The treatments are usually given from Monday–Friday with a rest at the weekend. Your child’s doctor will discuss the treatment and possible side effects with you.
The length of treatment will depend on the type of cancer your child has.
Planning radiotherapy
Radiotherapy has to be planned carefully and this may take a few visits. On your child’s first visit to the radiotherapy department, they may have a CT scan or lie under a machine called a simulator. The CT scanner or simulator takes x-rays of the area to be treated.
The treatment is planned by a cancer specialist (clinical oncologist). Marks may be drawn on your child’s skin to help the radiographer, who gives the treatment, to position them accurately. This makes sure that the treatment is given to the right place each time.
Sometimes a mould or mask is made to keep the affected part of the body still each time the treatment is given. The doctors or specialist nurse will explain more about this if your child needs a mould or mask.
Treatment sessions
At the start of each radiotherapy session, the radiographer will position your child carefully on the couch and make sure they’re comfortable. During the treatment, your child will be left alone in the room, but they will be able to talk to the radiographer who will be watching from the next room. Your child will be able to listen to music or stories while the treatment takes place.
Radiotherapy is not painful, but your child has to lie completely still for a few minutes while the treatment is being given. Occasionally, they may need to have a general anaesthetic so the treatment can be given.
Remember, radiotherapy will not make your child radioactive and it is safe for them to be with other people.
Watch our children's guide to radiotherapy. It tells the story of Will and Sophie who have radiotherapy, and helps young children know what to expect.
Radiotherapy is an established, successful treatment option for childhood cancer. Most patients have it alongside other treatments such as chemotherapy and surgery.
Over the years, research has helped doctors understand which combination of treatments is best for each tumour type. Specialist radiotherapy doctors called 'clinical oncologists' work with the whole oncology team to agree and coordinate the most effective radiotherapy treatment plan for each patient.
As more and more children survive cancer, there is growing evidence that certain types of cancer treatment can affect a patient's health later in life. Doctors are now focusing on how to make treatments kinder and safer to avoid side effects that may happen years after treatment has finished.
What is proton therapy?
Proton beam therapy is a type of specialised radiotherapy using a radiation beam made up of high-energy protons instead of photons (or x-rays) as used in standard radiotherapy. The difference between the two is that when the proton beam hits the tumour cells, it stays within the tumour and doesn't carry on travelling through the body.
The cure rate for both proton therapy and standard radiotherapy is the same for the vast majority of patients but there are some advantages of proton therapy specifically for children.
What are the potential benefits?
The main benefit of proton therapy is that the beam is very precise and does not hit the surrounding cells and tissue. This means that healthy cells outside of the tumour are not exposed to unnecessary radiation and potential damage.
Proton therapy can therefore be a good choice for children whose bodies are still growing and maturing, and for patients whose tumours are close to vital organs. The impact of less radiation exposure helps reduce the risk of long-term side effects occurring in patients making it a safer treatment option for some children.
It is important, however, to note that side effects can still happen and may be different to other radiotherapy treatments.
Is proton beam therapy right for every child with cancer?
Proton therapy does not always offer any advantage over standard radiotherapy. It depends on the location and/or type of tumour being treated. Proton beam therapy has to be delivered in highly-specialised treatment units and this can mean being away from home for 6-8 weeks which can be a significant challenge for some families. Sometimes either the cancer itself, the treatment or other medical problems can make travelling away from their local healthcare system very difficult.
Your child's clinical oncologist is an expert on all radiotherapy options available and will work in collaboration with the rest of your child's hospital team to make sure that each patient receives the best treatment that is right for them.
How can my child be referred for proton therapy?
Your child's clinical oncologist will discuss with you whether proton therapy is the best option for your child and will talk you through the pros and cons of both types of radiotherapy. With your permission, they will then ask the NHS Proton Therapy Clinical Reference Panel for advice regarding potential treatment with proton therapy. The panel consists of experienced paediatric clinical oncologists who have both expertise in radiotherapy for childhood cancer but also proton beam therapy. A referral may then be made to one of the proton therapy centres approved for treatment by NHS England.
Where can my child have proton therapy?
It is important that proton beam therapy should be given in a well-equipped unit by an experienced and fully-trained team. It is more complicated and time-consuming to deliver than standard radiotherapy and has to be carefully integrated with other treatments to get the best results. There also has to be appropriate specialist support for families.
The first NHS UK proton beam facility opened in 2018 at the Christie Hospital in Manchester. A second one, at University College London Hospital, opened in 2021. These centres have been carefully designed to deliver world-class radiotherapy specifically for children, with the addition of local support of a designated children's hospital and an active clinical healthcare programme.
The two NHS centres will need to build up towards full capacity after they have opened so there will still be a need to send some children and their families abroad for treatment in the short term. The ultimate aim is that all children eligible for proton therapy will be treated at one of the two NHS centres in the UK.
Proton therapy in the UK, however, will still mean being away from home for 6-8 weeks which may be a challenge for some families.
If you have any further questions about proton therapy, please talk to your child's doctor.
The immediate side effects of radiotherapy are usually very mild. We discuss some of the general side effects here. Your child might have other side effects depending on the area of the body being treated. Your doctor or nurse will be able to explain these to you.
Tiredness
Your child may feel very tired while they are having radiotherapy and for a few weeks afterwards. Their energy levels may take a few months to return to normal once the treatment is finished.
Effects on the digestive system
You may find that your child loses their appetite. It may help for them to eat small snacks and meals frequently throughout the day, rather than large meals. Some children feel sick (nausea) or may be sick (vomit). Your child’s doctor can prescribe drugs to help with this.
Effects on the bone marrow
Radiotherapy to some parts of the body can sometimes affect the bone marrow, which produces the different types of blood cells. If this is likely to be a problem, your child will have regular blood tests during their treatment to check their blood cell levels. If these become low, they may feel very tired and lethargic. Let your child’s doctor know if this becomes a problem. Some children may need to have a blood transfusion – your child’s doctor can give you more information about this.
Effects on the skin
Some children develop a skin reaction similar to sunburn while having radiotherapy. This can happen after 3–4 weeks of treatment. In children with pale skin, the skin in the treatment area can become red and sore or itchy. In those with dark skin, it becomes darker. The extent of the reaction depends on the area being treated and your child’s skin type. Some children have no skin problems at all. Your child’s radiographers will be looking out for these reactions and will advise you about skin care.
Long-term side effects
Radiotherapy can sometimes cause other long-term side effects, which can develop gradually, months or sometimes years after the treatment. As time goes by, the effect of radiotherapy on any growing tissues may become more noticeable. In particular, radiotherapy to the brain can affect a child’s growth and development. Your doctor will be able to discuss this with you in more detail when planning treatment.