About Stereotactic Body Radiation Therapy (SBRT) to Your Chest

This information will help you get ready for your stereotactic body radiation therapy (SBRT) to your chest at MSK. It explains what to expect. It also explains how to care for yourself before, during, and after your radiation therapy.

This information is general. Your radiation therapy team will design a treatment and care plan just for you. Because of that, some parts of your treatment may be different than what’s described here. Your radiation therapy team will talk with you about what to expect.

About radiation therapy

Radiation therapy uses high-energy radiation to treat cancer. It works by damaging the cancer cells, making it hard for them to multiply. Your body can then naturally get rid of the damaged cancer cells. Radiation therapy also affects normal cells, but they can fix themselves in a way cancer cells can’t.

Radiation therapy takes time to work. It takes days or weeks of treatment before cancer cells start to die. They keep dying for weeks or months after radiation therapy ends.

You can have radiation therapy before, during, or after surgery or chemotherapy (chemo).

About external beam radiation therapy

You’ll have a type of radiation therapy called external beam radiation therapy. During your treatments, a machine will aim beams of radiation directly at the tumor. The beams will pass through your body and destroy cancer cells in their path. You will not see or feel the radiation.

About SBRT

With SBRT, imaging scans are used to guide the radiation. Radiation is only delivered to the target area, sparing nearby healthy tissue. That means you can get higher doses (amounts) of radiation during each treatment. You will have an imaging scan before each of your treatments to make sure the high doses of radiation are being given to the correct area.

SBRT is used to treat lung tumors that are small and only in your lungs. It can also be used to treat cancer that has spread to your lungs from another part of your body.

Your role on your radiation therapy team

Your radiation therapy care team will work together to care for you. You’re a part of that team, and your role includes:

• Getting to your appointments on time.
• Asking questions and talking about your concerns.
• Telling us when you have side effects.
• Telling us if you’re in pain.
• Caring for yourself at home by:
  • Quitting smoking if you smoke. MSK has specialists who can help. To learn more about our Tobacco Treatment Program, call 212-610-0507. You can also ask your nurse about the program.
  • Caring for your skin based on our instructions.
  • Drinking liquids based on our instructions.
  • Eating or avoiding the foods and drinks we suggest.
  • Staying around the same weight.

What happens before SBRT to your chest

Simulation appointment

You’ll have a treatment planning procedure called a simulation before you start your radiation treatments. Your radiation therapists will take imaging scans during your simulation. They will make a mold of your upper body for you to use during your simulation and treatments. They will also mark your skin with little tattoo dots. All these things help to:

• Map your treatment site.
• Make sure you get the right dose of radiation.
• Limit the amount of radiation that gets to nearby healthy tissues.

Your simulation appointment may take 1 to 2 hours or longer. The exact length depends on your treatment plan.

Medicines to take

You’ll be lying still in one position for a long time during your simulation. If you think you will be uncomfortable, talk with your healthcare provider ahead of time. You can also take an over-the-counter pain medicine or your usual pain medicine 1 hour before your simulation.

If you think you may get anxious during your simulation, talk with your healthcare provider ahead of time. They may suggest medicines to help.

What to eat and drink

Your healthcare provider will tell you if you need to follow special instructions for eating or drinking before your simulation. If you don’t need to follow special instructions, you can eat and drink like usual on the day of your simulation.

What to wear

Wear comfortable clothes that are easy to take off. You will need to undress from the waist up and change into a hospital gown.

Do not wear jewelry, powder, lotion, or cream unless a member of your care team says it’s OK.

Take devices off your skin

You may wear certain devices on your skin. Before your simulation or treatment, some device makers recommend you take off your:

• Continuous glucose monitor (CGM)
• Insulin pump

If you use one of these, ask your radiation oncologist if you need to take it off. If you do, make sure to bring an extra device to put on after your simulation or treatment.

You may not be sure how to manage your glucose while your device is off. If so, before your appointment, talk with the healthcare provider who manages your diabetes care.

What to expect when you arrive

A member of your radiation therapy team will check you in when you arrive. They’ll give you an identification (ID) wristband with your name and date of birth. During your appointment, many staff members will check your ID wristband and ask you to say and spell your name and date of birth. This is for your safety. People with the same or a similar name may be getting care on the same day.

