Radiotherapy is one of the methods used to treat cancer. With radiotherapy, we destroy a tumour with radiation. HMC (Haaglanden Medical Centre) operates a high-quality radiation department at HMC Antoniushove. On this webpage, we will provide you with more information about the radiation treatment that we can offer you.
Getting to the Radiotherapy department
You may receive your radiation either as an outpatient (you visit the radiation department) or as an inpatient (during your stay in hospital). We will arrange your transportation to the Radiotherapy department if you are staying in hospital. You must arrange your own transportation if you are at home (again) and visit us for your radiation treatment.
If you are unable to get to the hospital with your own transportation or by public transport and have to take a taxi, you can often claim all or part of the costs of the taxi from your health insurance company. This will depend on your health insurance package. Your health insurance company will be able to provide you with more information on this subject.
The Radiotherapy department is located on the ground floor of the hospital. The department can be accessed via the Gruttolaan 18 entrance and via the red route in the hospital. The department is indicated on the signs as the Radiotherapy department (Bestralingsafdeling).
If you are in a wheelchair and in need of help to get from the central hall to the Radiotherapy department, the receptionists in the central hall will be happy to help you. Wheelchairs are also available in the Radiotherapy department. A coin deposit is required for this.
HMC patient ID card
Bring your HMC patient ID card with you when you visit the hospital. If you do not have a patient ID card, you can have one made when you visit the hospital for your first appointment at the Radiotherapy department. This can be done at the registration desk in the central hall. You will need a passport of driving license to obtain the patient card.
If you need to do this, we suggest that you arrive at the hospital 15 minutes before your appointment at the Radiotherapy department, to make sure you arrive at your appointment in time.
Cell division and radiation
All human tissues consist of cells. These cells are continuously dividing. In this way, old or damaged cells are replaced by new ones. This division of cells in the body can get out of control. These abnormal cells divide without control and may form a malignant tumour. Cancer cells can also invade nearby tissues.
By treating these cancer cells, they are damaged so much that they can no longer divide. In the end, these cells are destroyed. Cancer cells are more sensitive to radiation than healthy cells, as they divide more quickly. Unfortunately, healthy cells near the tumour are also affected by the radiation.
We can limit this side-effect by giving the radiation treatment in a number of small doses (‘fractions’). As a result, the cancer cells stop dividing and will be destroyed. In between fractions, the surrounding healthy tissue is often better able to recover from radiation injury.
You will be given a series of outpatient treatments, which may consist of one or multiple fractions during several weeks. Some tumours require a longer radiation period than others. Some tumours have to be treated three times a week, while others have to be treated four or five times a week, to get the best results. The purpose of the radiation also influences the number of treatments. If the goal of the radiotherapy is palliative e.g. to reduce pain, a single radiation may be sufficient, depending on the type of tumour. If the aim of the treatment is curative (to cure you), more treatments are usually necessary.
Before your treatment starts, we will inform you about the length of the radiation period and the number of treatments a week.
Types of radiotherapy
There are various types of radiotherapy:
- External beam radiotherapy: The radiation is directed at your tumour from a machine located away from your body, usually a linear accelerator or an orthovoltage unit for skin cancer treatment.
- Internal radiotherapy (brachytherapy): In this type of radiotherapy, we place a radiation source with the help of a special holder nearby the tumour inside your body. We sometimes combine internal radiotherapy with external radiotherapy.
- Intraoperative radiotherapy (IORT): This means that you are irradiated during the operation. Your doctor will discuss this with you if IORT is a possibility for you.
Your first visit to the Radiotherapy department
You will be referred to a radiation oncologist if radiotherapy may help you. During the first consultation, the radiation oncologist will talk with you about the history of your illness and the reason for and purpose of the treatment. Bring a list of current medication with you to this appointment. A physical examination will sometimes be carried out at this first appointment The radiation oncologist will tell you how much radiation you will receive, how long the treatment will take, how many treatments a week you will be receive and what preparations are needed. The radiation oncologist will also tell you what side-effects to expect. Finally, the radiation oncologist will ask for your consent to the treatment. It is of course entirely up to you to decide whether to start this treatment.
Do not hesitate to ask the radiation oncologist any questions you may have, so that things are clear to you and you are not left with unanswered questions. It is a good idea to bring along someone you are close with to the first consultation. This will help to remember everything that was discussed. After this meeting, you will go to the CT-scan located in our department (see below). Either this can be directly after the consultation with your doctor or otherwise an appointment is scheduled as soon as possible thereafter.
The preparations for the radiation are carried out with the help of a CT (computerised tomography) scan. The CT scan makes pictures of a part of your body. By stacking these pictures on top of each other in the computer, a three-dimensional image is created. The radiation oncologist can then indicate exactly which area should be irradiated and which parts of your body should not be irradiated.
