More specialised types of external radiotherapy
Specialised types of external radiotherapy may be used to treat certain cancers.
4D radiotherapy (4-Dimensional radiotherapy)
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This treatment uses a radiotherapy machine that is able to take pictures or images during your treatment. The pictures are taken over a period of time so that they capture any movement of the tumour. The information from the pictures is used to adjust the radiotherapy treatment area during your treatment. This means that as the tumour moves, it’s possible to make sure it’s fully treated. 4D radiotherapy is particularly helpful for tumours that are in an area of the body that moves during the time you’re having treatment. For example, tumours in the lung which move as you breathe.
4D radiotherapy isn’t widely available in the UK. Some treatment centres are using it in clinical trials to find out which people will benefit most from it.
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This treatment is very precise because it uses many small beams of radiation to target the tumour. It’s able to deliver high doses of radiotherapy to very small areas of the body, which reduces side effects.
Only a small number of people have tumours that are suitable for treatment with stereotactic radiotherapy. It’s used to treat a variety of brain tumours and small tumours in the body, such as in the lung and liver.
A number of different machines can give this type of treatment. They include LINACs and specially designed machines such as CyberKnife™. Gamma Knife™ is another machine that’s used to give stereotactic radiotherapy to the brain. This treatment is only available in a few large radiotherapy centres.
If the treatment is suitable for you, your team will discuss it with you. You can read more in our section on stereotactic radiotherapy for brain tumours.
Total body irradiation (TBI)
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This type of radiotherapy is used much less often than other types of radiotherapy, but may be given to people who are having a stem cell transplant as part of their treatment. TBI involves giving a large single dose, or 6–8 smaller doses, of radiation to the whole body to destroy the cells of the bone marrow.
This type of radiotherapy is described in detail in our sections on donor stem cell (allogeneic) transplants and high-dose treatment with stem cell support.
Proton therapy is used to treat cancers affecting the back of the eye, the base of the skull or the spine. It’s given using a machine that uses proton radiation to kill the cancer cells rather than x-rays. The proton beam is aimed directly at the cancer and causes very little damage to surrounding healthy tissues.
Proton therapy is currently only available to treat tumours of the eye in one UK NHS trust, the Clatterbridge Cancer Centre in Liverpool.
There are plans to have two new proton treatment centres, one in London and one in Manchester in 2017. Until the treatment is available in these centres, the Department of Health can arrange for people who need this type of radiation to have it in the USA or Europe, paid for by the NHS.
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This uses a special machine to give a single dose of radiation in the operating theatre at the time a cancer is removed. Research is being carried out to see if this could be an alternative for women with early breast cancer who would normally have a course of radiotherapy after surgery.
External radiotherapy for children
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Radiotherapy can be a frightening experience for both children and their parents, but once everyone understands what is involved, this fear can be reduced. Radiotherapy staff are used to treating children and can offer help and support. A play therapist will often be available as well to provide support.
Young children, especially those under three, may have their treatment under a mild general anaesthetic. You’ll probably have a morning appointment, as your child can’t eat or drink for at least four hours before their anaesthetic. The anaesthetic is usually given in the radiotherapy department by an anaesthetist. You can stay with your child until they’re asleep.
Although you won’t be able to stay in the radiotherapy room during your child’s treatment, you may be able to watch them through the window or a camera. The nurses will look after your child until they wake up, usually after 20–60 minutes. You will then both be able to go home unless your child is an inpatient, in which case a nurse will take them back to the ward. Older children may take a while to get used to the size and sound of the machines, but this should get easier once they get to know the staff and the surroundings.
If you’re finding it difficult to cope with your child’s illness, you may find it helpful to contact a children’s cancer group. Sharing your experiences with other parents can help you cope with your own problems and fears.