Radiotherapy for brain tumours
Radiotherapy treats cancer cells by using high-energy rays to destroy the cancer cells while doing as little harm as possible to normal cells. It's usually given using beams delivered from outside the body (external radiotherapy).
Radiotherapy may be the main treatment if the brain tumour can’t be removed with surgery. It’s also often used after surgery to treat any cancer cells that may have been left behind, and can sometimes be used if the tumour has come back after surgery. Radiotherapy may sometimes be given along with chemotherapy tablets to some people with high-grade gliomas.
Radiotherapy is given in the hospital radiotherapy department as a series of short, daily sessions from Monday-Friday, with a rest at the weekend. The length of your treatment will depend on the type and size of brain tumour, but it is usually 2-6 weeks. Some people will have different treatment plans and may have treatment on only three days a week. Your doctor will discuss your treatment plan with you beforehand.
You may need to wear a mask when having radiotherapy.
This covers the whole of your face and the front of your head. This mask or shell is usually made from perspex (a type of plastic) or from a type of mesh plastic, which is moulded to fit the shape of your face.
A radiotherapy mask keeps your head as still as possible during treatment. This makes sure that exactly the right area is treated. Your mask will be made before your treatment is planned.
It allows you to see and breathe normally, but it may make some people feel claustrophobic. You will only have it on for a few minutes at a time and most people soon get used to wearing it.
For some high-grade tumours, a smaller dose of radiotherapy is given to the whole head. In this case, a mask isn’t needed to help pinpoint the treatment, but is still used to help keep you still for your treatment.
Planning your treatment
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Radiotherapy has to be carefully planned to make sure it’s as effective as possible. It is planned by a cancer specialist (clinical oncologist) and it may take a few visits. On your first visit to the radiotherapy department, you’ll be asked to have a CT scan or lie under a machine called a simulator, which takes x-rays of the area to be treated.
Marks are usually drawn on your radiotherapy mask to help the radiographer (who gives you your treatment) position you accurately and to show where the rays will be directed. These marks must stay visible throughout your treatment. Because the marks are drawn on your mask, you shouldn’t need to have any marks drawn on your skin. It’s also unlikely that permanent marks on your skin (tattoos) will be needed.
However, if permanent marks are needed they’re extremely small and will only be done with your permission. It may be a little uncomfortable while they are done.
Before each session of radiotherapy the radiographer will position you carefully on the couch using the mask, and make sure you’re as comfortable as possible.
During your treatment, which will only take a few minutes, you’ll be left alone in the room but you can indicate to the radiographer, who will watch you carefully from the next room. Radiotherapy is not painful but you do have to be still for a few minutes during treatment.
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Conformal radiotherapy uses the same radiotherapy machine as normal radiotherapy treatment. However, inside the machine is a device called a multi-leaf collimator, which allows the beam of radiation to be shaped very precisely so that it ‘conforms’ to the area of the cancer. As a result, the healthy surrounding cells and nearby structures receive a lower dose of radiation, so the possibility of side effects is reduced.
Intensity modulated radiotherapy (IMRT)
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High-resolution intensity-modulated radiotherapy, which is sometimes called three-dimensional IMRT (3D IMRT) also uses a multi-leaf collimator. During this treatment, parts of the multi-leaf collimator are moved while the treatment is given. This enables the treatment beams to be shaped very precisely and allows the dose of radiotherapy to be altered in different parts of the treatment area. Again, the aim is to reduce the side effects of treatment. It’s not suitable for all people with a brain tumour. Your specialist will be able to tell you more about this.
Stereotactic radiotherapy and radiosurgery
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These types of radiotherapy enable doctors to direct radiation more accurately at small brain tumours. The aim is to deliver higher doses of radiotherapy to the tumour, while doing as little harm as possible to surrounding brain tissue, and to minimise the side effects of treatment. These treatments are sometimes given after standard external radiotherapy or to treat small tumours that can’t be removed with surgery.
This type of radiotherapy uses a standard radiotherapy machine that has been adapted. The machine gives concentrated beams of radiation from several different angles, which overlap at the brain tumour. This is done either by moving the machine during treatment or by aiming individual beams from a number of different directions.
The radiotherapy dose to the tumour is very high and the dose to surrounding healthy tissues is very low. Several doses are given. Before treatment, several scans of the brain are taken. These scans are then analysed by computers to ensure that the radiotherapy is precisely targeted to the brain tumour.
A special head frame will be fitted to you before you start the treatment. This frame helps to keep your head still while having the radiotherapy.
