Radiotherapy

Radiotherapy treatment uses precise doses of high energy radiation to treat both benign and malignant tumours

It uses high energy X-rays to destroy the tumour, whilst causing as little damage as possible to normal cells.

Radiotherapy is given in small, equal doses over a specific number of days or weeks. The specific amount of radiation and number of treatments required will depend on the type of tumour you have. More information about radiotherapy can be found on our website and you can also read more in our patient information booklets.

Radiotherapy is available at The Christie, Withington and The Christie at Salford Royal.

Proton beam therapy is an advanced form of radiotherapy. The Christie is now home to the UK’s first high-energy proton beam therapy service but this is not appropriate or necessary for most types of brain tumours in adults. 

Your doctor can explain this to you more fully and you can read more about proton beam therapy in our website section.

Radiotherapy for primary brain tumours (including pituitary and base of skull)

This information is about radiotherapy treatment for primary brain tumours. The Christie is a specialised radiotherapy centre, and patients come for treatments that are not available in general hospitals.

Agreeing to treatment

Consent to treatment

The doctors, nurses and specialist radiographers will give you some written information to support what they have said about your treatment. At the time your treatment is being planned, you will have the opportunity to discuss anything you do not understand, or any worries or concerns you may have.

We will ask you to sign a consent form agreeing to accept the treatment that you are being offered. The basis of the agreement is that you have had The Christie’s written description of the proposed treatment and that you have been given an opportunity to discuss any concerns.

You are entitled to request a second opinion from another doctor who specialises in treating this tumour. You can ask your own consultant or your GP to refer you. Your consent may be withdrawn at any time before or during this treatment. Should you decide to withdraw your consent then a member of your treating team will discuss the possible consequences with you.

Radiation can be harmful to the unborn child. It is important to let the radiographers know if you have missed a period, or suspect that you might be pregnant before you are exposed to any radiation.

What are the benefits of treatment?

Treatment is aimed at shrinking or controlling the brain tumour to improve symptoms or prolong life.

Are there any alternatives to this treatment?

Treatment for brain tumours can include surgery, radiotherapy, chemotherapy, other medication or active surveillance (watchful waiting) or a combination of these. Alternatives to radiotherapy may include one or more of these options. Your consultant will discuss this with you.

What will happen if I do not have this treatment?

Without treatment the brain tumour may grow and cause further symptoms. If you are worried about having treatment or you would like to consider not having treatment, please contact your neuro-oncology specialist nurse, consultant or specialist radiographer.

You can change your mind about having treatment at any time before you start radiotherapy. This will not affect your relationship with the medical staff. If you want to have treatment it is important to complete it, so that the treatment is effective.

Preparation for treatment

You may be able to have your preparation and/or treatment at The Christie at Salford. Please speak to a member of your treating team if you would like to discuss this.

The specialist doctor who will look after you is a clinical oncologist. They will ask you some questions, examine you and explain your treatment options.

A team of professionals including consultants, specialist registrars, clinical nurse specialists, specialist radiographers and allied health professionals will care for you. Once your treatment has been decided, we will give you an appointment for your treatment preparation.

Mould room preparation

People having radiotherapy to the brain have to wear a form of head immobilisation (mask) while they are having treatment. This helps to keep your head still during the treatment and also allows marks to be placed on the mask which ensure that the treatment is given to the same area each day. You will need to remove all ear jewellery for the mask making and every day for treatment.

Your mask will be made by a team of specially trained staff. They will discuss the procedure with you. Many people – especially if they are a bit claustrophobic – worry about having a mask made. But most people cope very well and help from our complementary therapy team is available.

Scans and verification

To help with the planning of your treatment you will have a CT scan. This scan is taken while you are wearing the mask that has been made for you.

Some people may be required to have an injection of dye (contrast) for the CT scan. This will be administered through a cannula in the vein.

The scans to plan your radiotherapy are solely aimed to give enough information to plan the radiotherapy accurately. These scans are not diagnostic and therefore do not give sufficient information to assess the status of your tumour or any other abnormalities.

Most patients will also need an MR scan to help with treatment preparation. You will need to attend The Christie in Withington for this MR scan.

For the MR scan, most patients will need to have an injection of dye (called contrast) into a vein during the scan. This dye helps your doctor to plan your treatment.

Once these planning scans have been taken, your doctor will plan your treatment. Planning is very important and as a result it can take several weeks for your treatment to be ready. Your treatment will start a couple of weeks later.

