Total Body Irradiation (TBI)
Total Body Irradiation
This leaflet will help you understand what will happen when you come to Velindre Cancer Centre to have Total Body Irradiation (TBI) radiotherapy treatment. It will explain how the treatment is given and the side effects that may be experienced. There are also contact numbers for more information and support.
Although this information is primarily for patients who are due to have TBI treatment, it can also be used by caregivers, family and friends to help gain a better understanding of the treatment.
Why this treatment?
Radiotherapy to the whole body is called total body irradiation or TBI.
Your doctor has decided that you would benefit from a course of Total Body Irradiation.
Total body irradiation is a radiotherapy treatment technique that is used to kill leukaemic cells and suppress the immune system before a bone marrow transplant. Without the treatment, your body’s natural immune response may reject the bone marrow transplant.
Who you will meet
Throughout your treatment, there are a range of health professionals that you are likely to encounter.
You will have an initial discussion with your doctor or clinical oncologist to discuss the treatment, gain an understanding of side effects, learn about the process and sign a consent form.
During the radiotherapy aspect of your treatment, you will meet a team of therapeutic radiographers and medical physicists who will be with you each day to get you ready for treatment. As Velindre Cancer Centre is a teaching hospital, it is likely that student radiographers and medical students are present.
As you’ll being staying on the ward at Velindre, you will also be cared for by nursing staff and health care assistants.
Before starting your radiotherapy
Before your radiotherapy treatment starts, you will visit Velindre Outpatients department. At this appointment you will meet your consultant or a member of their team. The doctor will explain your radiotherapy treatment and the possible side effects. You will then be asked to sign a consent form.
You will also meet members of the radiotherapy team who will explain the treatment process and take your measurements. The radiotherapy treatment is given to your whole body from head to toe, so we need to take measurements of your head, neck, shoulders, chest, waist, hips, knees, and ankles. Where possible, these measurements are done at your outpatient appointment the week before starting radiotherapy and are used to calculate the dose for your treatment.
Please ask any questions you may have about your treatment and stay at Velindre.
Starting your treatment
The night before your treatment begins, you will be brought to Velindre Cancer Centre from the University Hospital of Wales (UHW). You will be admitted to First Floor Ward. You may have six treatments of radiotherapy over three days. The first treatment will usually start on a Tuesday morning. Then you will have two treatments a day for three days. Treatments will be given at least six hours apart, one in the morning and one in the afternoon. When your last treatment has finished you will be taken back to the Transplant ward in the University Hospital of Wales (UHW).
During your stay at Velindre hospital we will take all necessary care to reduce the risk of infection. However, as you are having your treatment in the Radiotherapy Department, you are not in strict isolation at that point. There is no preparation you need to do before coming for your treatment.
During your treatment
When you arrive at the radiotherapy treatment room, we will ask you to undress to your underwear. If you would like to wear a bra, we would need you to wear a sports bra or a soft bra with no metal clasps. We will maintain your dignity at all times. You will lie on your back on a firm couch with a sponge under your head and a foam support under your knees. We will make sure you are as comfortable as possible as you will need to stay still for the whole treatment. There will be music playing in the background during your treatment and you can select a playlist or bring in a CD of your choice to listen to.
During your treatment we will tape small radiation measuring devices to different parts of your body so we can check that the radiation is given evenly through your body.
To get you in the right position, the room lights are dimmed, and the couch will be placed in the beam of light that comes from the treatment machine. This light shows where the radiation will go. A clear Perspex screen with flat brass pieces are placed beside the couch. We adjust the brass pieces, so they are beside your head and chest. This makes sure the dose to your head and lungs is adjusted to your specific measurements. The set-up may take 20 minutes for each side of your body.