Your radiation therapists will review what to expect during the simulation. If you haven’t already signed a consent form, they will go over the form with you. They will answer any questions you have and ask for your signature.

You’ll need to change into a hospital gown for your simulation. Keep your shoes on.

What to expect during your simulation

Your radiation therapists will help you onto the simulation table. The table will have a sheet on it, but it’s hard and does not have a cushion. If you have not taken pain medicine and think you might need it, tell your radiation therapists before your simulation starts.

Your radiation therapists will help you get into position for your simulation. You will lie on your back with your arms above your head or at your sides. You will see red or green laser lights on the walls. Your radiation therapists use these as a guide when they position you on the table.

Do not move once your simulation starts. It’s important that you stay in the same position. Your radiation therapists can play music for you to help pass the time. Tell your radiation therapists if you feel uncomfortable or need help.

Imaging scans and positioning

Your radiation therapists will use CT scans to check and adjust your position throughout your simulation. These scans are only to plan your treatments. They are not for diagnosis or to find tumors.

You’ll feel the simulation table move into and out of the scanner and hear the scanner turn on and off. Even if it seems loud, your radiation therapists will be able to hear you if you need to speak with them. They will walk in and out of the room during the scans, but the room has a microphone, speaker, and camera. Someone will always be able to see and hear you.

Deep inspiration breath hold (DIBH)

Your radiation therapists may ask you to hold your breath for 15 to 20 seconds at a time during your simulation and treatment. Whether they do depends on your treatment plan and the shape of your body. Your care team will let you know if you will need to do this.

To learn more, watch About Deep Inspiration Breath Hold (DIBH) and the Visual Coaching Device.

Upper body mold

Your radiation therapists will make a mold of your upper body. You will lie in this mold during your simulation and each of your treatments. It helps make sure you’re in the exact same position every time.

Skin markings (tattoos)

Your radiation therapists will use a felt marker to draw on your skin in the treatment area. They will also make permanent skin markings called tattoos once they’re sure you’re in the right position. They’ll make the tattoos using a clean needle and a drop of ink. Each one will feel like a pinprick. They will not be bigger than the head of a pin.

Your radiation therapists will take several photos of you in your position after they make the markings. They will use the photos and markings to make sure you’re in the right position for your radiation treatments.

You can wash off the felt markings after your simulation. The tattoos are permanent. They will not wash off. Talk with your radiation oncologist if you’re concerned about having tattoos as part of your radiation therapy.

Scheduling your treatments

SBRT is usually given in 1 to 5 treatments. Your schedule will be based on what your radiation oncologist recommends.

Call your radiation oncologist’s office to tell your care team if you can’t come in for treatment for any reason. Talk with your radiation therapist or scheduler if you need to change your schedule for any reason.

Checking your treatment schedule

You can see your treatment schedule in your patient portal, MSK MyChart. If you do not have a MSK MyChart account, you can sign up at mskmychart.mskcc.org. You can also ask a member of your care team to send you an invitation.

It’s very helpful to use MSK MyChart to keep track of your appointment times. We will call you if we need to reschedule any of your treatment appointments.

Planning your treatment

Between your simulation and first treatment, your radiation oncologist will work with a team to plan your treatments. They will use your simulation scans to plan the angles and shapes of your radiation beams. They will also determine the dose of radiation you’ll get. They carefully plan and check all the details of your treatments. This can take up to 2 weeks.

What happens during SBRT to your chest

You’ll be in the same position for your radiation treatments as you were for your simulation. You may want to take pain or anxiety medicine before your radiation treatments if it was helpful for your simulation. Take it about 1 hour before your appointment.

Wear comfortable clothes that are easy to take off. You may need to change into a hospital gown for your treatments.

Your treatment appointments

Each day you have treatment, check in at the reception desk and have a seat in the waiting room. When your radiation therapists are ready for you, you will be shown to the dressing room and asked to change into a hospital gown. Keep your shoes on.

Your radiation therapists will bring you to the treatment room. They will help you lie in your mold on the treatment table. They will position you exactly how you were lying during your simulation.

