Having stereotactic ablative radiotherapy treatment to the lung

Your Oncologist has advised that you would benefit from a course of SABR treatment to the lung. Stereotactic ablative radiotherapy (SABR) can also be referred to as stereotactic body radiotherapy (SBRT).

Radiotherapy is the use of high energy x-rays to treat cancer. It destroys the cancer cells in the area that we are treating and aims to stop cancer cells growing by either shrinking the tumour or completely destroying it.

SABR is an effective way of giving focused radiotherapy to try to control the tumour whilst sparing normal healthy tissue by:

• Small precise beams of radiation.
• High dose of radiation at each treatment.

You will have radiotherapy in 3, 5 or 8 treatments on alternate days over a period of two weeks. The rest days between treatments allow for normal cells to recover and repair. We will make up for any bank holidays that occur during your treatment.

It is very important that you attend all of your radiotherapy appointments. If you are feeling unwell or think that you may be unable to attend for any other reason, please contact the radiotherapy department as soon as possible on: 01273 664901 as it may be important to have an urgent medical review.

Computer tomography planning scan

Your first appointment will be a CT scan, which will take around 30-40 mins. It may be necessary for you to have an injection of special dye known as contrast to make some areas show up better on the scan. The CT staff will let you know if you need this.

You will be asked to lie on your back with your arms up above your head holding onto handles. There will be cushions under your head, knees and feet. A small breathing monitoring device will be attached around your chest/abdomen which is linked to the CT scanner.

The aim is to find a position that is comfortable and reproducible for the treatment sessions, that can take up to 45 minutes to deliver. It is very important you let staff know if the position is too uncomfortable as adjustments can be made.

After the CT scan the radiographers will have to have make three permanent tattoo dots on your chest. These allow us to position you accurately during treatment They are about the size of a pinpoint, but are permanent and are only made with your permission. If you are concerned by this please let the CT radiographers know and they can discuss other options with you.

If you are taking any medication, particularly for pain, please bring them with you to the hospital. Make sure you take your pain relief before the planning scan appointment as this will make it more comfortable when we position you for your scan.

Moulds and masks

As part of the CT scan process, depending where in your lung the tumour is may mean that a mould or mask may be required to help you stay still for the treatment.

The team will tell you more about this if a mould or mask is required.

Please report to radiotherapy reception when you arrive each day for treatment. On the first day the treatment radiographers will have a brief discussion with you and answer any questions which you may have.

You may need to remove some items of clothing and will then be asked to lie down on the treatment bed. The radiographers will position you carefully on the treatment couch, adjusting the height and position of the bed to align the marks on your skin.

We will also be making pen marks on your skin to monitor your position which will wash off. It is important for you to remain as still and relaxed as possible and to breathe normally.

When you are in the correct position the radiographers will leave the room. They will be watching on CCTV just outside the treatment room whilst they deliver the treatment. They can see you at all times so if there are any problems wave or call out and they can be back into the room very quickly. The radiographers will be in and out of the treatment room moving panels attached to the machine and adjusting the bed position but we want you to remain still and in position.

The radiographers will inform you when the treatment has been completed and you are able to move freely again.

The treatment will take between 30 and 45 minutes to complete.

Radiotherapy treatment is completely painless, you will not see or feel anything while it is being delivered.

Side effects can vary from patient to patient. Not everyone will experience all of the side effects but it is important you are aware of them.

If you are someone who smokes it is important to stop as this can increase the risk of side effects occurring. We can offer you help and support for smoking cessation. Please ask if this applies to you.

It is important to tell the radiographers how you are feeling when they ask, particularly if you feel symptoms worsen so we can get you the care that you need.

These side effects can occur up to 6 weeks after completion of your treatment. They are usually temporary and gradually resolve by themselves without intervention.

Tiredness

• It is common you will feel more tired than usual following radiotherapy.
• Ensure you drink plenty of fluids and keep up nutritional intake.
• Prioritise tasks and try to keep as active as possible but listen to your body and rest when needed.
• Your energy levels may take weeks or months to return to normal.

Skin reaction

Skin reactions are uncommon but may occur where you are having treatment across your chest, it may look pink/red or darker and become dry and itchy.

To avoid developing a skin reaction:

• When washing avoid extremes of temperature and avoid vigorous rubbing with a towel.
• Instead, pat skin dry gently.
• Use your normal washing products. If this causes a reaction we may ask you to use something else (e.g. E45 or Aveeno).
• Wear loose-ftting, breathable clothing (e.g. cotton/wool).
• Avoid exposing the skin in the area we are treating to the sun or cold wind (If you are going to be in the sun wear a high factor sun cream).

Shortness of Breath and/or raised temperature

• Following treatment to the chest the lung tissue may become inflamed, this is called ‘radiation pneumonitis’. It can result in breathlessness, wheezing, cough or fever that may last up to 12 weeks following treatment and can sometimes be mistaken as a chest infection.

Please seek advice from the radiotherapy team or GP before using antibiotic medication.

• Radiation pneumonitis is rare and less likely to happen with SABR treatment but if this is suspected you may be prescribed some oral steroid medication to help reduced the inflammation and manage your symptoms.

Chest Pain

• If your lung tumour is close to the chest wall following treatment you may experience. some chest, rib and back pain.
• This is usually mild and often can be relieved with simple over the counter pain relief medication such as paracetamol.
• If the pain is more severe or persists for a long period of time please seek advice from your radiotherapy team.

Lung scarring / lung collapse

• SABR treatment to the lung may cause scarring in the area that was treated. This is permanent and may cause a small portion of lung to collapse.
• The precise planning of treatment keeps this to a minimum however those that experience this can feel short of breath and may require oxygen either temporarily or permanently.
• The chance of this happening is small.

Continued chest wall pain/ rib fractures

• For tumours close to the ribs there is a chance that the radiotherapy may weaken the ribs and cause pain and rib fracture.
• For most patients this does not cause any symptoms and is discovered when you have a scan after the treatment.
• A small number of patients with a rib fracture may require painkillers, sometimes for a long period of time to help manage the discomfort.

Upper arm nerve damage (brachial plexopathy)

• For tumours close to the top of the lungs, there is a very small risk of the radiotherapy treatment damaging the nerves going into the arm.
• This would mean that there may be weakness or numbness in part of the arm which could be permanent.
• The chance of this happening is very small. Great care is taken in the planning process in order to avoid/ minimise the dose of radiation to these nerves.

Secondary malignancies

• As with any dose of ionising radiation the treatment does carry a small risk of causing another cancer in the area that has been treated, many years after treatment.
• The risk of this is small and if relevant the team will discuss this with you.