Stereotactic radiosurgery (SRS/SRT): End of treatment: cerebral metastases

You are receiving this leaflet because you have recently had stereotactic radiosurgery to the brain. It is important that you look after yourself over the next few weeks. If you have any questions or worries not covered in this leaflet, please do not hesitate to call a member of your treatment team or the Addenbrooke’s acute 24 hour oncology helpline.

Steroids (Dexamethasone): What to do on the day/days after SRS/SRT treatment?

For patients who were on steroids prior to radiosurgery

Single session: You were asked to temporarily increase your steroid dose on the day of treatment and the day after to try and minimise any possible side effects including swelling to the brain (due to this treatment response, it is important that you have someone at home with you tonight).

After treatment, please revert back to the dexamethasone dose that was advised for you. Do not stop your steroids after radiosurgery unless you were given specific instructions to do so. Please call the Addenbrooke’s oncology helpline if you have any immediate concerns. Your steroid dose will be reassessed one week after receiving your SRS/SRT treatment.

Multiple sessions: If you received a course of treatment over several days, please follow the dexamethasone steroid dose that was instructed for you on completion of your treatment. Do not stop your steroids after radiosurgery unless you were given specific instructions to do so. If you have any issues after the course of treatment please contact the SRS team, or in a clinical emergency contact the Addenbrooke’s oncology helpline. Your steroid dose will be reassessed one week after receiving your SRS/SRT treatment.

For patients who were not on steroids prior to radiosurgery

Single session: You were asked to take a steroid dose on the day of treatment and the day after to try and minimise any possible side effects. When you have SRS to the brain there is a risk that there will be swelling around the area(s) of brain treated. Due to the initial treatment response (swelling), it is important that you have someone at home with you the night of your treatment.

Please call the Addenbrooke’s oncology helpline if you have any immediate concerns.

Multiple sessions: If you received a course of treatment over several days, please follow the steroid course that was instructed for the period of your treatment.

If you have any issues after the course of treatment please contact the SRS team or in a clinical emergency contact the Addenbrooke’s oncology helpline.

Side effects

Nausea/vomiting: You may find that you experience some nausea in the days following your treatment and this can last for a couple of weeks. Your doctor will have prescribed some anti-sickness medication to have available at home after the radiosurgery. Please take these as necessary:

• Domperidone: Mild anti-sickness for nausea; Take one tablet (10 mg) three times a day as needed.
• Ondansetron: Strong anti-sickness for vomiting; Take one to two tablets (4 mg to 8 mg) three times a day as needed.

Fatigue: You may feel very tired immediately after your stereotactic radiosurgery. This may continue for a few weeks after your treatment. Listen to your body. You may need to rest and relax more than usual. However, it is good to maintain a level of activity such as gentle walking, if you feel able. Do not be afraid to ask friends and family for help. Having enough to drink can prevent tiredness from dehydration.

Headaches: If you develop frequent headaches that are not relieved by your usual pain killers, please call the Addenbrooke’s acute 24 hour oncology helpline.

Skin reaction: Treatment for tumours that are located close to the skin surface may cause a skin reaction over the area being treated. Red or itchy skin in the treated area may worsen over the next 14 days before it settles. Continue to bathe the area gently with tepid water and an unscented soap. Epimax® or E45® can be used to moisturise the skin and reduce itching.

Seizures: There is a small increased risk that you may have a seizure (fit) after your treatment. However, this is usually more likely if you have had seizures in the past. In the event of having a seizure that causes loss of consciousness, relatives or witnesses should call 999 for immediate help, and then notify us once you are stabilised.

Neurological symptoms: (for example- limb weakness, speech disturbance)

If you experience any new or worsening neurological symptoms after your SRS/SRT treatment, please call the Addenbrooke’s acute 24 hour oncology helpline. It may be that we need to review/restart steroids.

Follow-up

A week after your treatment has finished you will be reviewed by the neuro oncology consultant via telephone or you may be asked to attend the outpatient clinic. During this discussion the doctor will assess your progress after SRS/SRT, discuss any continuing side effects with you and will reassess your steroid dose if necessary.

You will then be discharged from the care of the neuro oncology team and will be followed up at your local hospital and their oncology team (if not at CUH). On completion of receiving SRS/SRT you will be required to have an MRI scan every three months at your local hospital.

We may also request information from your own oncologist about your response to radiosurgery treatment.

It is possible to have radiosurgery again to other lesions in the brain, but we are required to wait at least three months between radiosurgery treatments. If you have questions about further radiosurgery treatment in the future, please speak to your own oncologist.

Driving

If you have a brain tumour and you drive any type of vehicle, you must contact the DVLA and inform them of your diagnosis. If you have a single brain metastasis on your scan, and it is treated with radiosurgery, then you may reapply for your licence if you are well 12 months after completion of radiosurgery. If you have more than one metastasis on your scan, then you may reapply for your license 24 months after radiosurgery. The DVLA also has strict guidelines if you have suffered from seizures before, during, or after your treatment.

Failure to comply with these regulations is illegal and potentially dangerous; your insurance will be invalid and you may be fined up to £1000.

Contacts

If you have any worries or questions about any aspect of your treatment, please do not hesitate to contact one of the team.

Addenbrooke’s acute 24 hour oncology helpline: 01223 274 224

Rosanna Stott - Specialist SRS/SABR radiographer - 01223 596329

Radiotherapy reception - 01223 216 634

Oncology reception - 01223 216 551 / 216 552

DVLA - DVLA Website - contact the DVLA (opens in a new tab)

0300 790 6806

Drivers Medical Group, DVLA, Swansea, SA6 7JL