation therapy to your head and neck can affect the salivary glands which produce the saliva in your mouth.

The decrease in saliva can make your mouth and throat feel dry.

Manage this with regular mouth washing and using produces that will help keep your mouth moist.

Speak with your nurse or doctor if you develop any symptoms.

Changes to taste

Taste changes can be a combination of factors including:

• Reduced ability to taste things
• Loss of taste function of the tongue ie: sweet, bitter, salty
• Changes to your taste eg: metal taste

Taste changes can lead to loss of appetite and weight loss. Your weight will be monitored regularly.

Lung symptoms

Symptoms can include:

• Shortness of breath
• Cough
• Coughing up blood
• Heartburn
• Infection

There are several ways to manage these:

• Antacids for heartburn.
• Pursed lip breathing or deep breathing exercises.
• If you have a dry cough as cough mixture may help.
• If the cough is moist and includes sputum/phlegm talk to your doctor or nurse.

If you have a sudden onset of shortness of breath or coughing up blood see your GP or go to the nearest emergency department or call 000.

Oesophagitis

A breakdown in the lining of the oesophagus may cause pain, heartburn or a feeling you have something stuck in your throat.

This can be managed with antacids, local anaesthetic gel or other pain relief.

Talk to your treatment team if you are concerned.

Diarrhoea

Diarrhoea is a common side effect of radiation therapy to your lower stomach and pelvis area if your bowel is in the treatment area.

You may develop loose bowel movements and find you need t go more than normal.

Diarrhoea may start about 2-3 weeks after your treatment has started.

• Sitz baths – a warm, shallow salt water bath using 1 tablespoon of salt to 4 litres of warm water.

Ask you treatment team about medication or if you have any questions.

Constipation

Constipation may be due to a number of causes. Constipation is common and needs to be treated early. If bowels not opened for greater than 2 days or what is outside your normal routine let your doctor or nurse know.

For relief of constipation

• Increase fluid intake
• Gentle exercise where possible
• Increase your diet to high fibre including whole grains, fruit and vegetables until constipation settles
• Take laxatives as recommended by your doctor.

Urinary symptoms

These can include:

• Burning/stinging
• Frequency/urgency
• Blood in urine
• Inability to urinate

If you experience any of these symptoms please tell your doctor or nurse.

Stay well hydrated.

Intimacy and sexuality

Radiation therapy can affect a person’s fertility and sex life.

Your doctor will discuss this with you prior to commencing treatment. Some radiation treatments may cause temporary or permanent infertility. Tiredness or feeling unwell may affect your desire for intimacy.

• It is important to use barrier contraception (condom) to avoid pregnancy.
• Inform your doctor immediately if you think you may be pregnant.
• Women may experience menstrual changes (irregular periods or cease causing menopausal symptoms).

Good communication and support will help during your treatment. If you have any concerns or questions discuss this with your doctor or nurse.

Vaginal dilators

A side effect of radiation to the pelvis is the development of scar tissue in your vagina.

This scar tissue can cause your vagina to narrow or close, it may shorten the length and may cause your vagina to become dry, tender and less elastic.

The dilator should be used at least 2-3 times a week for 5 minutes at a time. If you are having sexual intercourse regularly, vaginal dilation is still required however may not be needed as often.

A nurse will speak to you at the end of your treatment about using dilators.

Diarrhoea

Diarrhoea is a common side effect of radiation therapy to your lower stomach and pelvis area if your bowel is in the treatment area.

You may develop loose bowel movements and find you need t go more than normal.

Diarrhoea may start about 2-3 weeks after your treatment has started.

• Sitz baths – a warm, shallow salt water bath using 1 tablespoon of salt to 4 litres of warm water.

Ask you treatment team about medication or if you have any questions.

Constipation

Constipation may be due to a number of causes. Constipation is very common and needs to be treated early. If bowels not opened for greater than 2 days or what is outside your normal routine let your doctor or nurse know.

For relief of constipation

• Increase fluid intake
• Gentle exercise where possible
• Increase your diet to high fibre including whole grains, fruit and vegetables until constipation settles
• Take laxatives as recommended by your doctor.

Urinary symptoms

These can include:

• Burning/stinging
• Frequency/urgency
• Blood in urine
• Inability to urinate

If you experience any of these symptoms please tell your doctor or nurse.

Stay well hydrated.

Intimacy and sexuality

Radiation therapy can affect a person’s fertility and sex life.

Your doctor will discuss this with you prior to commencing treatment. Some radiation treatments may cause temporary or permanent infertility. Tiredness or feeling unwell may affect your desire for intimacy.

Good communication and support will help during your treatment. If you have any concerns or questions discuss this with your doctor or nurse.