Radiotherapy to the brain

Radiotherapy is a treatment that involves the use of high-energy radiation. It is commonly used to treat cancer. It can be used alone, with or without surgery or in combination with chemotherapy. The appropriate treatment will be discussed with you by your cancer doctor.

 

What to expect on your first visit

On your first visit, you will attend the 'Mould Room' at Clatterbridge Cancer Centre - Liverpool or Wirral (appointment letter will indicate which). This is where all immobilisation equipment (accessories to help keep you still during treatment) is made. You will also have a CT planning scan (+/- a MRI scan).

We may also record your height and weight and send you for some blood tests at this appointment.

Treatment mask (thermoplastic)

This mask starts as a flat sheet of perforated plastic attached to a frame. It is placed in a hot water bath where it becomes soft and flexible. It is then placed over your face and head and feels like a warm, wet flannel. We mould the plastic sheet to get a perfect impression of you, which can feel a little strange, but is painless. The mask sets in approximately five minutes and is ready to use straight away. As the mask is perforated, it allows normal breathing.

The planning stage

As part of the planning process for your radiotherapy treatment, you will require a Computerised Tomography (CT) scan and possibly a Magnetic Resonance scan (MRI). The CT scan only takes a few minutes and provides us with a picture of your internal anatomy. If you require an MRI scan, these take longer, approx. 40 minutes but full details, including time, will be discussed with you by the mould room staff. To help us see the area that we need to treat, you may need an injection of contrast (dye). We will discuss this in more detail with you when you arrive for your planning appointment.
 

Therapeutic radiographers operate the radiotherapy machines to give you the precise treatment prescribed by your cancer doctor. They will explain to you what is going to happen and take you into the treatment room. You will be asked to remove any clothing and jewellery that cover the area being treated. The therapeutic radiographers will help you onto the treatment bed, position your mask and adjust both the bed and the machine to the exact positions that are required. You will also be asked to keep as still as possible.

The radiotherapy machines are quite big and if you have never seen them before you might feel anxious. There is no need to worry - you won’t see or feel anything during treatment. 

Once you have been positioned for your treatment, the therapeutic radiographers will leave the room and operate the machine from outside the room. The treatment machine will rotate to different positions during your treatment, you will be required to lie still and breathe normally throughout. Each daily treatment session will take about 15 minutes in total. This includes time for you to change, for the therapeutic radiographers to help position you for treatment and for the actual delivery of the treatment.

During your treatment you will be alone in the room, but the therapeutic radiographers will be watching you carefully on a closed circuit television system.

General information about side effects of treatment

Radiotherapy can cause general side effects such as tiredness, but there are some effects which are specific to having radiotherapy to the brain. Side effects depend on the number of treatments you have. Every patient is different and you may not have the same side effects as somebody else.  While you are having radiotherapy, it is very important that you continue to take the medication prescribed by your cancer doctor. Do not change anything unless you have discussed it with your cancer doctor first.

Most side effects are temporary but some may last for weeks or months after your treatment has finished.

During your treatment, a therapeutic radiographer or nurse will be able to answer any questions and deal with most of your problems. However, your cancer doctor will also see you regularly throughout your treatment. It is important to let us know about your side effects. 

Occasionally, it may be necessary to come into hospital to help you cope with your side effects during treatment.

Side effects during and after your treatment

Headaches

Headaches are a very common side effect of radiotherapy to the brain. These may be due to increased swelling as a result of the treatment. You may be prescribed a steroid drug called Dexamethasone for this. Always remember to carry your steroid card which has instructions about taking Dexamethasone.

You can also take painkillers to help you, such as paracetamol. It is important that you tell the therapeutic radiographers who are treating you if you are having headaches.

Nausea (feeling sick) and vomiting (being sick)

Treatment to your brain may make you sick or feel sick. If it is going to happen, it usually occurs two to six hours after your treatment and usually settles within a couple of hours. If you have not felt sick with your first or second treatments, you are unlikely to be affected by the remaining treatments.

If you do feel sick, let the therapeutic radiographer or nurse know so that they can advise you of any self-help solutions or give you the necessary medicine.

You can help yourself by:

• Trying to drink plenty of non-alcoholic drinks, especially if you do not feel like eating
• Trying to eat small meals four or five times a day, rather than the usual three meals a day
• If possible, having your meals prepared for you

If you are taking steroids, this can reduce the likelihood of nausea.

Your skin (scalp)

Your skin may become red and itchy. The reaction is similar to mild sunburn. Any soreness should quickly heal when your treatment has finished. If your skin becomes uncomfortable, ask the therapeutic radiographer or nurse for advice.

Your hair

Any hair included in the treatment area may gradually fall out. Whether or not you lose your hair depends very much on the dose of radiation and the number of treatments you are going to have. Your cancer doctor will discuss this with you.

Hair loss is usually temporary and it will usually start to grow again three to six months after finishing your treatment.

However, for some patients the hair loss will be permanent. If necessary, the therapeutic radiographers or nurses will arrange for you to see someone about obtaining a wig. Turbans, scarves, caps and hats are alternatives to wearing a wig.

If you require a wig, then ask the therapeutic radiographer and they will be able to give you advice on who to contact. It is a good idea to get your wig before you lose a lot of hair, so that you can match it with your natural colour. 

Tiredness

It is common to feel more tired than usual during your treatment and for several weeks after your treatment has finished. It is important to rest when you feel the need to do so and ask your family and friends to help when they can. Gradually, you will get back to normal activities.

If you develop any of the following symptoms, please let your cancer doctor, therapeutic radiographer or nurse know, or contact your GP:

• Severe headaches
• Changes in your eyesight
• Fits or seizures
• Vomiting
• Weakness in limbs or difficulty walking

Possible long-term side effects

It is possible for some side effects to occur months or years after the treatment has finished. Some patients may notice short-term memory loss and other late effects will depend on the part of the brain treated. Your cancer doctor will discuss any possible late effects with you.

You will receive a follow-up appointment to see your cancer doctor at a clinic close to your home, usually 4-6 weeks after treatment has finished. This appointment will be sent through the post at the end of your treatment.

At this appointment, the cancer doctor will discuss how you have been since your treatment and will often arrange for you to have a follow-up scan. If you are worried about anything you feel may be related to the tumour or the treatment, please contact us and, if necessary, we can arrange an earlier follow-up appointment for you. 

It can take many months before you feel you have recovered from the treatment side effects. If you are feeling low or experience mood swings, it may be useful to speak to your GP or cancer doctor. Some patients find it useful to have the support of others who have experience of cancer by attending local support groups. Contact your local Cancer Information and Support Centre for more details. 

The Clatterbridge Cancer Centre NHS Foundation Trust

www.clatterbridgecc.nhs.uk
Telephone: 0151 556 5000

• To contact The Clatterbridge Cancer Centre specialist neurological nurse, please ring 0151 556 5850 
• To contact the Mould Room, please ring 0151 318 8451
• To contact your treatment machine, please see your treatment appointment list for details.

Macmillan Cancer Support

Macmillan booklets about coping and living with cancer and treatment side effects are available free of charge. These can be ordered by telephoning 0808 808 00 00 or by visiting a Cancer Information Centre (sited in the main entrance of Clatterbridge Cancer Centre - Liverpool).

Macmillan Cancer Support

www.macmillan.org.uk

Telephone 0808 808 00 00

Cancer Information and Support at: Clatterbridge Cancer Centre – Liverpool, Tel: 0151 318 8805