Treatments A-Z

In Brachytherapy radiation sources are placed directly into the body.

This allows the delivery of high radiation doses to cancer cells and minimises impact on surrounding normal tissues.

It is most commonly used to treat cancers of the uterus, cervix and vagina in women and prostate cancer in men, either alone or in combination with external beam radiotherapy.

Depending on the area to be treated, this can be done under anaesthetic in an operating theatre or in the brachytherapy suite. Radiation can then be delivered on a short-term basis (through hollow tubes placed into the body), as in most gynaecological cancers, or via radioactive seeds that are placed permanently into the tumour, as in the treatment of prostate cancer.

The Rathgar centre is also the national treatment centre for ocular brachytherapy, where radiation is used to treat melanomas arising within the eye.

Currently, all brachytherapy in the St. Luke’s Radiation Oncology Network is carried out in the Rathgar centre.

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Chemotherapy is the use of drugs, usually given intravenously or by mouth that travel around the whole body to kill cancer cells.

It can be used alone or in combination with radiotherapy, where it enhances the effect of the radiation.

Chemotherapy is mainly given on an outpatient basis involving visits to hospital every one to three weeks. Some drugs, however, require a short admission of two or three days to hospital.

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Deep Inspiration Breath Hold Radiotherapy is external beam radiotherapy that is delivered while the breath is held in comfortable inspiration. It is most commonly used when treating breast cancers.

Treatment planning (CT) and treatment delivery are completed in breath hold with monitoring of the breathing pattern.  As a result, both CT planning and treatment times may be slightly longer than standard EBRT.  Apart from breath hold, it is identical to standard EBRT breast radiotherapy.

This technique is mainly used where there is need to reduce the amount of normal tissue that receives radiation.

DIBH is currently available, where necessary, in the St Luke’s Centre at Beaumont and St James’s Hospitals.

What is Deep Inspiration Breath Hold Radiotherapy?

Becoming aware of your breath

Deep Inspiration Breath Hold Practice

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If a patient is going to require radiotherapy to the mouth or neck region, it may be necessary to be reviewed by a specialist dentist.

This will usually take place at the Dublin Dental Hospital http://www.dentalhospital.ie/.

This will be discussed in more detail by the radiation oncology team and is highlighted in the Head and Neck Cancer Radiotherapy guide.

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External Beam Radiotherapy (EBRT) refers to radiation directed at you from outside the body. This can be delivered in a number of different ways, including via a Linear Accelerator (Linac), Cobalt or Orthovoltage units.

Treatment is painless and non-invasive and is similar to having an x-ray taken. The patient must remain as still as possible during treatment. The treatment time for each patient differs depending on the dose of radiation prescribed, it can take up to twenty minutes to deliver the treatment. The radiation therapists bring the patient into the treatment room and set the patient up they leave the room and go to the control area to switch on the beam. During the treatment the patient is alone in the treatment room but the radiation therapists constantly monitor them via cameras in the treatment rooms.

Depending on the area to be targeted, different methods of delivering treatment are chosen and your team will discuss your case with you in detail before starting treatment.

There are five different forms of external beam radiotherapy;

Intensity-Modulated Radiotherapy (IMRT)

Intensity-Modulated Radiotherapy (IMRT) is a form of external beam radiotherapy that uses linear accelerators to deliver multiple small radiation beams to a tumour.

It allows shaping of the radiation dose to improve the targeting of the tumour and minimise the radiation dose to the surrounding normal organs.

This therapy is mainly used where a tumour is situated close to normal tissues that have a high risk of damage from radiation.

IMRT is available in all St Luke’s Radiation Oncology Network  centres.

Volumetric-Modulated Arc Therapy (VMAT) / RapidArc^TM

Volumetric-Modulated Arc Therapy (VMAT) is a newer form of IMRT that delivers external beam radiotherapy through a continually rotating radiation source that encircles the patient.

It makes changes in the speed of rotation, the shape of the radiation field and the strength of radiation. This results in the faster delivery of precisely targeted radiation doses.

VMAT – in the form of RapidArc^TM – is currently available in all centres in the St. Luke’s Radiation Oncology Network.

Image-Guided Radiotherapy (IGRT)

Image-Guided Radiotherapy (IGRT) uses imaging with x-ray or CT during a course of radiation.

This continually reassesses the movement of the patient and of the organs within the body to allow more precise targeting of the tumour.

IGRT is available in all centres in the St. Luke’s Radiation Oncology Network.

Stereotactic Radiosurgery (SRS)

Stereotactic radiosurgery (SRS) is used in the treatment of tumours in the head (intracranial).

It uses multiple small beams to precisely target the region to be treated. The head is very carefully immobilised using an individualised frame that fits around the head and minimises movement during treatment.

Like brachytherapy, it may be used alone or in combination with surgery or external beam radiotherapy.

There are many ways of delivering SRS, including with Gamma Knife^TM, CyberKnife^TM and linear accelerators.

In the St. Luke’s Radiation Oncology Network, all stereotactic radiosurgery is currently delivered in St Luke’s Hospital, Rathgar using linear accelerators.

