This leaflet answers common questions about the use of Stereotactic ablative body radiotherapy (SABR) in treating renal cell cancer. Renal cancer is where cancer cells have grown in the kidney.

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.

In most cases, it will be possible for a carer to accompany you to your appointment or the radiotherapy department if required. Please ask your doctor or a member of the radiotherapy team if this is possible.

What is SABR?

SABR is a very effective radiotherapy treatment technique, where a high dose of radiation is given to the tumour and the dose to surrounding areas is reduced. It is a precise treatment which uses a higher dose of radiotherapy per treatment compared to standard radiotherapy. This means that the treatment can be completed in fewer visits to hospital.

How is SABR given for renal cancer?

SABR for renal cancer is given as a course of one to three treatments a week, depending on the location of your cancer. These may be completed all in the same week or may be across two weeks. Your oncologist will tell you how many treatments you will be having.

SABR is given on weekdays with at least 40 hours between sessions. You will need to attend the radiotherapy department as an out-patient.

Most people will need anti-sickness tablets to help with the side effects of treatment. You will be given a prescription for these from your oncologist. These need to be taken just before your first treatment appointment.

Your radiotherapy planning appointment

Before you start your treatment, you will need to attend the radiotherapy department for a CT planning scan. This will take 30-40 minutes and will help ensure your treatment is accurate.

For your scan, you will be positioned in a specific way. Various techniques may be used to help you stay in the same position whilst keeping you as comfortable as possible. It is important that you remain still for the scan, and tell the radiographers if you feel you won’t be able to stay in that position for the duration of the scan.

Your planning CT scan may have two parts. The first part will take a little longer and will involve us recording your breathing using a box placed on your chest. This allows us to see how your chest moves as you breathe so that we can take this into consideration when we plan your treatment.

For the second part, you may be given contrast during your scan. This is a fluid thicker than water mostly given through the veins in your arm, but in special circumstances can be given as a drink. Contrast allows us to see certain structures on your scan, making it easier to outline exactly where the treatment needs to be given.

Some patients are asked to return for a second scan. This will involve wearing an abdominal compression belt. This is a piece of equipment which is wrapped around your abdomen and then inflated. It is used to reduce the amount your organs move whilst breathing. It is not painful and, if suitable, will need to be used in every treatment session.

You may be required to fast before your planning scan and treatment. This will mean that you cannot eat two hours beforehand.

You will receive a phone call from a radiographer before your planning scan to let you know if you need to do anything before your appointment. You will also have a meeting before your scan with a radiographer to go through any questions you may have.

Your radiotherapy treatment appointments

Please arrive at least 20 minutes before your first appointment time, as you will be asked to give a urine sample before your first treatment. Please inform a radiographer as soon as possible if you develop a urine infection.

Your radiotherapy treatment will be like having the CT planning scan. The equipment and your position will be the same, and you may even see the same radiographers, but the machine used is different. Treatment times can vary; however, they usually take between 30-45 minutes with your first session usually taking the longest.

If you have any questions about the treatment appointment, please ask the radiographers before going into the treatment room.

Risks and side effects

Radiotherapy can damage normal cells in or around the area being treated which causes side effects. Your doctor will discuss the relevant side effects for your particular treatment during your appointment at the oncology clinic, before you agree to the radiotherapy treatment.

Short-term side effects

Short-term side effects typically peak 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.

Possible short-term side effects from SABR are:

  • Nausea and vomiting. This can happen just a few hours after treatment or at any time during the treatment course. To help reduce this, you will be given anti-sickness medicine.
  • Develop discomfort in the tummy area. This is usually mild and relieved with over-the-counter pain killers.
  • Your skin may become slightly discoloured and itchy over the treated area. We advise you to use a moisturiser which is NOT zinc oxide based. Avoid antibiotics used on the skin and sun exposure to the area of treatment.
  • Radiotherapy may make you feel tired. Gentle exercise can help; however, we recommend ensuring you have enough energy for activities you enjoy doing first.

You may experience some or all these side effects. Please always let the radiotherapy team know if you have any worries or concerns.

Long-term side effects

Some side effects are long-term. These usually occur more than three months after finishing your course of treatment, but can start much later.

Possible long-term side effects are:

  • There is a small risk of liver and/or kidney damage, which can be assessed using blood tests. In rare cases (six per cent), the damage to the kidney results in dialysis being needed.
  • There is a small chance that the radiotherapy will damage your bowel (gut), which may lead to a blockage in the gut, requiring an operation.
  • It is possible to experience bleeding from the tumour into the kidney, which is rare but potentially serious. If you experience any flank pain, fever, vomiting or blood in your urine during or after treatment, please inform your clinical team and go to an emergency department.

After your treatment

Follow-up from radiotherapy can vary from person to person. Usually, you should expect an out-patient appointment four to six weeks after completing your treatment. This may be a telephone appointment. Outpatient appointments will continue on a three to six monthly basis, or more frequently if required.

Other useful contacts

Macmillan cancer support and information specialist

  • Tel: 020 7794 0500, extension 31337, Tuesday to Friday, 10am to 4pm.

Maggie’s centre

Radiotherapy and oncology counsellors