Planning your treatment

Before you can start your radiotherapy treatment, it needs to be carefully planned.

The radiotherapy department staff will explain what to expect. You will have scans of the area to be treated. This helps the radiotherapy team decide the exact dose of radiotherapy and area to be treated.

You may need other things done as part of the planning process. You must stay very still during radiotherapy and in a particular position. So you may need to wear a mould or mask on the part of your body being treated to help keep you still. This needs to be made before your treatment starts. It might feel uncomfortable but you won’t have it on for very long.

A small, permanent mark (tattoo) may also be made on the skin to show the exact place the radiotherapy should be directed.

Let your radiographers know if you’re worried about any part of the radiotherapy process. It’s important that you feel involved and comfortable to ask questions at any time. They will give you advice on how to care for your skin before and during treatment.

Before you start treatment

Before you start your treatment, it needs to be planned. This makes sure the radiotherapy is aimed precisely at the cancer and causes the least possible damage to the surrounding tissue. All radiotherapy treatments are planned on an individual basis by your clinical oncologist, a physicist and sometimes by a senior or specialist radiographer.

Some people may need to have a mould or mask made before treatment planning.

First planning visit

Your first planning visit will usually take 30–60 minutes, although it may take longer. The staff in the radiotherapy department will tell you what to expect. They will also tell you beforehand if you need to prepare in any special way. For example, you may be asked to follow a special diet or drink plenty of water.

It‘s important for you to feel that you’re involved in your treatment, so feel free to ask as many questions as you need to.

You will usually have a CT (computerised tomography) scan taken of the area to be treated. This helps your oncologist, radiographer and physicist plan the precise area for your radiotherapy. Before your scan, you may be asked to remove some of your clothes (from the area of your body that needs treating) and to wear a gown.

The CT scan takes lots of pictures from different angles to build up a 3D picture of the inside of your body. During the scan, you may have an injection of dye into a vein. This allows different areas of the body to be seen more clearly. You may also be asked to have a full or empty bladder for the scan.

As well as a CT scan, some people have an MRI (magnetic resonance imaging) scan or occasionally a PET (positron emission tomography) scan. An MRI scan uses powerful magnetic fields to give a very detailed picture of the area that needs treating. A PET scan uses low-dose radioactive glucose (a type of sugar) to measure the activity of cells in different parts of the body. Your hospital team will tell you more about these scans.

During your scan, you’ll need to lie still on a hard couch (sometimes called a table). If you feel uncomfortable when the radiographers position you on the couch, let them know. They will try to make you more comfortable. This is important because, once you’re comfortable, the details of your position will be recorded. You’ll need to lie in the same position on a similar couch for your radiotherapy treatment.

The information from the scan is fed into a planning computer, which will be used by your radiotherapy team to work out the precise dose and area of your treatment.

Depending on the type of cancer you have, extra procedures might be needed as part of your planning treatment. If this is the case, you will be given information about them.

An icon of a green ring-binder calendar with the number 31 on it.

Radiotherapy moulds and masks

To help you stay still and in the correct position during your radiotherapy, you may need to have a mould or mask made before planning starts.

Moulds are used to keep a leg or an arm, or other body part, still during treatment. Masks keep your head and neck area still during treatment. They are often used for treatments to the brain or head and neck area. The names ‘mask’ and ‘mould’ are often used to mean the same thing. Occasionally, they are called shells.

Moulds and masks are made of a plastic mesh. The mesh is warmed and put on to your face, or other body part, so that the plastic gently moulds to fit the area being treated. Your mould or mask should fit snugly.

The mesh takes a few minutes to be moulded and become hard. The mask is then taken off and is ready to be used when you have your treatment.

If you have a mask that fits over your face, it may feel claustrophobic. But remember, you won’t usually have it on for very long and it has many holes in it, so you’ll be able to breathe easily. Your radiographers will tell you how long your treatment will take.

We have more information about radiotherapy masks if you’re having treatment to your brain or head and neck area.

Skin markings

Once the treatment area has been decided, markings are made on your skin to help the radiographers position you accurately for treatment.

Usually, permanent markings are made (tattoos). They are the size of a pinpoint and will only be made with your permission. It can be a little uncomfortable while the tattoo is being made, but it makes sure that the treatment is directed accurately.

If you’re concerned about having permanent tattoos, let your radiographers know. They can discuss alternative options with you.

If you have a mould or mask, some of the marks will be made on this.

The tattoos are tiny dots and are hardly visible. I told the nurse when having mine done that my daughter had jokingly said: “Mother, at 63 do you really think you should be having tattoos?”


Skin care

Before your treatment starts, the staff in the radiotherapy department will give you advice on how to look after your skin. This will depend on the type of treatment you are having and the area of your body being treated.

During your radiotherapy, you’ll need to take extra care of the skin in the area that is being treated. This is because the treatment may cause a skin reaction. We have more information about managing skin reactions if you have them.

If you swim, you’ll need to ask your specialist team whether you should avoid swimming until after your treatment has finished. They will also tell you when you can go swimming again after your treatment.

Back to Radiotherapy for advanced melanoma

What is radiotherapy?

For advanced melanoma, a short course of radiotherapy is often used to help reduce pain and improve symptoms.

Possible side effects

There are things you can do to help manage the possible side effects of radiotherapy treatment.

Who might I meet?

You will meet many different specialists before, during and after radiotherapy treatment.