Set-up procedure and first treatment

When you come for your first treatment appointment, you’ll have imaging scans before your treatment starts. These scans are called the set-up procedure. They usually take about 45 to 60 minutes.

Radiation treatments

You will have a low-dose CT scan before each of your treatments to make sure your position and the treatment area are correct. These scans are to make sure your position and the treatment area are correct. They are not to check how your tumor is responding to the radiation therapy.

Your radiation therapists will do their best to make sure you’re comfortable in your treatment position (see Figure 2). Once everything is ready, they’ll leave the room and start your treatment.

Do not move during your treatment. Your radiation therapists may give you instructions for breathing during your treatment, but most people can breathe normally.

You will not see or feel the radiation. You may hear the machine as it moves around you and is turned on and off.

You will be alone in the room during your treatment, but your radiation therapists will see you on a monitor and hear you through an intercom the whole time. Tell them if you’re uncomfortable or need help.

You will be in the treatment room for up to 1 hour, depending on your treatment plan. You’ll spend most of this time getting into your treatment position. The actual treatment only takes a few minutes.

You will not be radioactive during or after your radiation treatments. It is safe for you to be around other people and pets.

Status check visit

Your radiation oncologist or a radiation nurse will check in with you during your radiation therapy. They’ll talk with you about any concerns, ask about any side effects you’re having, and answer your questions. This status check visit may be a telemedicine visit or a visit before or after your treatment.

Call your radiation oncologist’s office if you need to speak with your radiation oncologist or radiation nurse outside your status check visit. You can also ask another member of your radiation care team to contact them when you come in for treatment.

Vitamins and dietary supplements during radiation therapy

It’s OK to take a multivitamin during your radiation therapy. Do not take more than the recommended daily allowance (RDA) of any vitamin or mineral.

Do not take any other dietary supplements without talking with a member of your care team. Vitamins, minerals, and herbal or botanical (plant-based) supplements are examples of dietary supplements.

Side effects of SBRT to your chest

Some people develop side effects from radiation therapy. The side effects you have and how strong they are depends on many things, such as:

• The area of your body being treated.
• The dose of radiation you’re getting.
• The number of radiation treatments you’re getting.
• Your overall health.

With SBRT, only a small area of your body is exposed to radiation. That means SBRT usually causes fewer side effects than other types of radiation therapy. About half of the people who have SBRT don’t have any side effects from treatment.

Here are the most common side effects of radiation therapy. You may have all, some, or none of these. Depending on the area being treated, your doctor and nurse may talk with you about other possible side effects.

Cough or shortness of breath

You may start to have a cough or shortness of breath after you finish radiation therapy. Call your doctor or nurse if you develop these symptoms or if they get worse.

Here are suggestions to help you feel more comfortable if you have a cough or shortness of breath.

• Do not smoke. Smoking irritates the lining of your airway and makes you cough more. MSK has specialists who can help you quit smoking. To learn more about our Tobacco Treatment Program, call 212-610-0507, or your nurse can refer you.
• Use 1 or 2 pillows to prop up your upper body while you sleep.
• Use a humidifier while you sleep. Be sure to change the water and clean the humidifier often. Follow the manufacturer’s instructions.
• Fatigue may make your shortness of breath worse. Follow the suggestions in the “Fatigue” section to help lessen your fatigue.
• Use cough medicine as directed by your doctor.

Skin and hair reactions

Most people getting SBRT don’t have any skin changes during their radiation therapy. You may notice skin changes 4 to 6 weeks after you finish radiation therapy.

Your skin may become pink or tanned on the front or back of your chest in the treatment area. Your nurse will teach you how to care for your skin during your treatment.

You may lose some or all of the hair in the treatment area. Hair most often grows back 3 to 6 months after you finish radiation therapy.

These guidelines can help you care for your skin during your radiation therapy. Follow them until your skin gets better. These guidelines are only for your skin in the radiation treatment area. You can care for the rest of your skin as usual.

