Overview

Stereotactic ablative radiotherapy (SABR) is a type of radiotherapy. SABR uses several small beams of radiation, given from different directions, to focus on the area that needs treatment. This means that less surrounding tissue is affected.

When recommending radiotherapy, your doctor will have thought about the risks and benefits of the treatment. They will also talk to you about these. Although there will be side effects, you can have the treatment if we feel that the benefits are greater than the risks.

You might decide that you do not want to have radiotherapy. This is an option for you to think about. In this case, you might want to talk again with your doctor and let them know what you have decided.

You can ask for a second opinion on your diagnosis or treatment at any time during your appointment or treatment process. Please speak to your cancer specialist (clinical oncologist) or GP for information about how to do this.

Asking for your permission (consent)

We want to involve you in decisions about your care and treatment. If you decide to go ahead, you will be asked to sign a consent form. This states that you understand what the treatment involves and agree to have it.

If you would like more information about our consent process, please speak to a member of staff caring for you.

Benefits of SABR

SABR treatment takes less time than traditional radiotherapy. With SABR, you’ll have 3 to 5 sessions (fractions) over 5 to 10 days.

With traditional radiotherapy, you would have at least 20 fractions over 28 days.

Your treatment teams

A consultant clinical oncologist will be in charge of your care. Clinical oncologists are doctors who are trained in the use of radiotherapy and chemotherapy. They are supported by a team of specialist registrars, therapeutic radiographers, nurses and administrative staff. 

Therapeutic radiographers are specifically trained to plan and give you the radiotherapy. They provide support and advice on radiotherapy side effects and how to manage them. The radiographers will have day-to-day responsibility for you while you are having radiotherapy.

Side effects of SABR

Any side effects of radiotherapy are usually only in the part of your body being treated.

Early side effects

These can happen during or shortly after SABR treatment, and will settle after a few weeks.

Side effects include:

• tiredness
• needing to pee more often and urgently, or peeing slowly
• some burning and stinging when you pee
• loose poo and wind
• passing small amounts of blood or mucus in your poo
• discomfort in your bottom (anus)
• tummy ache and feeling bloated
• feeling sick (nausea) and being sick (vomiting)

Skin changes

Skin in the treatment area can react to the radiation but this is not very common with SABR treatment.

On white skin the skin can appear red, but on brown and black skin redness can be harder to see. Your skin might also become dry and itchy for 1 to 2 weeks after treatment ends. This can cause the skin to blister and the area to get moist. If this happens, the skin will fully heal after treatment has finished.

You should moisturise the area to help your skin cope better during treatment. You can use your usual moisturiser. After each treatment, rub in a small amount of moisturiser 2 times every day, or more often if your skin is itchy.

Longer-term side effects

These are less common and can happen months to years after SABR. Longer-term side effects include:

• frequent change in bowel habit
• peeing more often or difficulty with emptying your bladder
• discomfort peeing or in your anus
• bleeding from your bladder or anus

Men with pelvic cancer may have problems getting an erection, and women may get menopausal symptoms. 

Rare late side effects

A late side effect is something that can happen months or years after treatment finishes.

Rare late side effects include:

• an obstruction, hole, or fistula (abnormal connection between two organs) affecting your bladder, bowel or anus
• nerve damage affecting how your bowels, bladder or legs work
• pelvic bone fractures
• swelling (lymphoedema) in your legs

Emotional effects of SABR

The side effects of SABR treatment can be both physical and emotional. Treatment can be very distressing for some people. It’s also common to feel overwhelmed following a cancer diagnosis.

It is important to look after yourself during and after treatment. Advice and support are available if you are finding it difficult to cope. There are many resources available for patients and their families and carers to cope with the emotional impact of cancer.

Macmillan has more information about cancer and your emotions.

Your oncologist will also speak to you about any side effects that you might have.

SABR planning

Planning your SABR will involve a long visit to the radiotherapy department, and you’ll have a few different procedures.

Throughout this process, the SABR team will be available to answer any questions you have.

A planning CT scan

You will have a CT scan to allow us to plan your treatment. Your specialist will use this scan to map out where to give you your SABR treatment. This is called the target for radiotherapy.

You might need to have a full bladder for the CT scan. Your radiographer will tell you before your appointment if you need to do this. If your bladder needs to be full for the planning CT scan, it will also need to be full for the rest of your SABR treatment.

You might also need to have an enema to empty your anus of gas and poo. This is done to limit changes in the size of your anus, as this can affect the position of the treatment target.

During the planning CT scan

For the radiotherapy planning CT scan you will need to lie flat on your back, with your arms on your chest. You will have this with or without a contrast agent.

The scan can take up to 1 hour. As part of the pre-treatment planning process, the radiographers will need to take some measurements and put small, permanent marks on your skin using ink and a small needle. These reference marks are used to position you at each SABR treatment appointment.

MRI scan

You might need an MRI planning scan to help your doctors to see the treatment target better.

Your personalised radiotherapy plan

The SABR team will create a personalised radiotherapy plan for you. All of your scans will be entered into a planning computer. The doctor will identify the target area that needs to be treated, and important organs that must only receive a small dose of radiotherapy.

First day of SABR treatment

You will have 3 to 5 SABR treatments. They might be each day, or every other day. Each appointment will last about 30 minutes.

The SABR treatment is given by a machine called a linear accelerator. This is a type of X-ray machine, and is sometimes called a ‘linac’. The staff operating the machine are therapeutic radiographers.

During the treatment, you will lie on a flat bed in the same position as you were for your planning CT scan. When you are in the correct position, the radiographers will leave the room and the treatment will start.

You will need to keep still for the treatment. The radiographers will be monitoring you and you can communicate with them throughout.

The machine will move around you. The radiographers might come into the room to re-position the machine. They will tell you what is happening throughout the treatment. The treatment is painless and you should not feel different immediately after it's finished.

Follow-up appointment

You will see your oncologist 2 to 4 weeks after treatment. They will check for any side effects and speak to you about how you can manage these.