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Discomfort on swallowing Sometimes the oesophagus (food-pipe) can become inflamed during radiation treatment. Again this is less common with SBRT treatment than conventional radiotherapy. This inflammation can result in pain or difficulty swallowing and may necessitate a diet of soft foods and fluid for a week or two. Hair loss SRS will not cause you to lose your hair on your head permanently. SBRT can cause some patchy hair loss on the chest (in males). Depending on the radiation dose, chest hair may or may not grow back. Nausea SRS and SBRT do not usually make you feel nauseous however if you do feel nauseous there are medications to help you control this. It is important that you let us know if you develop any of these side effects so we can help you manage them. Late side effects of treatment Late side effects, although uncommon (less than 1%) can occur after your treatment is finished. Rest assured, your doctor will discuss with you potential long term side effects that relate specifically to your treatment. Lung scarring / fibrosis / collapse Some of the treated lung around the cancer may be affected by the radiation treatment. This can result in scarring and very rarely may necessitate the use of oxygen therapy for either a short time or permanently. The risk of this is lower when receiving SBRT compared to conventional radiotherapy. Bone pain and fracture Radiation may weaken the bone which can cause pain or a fracture. In extremely rare cases, this may result in the need for long-term painkillers. Nerve damage For cancers near the nerves, there is a small chance of radiation damage. This can result in weakness, numbness, pain or loss of function and in some cases can be permanent. Our staff are trained to support you through your treatment. Second malignancy It is rare for patients to develop another cancer in the same treatment area due to radiation. Follow up Questions At the end of your SRS/SBRT treatment you will be given a follow up appointment to see your Radiation Oncologist in approximately two weeks. At this appointment, your Radiation Oncologist will assess any side effects from treatment and start follow up care. If you have any questions after reading this information write them down and ask your Radiation Oncologist at your next appointment. You may also be asked to fill out a questionnaire each time you are seen with questions about any symptoms following SRS/SBRT. This provides us with valuable information to help us refine our SRS and SBRT programs to ensure that we are delivering the highest quality of care to patients. Support Our team, including your Radiation Oncologist, Radiation Oncology Nurse, Radiation Therapists and administrative staff, are trained to help you through your cancer treatment. Whilst much attention is paid to your physical health we appreciate that your emotional health is important too. Being diagnosed and receiving treatment for cancer can be very distressing and will commonly result in lots of questions, anxiety, fear and sometimes depression. Stereotactic Radiation Therapy Patient Information Leaflet Please raise any side effects with our staff. If we are not able to assist directly, we have a wide network of health professionals who we can refer you to so that you can receive the support that you need. ROV-FRM-107 V1 www.radoncvic.com.au This leaflet provides information for patients and their family about Stereotactic Radiation Therapy • What is Stereotactic Radiation Therapy? • Your Stereotactic Radiation Therapy treatment including: – Positioning and CT Scanning – Treatment • What to expect • Side effects of Stereotactic Radiation Therapy treatment • Follow up and support What is Stereotactic Radiation Therapy? Radiation therapy is used to treat many types of cancer. It uses high energy X-rays to destroy cancer cells whilst causing as little damage as possible to the normal body cells around the cancer. There are two different types of stereotactic radiation therapy – Stereotactic Radiosurgery (SRS) and Stereotactic Body Radiotherapy (SBRT). SRS and SBRT enable a high dose of radiation to be delivered to the cancer cells using a precisely focused method whilst sparing the nearby normal tissues. The main differences between SRS/ SBRT treatment and conventional radiation therapy treatment are: • A higher radiation dose can be delivered to the cancer resulting in better cancer outcomes • The lower radiation dose to the other body tissues results in fewer side effects • SRS and SBRT is delivered in 1-5 sessions over 1-2 weeks (as opposed to 15+ sessions over 4+ weeks) The fundamental difference between SRS and SBRT is the number of sessions involved and the body area where the treatment is delivered. SRS is used to define treatments that involve one session only and usually relate to treatment to tumours in the brain. Treatments to the brain can also be delivered over multiple sessions, this is known as Fractionated Stereotactic Radiotherapy (fSRT). SBRT uses multiple treatment sessions, usually 1-5 and delivers treatment to areas outside the brain including the abdomen, pelvis, lung, bone and spine. Your SRS/SBRT treatment You will need to attend your radiation oncology department for a specialised planning appointment prior to starting your