Keep your skin clean

• Bathe or shower every day.
  • Use warm water and a mild unscented soap, such as Neutrogena®, Dove®, baby soap, Basis®, or Cetaphil®.
  • Be gentle with your skin when you wash it. Do not use a washcloth, loofah, or brush.
  • Rinse your skin well.
  • Pat your skin dry with a soft, clean towel.
• Your radiation therapists may outline your treatment area with a purple felt-tipped marker. You can remove these markings with mineral oil when your radiation therapists say it’s OK.
• Do not use alcohol or alcohol pads on your skin.

Keep your skin moisturized

You nurse may suggest that you start using a moisturizer on the first day of your treatment. If you aren’t likely to develop a skin reaction, you don’t need to use a moisturizer unless your skin becomes dry or itchy. You can use any over-the-counter (not prescription) moisturizer as long as it’s fragrance-free and doesn’t contain lanolin.

Your nurse may also recommend using other products. Do not use more than 1 product at a time unless your nurse tells you to use more.

If you’re using a moisturizer, apply it 2 times a day.

Avoid irritating your skin

• Wear loose-fitting cotton clothing. Do not wear tight clothing that will rub against your skin.
• Only use the moisturizers, creams, or lotions your radiation oncologist or nurse suggests.
• Do not use makeup, perfume, cologne, powder, or aftershave.
• Do not use deodorant if your skin is broken, cracked, or irritated. You can use deodorant on intact (not broken) skin. Stop using it if your skin becomes irritated.
• Do not scratch your skin if it’s itchy. Put on moisturizer. Ask your radiation nurse about ways to ease the itching.
• Avoid shaving your skin. If you must shave, use an electric razor. Stop if your skin becomes irritated.
• Do not put anything sticky (such as Band-Aids® or medical tape) on your skin.
• Do not expose your skin to very hot or cold temperatures. For example, do not use hot tubs, hot or cold water bottles, heating pads, or ice packs.
• Only swim in a pool if you do not have any skin reactions. Rinse off right after you get out.
• Avoid tanning or burning your skin. Use a sunblock with an SPF of 30 or higher if you’re going to be in the sun. Wear loose-fitting clothing over as much of your skin as you can.

Fatigue

Fatigue is feeling very tired or weak. When you feel fatigued, you may not want to do things. You may have trouble focusing, feel slowed down, or have less energy than usual. Fatigue can range from mild (not bad) to severe (very bad). It may be worse at certain times of day.

You may start to feel fatigued 4 to 6 weeks after you finish radiation therapy. The fatigue may last for several months. Fatigue usually gets better over time.

There are lots of reasons why you may develop fatigue, including:

• The radiation’s effects on your body.
• Traveling to and from your treatment appointments.
• Not getting enough restful sleep at night.
• Not getting enough protein and calories.
• Having pain or other symptoms.
• Feeling anxious (nervous) or depressed (unhappy).
• Side effects of some medicines.

Ways to manage fatigue

• If you’re working and are feeling well, it’s OK to keep working. But working less may help you have more energy.
• Plan your daily activities. Pick the things you need or really want to do. Do them when you have the most energy. For example, you may choose to go to work but not do housework. You may choose to watch your child’s after-school event but not go out to dinner.
• Plan time to rest or take short (10- to 15-minute) naps during the day, especially when you feel more tired.
• Try to sleep at least 8 hours every night. This may be more sleep than you needed before you started radiation therapy. You may find it helpful to:
  • Go to sleep earlier and get up later.
  • Be active during the day. For example, if you’re able to exercise, you could go for a walk or do yoga.
  • Relax before going to bed. For example, read a book, work on a puzzle, listen to music, or do another calming hobby.
• Ask family and friends to help with chores and errands. Check with your health insurance company to see if they cover home care services.
• You might have more energy when you exercise. Ask your radiation oncologist if you can do light exercise, such as walking, biking, stretching, or yoga. Read Managing Cancer-Related Fatigue with Exercise to learn more.
• Eat foods that are high in protein and calories. Read Eating Well During Your Cancer Treatment to learn more.

Some things can make your fatigue worse. Examples are:

• Pain
• Nausea (feeling like you’re going to throw up)
• Diarrhea (loose or watery poop)
• Trouble sleeping
• Feeling depressed or anxious

Ask your radiation oncologist or nurse for help if you have these or any other symptoms or side effects.

