Radiotherapy for carcinoid | Cancer Research UK
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Radiotherapy for carcinoid

Radiotherapy uses high energy waves to kill cancer cells. Doctors may recommend radiotherapy for carcinoid that cannot be removed with surgery, or has spread and is causing symptoms.

Targeted (radio labelled) therapy

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 treatment makes you slightly radioactive for a short time. You generally stay in hospital for a few nights, have a room of your own, and the time you can spend with visitors is limited. Your doctor or nurse will advise you about the precautions you need to take when you leave hospital, such as avoiding close contact with young children and pregnant women, and how long for. 

Selective internal radiotherapy (SIRT)

If carcinoid has spread to the liver, doctors can inject tiny beads coated with a radioactive substance into the blood supply to the liver. The beads get stuck in the small blood vessels around the tumour, and the radiation kills the tumour cells. After the treatment you stay in hospital overnight. You should avoid close contact with young children and pregnant women for about 10 days after treatment. Your doctor or nurse will talk to you about this before you go home. 

External radiotherapy

Rarely, carcinoid may spread to your bones or brain and for this you usually have external radiotherapy - the radiation is aimed at the tumour from a machine. 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.

 

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What radiotherapy is

Radiotherapy uses high energy waves to kill cancer cells. Doctors may recommend radiotherapy for carcinoid that cannot be removed with surgery, or has spread and is causing symptoms. 

You may have internal radiotherapy, such as targeted (radio labelled) radiotherapy, or external radiotherapy.

 

Targeted radiotherapy (radio labelled treatment)

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 to 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)

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. You usually have this treatment every 3 to 6 months. It helps to improve symptoms for most people, and may reduce the size of the tumour. 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. 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. Your doctor or nurse will advise you about how long you should avoid close contact with people, particularly young children and pregnant women, when you leave hospital.

About 4 to 6 weeks 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.

Peptide receptor radionuclide therapy (PRRT)

PRRT uses a radioactive substance called lutetium-177 or yttrium-90 attached to a man made form of the hormone somatostatin, such as octreotide (a somatostatin analogue). Doctors often use a treatment called Lutetium DOTATATE.

PRRT can reduce symptoms caused by carcinoid, and may help to reduce the size of your tumour. You usually have 4 cycles of treatment, 8 to 12 weeks apart. 

You have the PRRT through a drip into your arm. To help protect your kidneys from the radiation, you have extra fluids through the drip before and after the treatment. You stay in hospital for 1 or 2 nights. As long as the radioactivity levels in your body are low enough you can then go home. Your doctor or nurse will talk to you about how long to avoid close contact with children and pregnant women after treatment. 

You will have blood tests every 2 weeks to see what effect the treatment has on your blood cell count and kidney function.

The main side effects of this treatment include

  • Feeling sick
  • Increased pain for a few days after treatment - you will have steroids and painkillers to help
  • Diarrhoea
  • Tiredness (fatigue)
  • A drop in blood cell counts, which means you have an increased risk of infection and you may feel more tired than usual
  • Kidney damage  – this is very rare

PRRT is not funded on the NHS in England at the moment. The National Institute of Health and Care Excellence (NICE) is looking at this, and their decision is expected next year.

 

Selective internal radiotherapy (SIRT) 

This is another type of internal radiotherapy that doctors may use to treat tumours that have spread to the liver. It is also called radioembolisation. 

Tiny beads called microspheres are put down a thin tube into the main blood vessel that supplies blood to the liver (hepatic artery). The beads have been coated with a radioactive substance called yttrium-90. The beads are called SIR-Spheres or TheraSpheres. These beads stick in the small blood vessels around the tumour. The radiation destroys the tumour cells. 

After the treatment you need to stay in hospital overnight.

The most common side effects of this treatment include

  • A raised temperature
  • Chills
  • Feeling sick
  • Tiredness - this can last up to 6 weeks
  • Diarrhoea
  • Stomach ache
  • A feeling of pressure in the abdomen

You may have to travel to a specialist centre to have this treatment.

The range of radiation from the microspheres is very small. But as a precaution, you should avoid close contact with young children and pregnant women for about 10 days after treatment. Your doctor or nurse will give you specific advice about this before you go home.

Read more about SIRT.

 

External radiotherapy

It is rare for carcinoid to spread to the bones or brain but if it does, you usually have external radiotherapy - the radiation is aimed at the tumour from a machine. 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 treatment 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.

A photo of a linear accelerator, which gives radiotherapy

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.

Read about external radiotherapy.

 

Related information

Find out about

Internal radiotherapy

How treatment teams plan external radiotherapy

Treatment for carcinoid

Somatostatin analogues

Living with carcinoid

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Updated: 21 June 2016