treatment. This appointment will take between 1-3 hours. Positioning and CT Scanning SRS / fSRT - requires your head to be as still as possible. This immobilisation is achieved by making a customised head support and a plastic mask. These are made during your CT simulation appointment. The mould is made first using a foam product which forms around the head, neck and shoulders – maintaining the position and angular rotation of the head and neck for every SRS / SRT treatment. The mask is then made using a thermoplastic mesh which is warmed and placed over the face, hardening as it cools. The thermoplastic mask is shaped so as to give the exact impression of your face and head. There are holes in the mask so you can breathe easily. SBRT also requires the area of your body that is being treated to be as still as possible. Special vacuum cushions are used to maintain your body in a position that is ideal for treatment delivery; this positioning varies depending on the area of the body you are having treated. You may be required to have your arms up above your head, on your chest or by your side. In each case your arms will be supported by the moulded vacuum cushions. In most cases, your knees and feet will be supported by knee and foot position modules. For SBRT cases, after the completion of the CT scan, you will be given several permanent tattoos (small dots on your skin), which assist us to set you up in exactly the same position for your treatment. It is important that you are comfortable in your scanning position, as you will lie in the same position for the duration of your planning and treatment sessions. A custom made thermoplastic mesh worn by patient. A treatment plan is created, based on your CT scans and other important information. On the first day of treatment our nursing staff will conduct a patient interview. Skin care and treatment for potential side effects will be discussed. Your Radiation Therapists will coordinate all appointments with you. What to expect If you are not comfortable, please advise the Radiation Therapist. Once the mould and thermoplastic mask are made for your head and neck or the vacuum cushions have been moulded to your body shape, a CT scan of the area you are having treated is performed. If you are having treatment for lung cancer, your breathing is taken into consideration due to its impact on the position of the tumour. During the scanning process you may be given instructions on how to breathe. Once the session is complete you can go home. The images obtained during this CT scan along with any MRI/PET scans of your tumour are used by specialists to carefully plan your radiotherapy. After the CT/Planning session, it takes our treatment team 1–2 weeks to create your treatment plan. Treatment During treatment, you will be asked to lie on the treatment table in the same position as you were for your planning CT scan. The Radiation Therapist will help you get into the correct position and add any moulds or equipment that you may require. Scans are then taken of your position and adjustments are made to achieve submillimetre accuracy prior to treatment delivery. • SRS/SBRT treatment is usually given on 1-5 separate occasions over 1-2 weeks. Each treatment will last for about 30-60 minutes. • For each treatment you will be positioned in the same way as in the planning scan. • Scans will be taken prior and sometimes during the treatments to ensure that the radiotherapy is delivered accurately. • Once your setup is complete, the treatment staff will leave the room but they can still see you and speak to you via a 2-way intercom and closed circuit TV camera. • It is very important during the treatment that you breathe in a steady pattern and remain very still. • You will see the treatment machine moving around you and hear it ‘buzzing’ but it will not touch you. You will not feel anything during the treatment. Regular check-ups with your Nurse and Doctor are scheduled. Early side effects of treatment Early side effects of treatment can occur whilst receiving and up to 12 weeks after the completion of your treatment. Your Radiation Oncology Nurse will talk to you about what side effects to expect and how you can look after yourself during treatment. Early side effects are usually temporary and can include: Tiredness / fatigue Radiotherapy can make you feel more tired than normal, particularly in the weeks following the treatment. This is normal and will gradually settle. Make sure you have plenty of rest, although light exercise can often make you feel better. Skin reaction The skin in some areas around your body may become slightly dry, itchy and red. If your cancer is very close to the skin, this reaction may be more prominent. Shortness of breath Sometimes when lung tissue is being irradiated it can become inflamed. This is referred to as “radiation pneumonitis” and can result in shortness of breath, a dry cough, wheezing and sometimes a fever. It usually develops 6-12 weeks after completing treatment. Radiation pneumonitis can be treated by medication. Chest / rib pain If your cancer is close to the chest wall / ribs then you may develop pain following SBRT treatment. This is usually mild and temporary although occasionally can be more significant or persist for longer. It can usually be managed with pain medications.