This information sheet is for patients who are being considered for five fractions of precision radiotherapy treatment for pancreatic cancer during the COVID-19 pandemic. 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. 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. Cancer cells are much less able than normal cells to repair this damage, so more of the cancer cells will be destroyed. The aim of your radiotherapy is to eradicate the cancer cells within the treated area. As radiotherapy is a local therapy, it will not prevent the spread of cancer cells.
What is five fractions for precision radiotherapy treatment for pancreatic cancer?
During the COVID-19 pandemic numerous measures are introduced by the UK Government to minimise the spread of infection whilst maximising the safety of patients who need treatment for cancer. Guidelines are being issued to modify radiotherapy treatment to enable fewer hospital visits and to use radiotherapy to stop tumour growth in selected patients who can’t have immediate surgery, or whose treatment is delayed. Based on the national guidelines we are considering five treatments of precision radiotherapy for the following group of patients with pancreatic cancer:
- For patients with inoperable cancer where the current standard of care is 28 treatments of radiotherapy following initial chemotherapy
- For patients with operable cancer who cannot proceed to immediate surgery and / or are not candidates for combination chemotherapy. Radiotherapy in this context is not a proven therapy, but has been introduced in this group of patients during the COVID-19 pandemic as a potentially helpful treatment whilst waiting for surgery.
How is the treatment planned?
Radiotherapy treatment is tailored to the individual patient and requires careful planning. The first appointment involves having a 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. 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.
How many treatments will I have?
You will have five treatments which will be given either on five consecutive days (except on Saturdays and Sundays) or on alternate days (Monday, Wednesday and Friday). The most appropriate treatment schedule for you will be confirmed by your oncologist.
What happens during treatment?
On your first day of radiotherapy, a member of the treating team will have a chat with you to discuss the treatment and how to minimise any side effects that it may cause. They will also check that you are happy to go ahead with your treatment, and this is an ideal opportunity to ask any questions that you might have. The radiotherapy units are quite large but they don’t actually touch you. Each treatment session takes 30-40 minutes. Once you are correctly positioned on the treatment couch, the radiographers operate the unit from outside of the room. A CT scan is taken on the treatment unit to check positioning, and adjustments are made if necessary. The treatment is then delivered. The units make a buzzing sound when giving the radiotherapy, but it is completely painless. A second CT scan is also taken at the end of each treatment session. A CCTV camera allows the radiographers to monitor you throughout. They can also talk to you via an intercom. There may be pauses during the procedure when the radiographers are reviewing your images or preparing the unit. Please ensure that you remain in the treatment position until the radiographers inform you that the procedure has finished. You will not be radioactive afterwards and are therefore safe to mix 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, but this doesn’t mean that you will necessarily get them. It is also possible that you may get a side effect not mentioned here. Most patients experience some degree of general fatigue and loss of appetite. Fatigue is a common feeling during and after 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 helpful to try to continue with some of your normal daily activities and to try and balance rest and activity. Mild fatigue occurs in 50% of patients. Even though radiotherapy is only given in patients with smaller tumours, pancreatic cancer is usually situated near parts of the bowel. It may therefore cause less common side effects of sickness, indigestion, heartburn and abdominal colic. However, these effects can be prevented with effective medication. You will be asked to take an anti-sickness tablet, and a tablet for abdominal colic, at least 30 minutes prior to radiotherapy. If you are not on any medications to suppress stomach acid production, you will have to take tablets to prevent gastritis during and until at least four weeks after completion of radiotherapy. Being a high precision treatment, the risk of late side effects are lower. Rarely, patients can develop bowel damage (for example, ulceration or bleeding) as late effects.
After treatment ends
Radiotherapy can continue to have a beneficial effect on the tumour for some weeks after the completion of treatment. The side effects, if any, from radiotherapy generally persist or worsen slightly for seven to ten days after the completion of treatment. They will then gradually subside over the next two to four weeks
Follow-up appointment and further care
We will speak to you over the telephone about three weeks afterwards to discuss how you are feeling.
- If you have had five fractions of treatment for an inoperable tumour, you will then see your oncologist three months after treatment with a follow-up CT scan. 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.
- If you have received radiotherapy as a holding measure until normal surgical service resumes, you will have an earlier appointment with your oncologist or surgeon to discuss the options of surgery. This appointment will be usually three to five weeks after completion of radiotherapy.
If you have any worries or questions about any aspect of your treatment, please do not hesitate to contact one of the team.
HPB Oncology Nurse Specialists - Telephone 01223 254545
Privacy and dignity
Same sex bays and bathrooms are offered in all wards except critical care and theatre recovery areas where the use of high-tech equipment and/or specialist one to one care is required.
We are smoke-free
Smoking is not allowed anywhere on the hospital campus. For advice and support in quitting, contact your GP or the free NHS stop smoking helpline on 0800 169 0 169.
Help accessing this information in other formats is available. To find out more about the services we provide, please visit our patient information help page (see link below) or telephone 01223 256998. www.cuh.nhs.uk/contact-us/accessible-information/
Cambridge University Hospitals
NHS Foundation Trust
Hills Road, Cambridge
Telephone +44 (0)1223 245151