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This page has been written for patients who are having a single fraction (one treatment) total body irradiation (TBI) for a relapsed haematological cancer, or a benign (non-cancerous) blood disorder such as sickle cell anaemia, aplastic anaemia, thalassaemia or some other condition.
You are having radiotherapy as part of your treatment regimen for a bone marrow transplant (BMT). This page explains the side effects you may experience during and after treatment, and how best to cope with them. We understand that this is a worrying time for patients and their families. We hope this page answers any questions you have. If you still have any questions or concerns, please ask. We are here to help.
We want to involve you in all the decisions about your care and treatment. If you decide to go ahead with treatment, by law, we must ask for your consent and will ask you to sign a consent form. This confirms that you agree to having the procedure and understand what it involves.
Staff will explain all the risks, benefits, and possible alternatives before they ask you to sign a consent form. If you are unsure about any aspect of your proposed treatment, please do not hesitate to speak to the team looking after you.
During your time with us we aim to provide the highest standards of care and support you in your decisions regarding your treatment. We will respect your dignity, individuality, and personal preferences.
Your care will be managed and given by therapeutic radiographers, doctors, and nurses. You will meet both male and female healthcare professionals during your treatment. If you have any concerns about this, please talk to the radiographers about it. We try to be sensitive to your needs, so please do not hesitate to discuss things with the team caring for you.
Radiotherapy appointments
All take place in the Radiotherapy Department, basement floor, main UCH hospital building.
TBI is used as part of the regime for high dose treatment to prepare the body for a bone marrow transplant. The radiotherapy is used to:
- Help get rid of the existing bone marrow to make space for the transplanted cells to grow.
- Lower your immune system to reduce the chance of your body rejecting the transplanted cells.
Radiotherapy is the specialised treatment of cancer (and some other diseases) using high energy radiation beams. These can either be photons (also called
x-rays), electrons or protons. Photons and electrons are delivered from a machine called a linear accelerator whilst protons are delivered from a machine called a cyclotron.
University College Hospital Trust is one of two NHS proton beam therapy (PBT) centres in the UK, alongside The Christie in Manchester. Proton beam therapy (PBT) is an advanced form of radiotherapy. However, it is not appropriate to treat all tumours with proton beam therapy. The most appropriate treatment for you will be decided by your clinical oncologist and discussed with you.
Radiotherapy does not hurt, and it will not make you radioactive. You are completely safe to be around partners, family, friends, and pregnant women. You will feel nothing from the treatment and the machine will not touch you. The most important thing is that you lie very still for treatment.
Before TBI, your treatment must be carefully planned. Your first visit will be to the radiotherapy planning pre-treatment department for a TBI planning CT scan. This involves the radiographers positioning you in the most comfortable but practical treatment position.
The treatment position will involve you lying on your back with your arms positioned across your chest. Support pads will be placed under your knees. The staff will take several measurements and then perform the CT scan. No special preparation is required for the scan. Once the scan is complete the radiographers will mark two specific points on your pelvis. These are alignment marks to ensure each treatment is accurate. The marks are permanent and are done by placing ink on the skin and then gently scratching the surface of your skin with a fine needle. The whole planning process takes about 30 minutes.
The date for the single treatment TBI will be coordinated and booked between radiotherapy and your haematology team. Your named nurse, or the ward, will be given the date and time for you to attend for treatment. You will be given anti-sickness medication to take approximately 30 minutes before treatment.
Treatment involves you lying on a special couch, in the same position as when you attended for the TBI measurements. There will be radiographers in the treatment room checking the measurements to ensure you are in the correct position. All that we ask is that you remain still and let the staff move you.
Once you are in the right position, bags of Vaseline® are placed over your feet, between your ankles and knees, and over your neck. These bags are to ensure the radiation treatment is evenly distributed throughout your body.
Special measuring devices will be attached to various parts of your body (over your clothes) with tape, for each treatment. These small devices monitor the dose you receive throughout your treatment. After checking you are comfortable, the staff will leave the treatment room.
Treatment is delivered to each side of your body. Once one side of your body has been treated, the radiographers and physicists will rotate the couch 180° and treat the other side. You will not feel anything during treatment, and the radiation will not hurt. You will only hear a buzzing noise when the machine switches on. The radiographers are watching you all the time on closed circuit television monitors, and members of your family can speak to you via an intercom system.
