Chemoradiotherapy means having chemotherapy and radiotherapy treatment together.
Chemotherapy uses anti cancer (cytotoxic) drugs to destroy cancer cells. The drugs circulate throughout the body in the bloodstream.
Radiotherapy uses radiation, usually x-rays, to destroy cancer cells.
When you have chemoradiotherapy
Your doctor might suggest chemoradiotherapy if you have:
- stage 2 or 3 non small cell lung cancer that can’t be removed with surgery
- or very early stage small cell lung cancer
You need to be fairly well to have this treatment because the side effects can be difficult to cope with.
The treatment can help to control the cancer. You might have it as part of a clinical trial.
You usually have treatment in the chemotherapy day unit or you might need to stay in hospital for a day or more.
Clare Disney (nurse): Hello, my name is Clare and this is a cancer day unit.
So when you arrive and you’ve reported into with the receptionist, one of the nurses will call you through when your treatment is ready, sit you down and go through all the treatment with you.
Morning, Iris, my name is Clare. I am the nurse who is going to be looking after you today. We’re going to start by putting a cannula in the back of your hand and giving you some anti sickness medication. And then I am going to come back to you and talk through the chemotherapy with you and the possible side effects you may experience throughout your treatment. Is that okay?
Before you have each treatment, you’ll need to have a blood test to check your bloods are okay. And you’ll also be reviewed by one of the doctors to make sure you’re fit and well for your treatment. Sometimes you’ll have the blood test taken on the day of your treatment; other times you’ll have it the day before your treatment when you see the doctor.
Each chemotherapy is made up for each individual patient, depending on the type of cancer they have and where it is and depending their height, weight and blood results.
So, depending on where your cancer is some people have their chemotherapy drug, their cancer drug by drip, some will have an injection and other people will have tablets.
So, Iris, your chemotherapy is going to be given to you in what we call cycles and the cycles are given every three weeks for a period of six cycles. So, you will be coming in for approximately five months for your chemotherapy.
Depending on where your cancer is and what type of cancer you have will be dependent on how often you come in for treatment. An example of a treatment cycle would be for you to come in on Day 1, Day 8 and Day 15 then to have a week’s break before you come back again for Day 1 treatment.
Depending on the type of treatment that you are having, we will also give you some anti sickness tablets to take alongside your chemotherapy and also some drugs to prevent any reactions if that’s appropriate.
All chemotherapy is given over different time periods, so it’s best to check with your nurse about how long you are likely to be in the unit for. This can range from anything up to an hour to an all day treatment slot, so please be prepared to bring along some bits to keep you occupied books and music.
So, before you go home it’s important to make sure you have got the tablets you need to go home with your anti sickness medications and any other symptom control tablets that you may require. Also, to make sure that you’ve got the telephone numbers for the oncology unit to phone if you have a temperature or you are experiencing any other symptoms at home that you need to ask advice about.
So, please make sure when you leave the unit that you’ve got all the information you require and if you’ve got any questions at all don’t hesitate to ask the nurse, who will be able to answer them for you.
Before your next cycle of treatment you will come in and see the doctor in the clinic room. You’ll have a blood test and an examination to make sure you are fit and well for treatment. You will then come back the following day or later on that week for treatment.
The most common chemotherapy drug is cisplatin and it is often combined with other chemotherapy drugs. You usually have it before the radiotherapy starts as a drip into your arm every 3 to 4 weeks. You might continue to have it during the radiotherapy treatment. Or you might have it when the radiotherapy ends.
A nurse puts a small tube into one of your veins and connects it to the drip. Or you might have a central line. This is a long plastic tube that gives the drug into a large vein, either in your chest or in your arm. It stays in while you’re having treatment, which might be for a few months.
You have radiotherapy in short sessions every weekday for about 4 to 6 weeks.
Before you begin treatment, the radiotherapy team works out how much radiation you need. They divide it into a number of smaller treatments. They call each treatment a fraction. This is called radiotherapy planning.
Daniel (senior 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's really important that you stay very very still when you're having your treatment. It’s also important to let the radiographers know right at the beginning if you're not comfortable, so they can adjust your position”.
(Radiographer): “Ok, all done we'll be back in a couple of minutes”.
(Daniel): “We leave the room and control the machine from a separate room. This is so we aren't exposed to radiation.
Treatment takes a few minutes and you'll be able to talk to us using an intercom.
We can see and hear you while you're having your treatment and will check that you're 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're aiming to give the same treatment to the same part of the body every day then the treatment process is exactly the same everyday. So you shouldn't really notice any difference.
You'll see someone from the team caring for you once a week while you're having treatment.
They'll ask how you are and ask about any side effects”.
Jeff (patient): “They get you from one sitting area to another. And then take you into the room where you undress to the waist and then lie down. And line you up by either moving you or asking you to shuffle a little.
And they check the dimensions and they talk to one another, and they say I'm fine this side, how are you?
Yes fine, ok, stay where you are Jeff, and that was it.
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….so no, no real noise and no discomfort”.
The radiographers might make pen marks or small tattoos on your skin in the treatment area. You may need to raise your arms above your head for a while. Or you might have a radiotherapy shell (mould) made to keep you still while you have treatment.
After your planning session
Your treatment starts a few days or up to 3 weeks after the planning session.
You lie under a large machine to have radiotherapy.
Chemoradiotherapy can cause side effects, such as tiredness, sickness, a sore throat, and a cough and breathlessness.