Radiotherapy for your lung at Velindre Hospital
This booklet will help you understand what will happen when you come to Velindre hospital to have radiotherapy treatment.
The booklet will explain how your treatment is planned and given. It will discuss side effects you may have and will tell you how to get more information and support.
A glossary is provided at the front of this booklet to help you understand any words that you may find unfamiliar. Contact telephone numbers are given at the end of the booklet.
We hope you find this information useful. Please ask us if you have other questions that we have not covered.
Please bring a list of all the medication you are taking every time you come to Velindre.
Patient information is available on Velindre website Please go to: https://velindre.nhs.wales/velindrecc/
Smoking is not allowed within the grounds and inside Velindre Hospital. If you need help giving up please ask us.
This information is evidence based and reviewed annually
Glossary of terms
Chemotherapy - a treatment for cancer using drugs
CT scanner (computerized tomography) - a machine that uses X-Rays to take detailed scans of your body
Dietitian - a person who helps patients to choose the best food to keep them healthy and strong
Therapeutic radiographer - a person who will plan or give radiotherapy treatment
What is radiotherapy?
Your doctor has decided you would benefit from a course of radiotherapy to your lung.
Radiotherapy is a treatment for cancer using high energy radiation, usually x-rays. The type and amount of radiation that you receive is carefully calculated to damage cancer cells, stopping them from dividing properly so they are destroyed. Your treatment will be planned to avoid as much healthy tissues as possible. However some healthy tissue is affected which causes side effects.
Radiotherapy treatment can be given alone, after or instead of surgery. It can also be given with or after chemotherapy.
Radiotherapy team looking after you
The doctor responsible for your care is called a Clinical Oncologist. They will prescribe your radiotherapy treatment. This will be planned by a team of physicists and planning radiographers. A team of therapeutic radiographers will give you your treatment.
Velindre is a teaching hospital so your team may include a student radiographer, student nurse or a medical student. If you don't want a student present during your clinic or treatment appointment, please tell your doctor or radiographer.
We will ask your name, address and date of birth every time you come to the radiotherapy department. This is to avoid any confusion.
During your treatment you will be seen by the review team. The team includes specialist radiographers with extra training to advise you on how best to deal with any side effects. They can also prescribe medication to help. They will provide information and advice on any practical, financial or emotional concerns you may have. You can speak to them at any point during your treatment; their number is at the end of this leaflet.
How many treatments will I need?
Radiotherapy is normally given Monday to Friday as an outpatient. The number of treatments you will need depends on many facts about you and your particular cancer. Everyone is different. Your doctor will decide how many treatments are best for you.
CHART treatment
Your doctor may advise you to have a type of radiotherapy treatment called CHART. This stands for ‘Continuous Hyperfractionated Accelerated Radiotherapy’. CHART treatment involves having radiotherapy three times a day, six hours apart, every day for 12 days including the weekend. You will usually stay as an in-patient for this treatment to make it easier for you to attend your appointments.
Having chemotherapy with radiotherapy
If you are having chemotherapy, your doctor will explain this part of your treatment and give you written information.
Transport to and from Velindre
Hospital transport is available but most people use their own transport. If you would like to use hospital transport, please give us as much notice as possible to arrange this for you. There is a high demand for transport so you will need to be prepared to wait for some time to be picked up and taken home. Spaces are limited so please consider travelling alone. Some local charities can also arrange transport. Also patients on particular benefits can claim travelling expenses, please ask when you come for your treatment.
Planning your radiotherapy
To plan your radiotherapy you will need to have a CT scan. You will be asked to attend the planning department which is at the front of Velindre hospital. This scan gives your doctor a detailed picture of the area that needs treatment.
You may see your doctor during this appointment if you have not signed a consent form for treatment, the doctor will discuss the benefits and risks of radiotherapy, it is your decision to go ahead with treatment, so please discuss any concerns you have before signing your consent form. If you have already signed your consent form for treatment during your outpatient appointment you may only see the planning radiographers who will explain everything that is going to happen to you.
We may need to inject a small amount of dye (called contrast) through a needle into your hand or arm before you have your scan. The dye helps to show the exact position of the area we need to treat on the scan. It should not cause any ill effects. If you do not need the dye for your scan this does not mean the planning of your treatment will be less accurate.
We will ask you to take off your top clothing and give you a gown to wear. We will ask you to lie on a flat board (called a wing board) with handles to hold on to so your arms are above your head. If you find this position uncomfortable please tell the radiographers as this is the position you will lie in throughout your treatment.
