Total body radiotherapy (TBI)

You might have radiotherapy to your whole body as part of a stem cell or bone marrow transplant. This is called total body irradiation or TBI. 

Radiotherapy uses high energy x-rays. The aim of the treatment is to help kill off leukaemia cells in the bone marrow.

You might have TBI twice a day for 3 or 4 days, or as a single treatment.

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 able to 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 treatment

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.

During treatment

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. 

After treatment

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.

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.

Side effects

Total body irradiation causes side effects. Let your doctor or nurse know straight away if any side effects get severe.

Towards the end of treatment you might notice that your skin gets reddened or darker and feels warm. It might also get dry.

During treatment and for 2 or 3 weeks afterwards you need to wash your skin gently using your hand and warm water and a non perfumed soap.

Don't use perfumed bath creams or shower gels and don't soak in a hot bath. Gently 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. 

Your radiographers will advise you to gently moisturise your skin 2 or 3 times a day. They can let you know which creams you can use. 

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. 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 exercise. A daily walk is good if you are able to do that.

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 after 2 or 3 days and can last up to three 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.

Possible long term effects

Some side effects can happen weeks, months or years after the treatment.

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. 

Most people who have this treatment as part of a transplant can't have children afterwards. This can be very difficult to cope with and your treatment team can give you support. 

Women might have vaginal dryness or an early menopause. 

Men might have a lowered sex drive. 

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