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CANCER - The Brain - Radiotherapy

External beam radiotherapy
The conventional type is external beam radiotherapy, which uses high energy rays to destroy the cancer cells while doing as little harm as possible to normal brain cells. Radiotherapy is given in the hospital radiotherapy department and the course is usually in daily sessions from Monday to Friday with a rest at the weekend. The length of the course, depending on the type and size of the brain tumour, is usually four to six weeks. You may need to make a number of visits to the radiotherapy department for your treatment to be planned.

You may need to wear a see-through plastic mask (sometimes called a shell or mould) during your treatment. This is made for you before you start treatment. It allows you to breathe normally and to see, but keeps your head completely still while the treatment is given. It helps the radiographer aim the rays most accurately at the tumour. This also means that the positioning marks can be drawn onto the mask rather than your skin. The mould may feel strange at first.

For secondary brain tumours, a smaller dose of radiotherapy is given to the whole head, so such extremely careful planning may not be needed.

During your treatment, which only takes a few minutes, you will be left alone in the room but you will be able to talk to the radiographer who will be carefully watching you from the next-door room. Radiotherapy is not painful, but you do have to be still for a few minutes while your treatment is being given.

Stereotactic radiotherapy
This type of radiotherapy enables doctors to give higher doses of radiation very accurately directly to brain tumours. It is sometimes also referred to as stereotactic multiple arc radiotherapy (SMART). The therapy is given using a linear accelerator. The machine gives concentrated beams of radiation to the brain tumour from several different angles. This is done to treat the cancer cells while doing as little damage as possible to the rest of the brain. This type of treatment is sometimes given after the standard external beam radiotherapy described above.

While you are receiving this treatment you may need to wear a frame to prevent your head moving during the scan and the treatment. The planning for this type of treatment takes about a week as staff have to ensure that the frame fits correctly. In one type of stereotactic radiotherapy, for example, you would need to have a dental impression, an X-ray and a CT scan with the frame on, to ensure the frame was positioned accurately so that the dose of radiation would be given to precisely the correct area. Apart from this you would only need wear the frame while you were receiving the therapy.

There is a lot of research going on into different ways of giving radiotherapy, for example, hyperfractionated radiotherapy- a smaller dose of radiotherapy given several times a day.

Interstitial radiotherapy
This type of radiotherapy is also referred to as brachytherapy. With this type of radiotherapy radioactive seeds (which are contained within a very fine hollow tube) or fine needles or wires carrying the radioactive substance are inserted into the tumour. This is done to ensure the dose of radiotherapy is delivered directly to the cancer without causing any problems to the surrounding tissue area. These types of implants are inserted in the operating theatre under a general anaesthetic. After a few days the implants are removed.

Standard radiotherapy does not make you radioactive and it is perfectly safe for you to be with other people, including children, throughout your treatment.

Side effects of radiotherapy
Radiotherapy to the head produces very few specific side effects. Occasionally there may be feelings of sickness (nausea) but this is very easy to treat. Most people feel tired during and after radiotherapy. It is best to try and get as much rest as you can, especially if you have to travel a long way for treatment every day.

The main side effect is hair loss in the treatment area. When the treatment has finished your hair may not grow back. Sometimes it grows back with a slightly different colour and texture, and perhaps not as thickly as before. The time it takes to grow back depends on the dose of radiotherapy you have received and the length of treatment. 

The scalp and skin in the treated area becomes red and dry and may feel tender during radiotherapy. Advice about skin care may vary from one hospital to another. Some departments will tell you not to wash the treatment area at all, for the time that you are having treatment. Others will advise you to use only tepid water to wash the area, and then to dry it by patting gently with a soft towel. You should check with the radiotherapy staff supervising your treatment about skin care, and shaving if relevant.

Because the skin is sensitive it is best not to over-expose it to the sun or cold winds. You may find it comfortable to cover the area with a soft scarf or hat made of natural fibres.

While you are having radiotherapy it is important to drink enough fluids and maintain a healthy diet. You may find that things taste different. If you don't feel like eating you could try supplementing your meals with high calorie drinks, which you can buy from most chemists. If there is a dietician at the hospital, he or she can offer helpful advice. If you feel sick, your doctor can prescribe anti-sickness tablets which can help.

Some people find the symptoms of the brain tumour temporarily get worse after the treatment has finished. This can make them think their tumour is progressing, but in fact it is a reaction to the radiotherapy treatment. If you find this happening to you it is very important to discuss it with your doctor or nurse, who will be able to provide the right treatment and medical support.

A rare side effect which can occur after the radiotherapy has finished is that the person may feel extremely sleepy and irritable for days on end. This can be very worrying. It usually passes within a couple of weeks, but you can feel tired for 6-8 weeks. This is often referred to as somnolence.