Specialist external radiotherapy techniques

There are some specialised types of radiotherapy which may be used in certain situations.

  • 4D radiotherapy (4 dimensional radiotherapy) - uses a machine that can take pictures during your treatment. It may be used to give treatment to tumours that move, such as the lungs which move as you breathe.
  • Stereotactic radiotherapy - is very precise and can give high doses of radiotherapy to very small areas of the body.
  • Total body irradiation (TBI) - treats the whole body with radiotherapy, used for people who are having a stem cell transplant as part of their treatment.
  • Proton therapy - uses proton radiation to treat cancers affecting the back of the eye, the base of the skull or the spine. It causes very little damage to surrounding healthy tissue.
  • Intra-operative radiotherapy - uses a special machine to give a single dose of radiotherapy. This is done when the cancer is being removed in an operation.

The type of radiotherapy you’re given will depend on the type of cancer you have.

4D radiotherapy (4 dimensional radiotherapy)

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.


Stereotactic radiotherapy

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.


Total body irradiation (TBI)

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.

We have more information about TBI radiotherapy in our information about allogeneic (donor) stem cell transplants and high-dose treatment with stem cell report.


Proton therapy

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.


Intra-operative radiotherapy

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.


Back to External beam radiotherapy explained

What is external beam radiotherapy?

External beam radiotherapy is the most common type of radiotherapy. A big machine directs external radiotherapy beams at the affected area.

Types of external beam radiotherapy

Different types of radiotherapy allow doctors to treat the cancer more accurately. This reduces your chances of having side effects.