Radiotherapy treatments

• Imaging of the patient before or during the treatment session improves our ability to concentrate the dose on the target volume. Using IGRT gives us more confidence in lowering complication rates and potentially escalating the tumour dose.
• Other specialised techniques used at NUH for patients from Nottinghamshire, the East Midlands and wider catchment areas include:
• Stereotactic ablative radiotherapy (SABR) and continuous hyper-fractionated accelerated radiotherapy (CHART) for certain lung cancers
• Total body irradiation in preparation for bone marrow or stem cell transplants
• Total skin electron therapy
• Paediatric radiotherapy
• Papillon treatment (contact brachytherapy) for certain rectal tumours
• Selective internal radiotherapy (SIRT) for certain cancers that have spread to the liver. 
• High dose rate brachytherapy for a variety of indications

Due to our size, expertise and experience we have numerous options available in order to offer the most appropriate treatment for our patients. These include tomotherapy IMRT - one of the most advanced integrated cancer treatment systems – and volume modulated arc therapy (VMAT), a new intensity-modulated radiation therapy (IMRT) treatment technique that combines 3D volumetric imaging and advanced treatment planning expertise.

IMRT and VMAT are methods of delivering the radiation in such a way that the high dose radiation region closely conforms to the shape of the volume being treated. This means that any radiation delivered to the surrounding normal tissues is kept to a minimum whilst at the same time ensuring the whole of the target area is treated and high levels of patient safety are maintained.

Nottingham's Radiotherapy Service is one of only four centres in the country delivering this innovative treatment for certain patients with early stage bowel cancer.

Papillon treatment offers patients an alternative to major surgery and a better quality of life. The technique reduces the likelihood of a permanent colostomy bag - a major concern for many patients. With the introduction of a Papillon machine to the Nottingham Radiotherapy Service, patients from across the Midlands can now explore this outpatient treatment option.

If you would like more information about Papillon treatment in Nottingham or to find out whether it might be a suitable option for you or someone you know who is suffering from early stage rectal cancer, please contact consultant clinical oncologist Dr Jamie Mills or Dr Eliot Chadwick at the Nottingham City Hospital on 0115 969 1169 ext 76226.

Further information is available here - www.cancerresearchuk.org/about-cancer/bowel-cancer/treatment/treatment-rectal/radiotherapy/internal-radiotherapy.

SABR is the delivery of very high doses of radiation to small tumours, while minimising damage to surrounding tissues.

Stereotactic radiotherapy is routinely used for treating small tumours in the lung. Nottingham has been selected as one of a group of centres delivering stereotactic radiotherapy through the Commissioning through Evaluation NHS England initiative. 

This investment will assess the use of stereotactic radiotherapy to treat metastatic (secondary) tumours, and the re-irradiation of cancers in the pelvis and spine. SABR for secondary tumours is a relatively new treatment.  Current research has shown promising benefit, and also that it can be given with relatively few side effects. Only a small number of people have tumours that are suitable for treatment with stereotactic radiotherapy.

Stereotactic radiosurgery (SRS/SRT) is a non-surgical radiation therapy treatment used to treat small tumours of the brain in adults.  It can deliver precisely-targeted radiation in fewer high-dose treatments than traditional therapy, which can help preserve healthy tissue. The treatment is usually given in a single treatment or occasionally several treatment sessions, dependent on the size of the tumour.

Stereotactic radiosurgery relies on several technologies

• three-dimensional imaging and localization techniques that determine the exact co-ordinates of the tumour within the body
• systems to immobilize and carefully position the patient and maintain the patient position during the treatment
• high energy x-ray beams that focus on a tumour or abnormality
• image-guided radiation therapy (IGRT) to confirm the location of a tumour immediately before and during the delivery of radiation. IGRT improves the precision and accuracy of the treatment.

SRS is the preferred option for radical local treatment in Brain Metastases depending on primary tumour and cancer status and it is also an alternative to invasive surgery, especially for patients who:

• Are unable to undergo surgery
• Have tumours that are hard to reach or located close to vital organs/anatomic regions
• Have mass effect symptoms

A multi-disciplinary team (MDT) of neuro-surgeons, radiologists, neuro- oncologists, palliative care consultants, clinical nurse specialists and radiographers are involved in SRS case selection, treatment planning and delivery.

SRS treatment is delivered in the radiotherapy department at City Hospital on an outpatient basis. Previously patients who require SRS would have had to travel quite far to centres that delivered it. However since July 2016 this treatment has been available at City Hospital, to provide treatment more locally and to the whole of the East Midlands. Currently in Nottingham SRS is used to treat patients with brain metastases which is where the cancer has spread from the primary tumour to the brain.

New Brain Metastases Multi-Disciplinary Team (MDT) for the East Midlands

Our specialist brain metastases Multi-disciplinary Team (MDT) meets weekly to discuss referrals. It aims to be easy to access and to deliver rapid outcomes for treatment decisions, delivering advice and care that is patient-centred, closer to home for all patients in the East Midlands with brain metastases.

The MDT includes: neuro-surgeons, radiologists, clinical oncologists, palliative care consultants, clinical nurse specialists and radiographers who meet weekly to discuss patients.  The MDT takes referrals for patients with brain metastases from NUH and from the wider East Midlands region.

If you are a healthcare professional from across the East Midlands including GPs, Nurse Specialists, including from hospitals Derby, Lincolnshire and Leicester and  AHPs and community providers who wish to learn more, contact: Michaela.mcloughlin@nuh.nhs.uk