Radiotherapy for your lung at Velindre Hospital This booklet will help you understand what will happen

when you come to Velindre hospital to have radiotherapy treatment. The booklet will explain how your treatment is planned and given. It will discuss side effects you may have and will tell you how to get more information and support. A glossary is provided at the front of this booklet to help you understand any words that you may find unfamiliar. Contact telephone numbers are given at the end of the booklet. We hope you find this information useful. lease ask us if you have other !uestions that we have not covered. lease bring a list of all the medication you are taking every time you come to Velindre. Patient information is available on Velindre website Please go to: www.wales.nhs.uk/cancercentre

Smoking is not allowed within the grounds and inside Velindre Hospital. f you need help giving up please ask us.
This information is evidence based and reviewed annually

!ontents age Introduction #lossary of terms What is radiotherapy% 'adiotherapy team C(A'T treatment Transport arrangements lanning your radiotherapy +tarting radiotherapy +ide effects C(A'T side effects -ate side effects 'adiotherapy to your brain .inishing treatment Contact numbers (elp/lines and websites " $ & & ) * * , "" "& "& ") "* "* "0

"lossary of terms !hemotherapy / a treatment for cancer using drugs !# scanner 1computeri2ed tomography3 / a machine that uses 4/'ays to take detailed scans of your body $ietitian / a person who helps patients to choose the best food to keep them healthy and strong #herapeutic radiographer / a person who will plan or give radiotherapy treatment

%hat is radiotherapy& 5our doctor has decided you would benefit from a course of radiotherapy to your lung. 'adiotherapy is a treatment for cancer using high energy radiation6 usually x/rays. The type and amount of radiation that you receive is carefully calculated to damage cancer cells6 stopping them from dividing properly so they are destroyed. 5our treatment will be planned to avoid as much healthy tissues as possible. (owever some healthy tissue is affected which causes side effects. We will tell you more about this on page "". 'adiotherapy treatment can be given alone6 after or instead of surgery. It can also be given with or after chemotherapy. Radiotherapy team looking after you The doctor responsible for your care is called a Clinical 7ncologist. They will prescribe your radiotherapy treatment. This will be planned by a team of physicists and planning radiographers. A team of therapeutic radiographers will give you your treatment. Velindre is a teaching hospital so your team may include a student radiographer6 student nurse or a medical student. If you don8t want a student present during your clinic or treatment appointment6 please tell your doctor or radiographer. We will ask your name6 address and date of birth every time you come to the radiotherapy department. This is to avoid any confusion.

9uring your treatment you will be seen by the information6 support and review team. The team includes specialist radiographers with extra training to advise you on how best to deal with any side effects. They can also prescribe medication to help. They will provide information and advice on any practical6 financial or emotional concerns you may have. 5ou can speak to them at any point during your treatment: their number is on page "0. How many treatments will need& 'adiotherapy is normally given ;onday to .riday as an outpatient. The number of treatments you will need depends on many facts about you and your particular cancer. <veryone is different. 5our doctor will decide how many treatments are best for you. !H'R# treatment 5our doctor may advise you to have a type of radiotherapy treatment called C(A'T. This stands for =Continuous (yperfractionated Accelerated 'adiotherapy>. C(A'T treatment involves having radiotherapy three times a day6 six hours apart6 every day for "$ days including the weekend. 5ou will usually stay as an in/patient for this treatment to make it easier for you to attend your appointments. +ee page "* for C(A'T side effects. Having chemotherapy with radiotherapy If you are having chemotherapy6 your doctor will explain this part of your treatment and give you written information.

#ransport to and from Velindre (ospital transport is available but most people use their own transport. If you would like to use hospital transport6 please give us two days notice to arrange this for you. There is a high demand for transport so you will need to be prepared to wait for some time to be picked up and taken home. +paces are limited so please consider travelling alone. +ome local charities can also arrange transport 1see page "03. Planning your radiotherapy To plan your radiotherapy you will need to have a CT scan. 5ou will be asked to attend the planning department which is at the front of Velindre hospital. This scan gives your doctor a detailed picture of the area that needs treatment. 5ou may see your doctor during this appointment if you have not signed a consent form for treatment6 the doctor will discuss the benefits and risks of radiotherapy6 it is your decision to go ahead with treatment6 so please discuss any concerns you have before signing your consent form. If you have already signed your consent form for treatment during your outpatient appointment you may only see the planning radiographers.

Picture of !# Scanner
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We may need to in?ect a small amount of dye 1called contrast3 through a needle into your hand or arm before you have your scan. The dye helps to show the exact position of the area we need to treat on the scan. It should not cause any ill effects. If you do not need the dye for your scan this does not mean the planning of your treatment will be less accurate. We will ask you to take off your top clothing and give you a gown to wear. We will ask you to lie on a flat board 1called a wing board3 with handles to hold on to so your arms are above your head. If you find this position uncomfortable please tell the radiographers as this is the position you will lie in throughout your treatment.