If you are uncomfortable or feel distressed at any time, treatment can be interrupted, and the radiographers will enter the room to resolve any problems. The entire procedure, including setting up and treatment will take two to three hours. The treatment beam is usually on for 40-50 minutes of this total time.
During treatment we recommend that you wear light, loose clothing, such as T-shirts, shorts, or track suit bottoms. Any clothes with metal fasteners must be removed. Jewellery, watches, and glasses will also have to be removed.
Online music is available in the treatment room, and you can choose which music you would like to listen to during treatment.
Your clinical oncologist will discuss with you how the TBI will affect you in more detail. However, there will still be plenty of opportunity to talk about anything that you feel needs further discussion.
There are side effects that start during treatment. They gradually get worse during treatment and for a couple of weeks afterwards and then get better after several weeks. Late effects can develop months or years after treatment has ended. The main side effects that occur after single fraction TBI are:
Skin changes
During treatment there will be no skin reaction. For a few days after treatment, you may notice that your skin may redden or darken, depending on your skin colour. You may get some dry peeling of the skin which may become itchy.
During treatment we advise that you wash normally using warm water and the soap products you would normally use. Gently pat the skin dry with a soft towel.
Radiotherapy skin reactions cannot be prevented, but to minimise any skin irritation we recommend using a moisturiser of your choice. Use the moisturiser frequently and gently smooth it on to your skin until it is absorbed.
Feeling sick
TBI can make you feel sick. You will be given anti-sickness medication to take before treatment, so this is not usually a problem. However, if you are still feeling sick it is important to inform the team, so that you can be given more medication.
Parotitis (swelling of the salivary glands)
The salivary glands often swell up soon after the treatment starts. This can be uncomfortable but can be controlled with mild painkillers.
Diarrhoea
Diarrhoea often occurs 10 –14 days after the treatment starts. Medicines and fluids can be given to help this. It may last for a week or two.
Hair loss
Many patients may have already experienced total body hair loss due to chemotherapy. If you have a full head of hair prior to the TBI, there will be some hair loss about the third week after treatment. The hair usually starts to grow back about three months after treatment.
You may wash your hair gently, using warm water and shampoo. When drying, use a soft towel and gently pat the scalp dry. You may also use a hair dryer on a cool setting or leave the hair to dry naturally. Brush and comb your hair gently using a soft brush or a wide rounded-toothed comb.
Tiredness
Tiredness is a very common side effect of treatment. You may feel more tired and have less energy than usual, both during and after treatment. Do not worry, this is normal. The tiredness is usually at its worst near the end of treatment and for several weeks afterwards. Do as much as you feel you can and rest when you need to. However, gentle exercise has been found to improve energy levels in patients. Please talk to your clinical team if you are struggling with tiredness. They can refer you to physiotherapy and occupational therapy for practical tips and advice.
At your first treatment appointment the radiographers will discuss the treatment with you and explain any possible side effects you may experience. They will ask how you are and how you are feeling.
Late side effects incurred during treatment can appear to develop months or years after radiotherapy has finished. They are the hardest to predict and, unfortunately, when they do occur, they are permanent.
Cataracts
The development of mistiness of the lenses of the eye can occur because of unavoidable radiation to the eye. Cataracts usually develops three to four years after treatment. In many cases this will not have an effect on your vision. However, if cataracts form, they can be removed by a simple surgical procedure.
Fertility
Single fraction TBI treatment can increase the risk of early menopause in females. It can also increase the risk of infertility in males and females. Your BMT team and the radiotherapy doctors will discuss these issues with you.
Second malignancy
Very rarely, patients who have received TBI treatment may develop a secondary tumour some years later. The radiotherapy doctors will discuss this risk with you.
All the staff are here to make sure your treatment goes as smoothly as possible and to support you through this difficult period. We will try to help you with any questions or problems you may have.
Radiotherapy Reception
Radiotherapy Review Team (via Radiotherapy Reception)
Out of hours oncology advice number (available 24 hours)
Mobile: 07947 959020
If you have any concerns that you would like to discuss in confidence, please contact our PALS (Patient Advice and Liaison Service) for information and advice.
Leukaemia Care
Blood Cancer UK
Young Lives vs Cancer (formerly CLIC Sargent)
w: www.
Macmillan Cancer Support
e: cancerline
Cancer Research UK
Maggie’s
Live Though This (LGBTIQ+ Cancer Support)
Carers UK
NHS Choices
w: www.
UCLH cannot accept responsibility for information provided by other organisations.
Services
Page last updated: 18 June 2024
Review due: 01 June 2026