Iridium radiotherapy treatment cancer of the tongue

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1.What is Iridium ?

Iridium is a radioactive material, which is in the form of horse-shoe shaped lengths of wire.  These will be placed into the tongue, so that the radiation is concentrated where the treatment is most needed.

The treatment can take from two to seven days, depending on the dose prescribed by the doctor.

2. What does the Treatment involve ?

The Room:
The room where you will be receiving your radiotherapy is on ward A5.  It has been specially designed for the treatment that you are going to have.  The doors have been lead lined for the safety of you and others.

Your room will contain a television, call bell and personal bathroom.

We do recommend that you bring books and magazines to read as you may feel isolated when your treatment commences.

Admission:
You will be admitted the day before the procedure.

When arriving on the ward, please report to the nurses station where you will be shown to your room.  A nurse will conduct an admission questionnaire to obtain information about you and your lifestyle and answer any questions you may want to ask.

Food and drinks are served throughout the day.  However; the nurses will be more than happy to make you additional drinks should you require.  Please use the call bell or internal telephone in your room.  Dial 2312 or 2312 to get through to the nurses station.

You will not be allowed to eat or drink from midnight on the day of the anaesthetic.

Pre Operative Care:
If you have not been seen by the doctors in the pre admission clinic then you will be seen on the ward, where you will have bloods taken and maybe an X-ray or ECG performed, if required.

Operation Day:
On the morning of the operation you will be assisted by a nurse to get ready for theatre.  You will be taken to theatre on your bed.  A staff member will accompany you and introduce you to the theatre staff who will look after you until you go into the operating room.

In the operating theatre, the hairpin wires are inserted into the tongue under general anaesthetic and held in place with small stitches, to stop them from moving or coming out.

When you wake up, before you come out of the operating theatre, you will have x-ray pictures taken to check the positions of the hairpin wires. 

Once the films have been taken, you will be collected by a nurse from A5 who will bring you back to the ward and make sure that you are as comfortable as possible.  They will do some standard checks at this time.

Appropriate medication will be administered to relieve any discomfort if required.

Mouthwash is given to keep the mouth clean.  A soft diet will be needed during this period.  You may eat and drink as you feel able.

During Treatment:
You will be kept in isolation in your own side room.  Visitors will be restricted and will have to follow some radiation safety guidelines whilst in the room (see section 3). 

Nursing staff will check on you and your treatment every four hours to make sure that the radioactive wires remain in the correct position and that you are comfortable.  If you yourself notice that any of the wires come loose or fall out, inform the nurses as soon as possible so that they can be put back into position.  DO NOT TOUCH OR PICK UP THE WIRES.  You may contact the nurses at any time using the call button and telephone.

You will be able to read, watch TV and eat and drink during the treatment.

On the second or third day you will be told exactly how long your treatment will last.  This cannot be known prior to starting the treatment, as it requires calculations using the x-ray pictures.

We do advise you to do deep breathing and foot and leg exercises to prevent the risk of complications whilst on bed rest.

Completion of Treatment:
When the treatment is complete, a doctor will remove the radioactive hairpins. 

You may go home once the treatment has finished.  You will NOT be radioactive and it is safe for you to be with family and friends.

Discharge:
Once treatment is complete a letter will be sent to your GP regarding the treatment you have received.  Any medication needed will be given to you and an outpatients appointment arranged and posted to your address at a later date.

3. Visitors

Because your treatment involves radioactive material, we request that a few simple radiation safety precautions should be taken during the time that the wires are in place.  If these simple rules are followed, the radiation does not pose a risk to visitors:

·        visitors must report to the nurse in charge of the ward prior to entering the room and when they leave

·        the time spent by each visitor with you should not normally exceed thirty minutes per day

·       visitors must sit behind the lead shields provided in the room

 ·        pregnant women and persons under 18 years of age must not enter the room

 If there is any reason that your visitors will have difficulty complying with these rules, please ask to speak to the Radiation Protection Supervisor, who will be happy to discuss them with you.

 4. Potential Side effects

This is a localised form of radiotherapy and side effects therefore only related to the area that receives treatment. There are two types of side effects; those which come on during or immediately after treatment and resolve acute (early) effects and those which can be long term late (delayed) effects.  These can come on within weeks or even years after treatment  and are permanent. Your oncologist will have taken these into account when considering the benefits of treatment and will inform you of those you are likely to get. Please discuss any concerns with your doctor, specialist nurse or radiographer at the time of consent or at any time during radiotherapy. The more common side effects will now be described but this does not mean you will definitely get them and it is also possible you may experience a side effect not mentioned.

4.a Early effects. 

The wires are painful and in a sensitive part of the body.  Be prepared to be in some discomfort while they are in place.  Occasionally there is some bleeding when the wires are removed, but this is self-limiting.

You can expect to have a sore tongue for 2 to 4 weeks after the treatment.  There can be a risk that the tongue will swell.  Small ulcers can also develop on the tongue at the positions where the wires were inserted.  These can take 2 to 4 weeks to heal.

There is a very small risk of developing a blood clot in the legs when lying in bed in hospital (thrombosis).  You will be given stockings to minimise this risk.

4.b Late effects
Rarely some dryness may develop in the mouth if the implants are next to a salivary gland – although this is unusual

If side effects are severe an ulcer may appear in the area of the implant – occasional this may take a long time to heal.

Usually the function of the tongue is good after implants but occasionally underlying thickening occurs (fibrosis). This may restrict the full movement of the tongue.  This very rarely may affect the speech but can usually be overcome with speech therapy. 

Further general information Your doctors and specialist nurses are in an ideal position to give you relevant information on your disease and treatment as they know your individual circumstances. Cancerbackup has a help line (0808 800 1234) and a prize winning video available in English, Italian, Urdu, Bengali, Gujarati & Hindi explaining Radiotherapy & Chemotherapy. Cancernet.co.uk has over 500 pages describing cancer, its management, practical tips and tool which patients, their carers and their doctors have found helpful during the cancer journey.