Picture of the wing board (you will need your gown off) 5ou will not see or feel anything during the scan. The radiographers will leave the room to turn the scanner on6 but they will be watching you very closely through a large window. The scan only takes a few minutes. We may need to draw one or more marks on your skin which we will use as reference points for your treatment. It is
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helpful for us to permanently mark these reference points6 but we will ask your permission before doing so. We will make a tiny dot by using the tip of a sterile needle to place black ink ?ust under your skin. It is a permanent mark but is as tiny as a freckle. This will mean we have accurate marks to position you for your treatment every day6 so you are able to wash during treatment.

' picture of permanent ink dot Starting your treatment There can be a few weeks in/between your planning scan and the start of your treatment. This is due to the time needed to plan your treatment and when the next available slot is on your treatment machine. At your planning appointment we will be asked if you prefer your treatment in the morning or afternoon. We will try to make your appointments match your preferred time but we cannot guarantee that this. lease tell us if you have any special needs that may affect your appointments6 such as@ needing transport having any other treatment 1chemotherapy for example3 personal difficulties 1collecting children from school3 language difficulties

We will send you a letter or call you with your first appointment. We will give you the rest of your appointments when you come for your first treatment. If you have a problem with the appointment6 please phone the radiotherapy booking clerk as soon as possible. The phone number is on page "0. If the answer machine comes on6 please leave your name and phone number slowly and clearly. We will ring you back as soon as possible. *our first radiotherapy treatment If you are an outpatient please come to the radiotherapy entrance which is around the back of Velindre hospital. #ive your name and hand your letter to the receptionist in the radiotherapy waiting room. They will tell you where to sit and wait or direct you straight to your treatment machine. If you are an in/patient6 one of the hospital porters will normally collect you and take you to the treatment machine. 5ou may be treated at any time in the day6 depending upon when there is a free slot on the treatment machine. If you are due to have chemotherapy the same day as your radiotherapy6 you will usually have chemotherapy first on the ward or day unit then you will have your radiotherapy. 5our radiographers will chat to you before you go in for your first treatment. We will explain what will happen during your treatment and tell you about the possible side effects you may experience. We will give you an information leaflet about skin care during your treatment. lease ask any !uestions you have about your treatment. We may need you to re/sign your consent form before you have your first treatment.
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7ccasionally unforeseen machine breakdowns can happen during your treatment. This may cause delays or cancellation of your appointment on that day. We will explain this to you in more detail on your first day. There are different types of treatment machines but most people have their treatment on a -inear Accelerator 1shortened to -A3. They each have a number6 so for example6 you may have your treatment on -A ) or -A *. The -A machines may look and sound different but they give the same treatment. $uring your radiotherapy treatment In the treatment room we will ask you to lie on the wing board in the same position you were for your planning. We will position you carefully using the permanent reference marks made at planning. When you are in the correct position6 we will ask you to lie still and breathe normally.

(aving treatment on wing board

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5our treatment may be given from different angles. 7n your first day of treatment we check your position at each of these angles before leaving the room to start your treatment. The machine can be controlled and moved to the different treatment angles by the radiographers outside the room. When the machine is moving6 it may come close to you but it will not touch you. When the machine is switched on you won>t feel anything6 but you may hear it bu22ing. 9uring your treatment if you feel the need to cough6 you may cough but try to cough into the air without moving your arms and try to keep your upper body as still as possible. We will watch you carefully on television monitors. If you feel too uncomfortable while the machine is on please wave your hand. We can switch the machine off and restart the treatment when you are comfortable again. Asually on your first day of treatment and at regular points afterwards6 we will take pictures or scan the area that is being treated6 you may be laying on the couch for a few extra minutes whilst this is done. The images are only used to help us check you are in the correct position for your treatment. 5ou need to lie still on the treatment couch for about "B/"* minutes6 but the treatment itself 1when you hear the bu22ing noise3 usually only take a few minutes. When your treatment is finished6 the couch is at a high level so please stay still until the radiographers have lowered the couch. 5ou can then get off and leave the treatment room.

