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Radiotherapy for chronic lymphocytic leukaemia (CLL)

Men and women discussing chronic lymphocytic leukaemia

This page tells you about radiotherapy for chronic lymphocytic leukaemia (CLL). There is information on this page about


A quick guide to what's on this page

Radiotherapy for chronic lymphocytic leukaemia (CLL)

Radiotherapy uses high energy rays to kill cancer cells. It is only used in particular circumstances in CLL. The main reasons why your specialist may recommend radiotherapy as part of your treatment are

Having your radiotherapy

You have this treatment from an external radiotherapy machine in the radiotherapy department at your cancer centre. You usually have a few daily treatments. Each treatment takes only a few minutes.

Radiotherapy as part of a transplant

You have radiotherapy to your whole body (total body irradiation – TBI) to kill off all your bone marrow, including the leukaemia cells. You may have TBI twice a day, for 3 or 4 days, or as a single treatment. For the planning and treatments you lie on a couch or stand in a specially designed frame. 

You have treatment for up to 15 minutes on both sides of your body. Once the treatment has ended you have donor bone marrow or stem cells (or your own stem cells) into your bloodstream through a drip. This happens on the ward.

Side effects

Radiotherapy can cause a skin reaction, similar to sunburn in the treatment area, and tiredness. These side effects may be mild, depending on how much treatment you have. Other possible side effects depend on the area of the body having the radiotherapy.


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What radiotherapy is

Radiotherapy uses high energy rays from a machine, similar to an X-ray machine, to kill cancer cells. 

Generally, radiotherapy is a treatment that treats one area of the body. But as part of a bone marrow or stem cell transplant,  you might have your whole body treated with radiotherapy. This is called total body irradiation (TBI). Bone marrow transplants or stem cell transplants are not used very often to treat CLL.

Radiotherapy is not commonly used for chronic lymphocytic leukaemia but it may be used in particular circumstances.


Why you may have radiotherapy for CLL

For CLL, there are a few reasons why you may have radiotherapy, including

Enlarged spleen

If your spleen is enlarged and causing you pain or making you uncomfortable, your specialist may suggest you have your spleen removed. If there is any reason why you can't have surgery, you may have radiotherapy to help to shrink the spleen and reduce symptoms. The radiotherapy can reduce pain and help you to feel more comfortable. 

You usually have treatment 3 times over a week. This works well for most people. If your spleen gets bigger again, you can usually have the treatment once again. You only need a very low dose of radiotherapy. The radiotherapy to your spleen may also help to control your leukaemia. It can be helpful if the leukaemia is making your red blood cell and platelet counts drop. The radiotherapy stops the spleen from destroying healthy blood cells. 

It is likely that you would have treatment to your spleen if you have CLL that is no longer responding to chemotherapy.

Bulky lymph nodes

If you have very swollen lymph nodes that are uncomfortable or don't look very nice, your doctor may suggest radiotherapy treatments to shrink them. You are only likely to have this type of treatment if your CLL isn't responding to chemotherapy very well any more.

There are different ways of having radiotherapy to swollen lymph nodes. You may have a treatment daily for 2 weeks or less. Or you may have your radiotherapy 1 to 3 times a week.

Radiotherapy before a transplant

Bone marrow or stem cell transplants are not a common treatment for CLL. But they are used for some people so we have included information about them. Before a transplant, you sometimes have radiotherapy to the whole body. You usually have it between your chemotherapy and marrow or stem cell infusion.

Doctors call this type of treatment whole body irradiation or total body irradiation (TBI). The aim of the radiotherapy is to kill any remaining bone marrow cells before you have your donor's stem cells. This is put into your vein through a drip on the ward. You usually have TBI twice a day, for 3 or 4 days.

Bone pain

You can have radiotherapy for bone pain. Some people whose CLL has changed (transformed) into a high grade disease, have bone pain. Bone pain happens because there are too many leukaemia cells in the bone marrow, causing pressure on nerves and causing pain. So your doctor may suggest external radiotherapy as a treatment to relieve the bone pain.


Planning radiotherapy

Before you begin your treatment, the radiotherapy team carefully plan your external beam radiotherapy. This means working out how much radiation you need to treat the cancer and exactly where you need it. 

Your planning appointment may take from 15 minutes up to a couple of hours. You will have a planning CT scan. The scan shows the cancer and the structures around it.

