Healthcare Professionals

All common cancer sites are treated, including radical treatment for prostate, breast, lung, head and neck, colorectal and gynaecological cancers. Palliative treatment is also available with priority access given as necessary.

Referal Form
    • Breast

    • Prostate

    • Brain, including pituitary

    • Head and Neck

    • Lung

    • Gynaecological – cervix, endometrium, vagina, vulva

    • Upper GI – oesophagus, gastric

    • Lymphoma & myeloma

    • Soft tissue sarcoma

    • Skin, including melanoma

  • Palliative radiotherapy is delivered in order to improve patient quality of life, reduce troublesome cancer-related symptoms and prevent or delay tumour related complications.

    The palliation of cancer related symptoms accounts for a large proportion of the patients treated at our centre. Some examples of indications for palliative radiotherapy include:

    • Malignant spinal cord compression (emergency indication)

    • Superior vena cava obstruction

    • Brain metastases

    • Painful bone metastases

    • Haemoptysis, haematemesis, PV bleeding

    • Local malignant obstructive symptoms –  including recurrent obstructive pneumonia, bladder outflow obstruction

    • Ulcerating malignant skin lesions

  • There are a diverse range of symptoms and signs which can raise suspicion of an underlying malignancy.

    A clinical assessment should include a thorough history and examination of the patient, focusing on duration of symptoms, the presence of past history of malignancy, gynaecological history, smoking history, alcohol consumption and family history.

     

    Warning indicators prompting further investigation include, but not limited to:

    • Persistent unexplained weight loss, energy loss

    • New onset headaches and/or new, sudden neurological complaints

    • Non-resolving neck lump, oral cavity lesion

    • Dysphagia, altered bowel habit, rectal bleeding, persistent nausea and vomiting, jaundice

    • Breast lump, axillary lump

    • Recurrent lower respiratory tract infections

    • Haemoptysis

    • Persistent abdominal pain, abdominal mass

    • Abnormal vaginal bleeding, persistent pelvic pain

    • Prostatic symptoms, malignant-feeling prostate gland

    • Testicular swelling

    • Palpable lymphadenopathy

    • Limb mass, swelling

    • Abnormal blood tests

  • In general patients are managed here in the centre and will contact us to discuss side-effects but from time-to-time they may present to their GP with problems.

    Time is taken before treatment commences to discuss with the patient any possible side-effects and strategies are put in place to help manage their impact on quality of life. As part of their care plan, patients are reviewed at least once weekly whilst receiving radiotherapy and again 6 weeks after completing treatment in our review clinic.

    Acute radiotherapy side effects are defined as those happening between the time interval from day 1 of commencing radiotherapy to day 180 (6 months). Long-term side effects are any side effects taking place after this time.  Acute side effects are predictable and usually temporary. Long-term side effects tend to be permanent.

    The severity and extent of side effects is determined to some extent by a number of factors

    • the total dose of radiotherapy delivered to the site

    • the daily dose of radiotherapy delivered

    • the duration of the treatment course

    • the anatomical site being irradiated especially if the same site is being re-irradiated

    • the delivery of concurrent chemotherapy

    • active smoking

    • underlying medical comorbidities.

    All relevant and potential side-effects are explained to patients prior to commencing treatment. Acute side-effects are managed during and immediately after completion of the treatment course. The presence of long-term side-effects is established in follow-up clinics.

     

    Acute Side-effects

    • The most common acute side-effects observed include:

    • Radiotherapy induced fatigue

    • Alopecia if the brain/skull is irradiated

    • Radiation dermatitis

    • Mucositis eg mouth ulcers, oral cavity and throat discomfort

    • Nausea, altered bowel habit, cramps

    • Proctitis

    • Urinary frequency

    Long-term Side-effects

    • Skin fibrosis, skin dryness

    • Infertility

    • Lymphoedema

    • Cardiac damage

    • Radiation pneumonitis

    • Radiation-induced malignancy (1/200 chance at 10-15 years)

    • Cognitive decline

    • Hypopituitarism

    Information leaflets on managing side-effects

    Advice for Men after Radiotherapy Treatment for Prostate Cancer

    https://www.materprivatelimerick.ie/wp-content/uploads/2013/07/Prostate-cancer-after-care-information.pdf

    Advice for Women & Men after Radiotherapy Treatment for Breast Cancer

    https://www.materprivatelimerick.ie/wp-content/uploads/2013/07/Breast-cancer-after-care-information.pdf

     

ABOUT TREATMENT DELIVERY

Below is some information regarding treatment delivery options in the management of patients, including External Beam, Brachytherapy, Radioactive Seed Implantation (RASI), Chemotherapy, Chemoradiotherapy.  We work closely with the Cancer Centre and the Oncology Department here in Limerick University Hospital.

