Radiotherapy

You have been referred by your doctor to the Department of Radiotherapy at the UMC Utrecht. The reason is that you have a tumor or a benign abnormality that can be treated with radiotherapy (possibly in combination with surgery or chemo/immunotherapy). Here, you can read what treatment with radiotherapy entails. Another word for radiotherapy is radiation. 

Side effects can also vary per patient. You can read information about this in a separate folder. You will receive this folder at the Radiotherapy department, if the information applies to you. We recommend that you also let your partner, family member or friend read this folder so that they will also have information about your treatment.

What is radiotherapy?

Radiotherapy is a medical treatment with radiation. Usually it involves X-rays or electron radiation. Both types of radiation are generated by electricity in a device: a 'linear accelerator'. This linear accelerator, which is also called a radiation device, produces a beam of radiation. This beam can be compared to a beam of light and can be switched on and off. The beam of radiation is precisely aimed at the area that needs radiation.

How does radiation work?

In the human body, new cells are constantly being formed and old cells are dying. If there are cells that divide faster than normal, the balance is disturbed. A growth or tumor can then develop; for the sake of readability, we will speak of a tumor in this leaflet. By this we mean both malignant and benign tumors. 

Radiation can damage the cells of the tumor so much that they cannot divide any further and therefore die. Tumor cells are much more sensitive to radiation than healthy cells. 

With external radiation, the tumor is irradiated from the outside. The radiation passes through the skin. Irradiation of healthy tissue is avoided as much as possible. However, there are also healthy cells in the area to be treated. These healthy cells are then also inhibited in their growth, but they generally recover sufficiently to not cause permanent damage.

For some types of tumors, internal radiation is used, also called brachytherapy. In this case, we use radioactive material that emits radiation. This material is introduced into the body for a short period of time. These treatment techniques and special devices treat the tumor from very close by. For some types of tumors, both forms of radiation are combined. This brochure describes the procedure for external radiation.

Separate brochures are available for internal radiation.

We can use radiotherapy to cure cancer. We call that a 'curative treatment'. A curative treatment can consist of different forms:

• Adjuvant therapy. This is radiotherapy after surgery. Radiotherapy is then given to destroy any remaining tumor cells and invisible metastases. 
• Neoadjuvant therapy. This is radiotherapy before surgery. The aim of this is to to reduce the size of the tumor so that it can be removed more easily by the surgeon.
• Complete treatment. Radiotherapy can also be used as a complete treatment. The radiotherapy should destroy the tumor completely. This treatment can be given for a limited number of tumor types, and only if there are no metastases outside the radiation area.

If patients can no longer be cured, we can also give radiotherapy. We call this a 'palliative treatment'. Radiotherapy can then be given for the following reasons:

• Inhibiting tumor growth. This can reduce your pain.
• To stop bleeding in the tumor.
• To ensure that surrounding organs are less affected by the tumor.

Palliative radiotherapy is often short-term. It is beneficial because it improves the patient's quality of life.

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The intake interview

The medical administration has received a registration letter from your referring specialist. Based on this, we have made an appointment for an intake interview with your doctor. This conversation can be with a radiotherapist, specialist in training of physician assistant.

• The radiation therapist is a doctor who specializes in radiation
• The physician assistant is a healthcare provider who is specially trained to take over certain tasks from a doctor.

Please bring a list of the medications you are taking with you to this conversation. You can request this list free of charge from your GP or pharmacy.

The intake interview consists of 2 or 3 parts:

1. The first part is the intake with the doctor’s assistant, she will ask you a number of questions to review.
2. The second part is an appointment with a researcher. This part of the intake only takes place if you are eligible to participate in a study. The last part of the intake is the conversation with your doctor.

Where does the intake interview take place?

The intake interview will take place at the department of Radiotherapy, Heidelberglaan 100. You can register for your appointment at reception 2 when you are in our department.

Administrative intake

You can report to reception 2 for your appointment when you are in our department. An employee will review the information we have on file with you. A digital passport photo will be taken and you will receive a card with your details.

Please bring this card with you every day. You can use it to register at the registration column at the entrance at location Heidelberglaan 100. At location Soestwetering 1, you can report to the reception. Then we will know that you are present.

The conversation with your doctor

During the intake interview, your doctor will ask specific questions based on the available data. Your doctor will discuss the treatment plan with you. You will receive an explanation about the radiation treatment and its side effects. If you don’t understand something or if you are worried about something, you can discuss it with your doctor. You can also ask all your questions. Use of medication, hypersensitivity to certain medications and whether you have an ICD or pacemaker can be discussed during the conversation. If necessary, a physical examination will be performed.

