Radiotherapy to the Pituitary

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1 The Beatson West of Scotland Cancer Centre Patient Information Sheet Radiotherapy to the Pituitary

2 This leaflet is intended for patients attending for radiotherapy treatment to the pituitary region of the brain. We treat each paient as an individual and the effects of treatment may vary from one patient to another, therefore specific details will be given to you by your doctors, radiographers and nurses. Before agreeing to this treatment we would like to feel sure that you understand its nature, and some of the possible consequences. This leaflet also contains some general advice about what to expect, and how best to cope with your radiotherapy treatment. Remember, if you are in doubt about anything, check with a member of staff. Preparation for Treatment The first step in the planning process is to construct a perspex shell ( also called a Beam Directed Shell BDS, or mask ) which will be custom made to fit the shape of your face. This is important for your treatment because; it enables the radiographers to give your treatment in exactly the correct area each day. it helps to support and keep your head from moving during treatment. we put the marks necessary to guide us onto the shell and not your skin. The whole process of making the shell will be explained to you in detail by our Mould Room staff when you attend for your first appointment. Once your shell is made, you will receive an appointment for a CT scan of your brain. This is similar to the scan you have already had, but as we will be using it to plan your treatment you will wear a mask during the actual scan. We may need to give you an injection of contrast fluid (dye) which will show up on your scan. This will be explained in detail if necessary. The scanning process takes about 10 minutes. Before your next visit, your doctor will mark out the area to be treated on these scans. Our physics staff will then compute this and produce a plan to give the treatment as your doctor intended. Before treatment starts, you will visit the simulator. This is a special x-ray machine similar to the treatment units used to give your radiotherapy treatment. The radiographers will take a set of x-rays as a final check to make sure your doctor is satisfied with the planned treatment.

3 How Is Treatment Given? Tou will have treatment on a linear accelerator, which is a type of x-ray machine. The staff who operate these machines are called therapy radiographers. They are specially trained professionals who are responsible for delivering treatment. The radiographer will explain everything to you before treatment starts and check that you know what to expect and how many treatments you will have. The radiotherapy will be given in small daily doses, Monday to Friday. The radiographers will help you lie on the couch, just as you were in the simulator. Once they have put your mask on they will dim the lights in the room while they position you for treatment. Your radiographers will leave the room while the machine isswitched on but this is only for a minute or so. They will be watching you the whole time on closed circuit TV. When the machine switches off the radiographers will come back into the room and move the machine into the correct position for the next part of the treatment. Radiotherapy treatment is painless and you should feel no different afterwards. The whole process only takes between 10 and 15 minutes. If you have any questions or are unsure about anything to do with your treatment, please speak to the radiographers. Effects of Treatment (Early) Each patient is individual and effects of treatment can vary. Generally, You may get tired as your treatment progresses. This tends to be 2-3 weeks into your course of treatment and will last for several weeks after treatment has ended. Skin in the treated area will be more sensitive and may become slightly pink or red as your treatment goes on. Again this tends to occur a couple of weeks into treatment and settles down after treatment ends. As the treatment progresses, hair within the treated area will gradually fall out. This tends to be 2-3 weeks into treatment. In most cases this is minor and hair will regrow during the months after treatment.

4 Very rarely, some patients comment on the unusual effects of nausea and altered sensation of taste. Please let us know, as it is possible for your doctor to provide medication to help the nausea. Skin Care During Treatment You may bath or shower during treatment. You may wash your hair once or twice a week with a mild baby shampoo and lukewarm water. Pat your hair dry gently with a soft towel and allow to dry naturally. Try not to rub the treated area and do not use the hot setting on a hairdryer or use hot brush/tongs etc. If the weather is hot and sunny you should avoid exposure of the area being treated. Perhaps sit in the shade or wear a widebrimmed hat. Only use creams or lotions in the area being treated which have been prescribed by your doctor at the Centre. However soothing others may seem, they may contain substances which could react with the x-rays to make your skin sore. General Advice During Treatment There is no reason to change your lifestyle during treatment, but it may help to, maintain a healthy diet. try to get plenty of rest and sleep, especially when the treatment begins to make you tired. accept offers of help from family and friends, especially with household chores and shopping. Effects of Treatment (Late) We believe that the benefits of your radiotherapy treatment far outway any risks involved, however there are some potential longterm effects you should be aware of. It is important to point out again that effects can vary in different people and your doctor will explain specific individual issues to you personally. The following effects can be taken as a general guide:

5 As explained earlier, hair loss from the treated area is usually temporary, but a few people may experience long-term hair loss where the hair does not grow back. As we are giving radiotherapy to your pituitary, there is a significant chance that there will be damage to this at some time in the future. For that reason you will be given regular check-ups by an endocrine (hormone) doctor after your treatment. If you show signs of pituitary failure you will be offered drug therapy to correct any problems. If you do not have an appointment with an endocranologist?, please let us know. To give the necessary treatment to your pituitary area, some small parts of the normal brain tissue will be contained within the x-ray fields. There have been reports of visual deterioration (eyesight becoming worse) or some damage to normal parts of the brain. However, it is important to know that these side effects are very rarely described with the treatment proposed here. By dividing the total radiotherapy dose into many small doses (treatments) given daily over a number of weeks, the possibility of damage is greatly reduced. A very rare but potentialy important effect is that radiation can cause tumours. Although this is a serious possible consequence of your radiotherapy, it is important to bear in mind that the effects are very rare. Also, if they do occur it is likely to be years after your treatment. Remember, we believe that the benefits of your radiotherapy treatment far outweigh the risks described here. After Treatment Ends Any effects of treatment will wear off in the weeks after treatment ends, however you may still be tired for a number of weeks. Normal washing can be resumed once your skin no longer looks red or feels itchy. Your radiotherapy doctor will arrange to see you 6 weeks or so after treatment ends.

6 Where can I get help? Information and Support All our staff are here to make sure your treatment gose as smoothly as possible and will try to help with any questions you may have. Further specialist help and information is available from: Macmillan Information Radiographer and Counsellor Tel: Information and Support Radiographer Tel: The Centre has a Radiotherapy Advice Line available for patients who have completed treatment. It is an answer phone service, where you can leave a message and your call will be returned by the Information Support Radiographer as soon as possible. Radiotherapy Advice Line Tel: Counselling and Clinical Psychology This leaflet deals with the physical aspects of your treatment, but your emotional well being is just as important to us. Being diagnosed with cancer can be a deeply distressing time for you and those closest to you. Within the department we have a counselling and clinical psychology service that can help with worries and difficulties you might be having. There is also a service for children and young people who are having difficulty coping with their relative s illness. If you think this may be helpful to you, please ask staff to put you in touch. Other Support There are also voluntary organisations providing information and support. These include: Maggies Centre: provides information and support and a regular programme of courses. Cancerbackup: provides information and support about all aspects of cancer. Macmillan Cancer Support: Develops services to provide specialist care at every stage of illness. Provides an information line and financial help through grants. Tak Tent providing information and support and access to some complimentary therapies. Benefits Enquiry Line: provides information on benefits and social security.

7 This leaflet is for general information only. For personalised information please ask a member of clinical staff. Leaflet reviewed by L. Webster & R. Rampling August 2006 Review August 2008 Designed & Produced by Medical Illustration Services Tel.: