Radiotherapy for acute myeloid leukaemia (AML)

Radiotherapy means the use of radiation, usually x-rays, to treat cancer. Doctors use a type of radiotherapy called external radiotherapy for acute myeloid leukaemia.

External radiotherapy uses a machine outside the body to direct radiation beams at the cancer to destroy it.

How does radiotherapy work?

Radiotherapy treatment works by damaging the DNA Open a glossary item within the cancer cells. DNA is the genetic code that controls how the body's cells behave. 

When do you have radiotherapy for acute myeloid leukaemia?

You might have radiotherapy to:

  • the whole body (total body irradiation, TBI) as part of conditioning treatment for a stem cell transplant Open a glossary item.
  • AML that has formed a lump outside the bone marrow (also known as myeloid sarcoma, granulocytic sarcoma, chloroma or extramedullary myeloid tumour)
  • the brain or spinal cord if AML has spread there, although it is rare for this to happen

Your healthcare team will explain the type of radiotherapy treatment you will be having.

How long is a course of radiotherapy?

You might have radiotherapy as a single treatment or a series of daily treatment sessions. A single dose of radiotherapy is called a fraction. A series of sessions makes up a radiotherapy course.

The number of treatment sessions you need depends on your situation. Your doctor will discuss with you how many sessions you need.

Total body irradiation (TBI)

Conditioning treatment prepares you for a stem cell transplant. TBI is part of the conditioning treatment. The number of radiotherapy fractions you have depends on the type of conditioning you have. For example, for reduced intensity conditioning (RIC) you may have 1 or 2 fractions. With full intensity (myeloablative) conditioning you might have up to 8 treatment sessions over 4 days. So 2 fractions a day.

Planning radiotherapy for acute myeloid leukaemia

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 to 2 hours.

You usually have a planning CT scan in the radiotherapy department.

The scan shows the cancer and the area around it. You might have other types of scans or x-rays to help your treatment team plan your radiotherapy. The plan they create is just for you.

Photo of a CT scanner

Your radiographers tell you what is going to happen. They help you into position on the scan couch.

The CT scanner couch is the same type of bed that you lie on for your treatment sessions. You have to lie as still as you can, so that the measurements are accurate and the radiographers can record your exact position. This means they can make sure you are lying in the correct position every time you have treatment.

Having the scan

Once you are in position your radiographers put some markers on your skin. They move the couch up and through the scanner. They then leave the room and the scan starts.

The scan takes about 5 minutes. You won't feel anything. Your radiographers can see and hear you from the CT control area where they operate the scanner. 

Watch our video about radiotherapy planning, this is just under 3 minutes long.

Depending on why you are having radiotherapy the radiographer might also do some extra things during the appointment. This may include:

  • making a mould or mask for radiotherapy to the brain

  • tattooing the skin

Ink and tattoo marks

The radiographers make pin point sized tattoo marks on your skin. They use these marks to line you up into the same position every day. The tattoos make sure they treat exactly the same area for all of your treatments. They may also draw marks around the tattoos with a permanent ink pen, so that they are clear to see when the lights are low.

Photograph of radiotherapy tattoo marks

The radiotherapy staff tell you how to look after the markings. The pen marks might start to rub off in time, but the tattoos won’t. Tell your radiographer if that happens. Don't try to redraw them yourself. 

Moulds or masks

If you are having treatment to your head you may need to have a mould (shell) made to keep you perfectly still while you have treatment.

Photograph of a mesh plastic mask used for radiotherapy for cancer of the head and neck and brain

The moulds are made in the mould room or in the CT scanning room.

After your planning session

You might have to wait a few days or up to 3 weeks before you start treatment.

During this time the physicists and your radiotherapy doctor (clinical oncologist) decide the final details of your radiotherapy plan.

Then the physicists and staff called dosimetrists plan the treatment very precisely using computers.

Having radiotherapy

The radiotherapy room

Radiotherapy machines are very big and could make you feel nervous when you see them for the first time. The machine might be fixed in one position. Or it might rotate around your body to give treatment from different directions. The machine doesn't touch you at any point.

Before your first treatment, your therapy radiographers Open a glossary item will explain what you will see and hear. In some departments, the treatment rooms have docks for you to plug in music players. So, you can listen to your own music while you have treatment.

Photo of a linear accelerator

Before each treatment session

The radiographers help you to get onto the treatment couch. You usually lie on your back and might need to raise your arms over your head.

The radiographers line up the radiotherapy machine using the marks on your body. Once you are in the right position, they leave the room.

During the treatment

You need to lie very still. Your radiographers might take images (x-rays or scans) before your treatment to make sure that you're in the right position. The machine makes whirring and beeping sounds. You won’t feel anything when you have the treatment.

Your radiographers can see and hear you on a CCTV screen in the next room. They can talk to you over an intercom and might ask you to hold your breath or take shallow breaths at times. You can also talk to them through the intercom or raise your hand if you need to stop or if you're uncomfortable.

You won't be radioactive

This type of radiotherapy won't make you radioactive. It's safe to be around other people, including pregnant women and children after your treatment.

The short video below shows how you have radiotherapy. It’s just over 2 minutes long.

Side effects of radiotherapy

Radiotherapy for AML can cause side effects. These will depend on:

  • where you are having treatment to

  • how much radiotherapy you have (the number or fractions and overall dose)

  • if you have it with other treatments such as chemotherapy

Your healthcare team will explain possible side effects and what to do if you have them.

  • Radiotherapy dose fractionation (Third edition)
    The Royal College of Radiologists (RCR), March 2019

  • Handbook of Treatment Planning in Radiation Oncology
    G Videtic, A Vassil and N Woody
    Springer Publishing Company, 2020

  • Walter and Miller's Textbook of Radiotherapy: Radiation Physics, Therapy and Oncology (8th edition)
    R Symonds, J A Mills and A Duxbury
    Elsevier, 2019

  • The EBMT Handbook
    E Carreras and others
    Springer Open, 2019

  • External Beam Therapy (2nd edition) 
    Peter Hoskin
    Oxford University Press, 2012

  • The information on this page is based on literature searches and specialist checking. We used many references and there are too many to list here. Please contact with details of the particular issue you are interested in if you need additional references for this information.

Last reviewed: 
16 Apr 2024
Next review due: 
16 Apr 2027

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