Radiotherapy uses radiation, usually x-rays, to treat cancer cells.
You might have radiotherapy to your whole body before a stem cell transplant. This is called total body irradiation or TBI. You also have chemotherapy. The aim of this intensive treatment is to kill the leukaemia cells. It also destroys your immune system. This means that after your transplant your body is less likely to reject the new healthy stem cells and they can grow.
You usually have TBI twice a day for 3 or 4 days, or as a single treatment.
The radiotherapy room
Radiotherapy machines are very big. They rotate around you to give you your treatment. The machine doesn't touch you at any point.
Before you start your course of treatment your
You have a planning session a week or two before your first treatment. It takes around an hour. This session is for your radiotherapy team to carefully plan your radiotherapy and work out what shielding you need to make sure your whole body receives the same amount of radiation.
Your nurse gives you anti sickness medicines about half an hour before the treatment.
In the radiotherapy room, the radiographers help you to get into position on the radiotherapy table. They darken the room and line you up in the radiotherapy machine using laser lights and marks on your skin. You will hear them saying measurements to each other to get you in the right position. They attach devices over your clothes that measure the treatment dose to various parts of your body.
Then your radiographers leave you alone in the room for 10 to 15 minutes while you have the treatment. They can still see and hear you. You must lie very still and not move. Afterwards, your radiographers come back into the room to turn the radiotherapy couch. You then have treatment for another 10 to 15 minutes to treat the other side of your body.
You go back to the ward after each treatment. In between treatments you must stay away from anyone who may be unwell. Your white blood cell count will be very low, so it is easy for your body to pick up an infection.
Once you have finished the course of radiotherapy, you have the stem cell transplant through a drip into your bloodstream. This happens as an inpatient on the ward.
Total body irradiation causes side effects. These may happen shortly after treatment, or months or years afterwards (long term effects). Your radiotherapy team will talk to you about the possible side effects before you start treatment. Let your doctor or nurse know straight away if you get any side effects.
Early side effects include:
Towards the end of treatment you might notice that your skin starts to look red or darker and feels warm. It might also get dry. Your radiographer will tell you how to look after your skin during treatment and for a few weeks afterwards.
Tips for looking after your skin:
- Gently wash your skin using your hand and warm water and a non perfumed soap.
- Pat your skin dry using a soft towel.
- Don't apply any cosmetics, perfumes, after shave or skin creams while having this treatment.
- Avoid shaving because this can make the skin sore, unless you use an electric shaver, taking care not to pull on the skin.
You might already have lost your hair due to chemotherapy. But if you haven't, your hair will fall out around 3 weeks after you started TBI. It will begin to grow back within a few months after the end of treatment but it might be a different texture or colour.
You can wash your hair and scalp normally using warm water and a mild shampoo, such as a baby shampoo. Gently massage your scalp and dry it with a soft towel.
Losing hair can be very upsetting and you might feel very emotional. This is quite natural.
You can get a wig or find other ways of covering your head.
You will feel sick at times and you may be sick (vomit). Your treatment team will give you anti sickness medicines. Let them know if you still feel sick, as they can give you other medicines.
TBI can make you feel very tired. The tiredness usually comes on gradually as you go through your treatment. By the end of the treatment you may feel very tired.
The tiredness usually carries on for about 6 to 8 weeks and then starts to get better. But for some people it can become very severe a few weeks after the end of treatment. You might also feel drowsy and irritable. This is called somnolence syndrome. It doesn't need treatment and gets better on its own over a few weeks.
It is important to rest or sleep when you need to. But it is likely to help if you can get some regular light exercise. A daily walk is good if you are able to do that. Your nurse will help advise you about what you can do.
Tell your doctor or nurse if you have diarrhoea. They can prescribe medicine to help you.
Drink at least 2.5 litres of fluid a day. This helps to keep you hydrated.
Ask your nurse about soothing creams to apply around your back passage (rectum). The skin in that area can get very sore and even break if you have severe diarrhoea.
This usually starts 2 or 3 days into your treatment and can last up to 3 months. It helps to regularly sip drinks and to often clean your mouth. Your nurses will tell you how to do this.
Drink plenty of fluids. Aim for between 1 or 2 litres a day. This can include water, squash or hot drinks.
Let your doctor or nurse know if you feel sick and can't drink enough.
TBI destroys your immune system so you are at risk of infection. You stay in a single room on the ward until your immune system is starting to work properly. Your treatment team will keep a close eye on you and treat any infections you might get.
To reduce the risk of infection your nurse will ask you to shower and change your clothes daily. You use mouthwashes to help keep your mouth clean. Your visitors should wash their hands before they come into your room. They might need to wear gloves and aprons like the nurses and doctors. They shouldn't visit if they have coughs or colds.
TBI can cause swelling and soreness of the lining of your mouth, tongue and throat. This usually starts about a week after starting treatment. It can be very painful and stop you from wanting to eat and drink. Tell your nurse and doctor straight away if you start to get any pain. They can give you painkillers for this. You may also need a drip of fluid to keep you hydrated.
Your nurse will remind you to keep your mouth clean, using a soft toothbrush to clean your teeth and rinsing regularly with a mouthwash. You can keep your lips moist with a lip balm such as Vaseline.
Possible long term effects
Some side effects can happen weeks, months or years after the treatment. Long term side effects include:
The lens inside your eye can cloud over so that you can’t see very well. This is called a cataract. If you do get cataracts, they can be treated with simple surgery. Doctors take out the clouded lens and put a false one in its place.
Inflammation of the lung tissue can happen in a small number of people between 6 weeks to 6 months after treatment. You might have shortness of breath and a cough. Let your doctor or nurse know straight away if you have this.
Unfortunately, most people who have this treatment as part of a transplant can't have children naturally afterwards. This can be extremely difficult to cope with, particularly on top of your cancer diagnosis. Your treatment team can give you support.
Men may be able to store sperm before they start treatment to use in the future. This is called sperm banking. Your doctor will give you information about this.
Women may also have vaginal dryness or an early menopause. You might have hormone replacement therapy (HRT) to help with the symptoms.