Your doctor has recommended that you have highly conformal radiotherapy for metastatic disease in your brain. This information page has been written to help answer some of the questions you may have about brain metastases, and their treatment with this specialised radiotherapy technique.
We understand this is a worrying time for patients and their families, and we hope this booklet can help to answer any questions you have. If you have any questions about the treatment or information in this booklet, please speak to the team looking after you. 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 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.
A metastasis, often referred to as a secondary, is a small tumour formed from cancer cells that have travelled through the blood steam from a tumour in another part of the body.
Usually, the site of the primary tumour is already known but sometimes metastases in the brain can cause problems before a tumour elsewhere is identified.
The treatment recommended for you depends upon the following factors:
- Your primary cancer diagnosis.
- The extent of your primary cancer.
- Any other cancer treatments that are planned for you.
- The number and size of your metastases.
- How fit and well you are.
Brain metastases can be treated by surgery, whole brain radiotherapy, highly focused fractionated radiotherapy, single fraction radiotherapy (often called radiosurgery) or a combination of these treatments.
If a metastasis is not lying deep in the brain and is easily accessible, it may be possible to remove it with surgery. This involves an open neurosurgical operation where as much of the tumour as possible is taken out.
Radiotherapy is the use of high-energy x-rays to treat disease. X-ray beams delivered from outside the body (external beam radiotherapy). It is the most common treatment for brain metastases. Radiotherapy may be also offered after surgery: either if the metastasis has not been removed entirely or if it has re-grown after complete removal.
The treatment recommended for you depends upon the following factors:
- Your primary cancer diagnosis.
- The extent of your primary cancer.
- Any other cancer treatments that are planned for you.
- The number and size of your metastases.
- How fit and well you are.
Brain metastases can be treated by surgery, whole brain radiotherapy, highly focused fractionated radiotherapy, single fraction radiotherapy (often called radiosurgery) or a combination of these treatments.
If a metastasis is not lying deep in the brain and is easily accessible, it may be possible to remove it with surgery. This involves an open neurosurgical operation where as much of the tumour as possible is taken out.
Radiotherapy is the use of high-energy x-rays to treat disease. X-ray beams delivered from outside the body (external beam radiotherapy). It is the most common treatment for brain metastases. Radiotherapy may be also offered after surgery: either if the metastasis has not been removed entirely or if it has re-grown after complete removal.
Whole brain radiotherapy is a course of five daily treatments over one week. If it is suggested as a suitable treatment for you, you will be given an information sheet explaining the details. Fractionated or single fraction radiotherapy can be delivered with different radiotherapy machines called a Linac (Linear Accelerator), Gamma Knife or Cyberknife. At UCH, we specialise in Linac based radiotherapy also called highly conformal radiotherapy.
Highly conformal radiotherapy is a highly accurate way of giving localised radiation treatment to the brain. Radiation is beamed at the tumour with one or more arcs (beams coming from different angles). Single fraction highly conformal radiotherapy (often called radiosurgery) is used to treat single small and, in selected patients, multiple small brain metastases or to irradiate the site where the surgeon has removed the brain metastases (surgical bed). The treatment is delivered in one single session (fraction) of radiotherapy.
Fractionated highly conformal radiotherapy is used to treat single large metastases and, in selected patients, to re-irradiate brain metastases already treated with radiotherapy. The treatment is delivered in five sessions (fractions) of radiotherapy over one week.
In both cases, the purpose of the treatment is to control the metastases and stop them from growing. As a result, hopefully your symptoms should improve.
Before beginning radiotherapy, your treatment must be carefully planned. To ensure your treatment is accurate, you will have a personalised immobilisation mask made of your head and neck. You will wear the mask each day during your treatment. The mask has three purposes:
- To help you keep still during your treatment.
- To ensure you are in the same position each day for treatment.
- To prevent having to draw treatment marks on you, as they are drawn on the mask.
To make the mask, a thermo-plastic material is used which is hard when dry and is heated to allow it to soften. This is placed over your head and shoulders and held in position, for twelve minutes, until it begins to harden. After your mask is made you will have a radiotherapy CT planning scan to gain information of the area to be treated whilst you are lying in the treatment position.
When it is time for your scan the radiographers will take you in to the CT scanner room. The radiographers are there to explain the procedure and to answer any questions you may have. You will be asked to change into a hospital gown and remove all clothing down to your waist. The radiographers will ask you to lie on the CT couch.
You will be positioned on the CT couch lying on your back wearing your mask. The radiographers will mark lines on your mask. These will be used to ensure you are in the correct position each day for your treatment. The scan will take approximately 5-10 minutes.
