Radiotherapy for spinal cord compression

Although you may have heard about radiotherapy from friends, relatives and/or other patients, it is important to remember that their experience may not be the same as yours.

In all cases, a doctor will explain your radiotherapy treatment to you and answer any questions you may have. We are here to help. If you would like further information or have any concerns, please ask a Radiographer or a member of the Radiotherapy Review Specialist team.

In most cases, a friend, relative or carer may accompany you to your appointments. Please ask your doctor or a member of the radiotherapy team if this is possible.

What is radiotherapy?

Radiotherapy uses precise, carefully measured doses of high energy x-rays to treat cancer. Cancer cells are more sensitive to radiation than normal cells, so the aim of treatment is for the x-rays to either destroy the cancer cells or stop them from growing, whilst avoiding and protecting the normal cells as much as possible.

Radiation also damages normal cells in or around the area being treated which causes side effects, but these will usually recover and heal after treatment.

What is spinal cord compression?

The spinal cord is the large bundle of nerves that runs from the brain to the bottom of the back. The bones of the spine (vertebrae) protect it. As it passes through each bone the spinal cord gives off smaller nerves called nerve roots. These supply the trunk, arms and legs with sensation (feeling), and control of muscles. This includes control of the bladder and bowel.

Spinal cord compression is pressure on the spinal cord and its nerves. This may happen because:

• The bones are affected by cancer.
• A secondary tumour is damaging the vertebra.
• The cancer has spread to tissues around the spine.

Why use external beam radiotherapy to treat spinal cord compression?

The aim of your treatment is to relieve your symptoms, which can vary depending on which part of the spinal cord is affected by the tumour. Sometimes radiotherapy may be used following surgery to treat spinal cord compression.

Radiotherapy will improve your symptoms and help to relieve the pain. Sometimes it can stop the weakness from becoming worse. Unfortunately, there is not a good result in all cases especially if the nerve damage is severe and there is no movement in the limbs at all. It can take two to four weeks after radiotherapy to get an improvement in symptoms.

The return of some strength or sensation in the first week is an encouraging sign. No change at all in the first week means that recovery is unlikely.

 The number of treatments you need depends upon a number of factors, such as which part of the body needs treatment and the size of the area. It is common to treat Spinal Cord Compression with five treatments. Sometimes, one or 10 treatment sessions are used. Your doctor or radiographer will explain how many treatments you will need and what side effects to expect.

You will need to attend the radiotherapy department as an outpatient or in some cases as an inpatient, for a course of daily treatments (Monday to Friday).

Your radiotherapy planning appointment

Prior to your radiotherapy treatment starting, you will need to attend the radiotherapy department for a CT planning scan. The position you are in for this scan will be the exact same as the position you will be in for your treatment.

It is important that you tell us if you find this position uncomfortable before we carry out the scan. There are often adjustments, we can make to help make you as comfortable as possible.

Unless you have been told otherwise by your doctor, please continue taking your medications as normal before your appointment.

If you take any medications to help manage your pain it is advisable to try to take these so that they are at their peak effect while you are with us to make lying on the couch as manageable as possible for you.

Your radiotherapy treatment appointments

The actual radiotherapy treatment is similar to having an x-ray/scan. Each session takes approximately fifteen minutes in total, most of which is spent ensuring you are in the correct position, although the actual delivery of the radiation lasts only a few minutes.

If you took pain relief for your planning appointment or if you found the position you were in uncomfortable, we recommend you use your standard pain relief for this appointment. If you feel you need additional pain relief, please discuss this with the radiographers who will be able to advise you or refer you on to a doctor as needed.

We will regularly take x-ray images before delivering your radiotherapy treatment to confirm that the area we intend to treat is in the correct position.

Short term side effects

Some side effects are short term, or “acute”. Short term side effects typically reach their peak about two to three weeks after you finish your treatment and take a further two to three weeks to reduce. However this will not be the case for all patients. Examples of possible short term side effects from radiotherapy for Spinal Cord Compression are listed below.

• Within the first few days, you may notice a temporary increase in pain in the treated area, particularly if you have a single treatment. During this time, if any pain is not under control with your usual medicines, you should contact your GP, District or Macmillan Nurse.
• Depending on the area being treated you may also feel nauseous following radiotherapy. Your treating team will discuss this potential side effect with you and provide you with medication to support where necessary.
• When treating the abdomen or pelvic areas, you may notice that your bowel motions become more frequent and loose for a short time (Diarrhoea). This occurs because we cannot avoid bowel which lies in front of/close to the area(s) receiving treatment.
• When the back bones (spine) of your chest or neck area are treated, it is possible that your gullet/throat could become a little sore for a short time as these areas lie in front of the spine and may receive some radiation dose. If this soreness is troublesome, painkillers may be helpful as well as eating softer foods and avoiding very hot or very cold food and drink until it settles.
• When treating the chest, we may cause some irritation to the lungs leading to a mild cough or some shortness of breath. This will settle a few days after treatment has completed. Your treating team will discuss this side effect with you.
• You may lose some hair in the area you have treatment. This often grows back but may be thinner and/or a different texture than before.
• Your skin may become discoloured in the treated area. We advise you not to soak in hot baths, to use a mild, non-perfumed soap and to pat the area dry rather than rubbing. Please do not use talcum powder or any lotions and creams other than those advised by us. Please ask one of your radiographers for information on this.
• You may become tired. We advise that you maintain your current levels of activity as much as you can.

You may experience some or all these side effects. Please always let the radiotherapy team know of anything worrying you, as we want to help you recover as soon as possible.

Long term side effects

Some side effects are long term. These usually occur more than three months, but sometimes much longer, after finishing your course of treatment. It is unusual to have long term side effects following a course of radiotherapy for Spinal Cord Compression.

However please let your doctor know if this does happen. You may require additional tests and there may be treatments that can be offered to help.

After your treatment

Follow up from radiotherapy can vary depending on the treatment you have received. You may be referred to your surgeon for follow up. Sometimes you will be followed up by your radiotherapy doctor.

There will also be involvement from your specialist nurse team and sometimes physiotherapists as needed. If you are taking steroids to help with some of your symptoms these may be gradually reduced, but this should be done following the advice of the doctors and nurses managing this part of your care.