Stereotactic Body Radiotherapy (SBRT)

Stereotactic body radiotherapy is a specialised type of external beam radiotherapy that allows the delivery of high doses of radiation to small tumours, while minimising the dose received by the surrounding normal tissues. It is used to treat a range of cancers including lung, kidney, prostate, spine and liver cancers.

Treatment times are generally longer than with standard EBRT.

SBRT is available in all centres in the St. Luke’s Radiation Oncology Network.

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Some cancers are hormone-sensitive, which means they tend to grow and divide more rapidly when high levels of particular hormones are present in the body.

One way of treating these cancers is to reduce the level of the hormone – oestrogen in some breast cancers and testosterone in prostate cancer – and this is often done in parallel with other forms of treatment, such as chemotherapy and/or radiation therapy.

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Image-Guided Radiotherapy (IGRT) uses imaging with x-ray or CT during a course of radiation.

This continually reassesses the movement of the patient and of the organs within the body to allow more precise targeting of the tumour.

IGRT is available in all centres in the St. Luke’s Network.

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Some patients having radiotherapy will need an individualised immobilisation device made to allow them to remain as still as possible during treatment planning and treatment.

Patients having treatment to the brain or head and neck will have a customised mask made that fits over their head and sometimes shoulders.

Some patients who are having treatment to the head and neck will have an individual stent (mouth bite) made prior to treatment, as well as an immobilisation device. The stent is made of a plastic type material in the Dental Hospital or in the department depending on the complexity of the mouth bite needed. It is placed in the mouth prior to CT and each radiotherapy treatment. It usually pushes the tongue or roof of the mouth (palate) away from the radiation in order to reduce the risk of side effects.

If you require a stent or mouth bite, your medical team will discuss it with you in advance.

Vac Bag

Another type of immobilisation device is a Vac Bag. This is a beanbag that is placed underneath or around the patient. Once they are comfortable and in the correct position for treatment, the air is sucked out of the bag to set it in place.

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Orthovoltage or contact therapy uses low-energy x-rays to treat superficial skin cancers.

This usually takes place over one to five weeks, depending on the location and size of the area to be treated.

Orthovoltage or contact therapy is available in St. Luke’s Radiation Oncology Network at St. Luke’s Hospital, Rathgar.

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To prepare for radiotherapy – and indeed during a patient’s radiotherapy/chemotherapy treatment – it may be necessary to take blood and other specimens.

These specimens are tested for the following reasons:

• We check a patient’s blood to see if they have the ‘normal levels’ of white cells required to combat infections. We also check levels of red cells and haemoglobin to ensure that the patient’s energy levels are sufficient during treatment.

• Haemoglobin is a type of protein that gives red blood cells their characteristic colour. It combines with oxygen and is very important in the transportation of oxygen to our body tissues.

• We test patient’s blood compatibility with donor blood in case the patient needs a transfusion. If levels of haemoglobin are too low a transfusion is needed.

• We conduct biochemical tests to check the healthiness of a patient’s organs before and during treatment. If test results show any abnormalities, i.e. scores which are outside the normal range, the doctor is informed and he may decide that the patient might need certain re-vitalising fluids and minerals.

• Pathology tests also check the patient’s microbial status we look for micro-organisms or ‘bugs’ in the body – which will allow the care staff to have standby antibiotics and other medicines on hand to help prevent the development of any infections during a patient’s treatment.

For more information see Phlembotomy (Blood Tests) FAQs page

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This therapy uses radiopharmaceuticals – radioactive elements combined with a drug or naturally occurring agent – that deliver therapeutic doses of radiation.

This is an option for some benign diseases such as generally overactive thyroid disease and some types of cancers – commonly thyroid cancers and some types of breast and prostate cancers.

Some patients can be treated as outpatients. Those requiring higher doses of radiation may require admission until their radiation levels have fallen to safe levels. This usually involves a short admission of three to four days to the Rathgar centre (see Radioiodine Information Booklet).

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Once a treatment planning scan (CT and in some cases a MRI) is acquired, the areas to be treated and the organs to be protected are outlined, and a customised plan is created for the patient.

The plan safely maximises the dose to be delivered to the tumour while minimising the dose to the surrounding organs.

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Patients have a CT and in some cases a MRI so that the patient’s anatomy can inform the creation of an individualised treatment plan. The patient is in the same position for the CT scan as they are for the delivery of the treatment.

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The treatment of many types of cancer often involves an operation.

Surgery is not always necessary. If required, it may be performed before or after other treatments, such as radiotherapy or chemotherapy.

Surgery is not carried out in any of the St Luke’s Radiation Oncology Network centres. It will usually take place within the hospital where a patient’s cancer is diagnosed.

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Targeted therapies are drugs that block the growth of tumours by acting on specific molecules that cause cancer cells to grow and divide rapidly.

Like chemotherapy, they can be given by mouth or intravenously but are associated with different types of side effects.

It is important to let your medical team know if you have been or are currently taking any of these drugs prior to receiving radiotherapy.

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