A treatment series consists of a number of radiation treatments. This number can vary per patient. The number of radiation treatment depends on the nature and extent of the tumor. There is no direct relationship between the seriousness of the condition and the number of radiation treatments.

Treatment dates

When the date of the first radiation appointment is known, you will be called by an employee of our care planning. After the first radiation appointment, you will receive a list of appointments for the first week. After that, you will receive the list of appointments for the following week every Thursday.

Preparation for radiation

Before you start the radiation treatment, some preparations are necessary. These preparations are not the same for every patient and may consist of:

• Making a mask of other aid (for example, for radiation in the head-and-neck region).
• Determining and marking the region or body part to be irradiated using a CT, MRI or PET-scan.

The mouldroom

This is the room where masks and other aids are made, which may be needed to perform the treatment as accurately as possible. It is important that you lie in the same position during each radiation treatment. In the case of radiation treatment of the head or neck, this is not possible without a custom-made mask.

The mask is made in the mouldroom. Such a mask is made of a special plastic. It has openings for the nose and mouth, so you can breathe normally. The mouldroom worker will explain the process before the mask is made.

The CT scan (Computed Tomography)

The CT scan is an X-ray machine that can image the inside of the body. A CT scan uses X-rays. Your doctor will determine the correct radiation area using the CT scan. The radiation therapists will then create a radiation plan. A CT scan that was made previously cannot be used because you were not in the same position a required for the radiation.

After the CT scan, small tattoo dots are placed on the skin. The tattoo dots on the skin are needed to position you correctly for each radiation treatment. If you have a mask, markings are placed on the mask. You may need to come back for a CT scan during the treatment series. This is necessary to check or possibly adjust the radiation area. You will be informed by your doctor and/or the radiation therapist if a new CT scan is necessary.

The MRI scan (Magnetic Resonance Imaging)

The MRI scanner creates images of the body using magnetic fields. To create a radiation treatment plan, some patients also undergo a MRI scan. If this applies to you, this will be discussed with you during the intake interview. At reception 2 you can get an information folder about the MRI scan.

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During the treatment

The treatment

The Radiotherapy department has two treatment locations. The main location is in the UMC Utrecht, location Heidelberglaan 100. The second location is next to the St. Antonius hospital Utrecht, location Soestwetering 1.

Location Heidelberglaan 100

This is the main location of the Radiotherapy department. The intake interview and preparation for the treatment will take place at this location. You can register at this location with your patient card at the registration pillar. Your appointment will appear here, as well as the waiting room where you can take a seat or the counter where you can register. You can also have a parking ticket printed here. Parking is possible at the entrance to the department, you can read more about this under the heading ‘transport’.

Location Soestwetering 1

This is the second treatment location of the Radiotherapy department. Only treatments are performed at this location. You can register at the reception. If you are going to be treated at this location, the preparation for the treatment will take place at location Heidelberglaan 100. The radiation treatments and therapy checks take place at location Soestwetering 1. If you are going to be treated at location Soestwetering 1, you will receive a separate information folder with practical information such as where you can park.

The radiation

The first time you come for radiation, the radiation therapists will explain the procedures involved in your radiation treatment and how the radiation will be given. The radiation will only start after the explanation. It is not possible for you to have the same radiation therapists for the entire treatment, but often you will see the same one or two radiation therapists regularly. Partners, children and parents can observe the radiation treatment process. This does not have to be requested specifically and it is not possible during the first radiation treatment, so that we can give you all our attention. Later during the treatment, the radiation therapists will have more time for explanations.

Just before your treatment you will be escorted to the changing room. If you need to remove your outer clothing for your treatment, we suggest bringing a cardigan or shawl. Then you will walk with a radiation therapist to the radiation room.

The irradiation

The information in this section concerns treatment with a regular radiation device. If you are going to be treated with an MRI linac, you will receive a separate folder about this.

How is the radiation treatment performed?

The radiation therapists will ensure that you lie every day in the same position as during the CT scan or MRI scan. The tattoo dots are used to position you the same way each day. If a mask has been made for you, you will be given this mask again to position you correctly. When you are in the correct position, the radiation device will move to the correct spot. First, a position image will be made. We use this image to check whether you are lying in the correct position. You will be lying alone in the room when the position image is made and the radiation is given. The radiation therapists can see you via cameras and can, if necessary, talk to you via an intercom system. The entire treatment takes about 15 minutes, but the radiation itself usually only takes a few minutes.

