Note: There are two forms of stereotactic radiotherapy. There is stereotactic surgery and stereotactic radiotherapy. For information on steresotactic radiosurgery, please see stereotactic radiosurgery.

Stereotactic Radiotherapy (fractioned) - What does it mean?  

It is very precise delivery of radiation to a small area of the brain with sparing of the surrounding normal brain. Fractionation means that the treatment course is divided into multiple smaller doses or fractions given daily (Monday ~ Friday) over several weeks. This minimizes the effect of the radiation on the normal brain and reduces the risk of late side effects.

To achieve high precision and to ensure that the treatment position is reproduced accurately each time, you will need to have a special frame made. The majority of patients find the head frame reasonably comfortable to wear during treatment sessions.

The head frame serves three main purposes: 

1.      It enables accurate reproducibility of the treatment position for each planning and treatment session.

2.      It prevents movement of your head during the treatment

3.      It removes the need for ink marks on your head or face. 

Prior to the treatment starting there are usually three planning visits needed. This leaflet aims to give a brief description of the planning and treatment process. 

First visit – Making Your Frame 

At this appointment the frame attachments will be made specifically for you. The frame is fitted and held securely on your head in two ways: 

¨      Mouth bite ~ a denture plate that fits onto your upper teeth.

¨      Back plate ~ a moulded support of the back of your head. 

   Making the mouth bite:
Once a correct size denture plate has been chosen for you it will be filled with the soft impression material. The denture plate is then placed into your mouth and you will be asked to bite on it to form a clear impression. The material sets in your mouth but will not stick to your teeth. The material takes about 4 minutes to set. Once it has set the plate will be removed from your mouth and attached to the main frame. 

   Making the back plate:
A putty-like material is placed on the back plate that is also attached to the main frame. The frame is placed over your head and the mouth bite fitted onto your teeth. The back plate is then rested against the back of your head and held securely in place for a few minutes until it has set.

The frame is then secured into place by straps across your head.The frame and the dental plate do not cover the mouth, nose or face and breathing is not impeded. Once the frame has been made and is fitting well we do some measurements to ensure that the frame can be relocated in the same position at each visit. To do this we use a clear plastic helmet, called a depth helmet, and a measuring probe. These measurements are taken with you lying down so that you are in the same position as you will be for your treatment. Two or more sets of measurements will be done on your first visit. Further sets of measurements will be taken before any planning or treatment.  To make the frame and take the initial measurements takes approximately one hour.

Second visit – Scanning and Planning

At this appointment a CT scan will be taken of you positioned in the head frame. During the scan you may be given an injection of contrast: this is a dye that helps to highlight the area needing treatment. The appointment usually lasts about 30 minutes. 
The Oncologist will use the information from this scan to plan your radiotherapy and this process normally takes a couple of weeks.

Third visit - Verification

The purpose of this visit is to check that your treatment plan is correct. This process is called verification and is carried out on a x-ray machine called a simulator. A set of x-rays will be taken of you positioned in the head frame. This appointment normally lasts about an hour. 

Treatment

The treatment is given in one of the radiotherapy treatment rooms. At each treatment the head frame will be fitted and measurements taken to ensure that it has been located correctly. You will be positioned for treatment using the room lasers and lights. 

Whilst the machine is switched on the radiographers will leave the room but will be watching you on closed circuit TV. They can stop the treatment at any time. You will not feel anything during treatment but may be aware of a buzzing sound. The treatment is divided into several fields with the treatment machine positioned slightly differently for each. Each treatment field takes about one minute and the radiographers will come into the treatment room between fields. The whole treatment takes about 20 minutes to deliver.  Each week throughout the course of your treatment you will have an opportunity to see either the doctor or a specialist radiographer to discuss any queries or problems that arise.  The radiotherapy will not make you ill and you will be well enough to travel. Many patients carry on their normal daily activities before and after the daily treatment session.
 

Driving

You may or may not be allowed to drive yourself. This should be discussed with your doctor prior to treatment.

Medication

If you are currently taking steroids, the dose is often kept at the same level between leaving hospital after your operation and starting radiotherapy. This dose may be adjusted during your radiotherapy following discussion with the doctor.

Side effects

Any side effects vary from person to person. The type and site of your tumour may also determine the side effects you may experience.  The most common side effects are listed below: Unfortunately, you

Hair loss:  Unfortunately, you will lose your hair in the area being treated. This normally happens two to three weeks after the beginning of radiotherapy. We try to arrange treatment so that your hair will re-grow, but your treatment will never be compromised for the sake of keeping your hair. Hair can take a long time to re-grow following radiotherapy. A wig can be organised for you if required. During radiotherapy you can continue to wash your hair normally but using a mild baby shampoo. The hair should be gently towel dried and a hairdryer should not be used. 

Skin: The skin in the treatment area may gradually redden from the second week of treatment onwards. It may become dry, itchy and sore especially around the ears if they are in the treatment area. To minimise dryness and irritation aqueous lotion may be used in the treatment area. During the summer months the area should be protected from the sun to prevent sun damage. Any reaction will soon clear up after treatment has finished. 

Tiredness: This side effect varies greatly from person to person. Generally it increases throughout the radiotherapy and may last for a few weeks after completion of your treatment (see information on coping with fatigue).  

Pituitary function: In some patients the pituitary gland may receive a dose of radiotherapy, this may affect the gland and its hormone production. If it occurs, this happens a year or more after radiotherapy, and is easily managed. If this side effect applies to you, the team will explain it fully.

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.