Radiotherapy to the brain (long course)

Your oncology team have recommended a course of radiotherapy to treat your tumour. Although there may be side effects it is felt that the advantages for you outweigh the disadvantages. If you decide to go ahead, you will be asked to sign a consent form. However, you are free to change your mind at any time. If you have any questions or would like more advice, please ask a member of your oncology team. These pages are designed to give you basic information about radiotherapy treatment to the brain. They describe the treatment process and explain the common side effects you may experience.

Radiotherapy treatment

The radiotherapy is usually given every day and several factors affect the total number of treatments required including the type of tumour you have. Some patients may have only 15 visits while others receive between 30 and 40 treatments delivered once daily Monday to Friday. Most patients are well enough to travel from home each day for their treatment.

Before radiotherapy starts

Pregnancy

It is very important that you are not and do not become pregnant while undergoing radiotherapy planning or treatment. If you think that you may be pregnant at any point, please inform your treatment team immediately.

Pacemakers

If you have a pacemaker, please tell your doctor or radiographer as soon as possible. We will arrange a pacemaker check before and after your treatment.

What will happen on my first day of treatment?

When you arrive for your first treatment, please book in at the radiotherapy reception. A radiographer will speak with you to discuss the treatment and how best to minimise any side effects that it may cause. They will again confirm your consent to go ahead with treatment. Please feel free to ask any questions.

Radiotherapy treatment is given by a machine called a linear accelerator (or linac). The machine is quite large and will move around you. It comes close to you, but it will not touch you. The procedure will take 15 to 20 minutes.

At each treatment appointment the radiographers will help to position you in your mask on the treatment couch. The lights will be dimmed, and the room laser lights used to make sure you are in the correct position. Once you are correctly positioned on the treatment couch, the radiographers will leave the room to switch the machine on. You will be alone in the room during treatment, but the radiographers will be watching you on monitors. They can also speak to you via an intercom. If you need help, raise your arm. The machine can be switched off and the radiographers can return to the room to assist you.

Computed tomography (CT) or x-ray images are taken initially to ensure that you are positioned correctly in your mask and that the treatment will be delivered accurately. There may be a short delay while these images are being assessed. The machine will make a buzzing sound when taking images and delivering treatment, but it is completely painless and will only last a few minutes.

After treatment, do not move or attempt to get off the table without assistance as it will be quite high. The radiographers will tell you when the procedure has finished and help you out of your mask and assist you down off the table. You will not be radioactive after radiotherapy and will be safe to mix with other people including children and pregnant women.

Each week throughout the course of your treatment you will have an opportunity to see or speak to either the doctor or the specialist radiographer to discuss any problems or side effects that arise.

Medication

If you are currently taking steroids, the dose is often kept at the same level between leaving hospital and starting radiotherapy. This dose may be adjusted during your radiotherapy following discussion with the doctor; you should not stop this medication suddenly.

What are the possible side effects of treatment?

Any side effects from the treatment vary from person to person. The type and site of your tumour may also determine the side effects you experience. These will be discussed fully with you before you start your treatment. The most common side effects you may experience are listed below.

Acute side effects

These side effects may occur during the course of the radiotherapy or in the first few weeks after the end of treatment.

Hair loss

Unfortunately, you will lose your hair in the area being treated, this normally happens about three weeks after the start of the radiotherapy. Your hair should re-grow, but this can take a long time (around three months) following radiotherapy. Occasionally hair loss can be permanent. A referral for a wig can be organised for you if you wish. For more information about the wig service, or to organise an appointment, please speak to one of the radiographers.

During radiotherapy you can continue to wash your hair normally using a mild shampoo. To reduce any skin reactions, we recommend that you gently towel dry your hair but if you wish to use a hairdryer a low heat setting is preferable and hair dye is not recommended.

Skin

The skin in the treatment area may become dry, mildly red and itchy. The following general advice should help you look after your skin during and after radiotherapy. It is advisable to start to follow these guidelines from the start of your radiotherapy and continue until any changes to your skin subside.