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Smoking during treatment +moking while you are having treatment can cause your side effects to develop early and possibly be worse then usual and harder for you to cope with. We strongly advise you to try to cut down or give up smoking. lease contact the +top +moking Wales for advice contact number on page Side effects 5ou do not normally experience side effects straight away. +ide effects normally start after about two weeks of treatment although sometimes having chemotherapy can cause the side effects to develop earlier. The side effects only affect the area of the body that we are treating. 'adiotherapy continues to work inside your body for up to +, days after you have finished your treatment so any side effects you experience will continue for this time also. After "B days you will start to feel better6 everybody>s recovery time is different. #iredness 'adiotherapy can make you feel more tired than usual. 5ou should listen to your body and rest if you need to. It is important to try to continue your normal activities during your treatment. +ome people find a little exercise6 drinking plenty of water and eating a healthy diet can help their tiredness. Skin reactions 5our skin within the treatment area may become pink and warm6 dry and itchy. We will recommend using mild soaps 1such as =simple> brand3 and moisturi2ers 1such as <paderm3 on your skin. We will discuss skincare on the first day of your treatment.
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!ough 5ou may develop a dry tickly cough or cough more then normal. Cough linctus may help to soothe the symptoms. 5ou may cough up mucous6 which can contain blood6 this is a normal reaction but please tell your radiographers if this happens. -reathlessness 5ou may become breathless or more breathless than normal. Swallowing difficulties 'adiotherapy can cause your gullet 1oesophagus3 to become sore and inflamed. 5ou may experience heartburn and indigestion. This could make eating and drinking uncomfortable. We can give you medication to help soothe this so that you can eat more easily. .ausea and lack of appetite 5ou may feel sick or go off your food. We can give you anti/ sickness tablets if you need it. It is important to try to eat a healthy diet and drink more fluids during your treatment so that you do not loose weight. If eating becomes a struggle6 it may help to eat several small meals a day than three main meals. We have dietitians available to give you advice on high calorie food and provide build up drinks to help you to keep your weight steady. !H'R# treatment side effects As this treatment is given over a short time6 the side effects can develop after the treatment has finished. 5ou will feel tired and may feel like you have the flu. Causing you to
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cough more often6 be more breathless and you may notice increase temperature. This can take a couple of weeks to recover from. If you are suffering with these symptoms we advise taking paracetamol regularly. If you are concerned about any of your side effects please contact the review radiographers 1phone number on page "03. /ong term side effects -ong term side effects are rare and do not happen to everyone. They can develop months or even years after the treatment has finished. 5our doctor will discuss this with you. lease tell us if you have any concerns. 9uring radiotherapy a very small part of normal lung tissue will be treated. This can cause some scar tissue to build up the result of this is that you may notice you become little more breathless then usual. Radiotherapy treatment to your brain 5our doctor may advise that you have some radiotherapy to your brain after or during your course of treatment to your lung. 5our doctor will explain if you need this treatment6 the reasons why6 the side effects and how many treatments you will need. Planning your brain treatment We will need to do a CT scan of your head so we can plan the treatment to your brain. +ome patients may need a mask to be made to keep their head still for this treatment. 5ou will be asked to visit the mould room6 you will receive a mould room leaflet explaining what will happen. If you do not have a mask made6 your treatment will not be any less accurate.
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#reatment for your brain This treatment may be given at the same time as your lung treatment. +o6 you will be in the treatment room for longer as both areas of your body will be treated. 5ou will be asked to lie in the same position as you were for the planning CT scan. The machine will move round you without touching you. When the treatment is being given the radiographers will be watching you outside the room and you will ?ust hear a bu22ing noise. 7nce the treatment is finished you will be able to leave the room. Side effects from brain treatment 'adiotherapy to your brain may cause headaches and you may feel sick. lease tell your review radiographers if this happens. ;edication and advice can be given to ease these effects. 'adiotherapy to your head will cause hair loss. This may happen during or after you have finished your treatment. This will depend on how many treatments you are having. 5our hair may grow back $/& months after you finished your treatment. We can give you more information on coping with hair loss. 9uring your treatment you should wash and brush your hair gently. Ase a mild shampoo such as a baby shampoo. The skin around your ears may feel sore. 5ou can use epaderm cream to soothe this.

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0inishing your treatment At end of your treatment you will be given an outpatient follow up appointment with your doctor. We will give you a follow up form with the details of your appointment6 also the telephone number of your review team to contact if you have any concerns after your treatment has finished. If you need to change your follow up appointment6 please ring your doctor8s secretary. The telephone number is at the bottom of your follow up form.

!ontact telephone numbers Velindre (ospital Information6 support and review radiographers 'adiotherapy booking clerks Trasport from Aberdare The 'owan Tree Cancer Care Transport from Eridgend +andville Transport from ;erthyr Cancer Aid ;erthyr B$C $B0" *,,, B$C $B0" *,,, ext 0)$" B$C $B"C 0,&0 B"))& )DC&0C

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Helplines and websites Tenovus freephone helpline ;acmillan www.macmillan.org.uk 'oy Castle -ung Cancer .oundation www.roycastle.org +top +moking Wales B,BB B,* $$"C B,B, ,B, "B"B B,B, ,B, BBBB

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