• Reference Number: HEY1218/2021
• Departments: Oncology (Cancer Services), Radiotherapy
• Last Updated: 22 April 2021

Introduction

This leaflet has been produced to give you general information about a type of radiotherapy called stereotactic ablative body radiation (SABR). Most of your questions should be answered by this leaflet.  It is not intended to replace the discussion between you and the healthcare team, but may act as a starting point for discussion.  If after reading it you have any concerns or require further explanation, please discuss this with a member of the healthcare team.

What is radiotherapy

Radiotherapy is the use of high energy X-rays and other types of radiation to treat cancer.  Radiotherapy works by causing chemical and physical damage to the cancer cells in the treatment area.  Although some normal healthy cells are also affected these are able to recover and repair themselves; unlike the cancer cells which are damaged beyond repair.

Radiotherapy has a number of different benefits.  For example, it can be used on its own or in combination with chemotherapy as a primary (first) treatment, to achieve a cure or long-term control; as an additional treatment prior to surgery to improve the cure rate in selected patients, as well as being used in the palliative setting for symptom control.   Radiotherapy does not make you radioactive and you are safe to be around people including children whilst you are on treatment.

What is Stereotactic Ablative Body Radiation (SABR)

SABR is an effective way of giving accurate radiotherapy to a tumour or metastasis. It is given in fewer treatment sessions and increases the chances of controlling the tumour by:

• delivering higher doses of radiation per treatment
• being given over fewer sessions either 1, 3, 5, or 8.
• treating smaller tumours, less than 5cm in size.

The aim is usually to eradicate or control the entire tumour or metastasis being treated.

Your oncologist will have discussed the treatment and side effects with you and gained your written consent to receive radiotherapy.  There are several stages prior to you actually starting your treatment.

Planning your treatment

Radiotherapy is designed individually for each patient so before you can start we will need to plan your treatment. This will mean a visit to our CT scanner for a scan so we can plan your treatment. This will all be carried out at the Queen’s Centre at Castle Hill Hospital. See leaflet ‘Introduction to Radiotherapy CT Planning’.

For this scan, you will be laid as you will be every time you attend for treatment; you may be on a piece of equipment known as an ‘immobilisation board’, this just assists you to keep in the same position every time, you may need to put your arms above your head or you may be required to lay flat on your back.

It is important that you are comfortable as this will be the position you will be in for your daily treatment. If you are not comfortable, please inform a member of staff at the time so adjustments may be made for your comfort.

For your CT planning and treatment appointments, you will have to expose the area of your body that you will be receiving treatment to.

Permanent skin marks

During the initial planning appointment pen marks will be drawn onto your skin, to ‘mark on’ the treatment site. As these pen marks will wash off, we prefer to make very small permanent skin marks before you leave the department. These permanent marks are made using a very fine needle and tattooing ink, and provide a permanent mark that we can use for reference when delivering your radiotherapy treatment. These permanent marks mean you are able to bathe and shower during treatment as normal.

Delivering your treatment

Radiotherapy is delivered using a machine called a Linear Accelerator, or Linac for short. The picture shows the two different types of linear accelerators we have within our department.

What happens during my treatment?

A member of staff will escort you into the treatment room. The treatment machines and rooms are very large and can appear quite overwhelming when you see them for the first time.

The radiographers will then assist you into the correct treatment position on the couch.  This is the same position that you were in for your CT planning scan. You will need to expose the area of your body that we are treating to allow the radiographers to see your ‘permanent skin marks’. The radiographers will move you closer to the machine and will start to move you back into the exact position you were in for your planning scan, using the permanent marks. The machine will move around you but it will not touch you. Once the machine is in the correct position the radiographers will leave the room but will be just outside the room watching you on a television monitor. This image is not recorded or stored; it is purely for patient safety. You will not see or feel anything apart from the couch and machine being moved into position and a buzzing noise while the radiotherapy is given. The average appointment time is 45 minutes, from walking into the room to walking out again.

Review appointments during treatment

You will have regular daily reviews with a therapeutic radiographer as you progress through your treatment.  This is to assess your general health and how you are coping with any side effects, so please be honest in your answers as this will be documented as an assessment of your treatment. You may be referred to one of our support team if further medical advice or intervention is required.