• We advise using a moisturising cream on the area of scalp being treated twice a day. It may be advisable to use a moisturiser that does not contain sodium lauryl sulphate (SLS). Examples of creams that may be used are E45 (contains Lanolin) or Diprobase. Please note that aqueous cream does contain SLS and is not recommended as a leave-on moisturiser. . There is no specific minimum time for application prior to treatment, but the time period should be sufficient to allow the cream to absorb and avoid an excessive residual layer on the skin during treatment. If there is an excess of cream on the skin prior to treatment, it may be gently removed before the treatment session.
• The skin behind the ears can be more sensitive to the radiotherapy, please let a radiographer know if you notice any blisters or soreness developing there as they will get an alternative ointment prescribed for you to use instead of a general moisturising cream.
• The skin may be sensitive, and it is best not to over-expose it to the sun or cold winds. Try wearing a scarf or hat to cover the area when you go outside.

Any skin reaction will peak one to three weeks after treatment finishes and gradually your skin should settle down.

Ears

If your ears are in the treatment area, they may also become pink and itchy. You may also notice that they feel blocked, and you may feel slightly deaf. Moisturising cream may help to reduce any reaction on the outside part of your ear, but we do not advise that you use anything in your ears. Any ear reactions should settle after treatment has finished but may take a few weeks. If you have any discharge from the ear or earache, you should inform a radiographer.

Tiredness

This side effect varies greatly from person to person. Generally it increases throughout the radiotherapy and may last for a few weeks after completion of your treatment. A few patients experience severe tiredness four to six weeks after completing radiotherapy and this is called somnolence. It normally settles without the need for any other treatment. For more information and advice on how to manage tiredness, contact Macmillan Cancer Support on freephone 0808 800 0000 Monday to Friday 09:00 (9am) to 20:00 (8pm) or visit the Macmillan website (opens in a new tab).

Headaches and nausea

Occasionally the radiotherapy can cause some swelling of the tissue in the area being treated. This may cause headaches, nausea and very rarely vomiting. Increasing the steroid dose normally treats this side effect and your doctor or specialist radiographer will advise you on an appropriate increase. Some patients have also experienced slight taste changes; however this is not very common.

Seizures

For patients who are having fits that aren't controlled by medication, radiotherapy may increase the likelihood of fits in the short term. Occasionally it is necessary to alter the medication to control the number of fits. This side effect should settle on completion of the radiotherapy.

Long-term side effects

These side effects occur months to years after the completion of the radiotherapy.

Pituitary function

The pituitary is a structure in the middle of your brain that controls your hormone production. If the pituitary gland is in the treated area your hormone production may be affected in the future. This may happen a year or more after radiotherapy and can be monitored with blood tests. This side effect can be treated using hormone replacement therapy.

Changes to vision

If the treatment area is near either your eyes or optic nerves this could result in cataract formation, reduced vision or extremely rarely a loss of vision. If this is a possibility it will be discussed with you fully before you sign the consent form or start your radiotherapy

What happens after treatment?

Radiotherapy continues to have a beneficial effect on the tumour for some weeks after treatment has finished. The side effects may persist or worsen slightly for seven to 10 days before they gradually start to settle down.

A follow up appointment will be arranged back in the neuro-oncology clinic a few weeks after the radiotherapy is completed. This is to see how you are and that any side effects have subsided.

Contact us

It is important to us that you have all the information about your treatment, that you feel you need, before the treatment starts If you are unsure about what happens next or have concerns about any aspect of your treatment please contact your oncology team. Some useful contact numbers are:

Contact Centre (main switchboard): 01223 245 151
Radiotherapy Reception: 01223 216 634
Kate Burton, Consultant Radiographer in Neuro-Oncology: 01223 216 580
Neuro-oncology clinical nurse specialists: 01223 256 676
Acute Oncology Service (AOS) – Addenbrooke’s emergency 24-hour helpline for oncology patients: 01223 274 224

Privacy and dignity

Same-sex bays and bathrooms are offered in all wards except critical care and theatre recovery areas where the use of high-tech equipment and/or specialist one-to-one care is required.