About brain tumour radiotherapy

Radiotherapy uses high energy waves (X-rays) to treat cancer. Doctors quite often use radiotherapy to treat brain tumours. It may be your main treatment if you have a brain tumour that your surgeon cannot remove. Or you may have radiotherapy after surgery either

• To treat any tumour that your surgeon couldn't remove
• To try to lower the risk of the brain tumour coming back in the future

You have radiotherapy treatment in the hospital radiotherapy department. You usually have the treatment as an outpatient, so you have to travel to the hospital every day throughout your course of radiotherapy. If you live a long way from the hospital you may be able to stay in the hospital in a hostel type room.

You are most likely to have radiotherapy for a brain tumour as a series of daily treatments, over as many as 6 to 7 weeks. You usually have one treatment a day, from Monday to Friday. For some types of tumour you may have treatment twice a day. 

If you are having a shorter course of palliative radiotherapy to help with symptoms or slow down your tumour, you will have treatment for about 2 weeks.

Many hospitals have radiotherapy machines that can give very precisely targeted radiotherapy treatment called stereotactic radiosurgery. This treatment can be given by different types of radiotherapy machines including LINAC machines with a mask system, specially adapted LINAC machines and the cyberknife. This treatment may be called stereotactic radiotherapy, radiosurgery, gamma knife treatment or cyberknife. The treatment is a way of giving targeted radiotherapy to the area of the tumour and can treat some small tumours in certain areas of the brain.

You will have 2 or 3 outpatient appointments before you start radiotherapy. This is so the radiotherapy doctor (clinical oncologist) can carefully plan your treatment. 

Specialists plan radiotherapy very carefully. At your first visit you will lie under a CT scanner (called a simulator) which takes images of the area to be treated. You may have an injection of dye (contrast) to help the doctor see this area more clearly. The doctor works out where to give your treatment to kill the most cancer cells and miss as much healthy brain tissue as possible. The photo above shows the view into a simulator room from the radiographer's control desk.

The doctors take many different scans of your brain from different angles. They then use a computer to work out

• The exact shape of the tumour
• Where important structures are in relation to the tumour (for example, your eyes)
• The direction to aim the radiation beams so that they avoid all the important structures

Once your doctor has all the scans it can take up to 8 hours to use them to plan your treatment. The radiotherapy beams will be exactly directed so that the radiation hits the tumour. Most healthy brain tissue will be outside the irradiated area. It may be possible for your doctor to tell you where you are most likely to lose hair before you start treatment. Generally, you lose hair from the point where the beams enter your head and also where they leave (the exit beam).

There are 2 main ways to have radiotherapy to the brain. You will either have to have a mask made. Or have a head frame fitted.

The plastic mask is sometimes called a shell or mould. It covers the whole of your face, the front of your head and your neck. The mask keeps your head completely still while you are being treated. You can see through it. Any marks that the radiographers need to line up the machine can be made on the mask instead of on your skin. Here is a picture of one type of mask:

You go to the hospital mould room to have your mask made before you start your treatment. Many radiotherapy departments use a type of plastic mesh called thermoplastic to make the masks. This is soft when warm and hardens as it cools. The warmed plastic is shaped to your face and head. It does not cover your nose or mouth, so you can breathe easily. When the plastic cools it gives an exact impression of your face and head.

Some hospitals use plaster of paris to make the mask. First of all, cool gel is smoothed all over your face. Then the mould technician covers your face with strips of plaster of paris bandage. Holes are left around your mouth and nose so that you can breathe easily. The plaster of paris sets very quickly. As soon as it sets it is lifted off. The technician uses the plaster mould to make a clear plastic mask that exactly fits your face.

You have to visit the mould room again to make the plastic legs that attach the mask to the radiotherapy treatment table. During this visit you may also have your radiotherapy planning. The radiographer may draw marks on your mask during the planning session as in the picture above. The marks help the radiographers to line up the radiotherapy machine very precisely when you have your treatment.

You only have to wear the mask when you go for treatment. Once you are lying down the radiotherapy staff put the mask over your head and fix it to the radiotherapy treatment table on either side. This stops you from moving while you are having treatment.

You may have a head frame as well as a mask for some types of treatment. There is detailed information about head frames on the page about stereotactic radiotherapy.

Below is a 360° photograph of a radiotherapy room containing a linear accelerator (LINAC) machine. If you can't see the photograph, you can download the Adobe Flash Player from the Adobe website. Use the arrows to move the picture and look around the room.

To have treatment you lie on the treatment table. The radiographer fits your mask and attaches it to the table. Each treatment only takes a few minutes. Exactly how long depends on the number of directions from which you will be treated. The linear accelerator beam can be moved around. In the photo, the beam would come from the top. But the machine can swing round in an arc, so that the beam can be aimed from the side. You may have one shot of radiotherapy from the front, then one from the side and one from the back. This sequence will be the same each time you have treatment.

The radiographer will help position you on the couch and make sure you are comfortable. You will be left alone for the minute or two the machine is switched on. But the staff will be able to hear you through an intercom and see you on a TV screen, so you can call if you need them. The treatment doesn't hurt. You will not be able to feel it at all. You must lie very still for the few minutes it takes to treat you.

Having external radiotherapy does not make you radioactive. It is perfectly safe to be with other people, including children, throughout your treatment course.

Apart from the other pages in this section that are specifically about radiotherapy for brain tumours, you can look at the general radiotherapy section. It tells you more about this type of treatment including

• What radiotherapy is
• How your radiotherapy treatment is planned
• Possible side effects