This leaflet provides information regarding the use of external beam radiotherapy in treating cancer, including details of the procedure and side effects that you may experience.

Although you may have heard about radiotherapy from friends, relatives and/or other patients, it is important to remember that their experience may not be the same as yours. In all cases, a doctor will explain your radiotherapy treatment to you and answer any questions you may have. 

We are here to help, so if you would like further information or have any concerns, please do not hesitate to ask a radiographer or a member of the radiotherapy review specialist team. 

In most cases, a friend, relative or carer may accompany you to your appointments. Please ask your doctor or a member of the radiotherapy team if this is possible.  

What is radiotherapy?

Radiotherapy uses precise, carefully measured doses of high energy x-rays to treat cancer. Cancer cells are more sensitive to radiation than normal cells, so the aim of treatment is for the x-rays to either destroy the cancer cells or stop them from growing, whilst avoiding and protecting the normal cells as much as possible.  

Radiation also damages normal cells in or around the area being treated which causes side effects, but these will usually recover and heal after treatment.  

Why use radiotherapy to treat cancer?

Radiotherapy may be given to treat and attempt to cure cancer (radical radiotherapy), as an alternative to surgery; for example, when surgery to remove the tumour is not possible for medical reasons. Radiotherapy can also be used to shrink the tumour prior to surgery (neoadjuvant therapy) or after surgery to keep the tumour from coming back (adjuvant therapy). 

Radiation can also be used alone for cancers that are very sensitive to radiation. It may also be the preferred form of treatment due to how it is a very local treatment, which limits the harm to nearby healthy cells.  

Prescribed doses may range from just a single session of radiotherapy, all the way to seven and a half weeks’ worth of radiotherapy, depending on the intent of the treatment and the condition of the patient. 

Radiotherapy may also be used to relieve symptoms of cancer when the cancer has spread outside the original organ site of the tumour to other parts of the body (palliative radiotherapy). This would be a shorter course of treatment, with the aim of controlling symptoms and minimising side effects. 

Chemotherapy

Some patients may receive a course of chemotherapy prior to radiotherapy (induction chemotherapy). Chemotherapy may also be given during radiotherapy (chemo-radiation), to try to make cancer cells more sensitive to radiation. Both are administered as an out-patient treatment. 

Chemotherapy may increase the risk of side effects, particularly infection and bleeding, and so will not be recommended for all patients. We will give you specific information leaflets on chemotherapy if it is recommended.  

Your radiotherapy planning appointment

Prior to your radiotherapy treatment starting, you will need to attend the radiotherapy department for a CT planning scan. This scan is different to the previous ones you may have had, as it will be used to design and tailor your radiotherapy treatment to your specific needs.  

This planning CT scan itself will only take five to 10 minutes. The rest of the appointment is getting you in the correct position. Remember that the position you are scanned in will be the exact position you will be in for all your treatments, so please tell us if you feel that you may struggle with this.  

Sometimes you will need an injection of dye alongside your planning CT scan to assist in seeing things clearly on the scan. A specific information leaflet is available if you require this.  

At the end of the planning scan, several permanent ink markings, usually three but sometimes more or less, are made on your skin using a pinprick of ink. These are to ensure that you are accurately repositioned for your treatment each day.  

Your radiotherapy treatment appointments

The actual radiotherapy treatment is like having an x-ray/scan. Each session takes approximately fifteen minutes in total, most of which is spent ensuring you are in the correct position, although the actual delivery of the radiation lasts only a few minutes.  

You will be asked to lie still on a treatment couch while the radiotherapy machine moves around you, giving the treatment from different angles and directions. You will be alone in the treatment room whilst the treatment is being given, but the radiographers will be always observing from outside and will speak to you via the intercom if necessary. You will not see or feel anything during this process and the machine will not touch you.  

We may perform an additional scan on some or all days as part of your treatment, to check the accuracy of your positioning.  

This treatment will not cause you to be radioactive and it is safe for you to be around other people, including small children and pregnant people, afterwards. 

Side effects of radiotherapy treatment

You may develop side effects as you go through the treatment. Most of the side effects begin at least one week after starting treatment, so for some shorter treatment courses this may be after you have completed your treatment. Short term side effects typically reach their peak about two to three weeks after you finish your treatment and take a further two to three weeks to reduce, however this will not be the case for all patients.  

