Radiotherapy for chronic myeloid leukaemia (CML) | Cancer Research UK
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Radiotherapy for chronic myeloid leukaemia (CML)

Radiotherapy uses high energy rays to kill cancer cells. Doctors generally only use radiotherapy for CML as part of a bone marrow transplant or stem cell transplant. For this, you have radiotherapy to the whole body, usually twice a day for 3 or 4 days. This is called total body irradiation (TBI). 

Your doctor may also suggest radiotherapy if your spleen is very enlarged, uncomfortable or painful. Radiotherapy can help to relieve your symptoms by shrinking the spleen.

Side effects of total body irradiation (TBI) 

If you have TBI, the side effects 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 or a second cancer many years after treatment. 

Side effects of radiotherapy to the spleen

Radiotherapy to the spleen can cause a skin reaction in the treatment area. This is similar to sunburn. You may be increasingly tired as you go through the treatment.


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What radiotherapy is

Radiotherapy is a treatment that uses high energy rays, similar to X-rays, to kill cancer cells. Radiotherapy is only used in particular circumstances in chronic myeloid leukaemia. 

You may have it as part of a bone marrow transplant or stem cell transplant. For this, you have radiotherapy to the whole body. Doctors call this whole body irradiation or total body irradiation (TBI).

You may have radiotherapy to shrink the spleen if your spleen is very swollen and uncomfortable.


Total body irradiation (TBI)

After high dose chemotherapy, you have radiotherapy to the whole body to kill off your remaining bone marrow cells. You then have your own bone marrow or stem cells, or your donor marrow or stem cells, given through a drip into your vein. This happens on the ward. 

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

First you have a planning session of about 90 minutes to create the treatment plan. You will need to remove jewellery, watches, glasses and any false teeth containing metal. The radiographers measure the thickness of various parts of your body and put small radiation monitors called diodes on your body. 

The radiographers may use padding material or gel bags between your knees and over your chest and neck. They make sure the treatment couch is in exactly the right position. During this session you have a very small dose of radiotherapy. The couch moves so you can have treatment to one half of the body. Then it turns to give treatment to the other side.

For the treatment sessions the radiographers help you to lie in the correct position on the couch. 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 TBI

If you have TBI, you are likely to have

  • Sickness – your nurse will make sure you have anti sickness medicines to help you.
  • Tiredness – this may become severe for a couple of weeks about 6 to 12 weeks after the end of treatment
  • Diarrhoea – drink plenty of fluids and ask your doctor for medication
  • A dry and sore mouth – your nurse can give you drinks and mouthwashes to help
  • Low blood cell levels, making you at risk of infection, anaemic, and prone to bleeding – you will have antibiotics, blood transfusions and platelet transfusions

TBI also causes complete hair loss. You will be at a high risk of infections for a while after the treatment and may be in a single room in hospital.


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)
  • Loss of ability to have a baby or father a child
  • A small risk of developing a second cancer later in life

Clouding of the lens of the eye (cataracts)

Many 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. 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 manmade one is put in it's place.

Loss of ability to become pregnant or father a child

Unfortunately, you are usually 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. Men may be able to bank sperm before their 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 was not treated.


Planning radiotherapy for the spleen

Your doctor may suggest radiotherapy if your spleen is very enlarged. An enlarged spleen can be uncomfortable or painful. Radiotherapy can help to relieve these symptoms by shrinking the spleen. You usually have treatment 3 times over a week. This works well for most people. If your spleen enlarges again, you can usually have the treatment once again.

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 for the spleen

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 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 the treatment. 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.


Side effects of radiotherapy to the spleen

The radiotherapy can cause a skin reaction in the treatment area. This is similar to sunburn. You may also feel increasingly tired as you go through a course of treatment. You might feel sick. Your blood cell levels may fall afterwards but they usually recover quite quickly. 

The radiotherapy dose you have for an enlarged spleen is very low. The treatment course is short, so it is unlikely that you will have bad side effects.


More information about radiotherapy

Find out about

General radiotherapy

Bone marrow and stem cell transplant

Transplants for CML

Total Body Irradiation (TBI)

Infertility and TBI

Radiotherapy skin markings

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Updated: 20 November 2014