Overview

 

Radiotherapy to the whole body is called total body irradiation (TBI). It is usually used to prepare your body for a bone marrow transplant. Radiotherapy is a treatment that uses high-energy X-rays or similar rays.

Your first appointment

Before having TBI, you’ll meet with a clinical oncologist (cancer specialist) and radiographer at Guy’s Cancer Centre. This is usually 2 weeks before treatment starts.

The radiographer will explain how the treatment is given. To plan your treatment, they will take measurements of your waist and hips. If you would like to see a treatment machine, please ask the radiographer.

Giving your permission (consent)

We want to involve you in decisions about your care and treatment. If you decide to have the procedure or treatment, we will ask you to sign a consent form. This says that you understand what is involved and agree to have the treatment.

Read more about our consent process.

Before treatment

You will stay in hospital the day before treatment and during your TBI. You will have TBI in the radiotherapy department at the Guy’s Cancer Centre.

If you are having 6 or 8 treatments, they will start on a Monday or Tuesday morning. You’ll have radiotherapy 2 times a day, early in the morning, and late in the afternoon.

If you are receiving your transplant from cord blood you will only have 1 treatment on any day of the week.

You’ll need to remove all of your clothes apart from underwear for the treatment. We ask that you:

• do not wear make up
• do not wear nail varnish
• do not wear jewellery
• do not wear an underwired bra

You will be able to wear a gown, or clothes with no metal fastenings.

During treatment

The radiographers will ask you to verbally confirm your consent to treatment, this will give you an opportunity to ask any questions prior to treatment.

Your radiographers will ask you to lie on a bed and put you into position for treatment. The position will have been decided in your first appointment when they took measurements of your body. They will tape small measuring devices called thermoluminescent dosimeters (TLDs) to different parts of your body. You will have TLDs on you for each radiotherapy session, but the number will change each time.

Your radiographers will place bags of Vaseline® (bolus) between your legs, under your knees, around your neck, and across your chest. This helps to make sure the radiation dose is given evenly across your body.

You will have a large, clear screen beside you. A square piece of lead will then be put on this screen to make sure your head gets an even dose of radiation.

The radiographers will leave the room during treatment, but will be monitoring you throughout. You might hear noises from the machine, but you will not feel anything. If you need anything during treatment, wave your hand and the radiographers will turn the machine off and come into the room.

After the first part of your treatment, the radiographers will rotate you and the bed around to treat your opposite side. Each side takes between 7 and 14 minutes to treat, and you will have both sides treated each time. You will be in the treatment room for up to 1 hour.

It is important that you keep as still as possible during your treatment, and continue to breathe normally. If you do move during treatment, the radiographers will come back into the treatment room to move you back into position.

Looking after yourself during radiotherapy

Washing

It is important to keep the treatment area clean. Wash yourself using tepid water and your usual soap or shower gel. You can use aqueous cream as a soap, but not as a leave-on moisturiser. Use a towel to gently pat the skin dry, and do not rub.

Moisturising

Moisturising in the treatment area will help your skin to cope better. You can use your usual moisturiser, but if you need to buy one, use one without sodium lauryl sulphate (SLS).

Start moisturising your skin 2 days before your treatment starts. During treatment apply the moisturiser sparingly two times each day, or more often if your skin is very itchy.

Drinking

Try to drink about 6 to 8 cups of water a day. This will stop you from becoming dehydrated.

Short-term side effects of radiotherapy

You might not have all of these side effects. If you do not, this does not mean the radiotherapy is not working. Everyone reacts differently to the treatment.

Feeling sick (nausea) and being sick (vomiting)

You will have anti-sickness medicine before your treatment. If you do feel sick or are sick, tell the staff treating you, and they can give you more medicine.

Diarrhoea

If you have diarrhoea, the staff treating you can give you medicines to help. Diarrhoea can make you dehydrated, so try to drink 6 to 8 cups of water a day to stay hydrated.

Skin reaction

Your skin might become dry or red 7 to 10 days after radiotherapy has finished. Look after your skin and always use sun block.

Hair loss (alopecia)

You are likely to lose the hair on your head and possibly body. Hair loss usually happens about 10 to 14 days after your radiotherapy ends. Your hair should start to grow back in a few months.

Mucositis

Mucositis is inflammation of tongue, throat, or the inside of your mouth. It’s important to look after your mouth during and after treatment to help reduce mucositis. To try and help this you can:

• use a gentle toothbrush and mouthwash
• eat a soft-food diet
• not eat spicy food
• let hot food and drink cool down before you have them

Parotitis

Parotitis is inflammation of your parotid salivary glands. These are in your cheeks in front of the ears. The inflammation can last a couple of days and cause some stiffness in the jaw. This is an uncommon side effect to radiotherapy.

If you do get parotitis, you can get medicines to relieve the symptoms.

These glands produce saliva to keep your mouth comfortable, so it’s important to drink plenty of water regularly, especially when eating. This should help stop your mouth becoming too dry.

Long-term side effects of radiotherapy

Cataracts

A cataract is when the lens of your eye becomes white. It causes blurred vision and eventually, blindness. It is a common condition in older people. TBI treatment speeds up the ageing process of the lens of the eye.

There is a high risk of getting cataracts about 2 years or more after treatment. If you get cataracts, your eye lens can be replaced in day surgery.

Pneumonitis

Pneumonitis is inflammation of your lungs, which can cause breathlessness and a dry cough. You might have symptoms of pneumonitis 1 month after your treatment finishes. Your symptoms can last for about 2 months.

Hypothyroidism

Some people might have decreased thyroid hormone levels after treatment. This can be diagnosed with a blood test and treated with medicine.

Early menopause

If you are pre-menopausal, you might have an early menopause due to the combination of chemotherapy and radiotherapy.

You might have symptoms such as:

• hot flushes
• dry skin
• dryness of the vagina

This can happen a few months after treatment is completed. You can be referred to a specialist for help with early menopause symptoms.  

Infertility and pregnancy

Having both chemotherapy and radiotherapy can make you infertile. You can choose to preserve your sperm or eggs before starting chemotherapy and radiotherapy.

If you want to have a baby, you should wait at least 1 year after your treatment is completed, or until your doctor tells you it’s safe to do so.

Liver and kidney damage

The combination of chemotherapy, radiotherapy and the bone marrow transplant might cause this, however it is not common.

Secondary malignancy

Secondary malignancy means getting cancer again. Having both chemotherapy and radiotherapy increases the risk of getting another cancer in the future.

After radiotherapy is complete

When you have completed your course of radiotherapy, you will begin your next stage of treatment at King’s College Hospital.

Follow-up

You will be reviewed regularly after your radiotherapy and bone marrow transplant, and monitored for long-term side effects.

It is important to discuss any concerns with the staff that are involved in your treatment, as well as your family and friends. You may find that you are asking yourself lots of questions. Talking to other people can help you to find the answers. Staff are able to signpost you to the available support.

Further support

• Dimbleby Cancer Care have a monthly support group for people who have had a stem cell transplant and their carers.
• King’s Macmillan Information and Support Centre provide drop-ins for people living with cancer.
• Leukaemia Care provides information, advice and support for people living with leukaemia.
• Blood Cancer UK fund research and campaign for change for people living with any blood cancer.
• Lymphoma Action provide information and support for people living with lymphoma.