Other side effects

You may have other side effects. Your radiation oncologist or nurse will discuss these with you.

Sexual and reproductive health

You may have concerns about how cancer and your treatment can affect your sex life. You are not radioactive. You can’t pass radiation to anyone else. It’s safe to be in close contact with others.

You can be sexually active during your radiation therapy, unless your radiation oncologist gives you other instructions. If you or your partner are able to have children, you must use birth control (contraception) to prevent pregnancy during your radiation therapy.

Talking with your radiation oncologist or nurse about your sexual health can be hard, but it’s an important conversation to have. They may not bring it up unless you share your questions and concerns. You may feel uncomfortable, but most people in cancer treatment have similar questions. We work hard to make sure everyone in our care feels welcome.

Sexual health programs

MSK offers sexual health programs. These programs can help you manage the ways your cancer or cancer treatment affects your sexual health or fertility. Our specialists can help you address sexual health or fertility issues before, during, or after your radiation therapy.

• To learn about our Female Sexual Medicine & Women’s Health Program or to make an appointment, call 646-888-5076.
• To learn about our Male Sexual & Reproductive Medicine Program or to make an appointment, call 646-888-6024.
• To learn about our Cancer and Fertility Program, talk with your healthcare provider.

Other sexual health resources

Read Sex and Your Cancer Treatment to learn more about sexual health during cancer treatment.

The American Cancer Society also has resources about sexual health issues during cancer treatment. They’re called Sex and the Adult Male with Cancer and Sex and the Adult Female with Cancer. You can search for them at www.cancer.org or call 800-227-2345 for a copy.

Emotional health

You might also worry about telling your employer you have cancer or about paying your medical bills. You may worry about how your family relationships may change, or that the cancer will come back. You may worry about how cancer treatment will affect your body, or if you will still be sexually attractive.

It’s normal and OK to worry about all these things. All these kinds of feelings are normal when you or someone you love has a serious illness. We’re here to support you.

Ways to cope with your feelings

Talk with others. When people try to protect each other by hiding their feelings, they can feel very alone. Talking can help the people around you know what you’re thinking. It might help to talk about your feelings with someone you trust. For example, you can talk with your spouse or partner, close friend, or family member. You can also talk with a chaplain (spiritual advisor), nurse, social worker, or psychologist.

Join a support group. Meeting other people with cancer will give you a chance to talk about your feelings and learn from others. You can learn how other people cope with their cancer and treatment and be reminded you’re not alone.

We know that all cancer diagnoses and people with cancer are not the same. We offer support groups for people who share similar diagnoses or identities. For example, you can join a support group for people with breast cancer or for LGBTQ+ people with cancer. Visit www.msk.org/vp to learn about MSK’s support groups. You can also talk with your radiation oncologist, nurse, or social worker.

Try relaxation and meditation. These kinds of activities can help you feel relaxed and calm. You might try thinking of yourself in a favorite place. While you do, breathe slowly. Pay attention to each breath or listen to soothing music or sounds. For some people, praying is another way of meditation. Visit www.msk.org/meditations to find guided meditations lead by our Integrative Medicine and Wellness providers.

Exercise. Many people find that light movement, such as walking, biking, yoga, or water aerobics, helps them feel better. Talk with your healthcare provider about types of exercise you can do.

We all have our own way of dealing with tough situations. Often, we do what worked for us in the past. But sometimes that’s not enough. We encourage you to talk with your doctor, nurse, or social worker about your concerns.

What happens after SBRT to your chest

After you finish treatment, you will have regular follow-up appointments with your radiation oncologist. You will have a CT scan before each of these appointments. Your radiation oncologist will use the images from the CT scans to see how your body responds to the treatment.

If you have any questions or concerns, talk with your radiation oncologist or radiation nurse.

Late side effects

Radiation may cause permanent changes in the treatment area. You may develop a cough, shortness of breath, fatigue, or rib pain months after your treatment. If you do, please tell your doctor. It’s important to go to your follow-up appointment so your radiation oncologist and nurse can watch for these side effects.