This treatment is only available in specialist hospitals and isn’t suitable for everyone with a brain tumour. You could ask your clinical oncologist whether it would be appropriate in your particular situation.
This is a type of stereotactic radiotherapy. It’s sometimes called gamma knife treatment, named after one of the machines that can be used to give this treatment. It can also be given from a standard radiotherapy machine that has been adapted, or from a machine called a cyberknife. Unlike stereotactic radiotherapy, stereotactic radiosurgery is given over one session, as a single-dose treatment, with the whole process taking about 4-5 hours.
It doesn’t use a knife but uses targeted beams of radiotherapy given from many different angles, which cross at the point of the tumour. You’ll have several scans and x-rays to find the precise area for the treatment to be given.
A special head frame will be made for you before you start treatment. This frame helps to keep your head still while having the radiosurgery.
Again, this treatment is only available in specialist hospitals and isn’t suitable for everyone with a brain tumour. It may be helpful to discuss with your clinical oncologist whether it’s a suitable treatment for you.
Side effects of radiotherapy to the head
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Side effects can be mild or more troublesome depending on the amount of radiotherapy given and the length of your treatment. Radiotherapy can cause side effects such as tiredness (fatigue), headaches, hair loss and feeling sick (nausea).
As radiotherapy often makes you feel tired, try to get as much rest as you can, especially if you have to travel a long way for treatment each day.
Our section on fatigue has helpful tips on ways of saving energy and dealing with tiredness, and includes a video of Denton sharing his story of coping with fatigue.
Some people develop headaches during the course of their radiotherapy. These can be controlled with painkillers and sometimes steroids, which will be prescribed by your doctor.
You will lose hair in the area being treated. Most hair loss is temporary but, unfortunately, it may be permanent for some people. It will depend on the dose of treatment you have had. Sometimes hair grows back with a slightly different colour and texture and perhaps not as thickly as before. It usually starts to grow back within 2–3 months of finishing treatment.
We have information that describes different ways of coping with hair loss as well as a video of Bengu talking about her experiences.
Some people develop a skin reaction, similar to sunburn, while having radiotherapy. This normally happens 3-4 weeks after the start of treatment. People with pale skin may find that the skin in the treatment area becomes itchy, or red and sore.
People with darker skin may find that their skin becomes darker and can have a blue or black tinge. The amount of the reaction depends on the area being treated and the individual person’s skin. Some people have no skin problems at all.
Your radiographers will be checking your skin but you should let them know if it feels sore. Staff at the radiotherapy department will be able to give you advice on skin care. As the skin is sensitive it’s best not to over-expose it to the sun or cold winds. Try wearing a soft cotton or silk scarf or hat to cover the area when you go outside.
Somnolence (feeling drowsy)
After finishing radiotherapy you may find that you generally slow down, have very little energy and feel much less active. This can happen about 4-8 weeks after treatment. You may also feel drowsy and spend more time sleeping. This gradually gets better over a few weeks.
Some people may feel sick but this can usually be treated effectively with anti-sickness drugs (anti-emetics), which your doctor can prescribe. You may also find that food tastes different and you may have a metallic taste in your mouth.
If you don’t feel like eating, you can try replacing meals with nutritious, high-calorie drinks. These are available from most chemists and can also be prescribed by your doctor.
We have more information and helpful tips on how to cope with different eating problems in our diet and cancer section.
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 getting worse. In fact it may be either a reaction to the radiotherapy treatment or because steroid treatment has been reduced or stopped.
If you find this happening it’s important to discuss it with your doctor or nurse, who’ll be able to provide the right treatment and support.
Modern ways of giving radiotherapy are designed to limit the chance of permanent side effects as much as possible, and very few people develop long-term problems. If you’re concerned about the risk of developing particular side effects from radiotherapy, it’s best to speak to your specialist before your treatment starts.
If a lot of the brain is treated with radiotherapy there’s a long-term risk of changes to your memory and ability to think clearly (intellectual impairment).
If the radiotherapy goes near your eyes there’s a risk of developing a cataract in the lens of the eye. This can make your vision cloudy, blurred or dim. Cataracts can usually be easily treated with a small operation. Radiotherapy treatment that includes the pituitary gland can affect hormone production, which can cause a variety of symptoms. If you notice any new symptoms you should discuss them with your doctor.
Radiotherapy can cause cancer, and a small number of people will develop a second cancer because of the treatment they’ve had. However, the risks of having radiotherapy are far outweighed by the benefits.
Long-term side effects can take months and sometimes years to develop.