Having Stereotactic Ablative Radiotherapy Treatment to lymph nodes or bones

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What is this information about?

This information is about having a type of treatment called Stereotactic Ablative Radiotherapy Treatment for tumours in your lymph nodes or bones. 

It tells you what to expect before, during and after your treatment. It also tells you what the possible risks and side effects of this treatment are.  

It includes a list of people who can support you and answer any questions that you may have during your treatment. 

Why have I been given this leaflet?

Your oncologist (specialist cancer doctor) has advised you to have a course of SABR treatment to lymph nodes or a bone. It is important that you know what happens during this treatment, and how to prepare. Reading this information will help you do this. 

The treatment may also cause some short- and long term-side effects. Keep this information in a safe place, so you can refer to it when you need to and share it with anyone living with you or looking after you.

What is SABR?

 SABR stands for Stereotactic-Ablative Body Radiotherapy. It can also be called SBRT, or Stereotactic Body RadioTherapy.  

Radiotherapy uses high energy x-rays to treat cancer. It destroys the cancer cells in the treatment area and aims to stop cancer cells growing by either shrinking the tumour or destroying it. 

SABR is a good way to give focussed radiotherapy which can control the tumour while avoiding normal healthy tissue. It does this with:

• small precise beams of radiation 
• a high dose of radiation at each treatment 

It is a non-invasive treatment option (no instruments inside the body). It can be carried out as an outpatient procedure, so you do not have to stay in hospital.

How often will I have radiotherapy?

You will have 3 or 5 radiotherapy treatments every other day over a period of up to two weeks. The days between treatments are rest days that allow for normal cells to recover and repair.  

We aim to see you at your booked appointment time. Sometimes this may not be possible because the right staff skill mix needed to give you your treatment are not available. But we will always try our best to keep to your appointment. 

Your treatment will be planned around any bank holidays. If the machines are due to have maintenance, your treatment will be planned around this too. This is to make sure that your treatment is not affected.  

How do I prepare for radiotherapy?

Having a CT planning scan. 

Your first appointment will be a CT planning scan, which will take around 30 to 40 minutes.  

You may need 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. 

The aim of a planning scan is to find a position for you that is comfortable and can be repeated for each treatment session. If the position is too uncomfortable, let staff know as adjustments can be made.  

We usually suggest these positions if you are having radiotherapy:  

• to your neck or upper chest: you will have a custom mask moulded to keep your head and shoulders still. You will lie on your back with your arms down by your sides and a cushion under your knees. A mattress may be added for comfort. 
• to your chest or abdomen: you will lie on your back, with your arms above your head, holding onto handles. To help you stay still, a vacuum bag can be moulded around you. You will have cushions under your knee. A mattress may be added for comfort. We may need to use a small breathing monitoring device which will be a belt linked to the CT scanner. 
• to your pelvis: you will lie on your back with cushions under your head and your arms across your chest. You will also have cushions to under your knees and feet for stability.  

After the CT planning scan, the radiographers will make some permanent tattoo dots on points close to the area of treatment. This will help us to position you accurately during treatment.  

The tattoo dots are about the size of a pinpoint. They are permanent and are only made with your permission. If you are concerned about this, please let the CT radiographers know and they will discuss other options with you.

Will I be contacted before the treatment starts if I have any questions?

Yes. A radiographer will ring you a day or so before your first appointment to explain the procedure and answer any questions you may have. 

What will happen when I have my radiotherapy treatment?

When you arrive for your treatment on the first day, please report to the radiotherapy reception. The treatment radiographers will talk with you and answer any questions you may have.  

The machine that delivers the radiotherapy is called a Linear Accelerator, also called a Linac. 

You may need to remove some clothing. You will then be asked to lie down on the treatment bed. The radiographers will position you carefully on the treatment couch. They will adjust the height and position of the bed to align the tattoo dots on your skin.  

Using pen marks, we will monitor your position throughout. These 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 room while the treatment is delivered. They can see you at all times and can talk to you.  

If you need them, they can be back in the room very quickly. Raise your hand if you need help. 

The radiographers will be in and out of the treatment room moving panels attached to the machine and adjusting the bed position. Please stay still and in position. The radiographers take several scans to confirm that your treatment is being delivered accurately.  

They will tell you when the treatment has finished and you can move freely again. 

Treatment will take between 30 and 45 minutes to complete. After this the radiographers will come and help you off the treatment couch.

The radiographers will monitor your side effects through the treatment. If you have any questions or queries please discuss this with the team treating you.

Does the treatment hurt?

No. Radiotherapy treatment is completely painless. You will not see or feel anything while it is being delivered. You will only hear a low buzzing. The machine will not touch you at any point. 

The radiographers will monitor your side effects through the treatment. If you have any questions or queries, please discuss this with the team treating you. 

Are there any possible side effects when you have a SABR to a bone or lymph nodes?

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

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. 

Side effects can be split into:

• Acute short-term (or early) side effects (up to 12 weeks after treatment). They are usually temporary. They gradually go away by themselves without help.  
• Long term (or late) side effects (months or years after treatment). The area and amount of radiation you are given will affect which side effects you may experience and how severe they are. Your oncologist will discuss this with you before treatment. 

