Radiotherapy is used to destroy cancer cells using high energy rays while damaging normal tissues as little as possible. It is not a common leukaemia treatment but may be used in the following ways.
Cranial radiotherapy in ALL
Radiotherapy may be given to the heads of people with acute lymphoblastic leukaemia (ALL), to prevent the spread of leukaemic cells to the brain. This is because most chemotherapy doesn't reach the brain. The only way of getting chemotherapy to the brain is to inject it into the spine (intrathecal chemotherapy) (see ‘Chemotherapy and how it is given’), and some people have this instead of, or as well as, cranial radiotherapy.
The number of doses of cranial radiotherapy varies between individuals. Kerry said she had two sessions a week for four weeks. Elaine had it on three days only. Each session lasts only a few minutes and is painless. A clear Perspex mould may be fitted over the head to hold it still, while the radiotherapy is given.
Kerry had cranial radiotherapy to prevent spread of leukaemia to the brain; it wasn't as bad as it sounds and she found it quite relaxing.
Kerry had cranial radiotherapy to prevent spread of leukaemia to the brain; it wasn't as bad as it sounds and she found it quite relaxing.
Age at interview: 32
Sex: Female
Age at diagnosis: 28
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Why did you need radiotherapy on your head?
Because with leukaemia it’s in the fluid that goes around your brain. Any medicines that you have specifically for disease, like chemotherapy, stop at your brain because it will kill your brain, if you have medicines and it goes up and around your brain, the radiotherapy was to treat it around the brain because leukaemia is notorious, if it comes back it can enter the brain, so obviously to stop that, kill the cells off by using radiotherapy.
So did they say you had got it in your brain?
No. It was clear but it was preventative for me. So that was quite lucky.
Then you had to wear a mask.
Yeah.
Tell me about the mask.
Yeah. It was a clear mask and you had to lie on the bed flat and you had to be strapped to the bed with the mask. I mean it sounds horrendous but it wasn’t actually that bad. The mask is see-through, it’s completely clear and you’re only there for a matter of ten minutes. And I found it quite relaxing, so long as you just relax and just think it’s going to be over in a minute that’s fine.
So which bit of your head was the mask shielding? Was it your face?
It’s not a shield, it’s to hold your head still.
Ah
So when the radiotherapy goes into the brain it’s in the specific spot they want it to.
Frances initially found cranial radiotherapy distressing because the mask made her feel claustrophobic, but found it less scary as she gradually got used to it.
Frances initially found cranial radiotherapy distressing because the mask made her feel claustrophobic, but found it less scary as she gradually got used to it.
Age at interview: 45
Sex: Female
Age at diagnosis: 42
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And then almost like immediately after that I then had radiotherapy. And I found the radiotherapy quite distressing mainly because I had to have a plastic mask fitted over my face, and I can get quite claustrophobic anyway, so even just getting the mould done I found quite difficult. And the first day they fitted the mask on to the machine for the radiotherapy, that was just horrible. But I have to say I got used to it very, very quickly. They promised me chocolate, so I’ll do anything for chocolate. So after the first few times it was fine. You knew what to expect and it certainly wasn’t anywhere near as scary. But during that time I was very sick.
Cranial radiotherapy causes side effects such as hair loss, nausea and vomiting, and tiredness (see ‘Unwanted effects of treatment’).
Total body irradiation (TBI)
Radiotherapy may be given to the whole body as part of preparation for a stem cell or bone marrow transplant (see ‘Stem cell or bone marrow transplants’). TBI involved attending the radiotherapy department twice a day for 3, 4 or 5 days. People had to sit, stand or lie in a certain position and remain still while receiving the radiotherapy. Although it was quick and painless the experience could be unsettling or nerve-racking. Some people had to travel to a different part of the hospital for the radiotherapy and found the commute tiring. Aley walked despite being offered a wheelchair. Some went to a different hospital for TBI and were given a bed there. Ian’s wife stayed at the hospital with him as it was quite a distance from where they lived.
Elaine's total body irradiation was painless but the twice-daily commute to the radiotherapy unit was tiring.
Elaine's total body irradiation was painless but the twice-daily commute to the radiotherapy unit was tiring.
Age at interview: 39
Sex: Female
Age at diagnosis: 35
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What was it like having the total body irradiation?
Didn’t feel anything basically. Just lying on a table in a certain position, your arm up for ten minutes one side and then they come in, turned the table round, ten minutes the other side. That was it. Twice a day. At the beginning the Monday, Tuesday was okay but by Wednesday I was starting to feel tired because I was having go half eight in the morning and half three in the afternoon to the cancer unit for the radiation. And I was getting really tired by the end of it. Feeling very sick as well. Having to wear a mask to go from the hospital to the cancer unit. They had a taxi for me but I had to wear a mask over my face and it just made me feel even more sick. I don’t know why. But yeah, just really, really tired. It was like an effort actually to get out of my bed and get ready.
Julie describes having total body irradiation. It was painless, but she felt like a caged animal and found the room cold.
Julie describes having total body irradiation. It was painless, but she felt like a caged animal and found the room cold.
Age at interview: 38
Sex: Female
Age at diagnosis: 27
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And then I had to go down to the radiotherapy unit and this was the most painless thing that they did to me. But I remember laying there sobbing. I felt I was like a caged in animal. Obviously they said the only way they could explain it to me was, ‘The thickest part of your body is your head. So with radiotherapy we need to make everything the same thickness’. So they laid me down on this slab and I just felt like as a caged animal. They put foam around my neck, underneath my arms, across my waist, underneath my legs. All I had on was my underwear and this sheet over me and so my body was the same thickness all the way down, and there I was in this room and it was so cold. I just remember laying on the bed with my arms flat, staring up at the ceiling and shivering with cold. And the tears were just streaming down my face because I just felt so caged in. And I had to lay perfectly still and I could see these, out of the corner of my eye I could see these red rays going all over the place and they called it TBI, total body irradiation.
And I had to do that along with the chemotherapy twice a day, could have been three times a day, every day. And it was the most painless thing they did to me, but the most awful thing because of the way it was.
Last reviewed: December 2018.
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