This leaflet provides information about stereotactic ablative body radiotherapy (SABR) for cancer treatment to their liver, including details of the procedure and side effects that you may experience. 

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, so if you would like further information or have any particular concerns, please do not hesitate to 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. The aim of treatment is for the x-rays to either destroy the cancer cells or stop them from growing, whilE protecting the normal cells as much as possible.

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

What is SABR and why is it used?

Radiotherapy may be given to treat or control cancer. SABR is high precision and high dose radiotherapy. It is given over fewer treatment sessions compared to standard radiotherapy. This can increase the chances of controlling the tumour and reduce symptoms more effectively than standard radiotherapy.

Your radiotherapy planning appointment

Prior to starting your radiotherapy treatment, you will need to have a CT planning scan. This scan is different to the previous ones you may have had, as it will be used to design and tailor your radiotherapy treatment to your specific needs.

We need to ensure that your liver is in the same position at the time of your planning appointment and when you come for treatment to maximise the accuracy of treatment, .

To minimise variation in position and movement we ask that you do not eat or drink anything for two hours before your scan or treatment. Just before your scan you may be asked to have oral contrast.

We also use a belt around your abdomen that is adjusted to create some pressure on your abdomen to reduce the amount of movement of your liver caused by breathing motion.

The CT planning session will usually take around 45- 60 minutes. The CT planning scan itself will only take 10- 15 minutes and the rest of the appointment is getting you in the correct position.

Remember that the position you are scanned in will be the exact position you will be in for all your treatments, so please tell us if you feel that you may struggle with staying in this position for your treatment sessions.

You will have an injection of dye when having your planning CT scan. This is to help us see things clearly on the scan. A specific information leaflet is available with more information if you would like this.

At the end of the planning scan, several permanent ink markings, usually three but sometimes more or less, are made on your skin using a pinprick of ink. These mark where the SABR treatment will be given, and ensure that you are accurately repositioned for your treatment each day.

Your radiotherapy treatment appointments

SABR is usually given over three or five treatments on alternate days. The actual radiotherapy treatment is like having an x-ray/scan.

Each session takes approximately 45- 60 minutes in total, most of which is spent ensuring you are in the correct position. We will perform additional scans before giving you your treatment to check the accuracy of your positioning. The actual delivery of the radiation lasts only a few minutes.

You will be asked to lie still on a treatment couch while the radiotherapy machine moves around you, giving the treatment from different angles and directions.

You will be alone in the treatment room whilst the treatment is being given, but the radiographers will be always observe from outside and speak to you via the intercom if necessary.

You will not see or feel anything during this process and the machine will not touch you.

This treatment will not cause you to be radioactive and it is safe for you to be around other people, including small children and pregnant people, afterwards.

Side effects of radiotherapy treatment

You may develop side effects as you go through the treatment. Most of the side effects begin at least one week after starting treatment, so for some shorter treatment courses this may be after you have completed your treatment.

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.

Potential short term side effects

  • lethargy (fatigue)
  • nausea and vomiting
  • dyspepsia
  • changes in bowel habits
  • pain
  • temporary changes in liver enzymes- this will be monitored using blood tests
  • skin reactions (colour changes, dryness and itchiness)

Potential long term side effects

These usually occur more than three months, but sometimes months or years later, after finishing your course of treatment.

Potential late side effects are rare but may be permanent and include:

  • Liver and/or kidney damage - this will be monitored using blood tests.
  • Damage to the bowel - this may lead to a blockage or perforation in the bowel (gut) requiring an operation.
  • Rib fracture (when treating peripheral lesions).
  • Biliary stricture (when treating central lesions).

For information on the possible side effects specific to your treatment, please review the information leaflet provided to you and consult the radiotherapy consent form filled in by your doctor when you were referred for radiotherapy treatment. If you do not yet have a copy of this, you may request one at any of your radiotherapy appointments.

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. The radiotherapy review specialist will see you regularly during your treatment. They will ask you about any side affects you may be experiencing and offer advice. They may also take additional tests if needed.

For information on the support available to you after your treatment finishes, please visit the finishing your radiotherapy treatment leaflet.

Working throughout your treatment

There are patients who can and do choose to work throughout their treatment. However, some patients also prefer to take sick leave from their workplace to prioritise their treatment appointments. This will all depend on each individual and how they feel they can manage their own time and energy.

If there are any concerns, a doctor can advise you best on what to do.

After your treatment

You will be seen in the week after completing your treatment and again four to six weeks after completing your treatment. Outpatient appointments will then continue initially on a three to six monthly basis, or more frequently if required.

How to find us

We strongly encourage you to come by public transport if possible. We are a central London hospital, and parking at the hospital and in the local area is extremely limited.

Parking at the Royal Free Hospital is free for patients having radiotherapy treatment, in allocated parking spaces only – these are available at the front of the main hospital entrance. You will need to display a radiotherapy parking permit in your car, which we will issue you during your first visit.

Please provide the radiotherapy receptionist with your car registration number on arrival to avoid being issued a parking fine. Free parking is only available for patients attending their treatment appointments and is not available for out-patient clinic appointments.

Patient transport

Patient hospital transport is available through a means tested assessment. Patients or a relative must book their own transport to and from the hospital if they are travelling from home.

Tel: 0333 240 4909.

An additional information leaflet designed to assist you in booking your transport is available if you require it.

Support available at the Royal Free Hospital

We have several support services are available for you to access, some of which are listed below. If you would like to know more about these, please ask a member of the radiotherapy team or one of your specialist nurses.

Macmillan cancer support

Macmillan is available for anyone with cancer and their loved ones. It provides a confidential and expert listening ear and a wide range of information booklets in a variety of languages.

It offers practical tips on treatment side effects, symptoms, and survivorship as well as referrals to other support groups and specialist services.

Royal Free Hospital

  • Location: Oncology outpatients department on the ground floor.
  • Opening times: Tuesdays to Fridays, 10am to 4pm.
  • Tel: 020 7794 0500, ext 31337
  • Email: rf.cancerinfo@nhs.net.

Chase Farm Hospital

Barnet Hospital

Maggie’s

Maggie's offers practical emotional and social support for anyone with cancer, their family and friends. We are here for you before, during and after treatment. You don't need an appointment or a referral and everything we offer is free.

Complementary therapy

A range of complementary therapy treatments, including massage and aromatherapy, are available at the Royal Free Hospital. For more information, please ask a member of the radiotherapy team.

Counselling

If you would like a referral to a specialist counsellor for patients with a cancer diagnosis and undergoing cancer treatments, please ask a member of the radiotherapy team, your radiotherapy doctor or one of your nurse specialists.

Alternatively, you can contact radiotherapy and oncology counsellors by telephone: 020 7472 6739