Picture of the wing board (you will need your gown off)
You will not see or feel anything during the scan. The radiographers will leave the room to turn the scanner on, but they will be watching you very closely through a large window. The scan only takes a few minutes.
We may need to draw one or more marks on your skin which we will use as reference points for your treatment. It is helpful for us to permanently mark these reference points, but we will ask your permission before doing so.
We will make a tiny dot by using the tip of a sterile needle to place black ink just under your skin. It is a permanent mark but is as tiny as a freckle. This will mean we have accurate marks to position you for your treatment every day, so you are able to wash during treatment.
A picture of permanent ink dot
Starting your treatment
There can be a few weeks in-between your planning scan and the start of your treatment. This is due to the time needed to plan your treatment and when the next available slot is on your treatment machine.
Please let us know if there is any time that you would be unable to come for treatment. We will take this in to account when we book your treatment. Please tell us if you have any special needs that may affect your appointments, such as:
- needing transport
- having any other treatment (chemotherapy for example)
We will send you a letter or call you with your first appointment. We will give you the rest of your appointments when you come for your first treatment.
If you have a problem with the appointment, please phone the radiotherapy booking clerk as soon as possible. If the answer machine comes on, please leave your name and phone number slowly and clearly. We will ring you back as soon as possible.
Your first radiotherapy treatment
If you are an outpatient please come to the radiotherapy entrance which is around the back of Velindre hospital. Give your name and hand your letter to the receptionist in the radiotherapy waiting room. They will tell you where to sit and wait or direct you straight to your treatment machine.
If you are an in-patient, one of the hospital porters will normally collect you and take you to the treatment machine. You may be treated at any time in the day, depending upon when there is a free slot on the treatment machine.
If you are due to have chemotherapy the same day as your radiotherapy, you will usually have chemotherapy first on the ward or day unit then you will have your radiotherapy.
Your radiographers will talk to you before you go in for your first treatment. We will explain what will happen during your treatment and tell you about the possible side effects you may experience. We will give you an information leaflet about skin care during your treatment. Please ask any questions you have about your treatment. We may need you to re-sign your consent form before you have your first treatment.
Occasionally unforeseen machine breakdowns can happen during your treatment. This may cause delays or cancellation of your appointment on that day. We will explain this to you in more detail on your first day.
There are different types of treatment machines but most people have their treatment on a Linear Accelerator (shortened to LA). They each have a number, so for example, you may have your treatment on LA 4 or LA 5. The LA machines may look and sound different but they give the same treatment.
During your radiotherapy treatment
In the treatment room we will ask you to lie on the wing board in the same position you were in for your planning scan. We will position you carefully using the permanent reference marks made at planning. When you are in the correct position, we will ask you to lie still and breathe normally.
Having treatment on wing board
Your treatment may be given from different angles. On your first day of treatment we check your position at each of these angles before leaving the room to start your treatment.
The machine can be controlled and moved to the different treatment angles by the radiographers outside the room. When the machine is moving, it may come close to you but it will not touch you. When the machine is switched on you won’t feel anything, but you may hear it buzzing.
During your treatment if you feel the need to cough, you may cough but try to cough into the air without moving your arms and try to keep your upper body as still as possible.
We will watch you carefully on television monitors. If you feel too uncomfortable while the machine is on please wave your hand. We can switch the machine off and restart the treatment when you are comfortable again.
Usually on your first day of treatment and at regular points afterwards, we will take pictures or scan of the area that is being treated. You may be laying on the couch for a few extra minutes whilst this is done. The images are only used to help us check you are in the correct position for your treatment.
You need to lie still on the treatment couch for about 10-15 minutes, but the treatment itself (when you hear the buzzing noise) usually only takes a few minutes. When your treatment is finished, the couch is at a high level so please stay still until the radiographers have lowered the couch. You can then get off and leave the treatment room.
Smoking during treatment
Smoking while you are having treatment can cause your side effects to develop early and possibly be worse than usual and harder for you to cope with. We strongly advise you try to cut down or give up smoking. Please contact the Stop Smoking Wales helpline for advice (contact details are at the end of this leaflet).
Side effects
You do not normally experience side effects straight away. Side effects usually start after about two weeks of treatment although sometimes having chemotherapy can cause the side effects to develop earlier. The side effects only affect the area of the body that we are treating.
Radiotherapy continues to work inside your body for approximately 2 weeks after you have finished your treatment so any side effects you experience will continue for this time also. After about 2 weeks you will start to feel better, but everybody’s recovery time is different.
