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Total body irradiation (TBI)

This page tells you about radiotherapy to the whole body. This is called total body irradiation or TBI. You can find the following information

 

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About total body irradiation (TBI)

Radiotherapy is a treatment that uses high energy rays, similar to X-rays, to kill cancer cells. Doctors may use radiotherapy to the whole body (total body irradiation) alongside high dose chemotherapy treatment for some types of leukaemia or lymphoma and myeloma. The aim of this treatment is to try to cure the cancer.

Having total body irradiation

You usually have the radiotherapy twice a day for 3 or 4 days. First you have a planning session of about 90 minutes to create the treatment plan. You lie on a treatment couch or stand in a specially designed frame that supports you.

The radiographers measure the thickness of various parts of your body. They may use padding material or gel bags between your knees and over your chest and neck. They make sure the treatment couch or standing frame is in exactly the right position. During this session you have a very small dose of radiotherapy aimed at one side of your body from a machine next to the treatment couch or frame. You then turn so that the machine gives treatment to the other half of your body. 

For the treatment sessions, the radiographers help you to lie in the correct position on the couch or stand in the frame. This may take up to half an hour. Then you have treatment for up to 15 minutes on both sides of your body.

Side effects of total body irradiation

The side effects of TBI include sickness, tiredness, diarrhoea, a sore mouth, hair loss and an increased risk of infection. You will need to be in hospital for some time after the treatment. You should not sunbathe for several months afterwards because TBI makes the skin more sensitive to the sun. It is possible that you may develop cataracts several years after treatment. There is also a small risk of developing a second cancer. Your doctor will monitor you for these long term side effects during your follow up appointments.
 

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About total body irradiation

Radiotherapy is a treatment that uses high energy rays, similar to X-rays, to kill cancer cells.  For some types of leukaemia, lymphoma or myeloma, doctors may use radiotherapy to the whole body (total body irradiation) alongside high dose chemotherapy treatment. The aim of this treatment is to try to cure the cancer.

 

Having total body irradiation

Total body irradiation (TBI) alongside high dose chemotherapy helps to kill off leukaemia, lymphoma or myeloma cells in the bone marrow. We have information about high dose chemotherapy as part of a stem cell transplant or bone marrow transplant in this section.

You usually have TBI treatment twice a day for 3 or 4 days. Or it may be just 1 or 2 radiotherapy treatments.

Radiographers give the treatment. They will explain to you how they plan and give radiotherapy.

Planning treatment

First you have a planning session of about 90 minutes to create the treatment plan. You will need to take off any jewellery, your watch and your glasses. You will also need to take out false teeth containing metal. Then you either lie on a treatment couch or stand in a specially designed frame.

If you are going to have treatment lying down the radiographers measure the thickness of various parts of your body and put small radiation monitors called diodes on your body. They may use padding material or gel bags between your knees and over your chest and neck. This is to make sure you receive an even dose of radiation throughout your body. 

During the planning session you have a very small dose of radiotherapy from a radiotherapy machine next to the treatment couch. The couch moves so you can have treatment to one half of your body. Then the couch turns so that the machine can give treatment to the other side.

If you are going to have treatment standing up, you stand in a specially designed frame that supports you. First you stand facing the radiotherapy machine and then you turn so that your back is towards the machine. 

Treatment sessions

The radiographers will help get you in exactly the same position as in your planning appointment. This may take up to half an hour. They will tape small radiation monitors to some areas of your body to monitor the dose.

The lights in the room will dim for a few minutes while the radiographers position you. They leave the room while the machine is on but will monitor you closely on closed circuit TV during the treatment. It is important that you stay as still as you can but you can breathe normally. The treatment takes up to 15 minutes on each side of your body.

You will have a buzzer that you can press at any time if you need the treatment to be stopped. During treatment you can have music played in the room and can take in your own music from home if you like. You will not feel anything but when the machine is on you will hear a beeping noise. 

 

Side effects of total body irradiation

During the treatment and for some time afterwards you are likely to have

  • Sickness – your nurse will make sure you have anti sickness medicines to help you
  • Tiredness – you may feel particularly tired about 6 to 12 weeks after your treatment, this may become severe for a couple of weeks
  • Diarrhoea – make sure you drink plenty to replace lost fluids. Your nurse will give you medicines to help
  • A dry and sore mouth – your nurse will give you drinks, mouthwashes and painkillers to help
  • Sensitive skin – your skin may go pink, darken and be itchy and more sensitive to the sun. Ask your nurse or radiographer for creams or lotions to soothe it.
  • Low blood cell levels, making you at risk of infection and anaemia, and prone to bleeding – you will have antibiotics, blood transfusions and platelet transfusions

This treatment also causes complete head and body hair loss. We have more information about radiotherapy side effects.

You will be at a high risk of infections for a while after the treatment and may be in a single room (isolation) in hospital. We have information about being in isolation and how to cope.

 

Long term side effects of TBI

TBI can have long term effects. It can make your skin sensitive and you will need to be extra careful in the sun for several months after treatment. Talk to your specialist about exact precautions you should take to protect your skin in the sun.

There are other long term effects that are more permanent. The treatment can cause

Clouding of the lens of the eye (cataracts)

Several years after treatment, it is possible that you will develop cataracts. This means the lens inside your eye clouds over and it becomes increasingly difficult to see. This is less common now as you have radiotherapy over a few days. If you develop a cataract, your doctor will refer you to an eye specialist (opthalmologist). These days, cataracts are fairly easy to treat with surgery. The eye specialist removes the clouded lens and puts a man made one in its place.

Loss of ability to become pregnant or father a child

Unfortunately, you will usually be unable to become pregnant or father a child after TBI and high dose chemotherapy. In women, the treatment is likely to cause an early menopause. Sometimes it is possible for women to freeze their eggs or embryos before cancer treatment. But it takes time to stimulate your ovaries to collect the eggs. Your doctor may not want you to delay starting cancer treatment. Men may be able to bank sperm before starting any treatment. Your doctor and nurse will talk to you about any questions you have about fertility.

We have more information about fertility and cancer treatment.

A second cancer

Bone marrow and stem cell transplants can increase your risk of getting a second cancer. This is a worrying thought but it is important to remember that it is a very small risk. And it is less of a risk to your health than if the leukaemia, lymphoma or myeloma was not treated.

Lung changes

TBI can cause changes in the lung such as thickening or scarring of the tissue (fibrosis). This can cause breathlessness, coughing or wheezing. You will have regular tests to check how well your lungs are working and may need antibiotics to prevent infection. Breathing exercises can help.

Underactive thyroid

The thyroid gland produces hormones that regulate our body metabolism. Low levels of these hormones can cause weight gain, tiredness, constipation and dry skin. You will have blood tests to check your hormone levels. If they are low, you can take thyroid hormone tablets.

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Updated: 16 March 2015