Support services

MSK support services

Counseling Center
www.msk.org/counseling
646-888-0200
Many people find that counseling helps them. Our counseling center offers counseling for individuals, couples, families, and groups. We can also prescribe medicines to help if you feel anxious or depressed. Ask your healthcare provider for a referral or call the number above to make an appointment.

Integrative Medicine and Wellness Service
www.msk.org/integrativemedicine
Our Integrative Medicine and Wellness Service offers many services to complement (go along with) traditional medical care, including music therapy, mind/body therapies, dance and movement therapy, yoga, and touch therapy. Call 646-449-1010 to schedule an appointment for these services.

You can also schedule a consultation with a healthcare provider in the Integrative Medicine and Wellness Service. They will work with you to come up with a plan for creating a healthy lifestyle and managing side effects. Call 646-608-8550 to make an appointment.

Nutrition Services
www.msk.org/nutrition
212-639-7312
Our Nutrition Service offers nutritional counseling with one of our clinical dietitian nutritionists. Your clinical dietitian nutritionist will talk with you about your eating habits. They can also give advice on what to eat during and after treatment. Ask a member of your care team for a referral or call the number above to make an appointment.

Rehabilitation Services
www.msk.org/rehabilitation
Cancers and cancer treatments can make your body feel weak, stiff, or tight. Some can cause lymphedema (swelling). Our physiatrists (rehabilitation medicine doctors), occupational therapists (OTs), and physical therapists (PTs) can help you get back to your usual activities.

• Rehabilitation medicine doctors diagnose and treat problems that affect how you move and do activities. They can design and help coordinate your rehabilitation therapy program, either at MSK or somewhere closer to home. call Rehabilitation Medicine (Physiatry) at 646-888-1929 to learn more.
• An OT can help if you’re having trouble doing usual daily activities. For example, they can recommend tools to help make daily tasks easier. A PT can teach you exercises to help build strength and flexibility. Call Rehabilitation Therapy at 646-888-1900 to learn more.

Resources for Life After Cancer (RLAC) Program
646-888-8106
At MSK, care does not end after your treatment. The RLAC Program is for patients and their families who have finished treatment.

This program has many services. We offer seminars, workshops, support groups, and counseling on life after treatment. We can also help with insurance and employment issues.

Sexual Health Programs
Cancer and cancer treatments can affect your sexual health, fertility, or both. MSK’s sexual health programs can help you before, during, or after your treatment.

• Our Female Sexual Medicine & Women’s Health Program can help with sexual health problems such as premature menopause or fertility issues. Ask a member of your MSK care team for a referral or call 646-888-5076 to learn more.
• Our Male Sexual & Reproductive Medicine Program can help with sexual health problems such as erectile dysfunction (ED). Ask a member of your care team for a referral or call 646-888-6024 to learn more.

Tobacco Treatment Program
www.msk.org/tobacco
212-610-0507
MSK has specialists who can help you quit smoking. Visit our website or call the number above to learn more. You can also ask your nurse about the program.

Virtual Programs
www.msk.org/vp
Our Virtual Programs offer online education and support for patients and caregivers. These are live sessions where you can talk or just listen. You can learn about your diagnosis, what to expect during treatment, and how to prepare for your cancer care.

Sessions are private, free, and led by experts. Visit our website for more information about Virtual Programs or to register.

Radiation therapy support services

American Society for Therapeutic Radiology and Oncology
www.rtanswers.org
800-962-7876
This website has detailed information about treating cancer with radiation. It also has contact information for radiation oncologists in your area.

External support services

There are many other support services to help you before, during, and after your cancer treatment. Some offer support groups and information, while others can help with transportation, lodging (a place to stay), and treatment costs.

For a list of these support services, read External Support Services. You can also talk with an MSK social worker by calling 212-639-7020.

Questions to ask your radiation oncologist

Before your appointment, it’s helpful to write down questions you want to ask. Examples are listed below. Write down the answers during your appointment so you can review them later.

What kind of radiation therapy will I get?

How many radiation treatments will I get?

What side effects should I expect during my radiation therapy?

Will these side effects go away after I finish my radiation therapy?

What kind of late side effects should I expect after my radiation therapy?