Radiotherapy for chronic lymphocytic leukaemia (CLL)

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. So doctors call it local treatment. Chemotherapy or biological therapy treat the whole body, so doctors call them systemic treatments. 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 or stem cell transplants are not used very often to treat CLL.

Radiotherapy is not commonly used for chronic lymphocytic leukaemia. But there are particular circumstances when radiotherapy may be used. 

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

• To treat a very large spleen that is causing symptoms
• To treat bulky lymph nodes that are causing symptoms
• Before a bone marrow or stem cell transplant
• Radiotherapy for bone pain

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 3 weeks or so. Or you may have your radiotherapy in 2 daily treatments with a rest day in between – so over a 3 day period.

Radiotherapy before a transplant

Bone marrow or stem cell transplants are not a common treatment at all 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 having chemotherapy and having your 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 into your vein through your drip. TBI is usually just one or 2 radiotherapy treatments.

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 radiotherapy as a treatment to relieve the bone pain.

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. There is information about side effects to particular areas of the body in the main radiotherapy section.

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. 

There is detailed information about the procedures for bone marrow and stem cell transplants in the cancer treatment section of CancerHelp UK. And more about how transplants are used for CLL in this section.

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 put in its place.

If you would like further information about radiotherapy, look at the main radiotherapy section in CancerHelp UK. It tells you more about this type of treatment including about

• What it involves
• Planning your treatment
• Possible side effects
• Follow up care after radiotherapy

For more information and support contact our cancer information nurses. They will be happy to help.