After the CT scan, the radiation technician will put several tattoo marks on your skin. A small drop of ink will be injected just below the surface of the skin as a permanent mark. These tattoos will ensure that your position on the radiation table during radiation exactly matches your position during the CT scan. These marks are only used to determine your position and therefore do not indicate the site of the tumour.
The information collected during the preparations serves as a basis for your treatment. the radiation team develops a treatment plan. This must be carried out carefully and therefore requires considerable time. You can start the radiation treatment approximately two weeks after the preparations.
As soon as possible, you will be informed of the date and time of your appointment for the first treatment.
Sometimes we need to arrange some items of equipment for the radiation. For example, a plastic ‘immobilization mask’ is needed when irradiating the head and neck area. This mask enables us to ensure the accurate positioning during the treatment. The mask helps you to lie still. An additional benefit of a fixing mask is that we can mark the positioning lines on the mask rather than on your skin. We will make a customised mask during the preparations and use it for each radiation session, which will only be used for your treatment, not for anybody else. You can breathe normally while wearing the mask.
For your first treatment appointment, please report to the front desk in the Radiotherapy department. A technician will meet you and will briefly go over your radiation treatment. You will be accompanied to the treatment room and will be positioned on the treatment table. Special attention is paid to ensure your position is exactly the same as in the CT scan. The radiotherapist will set up the radiation field. The tattoo marks or the lines on your mask will be used for this purpose.
Once you are positioned correctly, the technician will leave the room and enter the control room next door to start your treatment. Before starting treatment, we will first make a short CT scan as an additional check to ensure you are in the correct position. If necessary, we can adjust your position. The machine makes a buzzing noise during treatment. You will also hear the device switching on and off. You will not see or feel the radiation itself. Each session is painless.
Contact between you and the radiation staff will be maintained during treatment by means of a microphone, so you can always speak with the technician if you have any concerns. The technicians will closely monitor you on a television screen. Whenever necessary, they can pause the radiation and come over to you.
The entire radiation appointment lasts approximately 10 to 20 minutes, depending on the type of treatment. Radiation treatment is usually given from different angles. The treatment machine rotates. You remain in the same position all throughout the radiation. The unit automatically switches off once the radiation dose is given, so you can never receive a too high a dose.
You will receive your treatment appointments on a weekly base. If you would prefer to have your radiation at a certain time of the day, please let the technician know in advance. If you have any other appointments (either in the hospital or otherwise), give us notice before Tuesday, at least at one week’s notice. We will consider your preferences as much as possible.
Call the department if you think you are not fit to undergo treatment. For example, if you are feeling ill or have a temperature of more than 38 degrees Celsius. After consultation with the radiation oncologist, a decision will then be made on the best course of action. As much as possible, the treatment must proceed as planned.
At the end of your treatment series, you will be given a follow-up appointment or have a telephone consultation with your radiation oncologist. This appointment is usually three to six weeks after the last radiation.
Short-term side effects
In advance, we usually cannot accurately predict to what extent you will suffer side-effects. Whether or not side-effects occur also depends greatly on what part of your body was treated. Symptoms often occur during the radiation period. Sometimes, however, you will suffer from side-effects in the following weeks. The severity of the side-effects gives no indication of the impact the treatment has your disease.
Sometimes you will experience fatigue, drowsiness and loss of appetite after treatment. Regular trips to the hospital may also feel like an additional burden to you. If you experience symptoms of fatigue, the best thing to do is to adjust your activities to manage these symptoms. You can eat whatever you like, dietary requirements permitting. Physical exercise is certainly recommended during the treatment period. These activities can offer you a pleasant distraction.
It is possible that the skin in the irradiated area will show signs of redness during radiation. Your skin may show varying degrees of redness, dryness or flaking. Sometimes the skin may also be damaged. This all depends on the dose and the radiation site. Skin folds (armpits, underneath breasts, groins and between buttocks) are generally more sensitive to radiation than the rest of your skin. Any reaction of the skin will usually occur two to four weeks after the start of treatment. The skin will largely recover within four to six weeks after treatment.
Advice for taking care of irradiated skin
- You can use your own shampoo to wash your hair. Try to wash just your hair and keep the shampoo away from your scalp as much as possible. Therefore, do not massage the shampoo into your skin.
- Using soap/shower foam/cleansing foam during radiation is permitted. You can continue to use the skincare products you normally use.
- Pat your skin dry after washing (in other words, do not rub).
- Apply a thin layer of a hydrating cream, such as calendula cream, vitamin E cream or the cream you normally use on your skin, twice a day as required.
- Do not wear abrasive or stiff clothing or clothes that pinch.
