Whole brain radiotherapy (WBRT) to secondary brain tumours

You may find it useful to read our booklet called ‘Radiotherapy’.

If you use walking aids, wheelchairs etc. bring them with you, if possible, when you attend. When you arrive, if you require assistance or need a wheelchair, please ask at the reception desk in the front entrance.

The first appointment is at the pre-treatment department, called Planning, at Clatterbridge Cancer Centre - either Liverpool or Wirral. At this appointment we would like to make a device called a cast (or mould) followed by a CT scan of your head. We will mark the cast with reference marks in preparation for treatment. Planning takes about 20-30 minutes. 

The making of the cast, planning and treatment occurs while you are lying down and awake.
Each cast is individually made to ensure it fits well and is comfortable. Its purpose is to help you to stay still and to place the treatment marks onto it, rather than your skin. The cast made at planning is used again for each treatment. 

The cast starts as a flat sheet of plastic attached to a frame. It is first placed in a warm water bath where the plastic sheet becomes soft and flexible. Then it is placed over and onto your face and head; it feels like a warm, wet flannel. Using our fingers and gentle pressure, we mould the plastic sheet to your shape, which can feel a little strange, but is painless. The plastic cools and sets in approximately 10 minutes and is ready to use straight away. Usually, the cast will be made on the scanner bed and a very quick planning scan follows immediately after the making of the cast.

Following an assessment of your needs and the technical details of the treatment, we will confirm the date you will start your radiotherapy. The majority of people will start radiotherapy a few days later and we will give you a printed list of your appointments.

Those starting the same day should expect to be at the hospital for a few hours, so please bring your medication with you. You should eat and drink normally before you attend and while you are waiting. If you live locally and have brought yourself, rather than using hospital transport, for the appointment, you can choose to go home and return later in the day if you wish.

Depending on suitability, your treatment will be at one of our three sites - Clatterbridge Cancer Centre in Liverpool, Wirral or Aintree. Your preferred site can be discussed with your radiotherapy team but cannot be guaranteed.   

The treatment procedure is in the same position as the planning scan and takes around 10 - 20 minutes in total. It is painless and you should breathe normally throughout. 
 

The usual pattern for the development of the temporary (acute) side effects is to gradually start 5-10 days after the first treatment. They usually persist and worsen, the effects being most troublesome about 10 days after the last radiotherapy treatment. The side effects usually settle over the following 2-3 weeks. You will be reviewed during treatment and given medicines and advice to help you manage these effects.  

You are not made radioactive as a result of the treatment, and following treatment you are safe to mix with others including children and pregnant women.

Tiredness

This is an expected side effect of radiotherapy treatment, especially if you have a long distance to travel. Receiving radiotherapy to the brain can be particularly tiring. Tiredness may persist for a number of weeks, but usually it slowly improves. To help with this it is a good idea to keep activity to a manageable level and plan rest breaks into your routine.

Sickness and headache

Some people will develop these symptoms as a result of their treatment, which can cause slight temporary swelling of the brain tissues. Your doctor or radiographer may prescribe some medication (steroids) to prevent this.  If you develop these symptoms during treatment, please let us know as soon as possible.

Drowsiness (somnolence) 

This may occur after the treatment has ended. It is usually mild. This period of tiredness sometimes gets worse around 4-6 weeks after treatment and will then gradually improve.

Skin reaction, hair loss and wigs

The areas of skin within the treatment field may become inflamed (sore) as a result of treatment, with the area around the ears, the back of the neck and forehead being most troublesome. The skin reaction is likely to start about 10 days after the first treatment, with the peak of any discomfort about 10 days after it is completed.

You can help yourself by:

• Washing your hair/scalp very gently using a baby shampoo  
• Use warm/cool water 
• Gently drying with a soft towel, and take care to avoid the scalp when using a hair drier
• Protecting your head/scalp from the weather; both to cold wind and to bright sunlight during and for several months after your treatment has finished – wearing a hat is advisable
• Using any creams we give you and avoid using other hair products throughout your treatment and afterwards until your skin soreness has settled 

With WBRT, the whole scalp is treated resulting in temporary hair loss. Hair loss usually starts 2 weeks or so after starting radiotherapy. It usually starts to grow again three to six months after finishing your treatment, but may be thinner.

For the vast majority of people, it is possible to place the treatment fields in such a way to avoid treating the eyebrows.

Some people choose to wear a wig. Please visit the Macmillan Cancer Information and Support Centres in our centres for more information.

Memory loss   

It is recognised that some people who have WBRT may notice their memory isn’t as good as it was. There are a number of factors which can contribute to this and it varies from person to person. If it is troublesome, referral to an occupational therapist can help you find ways to cope. Your treatment team can organise a referral for you if needed.

Most people will be seen in the Oncology clinic a few weeks after finishing their radiotherapy. This appointment is likely to be at your local hospital.  

Alternatively, if you have contact with other teams for ongoing supportive care, e.g. District Nurse/Macmillan team staff that visit you at home, please consider contacting them and/or your GP if you have any concerns.

Macmillan booklets about ‘Coping and Living with Cancer’ and ‘Treatment Side Effects’ are available free of charge. These can be ordered by telephoning 0800 808 0000 or by visiting a Macmillan Information Centre (sited in the main entrance of Clatterbridge Cancer Centre - Liverpool, Wirral and Aintree).

We have specialist radiographers and nurses available to give additional information, advice and support to patients (and carers), if required. Please ask your team during treatment or call the Clatterbridge Cancer Centre hotline if treatment is complete.

If you have secondary brain cancer, you may be entitled to certain disability benefits, e.g. Personal Independence Payment, if you are under pension age or Attendance Allowance, if you are over pension age. We have a Macmillan Information and Support Centre who can refer you to the benefits service for advice regarding entitlement to ensure that you do not miss out on financial support.  Please ask a health care professional looking after you to make the referral on your behalf or visit the centre.  There are other sources of benefits advice, e.g. Macmillan Cancer Support telephone helpline on 0808 808 0000, your local Citizens Advice Bureau, local council advice service or other advice agencies.