 You will see below a list of early and late side effects of treatment: 

Early side effects of treatment

• Tiredness (fatigue). It is common to feel more tired than usual following radiotherapy. Your energy levels may take weeks or months to return to normal. To help with this, drink plenty of fluids and make sure you eat enough. Try and stay active but rest when you need to.  
• Skin reaction or soreness. This is not common. Your skin may look pink, red or darker and become dry and itchy. To help with this: 
  • When you are washing avoid very hot or very cold water and avoid vigorous rubbing with a towel. Instead, pat your skin dry gently.  
  • Use your normal washing products. If this causes a reaction, you can try something else (for example, E45 or Aveeno).  
  • Wear loose-fitting, breathable clothing (for example, cotton or wool) when possible.  
  • 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. 
• Sore throat. You may experience this if you are having treatment around your neck or upper chest. You can take your regular pain relief if needed. 
• A change of appetite or nausea and vomiting (feeling and being sick). Your appetite might change, and you might feel sick, especially if treatment is targeted at your abdomen (tummy). Please tell us if you feel very sick, as we can get anti-sickness medication prescribed for you.  
• Bowel and urinary (bladder) symptoms. This may happen if you have treatment in and around your pelvis. 
  • This may irritate or upset your normal bowel habits (how often you poo and what your poo is like). You may have diarrhoea, or feel like you need to poo without passing anything.  
  • If your bladder is irritated, you may need to pee more frequently, more urgently, and have side effects that are like an infection. Drink plenty to help reduce these effects as well as avoiding caffeinated drinks (like tea, coffee, coca cola) and acidic drinks (fruit juices). 
• Increased bone pain. Having treatment to an area of bone may mean you have a temporary pain flare during and following radiotherapy. You can take some pain relief (such as paracetamol) or other medicine from a pharmacist. If this is not enough, speak to a member of the team.  

Late side effects of treatment

• Bone pain or bone fractures (breaks). For tumours in or close to a bone, SABR treatment can weaken the bone. This means that you are at a greater risk of fractures. For most people, this does not cause any symptoms and is discovered when you have a scan after the treatment. A small number of people may have a fracture that needs surgery to fix. They may sometimes need pain relief for a long time to help manage the discomfort. 
• Damage to bowels or bladder. The risk is small but long-term serious damage to the bowel can happen. 
  • Possible effects may be a more permanent change in bowel habit, bleeding from the bowel or diarrhoea. Other rare but potentially life-threatening complications are narrowing of the bowel, perforation of the bowel (a hole in the bowel) or severe bleeding. This may need treatment with surgery. 
  • SABR could cause permanent damage to the bladder. Your bladder size can be restricted so you have to go to the toilet more frequently. You may have increased urgency (need to pee urgently) and bleeding. This may need further investigation.  
• Secondary malignancies (cancers). Any dose of ionising radiation treatment does carry a small risk of causing another cancer in the treatment area, many years later. The risk of this is small and if relevant, the team will discuss this with you. 
• SABR re-irradiation risks. If SABR is given to an area that has already had radiotherapy, this is called re-irradiation. Re-irradiation can increase the chance of more serious or long-term side effects. These risks may only become clear during the planning stage, when doctors can see how much the new treatment overlaps with the previous one. Because of this, the number of treatment sessions might be changed, or the treatment may not go ahead if the risks are too high. 

Who can I speak to if I have concerns?

SABR specialist radiographer

It is the role of the SABR specialist to support you during treatment and to give practical advice and information. They will be your key worker and your main point of contact with the hospital.  

They can be reached by calling through to reception numbers:  

Sussex Cancer Centre Radiotherapy: 01273 664901 

Eastbourne Radiotherapy Unit: 01273 938900 

They will hopefully be able to answer any queries between the hours of 9.00am to 5.00pm, Monday to Friday.  

Consultant Clinical Oncologist

If you have questions relating to your medical care, you can discuss these with your radiotherapy team or SABR lead radiographer. 

They can contact the appropriate team and consultant oncologist who is leading your care and treatment.

Clinical Nurse Specialists (CNS)

Your CNS is there for you to discuss any aspect of your treatment and you will usually see them during the consultation period. They can offer you advice, help on the practicalities of your treatment, and they can sign-post you to other support services that may help you.  

If you do not know the contact information of your CNS, let one of the radiotherapy team know and we can find out this information for you. 

Will I see anyone else during my treatment?

You may see Student Radiographers and staff in training. We are a teaching hospital. Sometimes we may have students or other members of staff observing or taking part in your treatment to learn. 

Please tell the treatment staff if you would prefer not to have an observer with you. 

How do I know if the treatment has worked?

The radiotherapy treatment continues to work for weeks or months after treatment ends so your oncologist won’t be able to tell you straightaway how the cancer is responding. However, they can help you manage any side effects. 

After treatment finishes, you will have regular check-ups. Your oncologist will do a physical examination and arrange tests or scans to check whether the cancer has responded to treatment. You may not know the full benefit of having radiation therapy for some months.

What happens after radiotherapy?

You will be reviewed approximately 2 to 6 weeks after completing your treatment.   

Your doctor will request that you have an up-to-date scan about 12 weeks after the end of your treatment.  

You will generally then be seen every 3 months for the first year after treatment. If at this point you do not require any further support or intervention from us, you will have fewer reviews with your consultant over the years (probably once a year). 

How will my personal information be used?

To keep improving our radiotherapy services, we regularly carry out audits in the department. This may involve using patient notes. Any data collected will have all personal and identifiable details removed to ensure patient confidentiality.  

However, if this is unacceptable to you, and you would prefer that your notes are not seen, please let your consultant know and your wishes will be respected.  

The department also takes part in clinical trials (a type of research) which you may be able to take part in. If necessary and appropriate, your doctor will discuss this with you. 

Further contacts

For emergencies out of hours contact your GP or call NHS 111. 

Get more local support from:

Macmillan Horizon Centre (Opposite SCC entrance)
Services on offer:

• Cancer information
• Complementary therapies
• Professional counselling
• Benefits advice
• Self-help and support groups
• Sign-posting to other services