What happens during treatment?

On the day of your first treatment, you will come to the radiotherapy department. If you are an inpatient, a porter will bring you to the department. Before the treatment begins, a radiographer will sit down with you and explain what will happen during the treatment. If you have any questions or worries, please feel free to discuss them with the radiographer.

The Christie is a training centre, so you may meet radiotherapy students who may be involved with the delivery of your treatment under full supervision.

Radiographers operate the radiotherapy machines to give you the precise treatment prescribed by the doctor. On each treatment visit, they will ask you how you are feeling and ensure that you are coping well as the treatment progresses.

The radiographer will help you on to the treatment bed, put your mask on you and adjust the bed and the machine to the exact positions that are needed. They will ask you to remove any clothing or jewellery including earrings that are in the area being treated.

During the treatment, you need to keep as still as possible. The radiotherapy machines are quite big and if you have never seen one before you might feel anxious. There is no need to worry – the treatment is painless. The radiographers are there to support and reassure you.

Once your treatment has been set up and the radiographers are happy that everything is correct, they will leave the room to switch the treatment machine on. They will be watching you carefully on a closed-circuit television system and talk to you via the intercom.

The whole treatment session may take between 10 and 30 minutes. Some people worry that they will be enclosed by the machine, but this will not happen. The machine will move around you, but nothing will touch you. The treatment machines make a buzzing noise when they are switched on. This is how you will know when the treatment is happening.

If you become worried, anxious or do not feel well while the treatment is being given, just raise your hand and the radiographers will interrupt the treatment and come to you immediately.

The prescribed radiation dose and the number of days over which it is given vary between patients. Treatment is usually given Monday to Friday. There is usually no radiotherapy given on Saturdays and Sundays and this is considered when your treatment is planned. Treatment is given on Bank Holidays.

You will usually be treated on the same machine throughout the course of your radiotherapy. However, the machines must be serviced frequently and as a result you may be treated on a different machine. The radiographers treating you will let you know about this. Do not worry; you will not miss any treatments due to this, and the treatment is the same.

On-treatment verification scans (Cone-Beam CT scans)

During your treatment, the radiographers will need to take a scan of the area you are having treated. This will be done at the same time as your treatment. These images are only to check that you are in the correct position for treatment. They are not a diagnostic scan and cannot be used to tell how your tumour is responding to treatment.

It is very important that you do not miss any treatment days as this may make your treatment less effective. If you feel you are unable to attend for any reason, please telephone the staff on your treatment machine and discuss the problem with a radiographer. Call the radiotherapy department on 0161 446 3485.

When you attend for your radiotherapy planning you will be introduced to a radiotherapy support worker who will liaise with you about your treatment appointments.

Side effects of treatment

Side effects can vary depending on the radiotherapy dose and the length of your treatment. Radiotherapy can cause general side effects such as tiredness, but there are some effects which are specific to having radiotherapy to the brain.

While you are having radiotherapy, it is very important that you continue to take the medication prescribed by your doctor. Do not change anything unless you have discussed this with your treating team first.

Headaches are a very common side effect of radiotherapy to the brain. These may be due to increased swelling due to the treatment. You may be prescribed a drug called dexamethasone for this. Always remember to carry your steroid card which has instructions about taking dexamethasone.

You can also take painkillers to help you such as paracetamol. It is important that you tell the radiographers who are treating you if you are having headaches.

Occasionally some people may have feelings of sickness. This can usually be effectively treated by anti-sickness drugs which your treating team can prescribe.

You may find that food tastes different. If your appetite is affected, try to eat little and often.

Radiotherapy often makes people feel tired. It builds up towards the end of treatment and can last for several weeks after the treatment has finished.

Take rests when you need to but try to maintain your normal daily activities as much as you can because we know that this can be beneficial. The Macmillan leaflet ‘Coping with fatigue’ provides further advice on this and is available from the cancer information centre.

This side effect occurs during the treatment, but can increase for a time after the radiotherapy has ended. You may find that you generally slow down, have very little energy and cannot be bothered to do much.

This period of lethargy, described as somnolence, is worse about 2 weeks after treatment but usually starts to go away within another week. Sometimes it gets worse again 4 to 6 weeks after treatment.

