Radiotherapy for carcinoid
This page is about radiotherapy for carcinoid.
Radiotherapy for carcinoid
Radiotherapy uses high energy waves to kill cancer cells. Doctors may recommend radiotherapy for carcinoid that has spread, can not be operated on and is causing symptoms.
All cells have receptors that cause changes in the cell when they are triggered. Carcinoid cells have particular receptors that doctors can use to treat carcinoid. They can attach radioactivity to the substances that trigger the receptors. These substances are very specific to the carcinoid cells, so the radioactivity is targeted at destroying only carcinoid cells. This type of treatment is called radio labelled therapy. It makes you slightly radioactive for a few days. You stay in hospital, have a room of your own, and the time you can spend with visitors is limited.
Selective internal radiotherapy (SIRT)
If carcinoid has spread to the liver, microscopic beads that are coated with a radioactive substance called Yttrium-90 can be injected into the blood supply to the liver. The radiation kills the tumour cells. After the treatment you stay in hospital overnight. The treatment continues to work for about 2 weeks. After one month the radiation has gone.
Rarely, carcinoid may spread to your bones or brain and for this you usually have external radiotherapy (from the outside of your body). It is especially helpful in controlling pain. You may have just one treatment or treatment for a few days. You may feel tired afterwards but the side effects are usually mild.
You can view and print the quick guides for all the pages in the Treating carcinoid section.
Radiotherapy uses high energy waves to kill cancer cells. The radiotherapy targets the cancer cells. It may also damage nearby normal cells but these can recover. Doctors sometimes recommend radiotherapy for carcinoid that has spread and is causing symptoms. You can have radiotherapy for carcinoid either as targeted (radio labelled) radiotherapy or from an external radiotherapy machine.
All cells have receptors that cause changes in the cell when they are triggered. For example, they may tell it to
- Make more cells
- Release substances
- Stop releasing substances
Special scans can show whether carcinoid tumours have particular receptors that doctors can use target radiotherapy. Doctors can attach radioactivity to the substances that trigger the receptors. These substances are very specific to the carcinoid cells, so the radioactivity is targeted at destroying only carcinoid cells.
There are different types of targeted radiotherapy
- 131 I-MIBG (Meta-ldo-Benzyl-Guanidine)
- Octreotide -90-Y-octreotide
MIBG is one substance taken up by carcinoid cells. Doctors attach radioactive iodine to the MIBG. The carcinoid cells absorb the MIBG and so pick up the radioactivity as well. We know from research that this treatment controls symptoms in 4 out of 5 people (80%). You need to be in hospital for a few days while you have this treatment.
You have a room on your own because the treatment makes you slightly radioactive for a few days. This means your visitors, nurses and doctors are only able to spend a short time with you. This is a precaution and is to protect them from being exposed to too much radiation.
Your sweat and urine are radioactive while you are in hospital. The hospital may have rules about changing your sheets daily, and may ask you to flush the toilet more than once after you use it. Usually the levels of radiation fall within a few days and you are able to go home. After treatment your levels of red and white blood cells and platelets may be lowered. This can make you feel tired and increase your risk of infection for a while. Most people recover quickly from this treatment.
Octreotide 90 Y is a newer type of targeted radiotherapy. Octreotide is similar to a naturally occurring hormone, called somatostatin. Doctors call octreotide a somatostatin analogue. By attaching radioactivity to the octreotide we can kill the carcinoid cells.
You can also have octreotide without the radioactivity as a treatment for carcinoid syndrome, and as a treatment before surgery.
Research has shown that octreotide 90 Y treatment can reduce the size of the tumour in around 3 out of 10 people (30%) treated. It can reduce the symptoms in 6 out of 10 people (60%) treated.
The main side effects associated with octreotide are
- A bloated feeling
- Feeling sick
- A drop in blood cell counts (rarely)
- Kidney damage – this is very rare
We need further research to find out about the longer term side effects of octreotide 90Y. Some doctors have reported damage to bone marrow in some patients, which can lead to a condition called myelodysplastic syndrome. This means your bone marrow has trouble making enough new healthy blood cells.
This is a method of targeted radionuclide therapy used to treat liver metastases. The procedure that is very similar to hepatic artery embolisation. But instead of blocking off the blood supply, tiny radioactive beads (microspheres) are injected into the blood vessels. They have been coated with a radioactive substance called Yttrium-90. The beads may be called SIR-Spheres or TheraSpheres. These beads stick in the tiny blood vessels (capillaries) within the carcinoid tumour and kill the cells with radiation. The radiation mainly works in the first 2 weeks after the injection.
Your doctor makes a small cut (incision) into your groin and gently pushes a thin tube into the main blood vessel (the femoral artery).Watching on a scan, the doctor guides the tube into the blood vessel that supplies the section of the liver where the carcinoid is growing. They then inject the microshperes in the tube. After the treatment you need to stay in hospital overnight.
Research has shown complete or partial response to this treatment in 40 out of every 100 patients, who have carcinoid liver tumours.
The side effects of this treatment include:
- Abdominal pain
- Feeling sick
- Loss of appetite
- Inflammation caused by the radiation to stomach, small bowel, pancreas or gallbladder
- Liver failure (this is very rare)
Microsphere treatment is not widely available in the UK so you may have to travel a long way for this treatment.
It is rare for carcinoid to spread to the bones or brain but if it does, you usually have external radiotherapy (from the outside of your body). It is especially helpful in controlling pain. You may have just one treatment or treatment for a few days.
Before you begin your treatment, the radiotherapy team carefully plan your external beam radiotherapy. This means working out how much radiation you need to treat the cancer and exactly where you need it. Your planning appointment may take from 15 minutes up to a couple of hours. You have a planning CT scan. The scan shows the cancer and the structures around it.
You have radiotherapy in the hospital radiotherapy department. Radiotherapy machines are very big. The machine may be fixed in one position or able to rotate around your body to give treatment from different directions. Before your first treatment your radiographers explain what you see and hear. The treatment rooms usually have docks for you to plug in music players. So you can listen to your own music.
You can't feel radiotherapy when you actually have the treatment. It takes anything between 10 to 25 minutes. It is important to lie in the same position each time, so the radiographers may take a little while to get you ready.
Once you are in the right position the staff leave you alone in the room for a few minutes. They watch you carefully on a closed circuit television screen. External radiotherapy doesn't make you radioactive. It is perfectly safe to be with other people, including children, throughout your course of treatment.
You may feel tired after the treatment but the side effects are usually mild. Radiotherapy to the brain causes hair loss in the treatment area but this grows back after a few months.
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