What are the side effects of SABR

The side effects depend on the area being treated and the dose of radiotherapy you receive. The side effects should be discussed by the doctor with you before you consent to have your radiotherapy they are grouped into Early and Late effects.

EARLY SIDE EFFECTS:

Tend to occur during treatment or up to 3 months after completing your treatment. They are temporary and include:

Skin

Your skin within the treated area may become discoloured and itchy. To help your skin feel better you should wash the area gently. Use a soft towel to pat the area dry, DO NOT rub. Skin reactions can get worse for a week or two after the radiotherapy is finished and you should continue to follow the advice given. The treatment area will be sensitive to the sun during treatment and also in the future, so please keep the area covered and use a high factor sun cream, at least factor 30 after treatment has finished.

Fatigue / tiredness

Radiotherapy can make you feel tired so it is important to rest as much as you feel you need to but still maintain gentle exercise. It is also important to drink plenty of fluids, more than you would usually drink, approximately 2 litres a day. It does not matter what the fluid is but we do not recommend alcohol. If you are unsure please ask one of the radiographers or radiotherapy support team within the department.

Discomfort on swallowing

You may find that you develop a sore throat or difficulty in swallowing, if the area being treated is close to your throat and gullet.  If your throat is sore while you are coming for your treatment, please tell the therapeutic radiographers treating you as medicine can be prescribed to help. If your treatment has finished, contact your Clinical Nurse Specialist or doctor for advice. Eating softer foods may help and also avoiding foods that are hot, cold, or spicy. If you do not feel like eating, try and drink plenty.

Shortness of breath

Sometimes radiotherapy to the chest can cause inflammation in the lungs, which can feel like a chest infection with shortness of breath, cough and sometimes a fever. This can happen during or within 3 months of finishing your radiotherapy treatment. If this occurs during your course of radiotherapy please inform the treatment staff as you may need medication to help you. If you have finished your treatment please contact your doctor for an urgent appointment.

OTHER ACUTE EFFECTS

It will depend on the area of body that is being treated and your doctor will discuss this with you during the initial consultation. This may typically include nausea, vomiting, diarrhoea, abdominal discomfort, indigestion and loss of appetite.

LATE SIDE EFFECTS:

Can occur many months to years after radiotherapy has finished. These late side effects are hard to predict and can unfortunately be permanent:

Bone fracture

For tumours close to the ribs there is a small risk that the radiotherapy may weaken the ribs and cause pain, and possibly a rib fracture. For most patients a rib fracture does not cause any symptoms and is incidentally discovered. A small number of patients can experience chest wall pain requiring pain relief medication, sometimes for a long period of time.

Lung damage

Irradiation of the lungs can lead to permanent scarring of the lung tissue, (less than 3 in 100), (fibrosis), although modern planning techniques have helped to reduce this risk. If lung damage occurs you will notice you become more breathless than normal and you may develop a cough.

Oesophageal damage

Scarring of the gullet and for it to become less elastic. In rare cases, further treatment may be required to improve your swallowing.  In a small number of patients (less than 1 in 100), the oesophagus can weaken and the walls become thin. This can result in a small tear occurring that is also a rare late side effect.

Second malignancy

Treatment with radiotherapy can give rise to a second primary cancer. This would normally occur in the area of the body that had received the radiation. This is a very rare long-term side effect and typically takes 12 – 15 years to develop.

ADD IN FURTHER SIDE EFFECTS

Further long-term effects depend on the part of the body that is treated and the type of normal organs in close proximity to that area. If an area within the abdomen, (tummy) is being treated, it could cause some permanent scarring to the bowel loops causing narrowing or perforation, (<1% risk) or scarring of the liver and bile channels coming out of the liver. Damage to blood vessels and nerves are rare but possible and such risks will be discussed with you by your clinician.

This leaflet should have answered most of your questions. If you have any further questions, please ask any member of your healthcare team.

Should you require further advice on the issues contained in this leaflet, please do not hesitate to contact the Radiotherapy Support Team (01482) 461206 Monday – Friday 8.00am – 6.00pm, excluding weekends and Bank Holidays or by email: hyp-tr.radiotherapy.information@nhs.net

Please read the information leaflet.  Share the information it contains with your partner and family (if you wish) so that they can be of help and support.  There may be information they need to know, especially if they are taking care of you following this examination.