CT scanner

You lie on the scanner couch with the treatment area exposed. The radiographers will put some markers on your skin. You need to lie very still. Once you are in position the radiographers move the couch up and through the scanner. The scanner is a doughnut shape. 

The radiographers leave the room and the scan starts. It takes up to 5 minutes. You won't feel anything. The radiographers watch from the next door room.

Before the planning appointment you may also have other scans, such as MRI scans or PET scans. Your treatment team can feed the other scans into the planning scanner.

Ink marks

Once the treatment team has planned your radiotherapy, they may put ink marks on your skin to make sure they treat exactly the same area every day. They may also make pin point sized tattoo marks in these areas.

After your planning session

You may have to wait a few days or up to 2 weeks before you start treatment. During this time the physicists and your radiotherapy doctor decide the final details of your plan. 

Your doctor will plan the areas that need treatment and outline areas to limit the dose to or avoid completely. They call this contouring. Then the physicists and staff called dosimetrists plan the treatment very precisely using advanced computers.


Having radiotherapy

Radiotherapy machines are very big. The machine may be fixed in one position or able to rotate around your body to give treatment from different directions. Before your first treatment your radiographers will explain what you will see and hear. The treatment rooms usually have docks for you to plug in music players. So you can listen to your own music.

You can't feel radiotherapy when you actually have the treatment. It takes anything between 10 to 30 minutes. It is important to lie in the same position each time, so the radiographers may take a little while to get you ready.

A photo of a linear accelerator, which gives radiotherapy

Once you are in the right position the staff leave you alone in the room for a few minutes. They watch you carefully on a closed circuit television screen.

Our page about having external radiotherapy has a video about having radiotherapy that you may want to watch.

External radiotherapy doesn't make you radioactive. It is perfectly safe to be with other people, including children, throughout your course of treatment.


Radiotherapy during a transplant

You may have radiotherapy as part of a stem cell or bone marrow transplant. In this case you have radiotherapy to your whole body. This is called whole body irradiation (WBI) or total body irradiation (TBI). The radiotherapy kills off all your bone marrow, including the leukaemia cells. You may have TBI twice a day for 3 or 4 days, or as a single treatment. 

First you have a planning session of about 90 minutes to create the treatment plan. You lie on a hard couch or stand supported by a specially designed frame.

The radiographers measure the thickness of various parts of your body. They make sure the treatment couch or frame is in exactly the right position. During this session you have a very small dose of radiotherapy aimed at your body, from a machine next to the treatment couch or frame. You have half your body treated for 10 to 15 minutes. Then you turn and have the other half treated.

For the treatment sessions the radiographers help you to lie or stand in the correct position. This may take up to half an hour. Then you have treatment for 10 to 15 minutes on both sides of your body.

Once the treatment has ended you then have donor stem cells or bone marrow (or your own stem cells) into your bloodstream through a drip. This happens on the ward.


Side effects of radiotherapy

Radiotherapy can cause a skin reaction, similar to sunburn in the treatment area. And you get tired as you go through a course of treatment. These may be the only side effects you have. The side effects may be mild, depending on how much treatment you have. Other possible side effects depend on the area of the body having the radiotherapy. 

If you have radiotherapy to your spleen, you may feel sick, as well as tired. Your blood cell counts may fall afterwards. But these usually recover quite quickly. Side effects are not usually severe because you have a low dose of radiation and a short course of treatment.

If you have total body irradiation (TBI) you will almost certainly have sickness and tiredness. Your doctor will make sure you have anti sickness drugs to help you. TBI also makes your hair fall out, but it is likely that you will have already lost your hair from the high dose chemotherapy. You will be at a high risk of infections for a while afterwards and will be in a single room in hospital.

TBI can have long term effects. You should not sunbathe for several months after treatment because it makes the skin more sensitive to the sun. Talk to your specialist about the exact precautions you should take.

Many years after treatment, it is possible that you may develop cataracts. This means the lens inside your eye clouds over and it becomes increasingly difficult to see. Your doctor may arrange a shield for your eyes during the treatment to try to prevent this side effect. These days, cataracts are fairly easy to treat with surgery. The clouded lens is removed, and a man made one is put in its place.


More information about radiotherapy

Find out about

External radiotherapy

Bone marrow and stem cell transplants

How transplants are used for CLL

Total Body Irradiation (TBI)

Radiotherapy skin markings

For general information and support

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Updated: 5 March 2015