Having radiotherapy for brain metastases

Radiotherapy uses high energy x-rays to destroy cancer cells. You might have radiotherapy to the brain if your lung cancer has spread there (metastases). You can have radiotherapy in the following ways:

  • stereotactic radiosurgery Open a glossary item
  • stereotactic radiotherapy Open a glossary item
  • whole brain radiotherapy 

Your doctor will tell you which treatment is best for your situation.

When you might have radiotherapy for brain metastases

Your doctor might suggest radiotherapy to the brain if your cancer has spread there. What type of radiotherapy you have might depend on:

  • the number of brain metastases you have
  • how well you are

If you have stereotactic radiosurgery, you usually have one treatment. If you have stereotactic radiotherapy, you might have up to 5 treatments.

Whole brain radiotherapy is usually given over 5 to 10 treatments.

The planning CT scan

Before your radiotherapy you have a planning session and a planning CT scan.

Photo of a CT scanner

The planning session takes between 15 minutes and 2 hours.

You also have a mask (shell) made that keeps your head very still.

Making the mask

Your radiographer or technician makes your mask in the radiotherapy department. They might call the mask a radiotherapy shell.

The mask covers your face, and the top and sides of your head. It attaches to the couch when you are lying down for the planning scan or radiotherapy treatment.

The process of making the mask can vary slightly between hospitals. It usually takes around 30 minutes.

Before making the mask

You need to wear clothes that you can easily take off from your neck and chest. You also need to take off any jewellery from that area.

Facial hair, long hair or dreadlocks can make it difficult to mould the mask. Your radiotherapy team will tell you if you need to shave or tie your hair back.

Making the mask

The technician uses a special kind of plastic that they heat in warm water. This makes it soft and pliable. They put the plastic on to your face so that it moulds exactly. It feels a little like a warm flannel and is a mesh with holes in so you can breathe.

After a few minutes the mesh gets hard. The technician takes the mask off and it cools down. You might need to have one more fitting to make sure it is exactly right.

You wear the mask for your planning CT scan. Your radiotherapy team keep the mask in the department for when you go back for treatment. You wear it for each treatment session.

Photograph of a stereotactic radiotherapy mask for treating brain, head and neck cancers

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

Your radiographers help you to get into position on the radiotherapy table. If you need to wear a mask for your radiotherapy, they will position the mask over your face and attach it to the table. The mask keeps your head completely still while you have treatment.

The room is darkened and your radiographers line you up in the radiotherapy machine using laser lights and the marks on the mask or your skin. You will hear them saying measurements to each other to get you in the right position. They then leave you alone in the room for a few minutes.

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.

Travelling to radiotherapy appointments

You might have to travel a long way each day for your radiotherapy. This depends on where your nearest cancer centre is. This can make you very tired, especially if you have side effects from the treatment.

You can ask the therapy radiographers Open a glossary item for an appointment time to suit you. They will do their best, but some departments might be very busy. Some radiotherapy departments are open from 7 am till 9 pm.

Car parking can be difficult at hospitals. Ask the radiotherapy staff if you are able to get free parking or discounted parking. They may be able to give you tips on free places to park nearby.

Hospital transport may be available if you have no other way to get to the hospital. But it might not always be at convenient times. It is usually for people who struggle to use public transport or have any other illnesses or disabilities. You might need to arrange hospital transport yourself.

Some people are able to claim back a refund for healthcare travel costs. This is based on the type of appointment and whether you claim certain benefits. Ask the radiotherapy staff for more information about this and hospital transport.

Some hospitals have their own drivers and local charities might offer hospital transport. So do ask if any help is available in your area.

Side effects of radiotherapy for brain metastases

Radiotherapy to the brain can cause side effects. Let your doctor, nurse or radiographer know about any side effects that you have. Then they can find ways to help you.

They generally last a number of weeks. Some might last for a few months after the treatment has finished. Your doctor will tell you more about long term side effects.

Radiotherapy to the brain can make you feel very tired. The tiredness usually comes on gradually as you go through your treatment. By the end of the course of treatment, some people may notice drowsiness or a desire to sleep. This is also called somnolence.

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.

You might feel sick at times. You can have anti sickness medicines. Let your treatment team know if you still feel sick, as they can give you another type.   

Tell your healthcare team if you keep getting headaches. They can give you painkillers to help.

Your skin can feel sore. This may start after your radiotherapy treatment is completed. Your radiographers may give you creams to soothe your skin. The severity of the skin reaction varies from person to person.

Tell the radiotherapy staff if you notice any skin changes.

Radiotherapy to the brain can cause hair loss in the treatment area. Your hair usually starts to grow back a few months after treatment ends. But this growth may be patchy at first.

Long term side effects

Your doctor will discuss with you any possible long term side effects from your type of radiotherapy.

  • Lung cancer: diagnosis and management

    National Institute for Health and Care Excellence, 2019 (updated 22 September 2022)

  • Management of lung cancer
    Scottish Intercollegiate Guideline Network, 2014

  • Non small cell lung cancer

    BMJ Best Practice

    Accessed March 2023

  • Small cell lung cancer

    BMJ Best Practice

    Accessed March 2023

  • Stereotactic radiotherapy for brain metastases in patients with lung cancer; outcome and toxicity in clinical practice

    K Gunnarsson and A Hallqvist

    Reports of Practical Oncology and Radiotherapy, 2022 July 29. Volume 27, Issue 3, Pages: 410 to 418

  • Brain tumours (primary) and brain metastases in over 16s

    National Institute for Health and Care Excellence (NICE), 2018 (updated 29 January 2021)

Last reviewed: 
24 Mar 2023
Next review due: 
24 Mar 2026

Related links