RESEARCH

Hull University Teaching Hospitals NHS Trust is a research-active Trust with a research strategy that includes cancer treatment and care. The radiotherapy department participates in national and international research studies to improve treatments to make them safer, more effective and to reduce side effects. We also develop patient-centered local research to improve your radiotherapy experience to benefit you and your family. We would like to encourage you to feedback about your experiences and ideas to help us to research the areas that are important to you. Your treatment will not be affected in any way should you not wish to take part.

PREGNANCY

It is advisable that women do not become pregnant while having cancer treatment because the radiotherapy/chemotherapy/immunotherapy can have an effect on the unborn child. It is suggested that you use a barrier form of contraception (e.g. condoms). Please speak with your healthcare team if you have any questions.

RADIOTHERAPY STAFF

CLINICAL ONCOLOGIST, REGISTRAR, CONSULTANT THERAPEUTIC RADIOGRPHERS

They are experts in radiotherapy and will be managing your treatment. They will take the responsibility for deciding what dose and how many treatments will be best for you; they will oversee the planning of your treatment. You may see them or a member of their team at your initial planning appointment and you can see them during your treatment if you have any problems or queries.

THERAPEUTIC RADIOGRAPHERS

Radiotherapy is delivered by male and female therapeutic radiographers who are specialist healthcare professionals that are trained to plan and deliver radiotherapy treatment and to use the specialist equipment. You will usually see the same team of radiographers and they will assist you with any questions or problems or refer you to a more appropriate person.

RADIOTHERAPY SUPPORT TEAM

The team consists of Nurse Practitioners, Registered Nurses, Radiographers and Clinical Support Workers (CSW’s), who are based within the Radiotherapy Department where they actively support and advise patients receiving radiotherapy treatment. They offer advice to patients and their families and carers and are able to make appropriate referrals and

PHYSICISTS, PLANNING DOSIMETRISTS AND MACHINE TECHNICIANS

Medical physicists are specialist scientists who have a key role in the individual planning of your treatment, along with the planning technicians. They may also have an input into the set-up of your treatment. They work together with the machine technicians to ensure that the machines are reliable and working accurately.

STUDENTS

At some point during your treatment you may encounter student radiographers. Everything they do is supervised fully. If you would prefer our students not to be present during the planning and treatment please let a member of staff know when you attend for your initial planning appointment.

OTHER MEMBERS OF STAFF

During your treatment course you may meet our receptionists, dieticians, oncology health staff, patient services staff, porters, volunteer workers. All are working together to provide you with a high quality of healthcare.

USEFUL CONTACTS

Health Centre

The primary aim of our health centre is to help patients and their families to have the best possible health and quality of life during and after treatment.  It is open to all oncology patients and their families in offering an informal atmosphere to those who wish to “drop in” to the centre.  Specially trained staff are able to advise on different aspects of coping with cancer. The centre is located in the Queen’s Centre at Castle Hill Hospital.  Opening times are Monday – Friday 9.00am – 5.00pm.

Noted below are contact details of useful organisations that provide information about cancer including radiotherapy treatments:

Macmillan Cancer Support

Provide information from specialist nurses on all aspects of cancer and its treatment, and on the practical and emotional aspects of living with cancer.

You can drop into the Macmillan Cancer Information Centre at the Queen’s Centre or call them on (01482) 461154 Monday – Friday 9.00am – 5.00pm.

Alternatively, free phone the national help line: 0808 808 0000 Monday – Friday 9.00am – 8.00pm.

Online: http://www.macmillan.org.uk

Write to Macmillan Cancer Support, 89 Albert Embankment, London, SE1 7UQ

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

• you must be able to give your consent
• you must be given enough information to enable you to make a decision
• you must be acting under your own free will and not under the strong influence of another person

Information about you

We collect and use your information to provide you with care and treatment. As part of your care, information about you will be shared between members of a healthcare team, some of whom you may not meet. Your information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.

We may pass on relevant information to other health organisations that provide you with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your doctor, or the person caring for you.

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You.

If you or your carer needs information about your health and wellbeing and about your care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.