You may have some dye (also called contrast agent) injected in to your arm via a temporary cannula. The dye makes the images clearer for planning your treatment. If you need this, the radiographers will explain what is happening before and during the process.
You will feel nothing during the scan. All we ask is that you lie still and breathe normally. After the scan is completed, you will be free to leave the hospital. Before you go, you will be given an appointment card with the date and time for your next visit, the radiotherapy treatment.
Treatment starts two to three weeks after your planning scan. Treatment will be given in one day (single fraction highly conformal radiotherapy) or in five consecutive days (fractionated highly conformal radiotherapy). A fraction will take approximately half an hour. This includes the time to fit the mask and settle you comfortably on the treatment couch in the correct position.
For each treatment session, you will be lying on your back, on the treatment couch, wearing your immobilisation mask. The radiographers will ensure you are in the correct treatment position by aligning the marks on the mask with laser lights. They will then move the treatment machine and couch into position using your personal treatment plan.
When final verbal checks have been made, the radiographers leave the room. To give you the best treatment, you will be treated from several different angles. The treatment machine will move around you but will not touch you. You will not feel anything, and you do not have to hold your breath. All we ask is that you keep still. The radiographers will be watching you at all times on a closed-circuit television. Please speak with your radiographers if you have any questions or concerns.
The treatment is normally given as an outpatient appointment but if there are concerns about the side effects, you might be advised to stay at the hospital and go home the day after your treatment is finished.
While you should be fit to travel home after treatment, we strongly advise that have an escort with you. Anyone who has a brain metastasis should not drive a car and you therefore need someone to take you home.
There are side effects that occur soon after treatment (acute side effects) and some that can occur months after treatment (late side effects).
Acute side effects: Highly conformal radiotherapy is usually well tolerated, and people do not usually experience any problems. Occasionally, the treatment may cause some swelling around the area being treated. This can cause headache, sickness or nausea. Some patients may experience temporary worsening of the symptoms they had initially.
To minimise the risk of side effects, you will be prescribed a steroid (generally dexamethasone) to be taken on the day of treatment and for two days after the treatment has finished. If you are already taking steroids, your dose will be increased over the treatment period and then gradually reduced to the usual dose.
There is a small risk that you may experience hair loss in the treatment area. This is temporary and hair should begin to regrow a few weeks after treatment has ended.
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. When washing your hair, use warm water and a non-medicated shampoo. Dry your hair using a soft towel, a hair dryer on a cool setting or leave to dry naturally. Brush and comb your hair gently using a soft brush or a wide rounded-toothed comb.
In patients who have had seizures before treatment, there is a very small risk that your seizures may increase in frequency during and after treatment. Let you doctor or specialist nurse know if this happens.
Late side effects: Highly focused radiotherapy may cause some damage to the area where the metastases were lying. This process is described as radiation necrosis and occurs six to 18 months after treatment in less than 5% of patients. Radiation necrosis may be asymptomatic, or it can cause symptoms.
When symptoms occur, they can be variable. Patients can experience headaches, nausea and fatigue or more severe symptoms like poor balance, arm or leg weakness and/or numbness, speech problems and seizures.
In some cases, radiation necrosis can require treatment with long term steroids or surgical resection.
If you start to have any symptoms, or have any worries, please contact your specialist nurse or the brain tumour team.
This page deals with the physical aspects of your treatment, but your emotional wellbeing and that of your family is just as important. Having treatment can be deeply distressing for some patients. Within the radiotherapy department there will be access and support from your specialist radiographer, specialist nurse, the treatment radiographers, and the Macmillan information and support team. However, if you feel you require further medical or emotional support you can be referred to a variety of health professionals who can help with any worries or difficulties you may be having.
You will have an appointment to come back to the outpatient clinic at the UCH/Macmillan Cancer Centre eight weeks after treatment. A brain MRI scan will be also booked for you around the time of your appointment.
We hope that you have found this leaflet helpful. If you have any questions or other worries and would like to speak to someone, please ask a member of staff.
If you have been provided with a physical copy of this page, please enter the name of your keyworker below.
My keyworker is:
Neuro-oncology Clinical Nurse Specialist
Neuro-oncology Specialist Radiographer
For general enquiries contact The Brain Tumour Unit:
e: uclh.
Radiotherapy Reception
Out of hours oncology advice number (available 24 hours)
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.
Maggie’s (Providing cancer information and support in centres across the UK and online)
Shine Cancer Support (cancer support for adults in their 20s, 30s and 40s)
Trekstock (for young adults in their 20s and 30s with cancer)
Young Lives vs Cancer (formerly CLIC Sargent)
OUTpatients (cancer support for LGBTIQ+ community)
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Page last updated: 17 September 2024
Review due: 01 July 2025