During the radiation it is important that you lie still. If you are unable to remain still or if you have to cough, you can say so. The radiation therapists will immediately stop the radiation and will be with you within a few seconds. The treatment van be carried out in two ways:

• You will be irradiated from different directions, and the radiation device will be stationary while the radiation is being administered.
• You will be irradiated using radiation arcs so that the radiation device will rotate around you at the same time that the radiation is being given.

The treatment outcome is not related to the way in which the radiation is given. It is important that you remain still until the radiation therapists say that the radiation is finished.

You don’t feel the radiation. You only hear the sound, a buzzing tone, of the radiation device.

The number of radiation treatments was discussed with you during the intake interview. Sometimes it is necessary to change the number of treatments or to add a break. Your doctor will then discuss this with you.

Controls

During the treatment you will have regular discussions with your doctor, the therapy check. If you wish, you van also request an additional consultation (via the radiation therapists). During the therapy check you can ask questions or discuss side effects. You can also discuss the side effects with the radiation therapists, who can refer you to a doctor if necessary.

Side effects

Radiation can cause side effects. Common side effects are:

• Fatigue
• Discoloration of the skin at the site of the radiation therapy.

These side effects usually occur after two weeks of treatment. In addition to the general side effects, there are also side effects that depend on the location where you are irradiated. Your doctor will discuss these side effects with you during the intake interview. The response to the radiation varies per patient. This cannot be predicted in advance.

Fatigue

In the KWF brochure ‘Fatigue after cancer’ you can read more about dealing with fatigue. This brochure is available at the Radiotherapy department. Your body needs extra energy to repair healthy cells and remove dead cells. In addition, travelling back and forth to the department can be an extra burden. Stress surrounding your illness or treatment van also effect how you feel. Therefore, try to relax and do things that you enjoy. If you feel tired, try not to make any major efforts and take extra rest, but keep moving.

Nutrition

It is not necessary to follow a special diet before radiation. It is important that you eat and drink enough. Sufficient nutrition helps you to stay fit and to keep your resistance as high as possible. Radiation can cause your appetite to decrease. Sometimes it is better to eat smaller amounts more often. It is important that you eat well and have a varied diet, even if you do not have much of an appetite. It is also important to drink enough. Your body van then get rid of waste products better. Drinking enough means one and a half liters per day, which is about ten glasses or cups.

Some patients receive guidance from a dietician. The dietician is affiliated with the Radiotherapy department. If this is necessary for you, your doctor will discuss this with you. Any appointments with the dietician will be combined with the radiation appointment.

For some treatments you will be instructed to drink a certain amount before the CT scan and radiation. If this is the case for you, you will be given clear instructions for this.

Psychosocial consequences

Your illness and treatment are causing you to go through a difficult time. This is accompanied by anxiety, worries and sadness. You may feel like you are living between hope and fear. If you have this feeling, you can indicate this to the radiation therapists or your doctor. Together we can then see what the best steps are.

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After the treatment

After the last treatment

Side effects are often worst at the end of treatment and shortly after. Side effects can also get worse after treatment. You can always contact us for advice about this.

After the last treatment, if you have any questions about the treatment or other questions related to the treatment, please contact the Radiotherapy department. You can contact us by phone or via the patient portal. For other questions, please contact your GP.

After the treatment you will have check-up with your doctor, we call this the follow-up appointment. This appointment can be at the Radiotherapy department or by telephone.

Transport

You will come to the Radiotherapy department for each radiation treatment. You do not need to be admitted to the hospital. You van, where possible, come by your own transport or by public transport. You can also use a taxi.

Own transport

If you come to the Radiotherapy department by car, you can park at the entrance of the department. The entrance of the Radiotherapy department location Heidelberglaan 100 is right next to the emergency department (SEH). If you come by your own transport, we recommend that you follow the signs to SHE. Please note: parking at the entrance of the Radiotherapy department is only for patients who are being treated in the Radiotherapy department. You need a parking card to be able to park. You will receive this parking card at the Radiotherapy department.

Public transport

The UMC Utrecht is easily accessible by public transport. From the main entrance, follow ‘route Q’. Current public transport travel information and timetables can be found at www.9292.nl.

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