Radiotherapy treatment
Radiotherapy uses high energy x-rays to treat cancer cells.
Why you might have radiotherapy for myeloma
Myeloma can damage areas of bone. This can weaken the bones, and cause pain. Sometimes this makes the bone break (fracture).
Radiotherapy aims to kill cancer cells in the bone. This can help to reduce pain and slow down the bone damage. This includes the bones of the spine. These bones protect the spine. Damage to the spinal bones can press on your spinal cord and cause pain and other changes.
Sometimes you need to have surgery to keep the bone stable before you can have radiotherapy. This means having an operation. The surgeon puts a metal pin into the bone to strengthen it and hold it together. They do this if there is a strong risk of the bone breaking before radiotherapy has had time to work.
More rarely, you might have radiotherapy as part of a stem cell transplant. In this case you have radiotherapy to your whole body. This is called total body irradiation (TBI).
Planning your treatment
The radiotherapy team plan your radiotherapy before you start treatment. This means working out the dose of radiotherapy you need and exactly where you need it.
Your planning appointment takes from 15 minutes to 2 hours.
You usually have a planning CT scan in the radiotherapy department.
The scan shows the cancer and the area around it. You might have other types of scans or x-rays to help your treatment team plan your radiotherapy. The plan they create is just for you.
The radiotherapy room
Radiotherapy machines are very big. They rotate around you to give you your treatment. The machine doesn't touch you at any point.
Before you start your course of treatment your 
explain what you will see and hear. In some departments the treatment rooms have docks for you to plug in your music player. So you can listen to your own music.
During the treatment
You need to lie very still on your back. Your radiographers might take images (x-rays or scans) before your treatment to make sure that you're in the right position. The machine makes whirring and beeping sounds. You won’t feel anything when you have the treatment.
Your radiographers can see and hear you on a CCTV screen in the next room. They can talk to you over an intercom and might ask you to hold your breath or take shallow breaths at times. You can also talk to them through the intercom or raise your hand if you need to stop or if you're uncomfortable.
Dan (radiographer): Before your treatment starts, your doctor will need to work out exactly where the treatment needs to go and also which parts need to be avoided by the treatment. To have radiotherapy, you lie in the same position as you did for your planning scans. We then line up the machine based on your tattoo marks. It is really important that you stay very, very still when you are having treatment; it is also important to let the radiographers know right at the beginning if you are not comfortable, so they can adjust your position.
Radiographer: Ok all done, we’ll be back in a couple of minutes.
Dan (radiographer): We leave the room and control the room from a separate room This is so we aren’t exposed to radiation. Treatment takes a few minutes and you will be able to talk to us using an intercom. We can see and hear you while you are having your treatment and will check that you are ok. When your treatment starts you won’t feel anything; you may hear the machine as it moves around you giving the treatment from different angles. Because we are aiming to give the same treatment to the same part of the body everyday, the treatment process is exactly the same everyday. So you shouldn’t notice any difference. You’ll see someone from the team caring for you once a week while you are having treatment. They’ll ask how you are and about any side effects.
Patient: They get you from one sitting area to another, then take you into the room where you undress to the waist. You lie down and they line you up by either moving you or asking you to shuffle a little. They check the dimensions and they talk to one another. They say: 'I am fine this side; how are you ...yes fine...ok, stay where you are, Jeff' and that was it. There were a few little clicks and lights go on and off and you can see a green laser beam which lines up with certain things on your body uh so no, no real noise and no discomfort.
You won't be radioactive
This type of radiotherapy won't make you radioactive. It's safe to be around other people, including pregnant women and children.
Travelling to radiotherapy appointments
Tell the radiotherapy department if you prefer treatment at a particular time of day. They can try to arrange this.
Car parking can be difficult at hospitals. It’s worth asking the radiotherapy unit staff:
- if they can give you a hospital parking permit
- about discounted parking rates
- where you can get help with travel fares
- for tips on free places to park nearby
If you have no other way to get to the hospital, the radiotherapy staff might be able to arrange hospital transport for you. But it might not always be at convenient times. To see if you're eligible they usually work it out based on your earnings or income.
Some hospitals have their own drivers or can arrange ambulances. Some charities offer hospital transport.
Side effects
The most common side effects of radiotherapy during and just after treatment are:
- reddening of the skin in the treatment area
- tiredness
- loss of hair in the treatment area
Radiotherapy for total body irradiation (TBI)
Rarely, you might have total body irridation (TBI) before an allogeneic stem cell transplant. You have radiotherapy twice a day for 3 or 4 days, or as a single treatment.
The radiographers help you to lie or stand in the correct position. Then you have treatment for 10 to 15 minutes on both sides of your body.
Total body irradiation is part of having intensive treatment for myeloma. So the side effects of this type of radiotherapy are likely to be more severe.
Common side effects include:
- sickness
- tiredness
- diarrhoea
- low blood cell levels
- complete head and body hair loss