When everything is set up correctly, the radiographers will leave the room to switch on the machine. We will then give the radiotherapy treatment to the first side of your body. When the machine is on you will hear a loud buzzing noise but will not feel or see anything. The radiographers will be monitoring you through the cameras. If you need anything, they can switch off the machine and come into the room to check you are ok. Treatment will restart when you are ready. It will take about ten minutes to give treatment to one side of your body. Once the first side of your body has been treated, the radiographers turn the couch around to treat the other side of your body. You will not need to move.
At the end of each treatment session, we remove the small measuring devices from your skin and give them to our medical physics team. They work out the radiation dose your body has received. This will be done at every treatment so the number and placement of the measuring devices may change.
The total time for each treatment may vary due to the time it takes to get you into the right position, but it will be approximately 1hr for each session so it may be best to use the toilet before entering the treatment room.
Side effects
The side effects of TBI (Total Body Irradiation) will affect your whole body. Your consultant will discuss the following possible side effects with you at your clinic appointment when you consent to treatment. This list is not exhaustive and side effects vary from person to person.
Short term side effects (can appear during or shortly after treatment but soon settle down) are:
· Dry mouth and sore throat (redness, pain, ulceration, dryness or taste changes)
· Swelling of your salivary glands at each side of your face for the first few days or so – you may notice puffiness.
· Mild redness and itchiness of your skin
· Nausea (feeling sick)
· Diarrhoea
· Losing your hair – this occurs after about two weeks, but the hair re-grows within a few months.
· Lethargy (tiredness)
· Urinating frequency – passing urine more often than normal
Long term side effects (may happen months or years after treatment) can be:
· Interstitial pneumonitis (lung complications due to inflammation and scarring). This is why we carefully measure the dose to your lungs during your treatment.
· Cataract (clouding of the lens) – the lens of the eye is very sensitive to radiation, and this can cause the early development of cataracts. This starts to develop 2 years or more after radiotherapy and is a lifelong risk. This is usually picked up and monitored by annual optician visits and easily treated by surgery.
· An underactive thyroid – the thyroid is a gland in the lower part of the neck which produces hormones (thyroxine) that help our bodies’ metabolism. It is sensitive to radiation and can gradually produce less thyroxine over time. Having an underactive thyroid can lead to a feeling of fatigue and weight gain. This can occur from two to three years after radiotherapy and is a lifelong risk. This is monitored by annual blood tests and can be treated with a replacement thyroxine tablet.
· Reduced spleen function – increased risk of infections
· Infertility – this can be a permanent side effect of chemotherapy and radiotherapy.
· Early menopause
· Low testosterone levels
· Due to this treatment (TBI), a new cancer may develop. This is very rare and affects only about 2% of patients having TBI treatment but the risk of cancer for all of us goes up with age and we recommend that you participate in the usual NHS screening programmes.
If you are a women, aged ≤35 years old and having TBI radiotherapy, you have a higher risk of breast cancer. If this applies to you, you will be enrolled in a breast screening programme. This will start 8 years after radiotherapy, or at age 25 years, whichever is later. Your oncologist will discuss this with you.
Further information
We hope this leaflet has been useful. If you, or your family, have any other questions or worries then please contact:
Information, support, and review radiographers: 029 2061 5888 ext. 6421. A specialist team available to advise you on treatment side effects, practical and emotional concerns
First Floor Ward: 029 2061 5888 ext. 4368.
Radiotherapy Reception: 029 2061 588 ext. 6343.
Velindre Outpatients Reception: 029 2061 588 ext. 6225
Supportive Care Team at Velindre Cancer Centre
Any information on:
Benefits and Welfare rights: 02920 316277
For support groups, carers and family support, befriending services, spiritual care, help in your area and talking to children: 02920 196132
Helplines and websites
Macmillan cancer support
Helpline: 0808 808 0000 9am – 8pm, Monday-Friday Website: www.macmillan.org.uk
Maggie’s Cardiff
Helpline: 02922408024 Website: www.maggie’s.org/southeastwales
F.PI 2 Issue 8 January 2024