- Once you have finished your radiation period and your skin has recovered again, we advise using a minimum sun protection factor of 30 when in the sun.
- Do not scratch.
- If the irradiated area also includes the armpit, removing armpit hair is possible if there is no irritation of the skin and you do not cause any wounds (do not wax). You can continue to use deodorant as usual.
- Using cosmetic products, heavily perfumed body lotions, hair dye, gels is possible if there is no irritation of the skin. It is still necessary to treat the irradiated skin with care.
- If the neck or face is treated, you are allowed to shave with either wet razors or an electric shaver. You can also use aftershave on the sensitive skin.
- It is important that the skin of the irradiated area (and healthy skin) is not exposed unnecessarily to the sun or a sunbed. You can use a sauna, swimming water (chlorinated and outdoor water) and hot tub unless your doctor advises not to.
- Do not put any bandages on the irradiated skin during the radiation period. You can use silicone bandages. If the skin is damaged, the doctor may need to be consulted. If your skin is damaged after the end of treatment, please contact the radiation department. You do not have to wait until your follow-up appointment. The technicians will always be happy to advise you and help with bandaging if your skin has been damaged.
Hair loss is confined to the treatment area. The extent of hair loss depends on the dose and the size of the radiation field. Hair loss can affect the hair on any body part such as head, beard, pubic area, armpit and chest. If hair loss does occur, this will usually occur within two to three weeks after the start of treatment. If we expect hair loss because of irradiation of the scalp, it is advisable to arrange a wig before starting the treatment. We advise you to contact your health insurance company in advance for payment of the costs. Alternatively, you can also choose to wear a cap, hat or scarf.
Usually your hair will regrow a few months after the treatment. Sometimes it changes in terms of volume, colour or thickness.
Symptoms resulting from treatment of the brain
As mentioned before you can experience hair loss. In addition, you may suffer (more) from headaches or nausea during the treatment. You should always report this to a technician or to the radiation oncologist. Usually we can prescribe medication to help relieve these symptoms.
Symptoms resulting from treatment of the lungs
After one to two weeks of treatment, you may temporarily experience pain when swallowing. Your radiation oncologist can prescribe drugs to deal with this pain.
Symptoms resulting from treatment of abdominal organs
You may suffer from cramps and have more bowel movements during treatment if your bowels are within the radiation area. If this is the case, the radiation oncologist may be able to prescribe drugs to reduce the side-effects. Make sure in all circumstances that you continue to drink plenty of fluids.
If your stomach is being treated, you may probably experience some nausea. If this is the case, try to drink plenty of fluids. However, it is better to do this in small quantities at a time. You would also be best advised to spread your intake of food over several smaller and lighter meals each day. It is certainly best to wait an hour after radiation before eating and drinking again. In addition, drug prescriptions may help.
You will feel the urge to urinate more often if your bladder or prostate is treated.
Sometimes you will also experience a burning feeling when urinating. Tell the doctor if you have these complaints.
If your reproductive organs are within the radiation area, this may have implications for your fertility. This depends on the dose of radiation given.
If you plan to have children, your radiation oncologist will discuss with you whether any precautionary measures should be taken.
Symptoms resulting from treatment of the head and neck area
Your salivary glands may be affected because of irradiation of the head and throat area. This means that you will produce less saliva. You may therefore suffer from a dry mouth. Other symptoms that you may experience include changes in taste, loss of smell, the formation of superfluous mucous and pain swallowing. Your mouth and tongue may also feel rough and sore. Over time, producing less saliva can result in serious deterioration of your teeth. You can prevent this by applying a special treatment to your teeth. If necessary, we can refer you to a dental hygienist for this.
You may suffer from pain when swallowing if a part of your throat or oesophagus has been irradiated. Your radiation oncologist can prescribe drugs that should relieve the symptoms a little. Often, you will be referred to a dietician. The dietician will advise you on what you can do to relieve the symptoms that occur because of the treatment.
Advice for a sore mouth, throat or oesophagus
- Keep your mouth as clean as possible by rinsing regularly with salt water (1 litre of water + 2 teaspoons of salt or 1 teaspoon of salt and 1 teaspoon of soda), chamomile tea or sparkling water.
- Use a soft toothbrush.
- Do not smoke.
- Make sure you eat a varied diet.
- Make sure that your food and drinks are not too hot.
- Sometimes ice cream and cold drinks will provide relief.
- Avoid alcohol.
- Do not consume any hot spices or heavily salted food. Physiological salt is fine.
- Orange (juice) or grapefruit (juice) may be too sharp. Bananas, pears, peach, apple juice, grape juice and other similar fruit drinks are often easier to cope with.