  • Radiotherapy (historically called radium treatment) is high dose ionising xray treatment. The high energy xray beams have the capability of disrupting the cancer cell DNA which is unable to repair itself. Normal cell DNA however is also damaged, thus causing side-effects. Normal tissues are usually able to regenerate and repair.

    External Beam Radiotherapy - 3D conformal radiotherapy is the most conventional form of treatment delivery. A CT-simulation scan is performed in order to design the treatment plan, allowing us to calculate and optimise the radiotherapy dose being delivered to the tumour and the surrounding normal tissues. Treatment is delivered on a linear accelerator, and typically 2-5 xray beams are used.

    Intensity modulated radiotherapy (IMRT) is a more precise form of external beam radiotherapy, using many beams of various intensity allowing the radiotherapy isodoses to conformed in a concave shape to the tumour volume, thus sparing surrounding normal tissues. This is routinely practiced in our department for some head and nEck, and prostate cancers.

    Image-guided radiotherapy (IGRT) employs daily or weekly MV or KV imaging acquired during treatment to ensure accuracy in patient set-up and target coverage. Corrections are made if unacceptable variations are observed.

     

    Brachytherapy is delivered by placing either temporarily or permanently a radioactive source in or near the tumour. This has the advantage of maximising the dose to the tumour and minimising the absorbed dose to surrounding normal tissues. Brachytherapy is a routine part of the management of cervical cancer. An MRI-compatible intrauterine tandem and ring applicator is inserted into the uterus, flush against the cervix on 3 separate occasions. Three fractions of high dose rate brachytherapy are delivered, with the applicator removed after each fraction is delivered.

    Brachytherapy is also used in the management of certain low-risk prostate cancers, uterine cancer and breast cancer. Permanent radio-active seeds or temporary high dose rate catheters are used in the management of prostate cancer. A temporary vaginal cylinder is used in the post-operative management of uterine cancer, and temporary breast catheters are used for breast cancer brachytherapy at our centre.

    Radioactive Seed Implant (RASI) is a procedure whereby 80-100 tiny radioactive pellets are permanently implanted directly into the prostate tissue. It is used to treat low and intermediate risk cancers of the prostate. In the Mater Private Hospital, this procedure has been in routine clinical use since 2002, treating on average 70 to 80 patients per year. In the Mater Private, Iodine-125 seeds are used. The seeds are 5mm in length by 0.5mm in width. These seeds are relatively low in energy, which means they give off radiation only over a very short distance. This is why they are used for implants, as they can treat the prostate without giving excess dose to the surrounding healthy tissue. The seeds stay in place permanently and continue to treat the prostate over a number of months following implant. Eventually, they lose all their energy and are no longer radioactive.

     
  • For certain forms of cancer, chemotherapy is also given before, during or after a course of radiotherapy.

    Neo-adjuvant chemotherapy is given before definitive surgery in some breast cancer patients, particularly locally advanced tumours at high risk of harbouring micrometastatic disease. In borderline resectable tumours the rationale behind this sequencing of treatment is to shrink the primary tumour to increase the potential of performing breast conservation surgery. Neo-adjuvant chemotherapy (followed by surgery and/or radiotherapy) is also sometimes used in the treatment protocols for oesophagus, gastric, lung and head and neck tumours.

    Concurrent chemotherapy is given during a course of radiotherapy. This is commonly practiced for head and neck, cervix, rectal and lung cancers. The rationale behind this sequencing of treatment is the radiosensitising ability of certain chemotherapeutic drugs. This enhances the radiotherapeutic effect and can sometimes enable a lower overall total radiotherapy dose, thus sparing potential long-term radiotherapy side effects.

     

    Adjuvant chemotherapy is given after definitive surgery for some cancers if there is concern about adverse risk features after pathological analysis eg. breast, lung, colorectal, gynaecological, head and neck cancers

    Sequential chemoradiotherapy is chemotherapy and radiotherapy given in sequence rather than at the same time. This is commonly used in the management of inoperable lung cancer (although a concurrent approach in associated with superior outcomes but is more toxic), and in the adjuvant treatment of certain endometrial cancers.

     

CLINICAL TRIALS

The Mid-Western Cancer Centre is enrolled in a large number of clinical trials.

Clinical trials are an integral component to the development, individualisation and enhancement of cancer treatments. Patients may be offered to participate in clinical trials but are under no obligation to agree to participate.  Please do not hesitate to ask us if you would like to find out more about clinical trials.

For a full list of trials please visit the All Ireland Cooperative Clinical Research Group website – www.icorg.ie. We hope to commence a number of ICORG approved radiotherapy trials in the near future.