Radiotherapy can also have long term side effects which usually occur more than three months, but sometimes much longer, after finishing your course of treatment.  

For information on the possible side effects specific to your treatment, please review the specific information sheet provided to you and consult the radiotherapy consent form filled in by your doctor when you were referred for radiotherapy treatment. If you do not yet have a copy of this, you may request one at any of your radiotherapy appointments.  

You may experience some or all these side effects. Please always let the radiotherapy team know of anything worrying you, as we want to help you recover as soon as possible. 

The radiotherapy review specialist will see you regularly during your treatment. They will ask you about any side affects you may be experiencing and offer advice on how to assist with these. They may also take additional tests if needed. For information on the support available to you after your treatment finishes, please read the ‘finishing radiotherapy treatment’ leaflet. 

Working

There are patients who can and do choose to work throughout their treatment. However, some patients also prefer to take sick leave from their workplace to prioritise their treatment appointments. This will all depend on each individual and how they feel they can manage their own time and energy. If there are any concerns, a doctor can advise you best on what to do. 

After your treatment 

Follow up from radiotherapy can vary depending on the treatment you have received. Sometimes you may be referred back to your surgeon or chemotherapy doctor for follow up and sometimes you will be followed up by your radiotherapy doctor.  

Usually, you should expect an out-patient appointment to be arranged for four to six weeks after completing your treatment. This may sometimes be a telephone appointment. Out-patient appointments will then continue initially on a three to six monthly basis, or more frequently if required. 

How to find us 

We strongly encourage you to come by public transport if possible. We are a central London hospital, and parking at the hospital and in the local area is extremely limited. 

When facing the front of the hospital, a separate entrance can be found to the right-hand side of the main Royal Free Hospital entrance. It can be found on the road next to the Pear’s building.  

Parking at the Royal Free Hospital is free for patients having radiotherapy treatment, in allocated parking spaces only – these are available at the front of the main hospital entrance. You will need to display a radiotherapy parking permit in your car, which we will issue you during your first visit.  

Please provide the radiotherapy receptionist with your car registration number on arrival to avoid being issued a parking fine. Free parking is only available for patients attending their treatment appointments and is not available for out-patient clinic appointments. 

Transport 

Hospital transport is available through a means tested assessment. Patients or a relative must book their own transport to and from the hospital if they are travelling from home. Transport may be contacted on 0333 240 4909. An additional information leaflet to assist you in booking your transport is available.  

Support available at the Royal Free Hospital

We have several support services are available for you to access, some of which are listed below. If you would like to know more about these, please ask a member of the radiotherapy team or one of your specialist nurses.  

Macmillan cancer support

MacMillan is available for anyone with cancer and their loved ones. It provides a confidential and expert listening ear and a wide range of information booklets in a variety of languages. It offers practical tips on treatment side effects, symptoms, and survivorship as well as referrals to other support groups and specialist services.  

The information centres can be found at:

Chase Farm Hospital

  • Location: Ground floor of the main building.
  • Opening times: Monday to Friday, 10am to 4pm.
  • Tel: 020 8375 2247.
  • Email: rf-tr.BarnetCancerInfo@nhs.net.

Barnet Hospital

  • Location: inside the main entrance on level one.
  • Opening times: Monday, Tuesdays, Thursdays, and Friday. Closed Wednesdays.
  • Tel: 020 8216 4142
  • Email: rf-tr.BarnetCancerInfo@nhs.net.

Royal Free Hospital

  • inside the oncology outpatients department on the ground floor.
  • Opening times: Tuesdays-Fridays 10am to 4pm
  • Telephone: 020 7794 0500 extension 31337
  • Email: rf.cancerinfo@nhs.net.

Maggie’s 

Maggie's offers practical emotional and social support for anyone with cancer, their family, and friends. They are here for you before, during and after treatment, you don't need an appointment or a referral and everything they offer is free.  

Complementary therapies

A range of complementary therapy treatments, including massage and aromatherapy, are available at the Royal Free Hospital. For more information, please ask a member of the radiotherapy team.  

Counselling

If you would like a referral to a specialist counsellor for patients with a cancer diagnosis and undergoing cancer treatments, please ask a member of the radiotherapy team, your radiotherapy doctor or one of your nurse specialists. Alternatively, you may contact them on the below number.