Tiredness (fatigue)
Radiotherapy can make you feel more tired than usual. You should listen to your body and rest if you need to. It is important to try to continue your normal activities during your treatment. Some people find a little exercise, drinking plenty of water and eating a healthy diet can help their tiredness. Walking can be very helpful to help with fatigue.
Skin reactions
We do not expect you to get much skin reaction with this treatment. Your skin within the treatment area may turn pink, feel warm and tender. We encourage you to continue your normal skin care routine during your treatment. We will discuss skincare with you on your first treatment.
Cough
You may develop a dry tickly cough or cough more than normal. A simple cough linctus may help to soothe the symptoms. You may cough up mucous, which can contain blood, this is a normal reaction but please tell your radiographers if this happens.
Breathlessness
You may become breathless or more breathless than normal.
Swallowing difficulties
Radiotherapy can cause your gullet (oesophagus) to become sore and inflamed. You may experience heartburn and indigestion. This could make eating and drinking uncomfortable. We can give you medication to help soothe this so that you can eat more easily.
Nausea and lack of appetite
You may feel sick or go off your food. We can give you anti-sickness tablets if you need it.
It is important to try to eat a healthy diet and drink more fluids during your treatment so that you do not lose weight. If eating becomes a struggle, it may help to eat several small meals a day rather than three main meals. We have dietitians available to give you advice on high calorie food and provide build up drinks to help you to keep your weight steady.
CHART treatment side effects
As this treatment is given over a short time, the side effects can develop after the treatment has finished. You will feel tired and may feel like you have the flu. This may cause you to cough more often, feel more breathless, and you may notice an increase in temperature. This can take a couple of weeks to recover from. If you are suffering with these symptoms we advise taking paracetamol regularly. If you are concerned about any of your side effects please contact the review radiographers (phone number at the end of this leaflet).
Long term side effects
Long term side effects are rare and do not happen to everyone. They can develop months or even years after the treatment has finished. Your doctor will discuss this with you. Please tell us if you have any concerns.
During radiotherapy a very small part of normal lung tissue will be treated. This can cause some scar tissue to build up. The result of this is that you may notice you become a little more breathless than usual.
Radiotherapy treatment to your brain
Your doctor may advise that you have some radiotherapy to your brain after or during your course of treatment to your lung. Your doctor will explain if you need this treatment, the reasons why, the side effects and how many treatments you will need.
Planning your brain treatment
We will need to do a CT scan of your head so we can plan the treatment to your brain. Some patients may need a mask to be made to keep their head still for this treatment. You will be asked to visit the mould room and you will receive a mould room leaflet explaining what will happen. If you do not have a mask made, your treatment will not be any less accurate.
Treatment for your brain
This treatment may be given at the same time as your lung treatment. You may be in the treatment room for longer as both areas of your body will be treated. You will be asked to lie in the same position as you were for the planning CT scan. The machine will move around you, without touching you. When the treatment is being given the radiographers will be watching you outside the room and you will just hear a buzzing noise. Once the treatment is finished you will be able to leave the room.
Side effects from brain treatment
Radiotherapy to your brain may cause headaches and you may feel sick. Please tell your review radiographers if this happens. Medication and advice can be given to ease these effects.
Radiotherapy to your head will cause hair loss. This may happen during or after you have finished your treatment. This will depend on how many treatments you are having. Your hair may grow back 2-3 months after you have finished your treatment. We can give you more information on coping with hair loss. During your treatment you should wash and brush your hair gently. You may continue to use your usual shampoo.
The skin around your ears may feel sore. You can use a moisturiser to help soothe this.
Finishing your treatment
At the end of your treatment you will be given an outpatient follow up appointment with your doctor. We will give you a follow up form with the details of your appointment. The telephone number of your review team will be on this form to contact if you have any concerns after your treatment has finished.
Contact telephone numbers
Velindre Hospital - 029 2061 5888
Information, support and review radiographers - 029 2061 5888 ext 6421
Radiotherapy booking clerks 029 2019 6836
Transport from Aberdare
The Rowan Tree Cancer Care - 01443 479369
Transport from Bridgend
Sandville - 01656 743344
Transport from Merthyr
Cancer Aid Merthyr - 01685 379633
Helplines and websites
Tenovus freephone helpline 0808 808 1010
Macmillan www.macmillan.org.uk 0808 808 0000
Roy Castle Lung Cancer Foundation - www.roycastle.org
British Lung Foundation 0300 003 0555
https://www.blf.org.uk/support-for-you/lung-cancer
Stop Smoking Wales 0808 274 4179
https://www.helpmequit.wales/
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