How is radiotherapy given?

Radiotherapy treatment will vary depending on your pancreatic cancer diagnosis and the type of radiotherapy you are having. You will go to the hospital for each treatment but you won’t need to stay overnight.

Each treatment session is called a fraction. You will usually have radiotherapy every day, Monday to Friday. Most treatment courses last three to six weeks (15-30 fractions). This will vary with the type of radiotherapy you have and the hospital where you are being treated. For example, if you have SABR you will have five fractions spaced out over one to two weeks.

If you are having palliative radiotherapy, you will usually have fewer treatment sessions (1, 5 or 10) over one to three weeks. The overall dose is usually lower. This can reduce the risk of side effects. You may still get some short term side effects, depending on the area being treated.

How is radiotherapy combined with chemotherapy?

Sometimes radiotherapy is used with chemotherapy. This is called chemoradiotherapy. The chemotherapy may make the cancer cells more sensitive to the radiotherapy, making it more effective.

You will usually have chemotherapy on its own for three to six months to begin with. You will then have a CT scan. If this shows that the cancer has not grown, you will start chemoradiotherapy.

The chemotherapy drug most often used with radiotherapy is capecitabine, which is a tablet that you can take at home. You will have radiotherapy and capecitabine every day from Monday to Friday, for three to six weeks.

Ask your oncologist if chemoradiotherapy is a suitable treatment for you, and if it’s available in your hospital. You could also ask about clinical trials using chemoradiotherapy.

Who will treat me?

The team who will plan and deliver your treatment may include these health professionals.

• A radiologist is a doctor who reads and understands images such as X-rays and CT scans.
• Oncologists are doctors who use radiotherapy (clinical oncologists) and chemotherapy (medical oncologists) to treat and manage cancer. They will be responsible for your treatment.
• A therapy or therapeutic radiographer is a technical specialist. They take X-rays and scans which are used to plan your radiotherapy and deliver the radiotherapy treatment. A small team of therapeutic radiographers will see you at every treatment session.
• Dosimetrists help create a personal radiotherapy plan. This is to make sure the cancer gets the maximum dose of radiotherapy while reducing the dose to the surrounding organs.
• A medical physicist is a healthcare scientist who helps work out the doses of radiotherapy and checks all aspects of your treatment plan.

They will work together to make sure your radiotherapy is delivered accurately and safely.

What should I expect when coming for treatment?

Planning the radiotherapy

Before your radiotherapy starts you will normally have a planning session, which takes around 45 minutes. You will have a CT scan to work out the best position for you to lie in on the radiotherapy table during treatment. It is important you are comfortable as you will be in the same position every day for your treatment. Some people may also have an MRI scan to help with planning. The radiographers will then make tiny permanent dots (tattoos) on your skin around the area being treated. These help make sure they get you into exactly the right position for each treatment session.

You may be asked not to eat for two hours before your planning session, but you might be given some water to drink. To make sure everything is exactly the same for treatment, you will normally have to do the same before each treatment session.

Different hospitals do things slightly differently and your oncologist and the radiotherapy team will discuss the process in detail with you. Ask them any questions you have about what will happen.

After the planning session, the radiotherapy team will produce a treatment plan for you. This means there will usually be a gap of two to three weeks between planning and the start of treatment. Your radiotherapy team will be able to tell you exactly how long you may need to wait.

Having treatment

The radiographers will position you on the radiotherapy table (often called a couch) using the tattoos. You might feel the couch move as the radiographers adjust the position from outside the room. The radiotherapy machine is called a linear accelerator or linac. They may move the radiotherapy machine around you to different angles to check the measurements. Another type of linac may be used, where the couch slides into it like a CT or MRI scanner.

The radiographers will leave the room to deliver your treatment but will watch you all the time using cameras. They can talk to you over an intercom and you may be able to talk to them. You might feel the couch move as they adjust the position from outside the room.

Radiotherapy machines are very big and can be noisy. You should try to relax and lie as still as you can. You may be able to listen to music. The machine will not touch you and the treatment isn’t painful.

With most standard radiotherapy machines, you will have a scan before the treatment is delivered. This is to help make sure the radiotherapy is delivered accurately, but it won’t check how well the treatment is working.

The whole process will take about 30 minutes. For SABR it will be longer – 45 minutes to more than an hour. The treatment itself only takes a few minutes. The rest of the time is spent making sure you are in the right position and doing pre-treatment checks. You can go home as soon as each treatment session is finished. After radiotherapy, it’s safe to be around other people, including pregnant women and children.

Radiotherapy and chemoradiotherapy can be tiring, so having someone to drive you to hospital can be helpful, especially towards the end of treatment.

Reviewed January 2024

Review date January 2026