- Avoid hard and coarse foods. Make your food easy to eat and have plenty to drink with your food.
- Cut off the crusts from bread or eat porridge instead of bread.
- Take into account that your meals will take longer.
- If required, you can be referred to a dietician.
Advice for the formation of superfluous mucus
- Rinse your mouth regularly with (mineral) water, drinks containing carbonic acid (sparkling water) and tea (with lemon).
- Soft drinks such as fruit juice, buttermilk, yoghurt drinks or similar.
- If you suffer from the formation of mucus after consuming dairy products, drink a sip of water afterwards. Make sure you continue to drink/eat dairy products, as these are an important source of protein and calcium.
Advice for a dry mouth
- You can keep your mouth moist by frequently drinking small sips, including during the night. You can also use a spray bottle with water.
- Combine solid foods with fluid.
- Have some gravy, sauce or applesauce together with your hot meal.
- Spread a creamy topping such as soft cheese, pâté or salad spread on your slice of bread. You can eat porridge if eating bread is too difficult.
- Sugar-free chewing gum, peppermints, acid drops or a popsicle. You can also use saliva substitutes as necessary.
Changes in your sexual life
Anyone diagnosed with cancer may experience changes in their sex life. The physical effects of the disease and/or treatment are one reason for this. However, fatigue and psychological reasons may also play a part. You can always seek the advice of your radiation oncologist about these symptoms.
If you are undergoing a longer series of treatment, time will regularly be scheduled to see your radiation oncologist about the progress of the treatment and the side-affects you may be experiencing. After the last radiation, you will receive a check-up appointment with your radiation oncologist. Your general practitioner and the referring specialist will be informed of the progress of the treatment.
Often the side-effects of the treatment are most noticeable immediately after the last treatment. The recovery period will take roughly as long as the total duration of the radiation treatment itself. You will be examined regularly in the years after your treatment. If you are worried about anything or experiencing symptoms between check-ups, please do not hesitate to call for advice or to arrange an additional check-up appointment.
Incidents, complaints, compliments and suggestions
Unfortunately, mistakes do occur. We have developed an incident reporting system for errors and accidents. An incidents panel investigates all reports. This panel also examines whether instructions have been followed and whether these instructions need to be improved. In serious cases, the hospital involves the Public Health Medical Inspector of South-Holland.
If you have any complaints about your treatment in the hospital, first discuss your issues with the person(s) directly involved, or with the person who is responsible for these employee(s). For example, your radiation oncologist or the healthcare manager. If you wish to file a complaint, you can contact the complaints officer for HMC Antoniushove by telephone on +31 (0)88 979 40 44 or by email at firstname.lastname@example.org.
We continuously want to improve our care. Your compliments and suggestions will help us. You can share your experiences with the Radiotherapy department of Haaglanden Medical Centre with us via www.haaglandenmc.nl/over-ons/kwaliteit-en-veiligheid.
If you have any questions or comments after reading this webpage, then please contact us.
2261 EV Leidschendam
Tel. no. +31 (0)88 979 23 57
Drop-off and car park at the department of Radiotherapy:
2261 EV Leidschendam
HMC car park:
Burgemeester Banninglaan 1
2262 BA Leidschendam
You can also call the number of the Radiotherapy department if you are suffering from health problems because of the treatment. At the weekend or outside of office hours, call the general hospital number +31 (0)88 97 97 900. You will be connected to the Acute Service department in HMC Antoniushove.
Informatieplein Oncologie (Oncology Information Point) (for support with non-medical matters)
Burgemeester Banninglaan 1 (external entrance to the left of the main entrance)
2262 BA Leidschendam
Tel. no. +31 (0)88 979 40 05
Websites of interest
- www.haaglandenmc.nl - This website provides, for example, webpages about radiotherapy and additional information about medical conditions and treatments.
- www.nfk.nl – This is the website of the Nederlandse Federatie van Kankerpatiëntenorganisaties (Dutch Federation of Cancer Patient Organisations).
- www.kwfkankerbestrijding.nl – This is the website of KWF Kankerbestrijding (KWF Dutch Cancer Society).
- www.kankerspoken.nl – This is a site for and about children who have a parent with cancer.
- www.voedingenkankerinfo.nl - This is a website with reliable information about nutrition during and after treatment for cancer.
- www.inloophuishaaglanden.nl - This is the website of the Stichting Inloophuis Haaglanden (Haaglanden Drop-In Centre Foundation). Inloophuis Haaglanden (the Haaglanden Drop-In Centre) provides a meeting place for people who have or have had cancer. The Drop-In Centre is also intended for partners, parents and children of people with cancer.
- www.mammarosa.nl – This is a website with information about breast cancer for women in the Netherlands with low literacy or who non-native speakers of Dutch.