Radiotherapy for haematological malignancies

Introduction

This information is for patients who are being considered for radiotherapy for different types of blood-related malignancies, including lymphoma. It explains how the treatment is planned and delivered and contains advice to help you look after yourself during and after the radiotherapy. It also explains the commonly seen side-effects of treatment, depending on the area of body being treated. If you have any questions or concerns about the information given to you, or any aspect of your treatment, please speak to a member of the team.

What is radiotherapy?

Radiotherapy uses carefully measured doses of strong x-rays to treat diseases. It works by causing damage to the cells within your body. Cancerous cells are much less able to repair this damage than normal cells, so more of the cancer cells will be destroyed. The aim of your radiotherapy is to eradicate either all the cancer cells within the treated area or a sufficient number of them to significantly shrink the tumour to and relieve symptoms. Depending on the type of your tumour, your oncology team will decide how many treatments are most appropriate for you. Treatment regimens vary according to individual needs.

Generally, tumours arising from haematological systems are very sensitive to radiation and therefore, smaller doses compared with other cancers are required to achieve a cure or symptom control. Therefore, side-effects of radiotherapy also tend to be less troublesome and easily manageable.

Where do I go for radiotherapy appointments?

Radiotherapy is planned and delivered in the Radiotherapy Department, which is part of the Oncology Department at CUH which is located on level 2 in outpatients. Treatments are usually delivered as daily outpatient appointments from Monday to Friday, occasionally Saturdays, or in some circumstances you may have two treatments scheduled on one day.

How is the treatment planned?

Radiotherapy treatment is tailored to the individual patient and requires careful planning. The first appointment involves having a computed tomography (CT) scan in the Radiotherapy Department, where tiny permanent marks (referred to as tattoos) are made on your skin. These are important reference marks used by the radiographers to accurately deliver your treatment. If you are receiving radiotherapy to the head and neck region, a device called an immobilisation mask will be made for you. A mask is individually made for each patient and is made from a thermoplastic material which is moulded to your shape. The mask may cover your head, face and shoulders. You can see and breathe through the mask. The mask helps to ensure that you are comfortably and securely positioned for daily treatment and also helps you to stay still to ensure accurate delivery of radiotherapy. If you have a mask, any marks to position your treatment will be drawn on the mask and not on your skin.

The specialist cancer doctor (oncologist) will use these CT images, and other images taken previously, to decide upon the area requiring treatment. The radiographers will also take your photograph, which is used as a safety check each day prior to your treatment.

What happens during treatment?

On your first day of radiotherapy, a therapeutic radiographer will have a chat with you to discuss the treatment and how to minimise any side-effects it may cause. They will also check that you are happy to go ahead with your treatment; this is an ideal opportunity to ask any questions that you might have.

The treatment machine used to deliver radiotherapy is called a linear accelerator ('Linac' or 'LA') or tomotherapy unit ('Tomo'). These treatment machines direct high-energy radiotherapy beams over a carefully planned area of treatment. In order to deliver treatment, patients are carefully positioned. You will be asked to lie flat on a treatment couch, which is similar to a CT (computed tomography) scanner couch, in the radiotherapy room. Once you are correctly positioned on the treatment couch, the radiographers will operate the unit from outside the room. A diagnostic image is taken on the treatment unit to check positioning, and adjustments are made if necessary. The treatment will then be delivered. The units make a buzzing sound when giving the radiotherapy, but it is completely painless. A closed-circuit television (CCTV) camera allows the radiographers to monitor you throughout, and they can also talk to you via an intercom. Radiotherapy is delivered by therapeutic radiographers. Each treatment takes 15-20 minutes.

In the majority of situations, the tumour will start shrinking during the treatment and subsequently continues to do so.

You will not be radioactive afterwards and will therefore be able to mix safely with other people in your household, including children and pregnant women.

What are the side-effects of treatment?

This section explains the commonly seen side-effects, depending on the area of body being treated, but this doesn’t mean you will necessarily get them. Generally, side effects of radiotherapy for haematological malignancies tend to be mild. Rarely, it is also possible that you may get a side-effect not mentioned here. Side-effects occurring during or immediately after radiotherapy are called early or acute effects. These usually start about 2 weeks after starting radiotherapy, persist during treatment, start subsiding 2-3 weeks after completion of radiotherapy and completely resolve 4-6 weeks after completion of treatment. Late effects usually occur 3 months after treatment. However, in the majority of situations, due to the lower dose of radiotherapy being used, the risk of late effects are minimal.

Fatigue, skin changes and body hair loss in the area of treatment are common early effects that can occur in all patients.

• General fatigue: Most patients experience some degree of general fatigue. Fatigue is a common feeling during and after radiotherapy treatment. Mild fatigue occurs in 50% of patients. It usually resolves within a few weeks of completion of the radiotherapy treatment. There is no reason to change your lifestyle during treatment, but it can be helpful to try and get enough rest and sleep, especially if you are feeling tired. It is also helpful to try to continue with some of your normal daily activities and to balance rest and activity.
• Skin changes: The skin in the treatment area may become dry, itchy and red. If there is significant risk of skin reaction, we will give you specialist skin care advice. General measures to minimise skin reaction (depending on the area being treated) include avoiding all types of irritation such as rubbing, perfumes, powders, and deodorants over the irradiated area, avoiding exposure to hot and cold temperatures and sun, wearing loose fitting and cotton clothes, and avoiding swimming in chlorinated pools and using hot tubs. We recommend using a fragrance-free moisturiser in the area, from the start, such as Aveeno or Diprobase.
• Hair loss: Radiotherapy can cause hair loss in the area of treatment. Facial and scalp hair loss could be permanent, especially when you receive five or more treatments.

Other side effects depend on the part of the body being treated and the organs adjacent to the area for radiotherapy., This will be discussed with you by your oncologist during your first consultation for radiotherapy. The following table summarises potential early and late side-effects if different organs in the body receive full dose of planned treatment:

Transport for radiotherapy

There is no restriction on driving during radiotherapy, if you are able to drive yourself for your appointments. If you feel too tired to drive and need medications that can make you feel slightly drowsy or sleepy, you will need to make arrangements for a lift.

If you require hospital transport, please ask radiotherapy reception for the transport contact number for your area.

Follow-up appointment and further care

After your treatment ends, we will speak to you over the telephone about six weeks afterwards to discuss how you are feeling. Your haematologist will arrange a review three months after treatment to discuss follow up and further treatment plan. If you have any problems, or notice new symptoms in the interim, please contact one of the team for advice. You don’t have to wait for your next scheduled appointment.

Contacts

If you have any worries or questions about any aspect of your treatment, please do not hesitate to call the haematology nurse specialists or radiotherapy.

Lymphoma Clinical Nurse Specialists contact : 01223 596279 (option 1)

Radiotherapy contact : Radiotherapy Reception: 01223 216634