You will lose any hair within the treatment area. Most hair loss is temporary although, unfortunately, in some people it may be permanent. This will depend on the dose and length 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 4 months of finishing treatment.

The cancer information service offers a coping with hair loss service to all patients. Drop in, telephone 0161 446 8100 or email the-christie.informationcentre@nhs.net.

Information about the wig service can also be given and vouchers for wigs can also be obtained for eligible patients. The wig room provides a drop-in service, please see The Christie leaflet ‘The wig fitting service’ for further information. It is a good idea to get your wig before you lose a lot of hair, so you can match it with your natural colour.

Head care advice and a ‘Talking Heads’ workshop is available at Maggie’s centre (close to The Christie in Withington), contact 0161 641 4848, or Headstrong at The Christie at Salford (call 0161 206 1455 or 0161 918 7804).

Some people develop a skin reaction, similar to sunburn, while having radiotherapy. This normally happens about halfway through the treatment (usually after 3 to 4 weeks).

People with pale skin may find that the skin in the treatment area becomes red and sore and itchy. People with darker skin may find that their skin becomes darker and can have a blue or black tinge.

The amount of 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 looking for these reactions, but you should let them know as soon as you feel any soreness.

The radiographers treating you will give you advice about the best way to take care of your skin during radiotherapy. Using a moisturiser is normally recommended, however if you are unsure, please check with a member of your treating team.

Some people might find that they develop a sensation of fullness of the ear with possible reduction of hearing in the affected ear. These are temporary and should resolve within a few weeks of completing treatment although for some people, this can continue for several months.

If you have ever experienced seizures or have concerns about seizures and would like further information, please speak to a member of the team.

Late/permanent side effects

Every effort is made to avoid late side effects. However, there is a chance you may experience serious late side effects, which can occur months or even years after radiation treatment.

Radiation can cause changes in the brain tissue which can result in changes to your thinking, problem solving and short-term memory.

Some people have patches of permanent hair loss, but you will be advised of this during the consent process if this is likely to happen.

If your pituitary gland is near your treatment area, you could develop hormone imbalances in the future. The pituitary gland controls your thyroid gland and adrenal glands. These affect growth, fertility, sugar balance and water balance in the body. You can take replacement hormones to correct any imbalances.

Your clinical team may refer to an endocrinologist after completion of radiotherapy to the brain if necessary.

Some people can have changes to their vision following radiotherapy including cataracts. You will have been advised if this is a risk when you started your radiotherapy treatment. You may also find that your eyes are dry in the long term, and you may require long term use of eye drops.

Radiation can cause changes to the blood supply to the brain. This can result in a small increased risk of stroke.

There is a small increased chance of other tumours developing in the future in the treated area following radiotherapy. You will have regular follow up scans to monitor this.

Some people find the symptoms of the brain tumour temporarily get worse either during radiotherapy or after the treatment has finished. This can make you think that your tumour is getting worse but, in fact, it is a reaction to the radiotherapy treatment. If you find this happening to you, it is important to discuss it with the treating team, who will be able to give you the right advice, treatment and medical support.

After the treatment: follow-up and scans

Your side-effects may last for some weeks after the treatment finishes, so it is important to continue with your skincare routine and take all medicines as prescribed by the treating team. Your first follow up appointment will usually be 4 to 6 weeks after your last radiotherapy treatment. This will normally be in the outpatient department (department 41) at The Christie. Most patients will have their first follow-up scan carried out 2 to 3 months after the end of radiotherapy treatment.

Radiotherapy works slowly and it can take up to 3 months for treatment effects to settle down and for any benefit to be seen. You will then have regular follow-up visits to the clinic with repeat scans.

Some patients ask about ‘warning’ signs they should look for once the treatment has been completed. There can be different signs depending on where the original tumour was located. For this reason, you should ask the doctor to discuss this with you.

Of course, if you are worried about anything you feel may be related to the tumour or the treatment, please contact us and, if necessary, we can arrange an earlier outpatient appointment for you.

Driving

All drivers who have a brain tumour are legally required to inform the DVLA of their diagnosis. Patients are not permitted to drive a car for a minimum of 1 year (for patients with low-grade tumours) or 2 years (high grade tumours) from the time of their main initial treatment (surgery or radiotherapy). In addition, patients with epilepsy must not drive for a minimum of 12 months from their last seizure.

You can read more about this on our page DVLA driving regulations: primary brain and spinal cord tumours.

Last updated: July 2023

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