Having radiotherapy for brain tumours

Radiotherapy means using radiation, usually x-rays to treat cancer cells. It is a common treatment for brain and spinal cord tumours.

You can have radiotherapy to:

the tumour and the surrounding area of healthy tissue
the whole brain
the whole spinal cord

When you have radiotherapy

Radiotherapy might be your main treatment if you can’t have surgery to remove the tumour for any reason. For example, if you are too unwell to have an operation. Or if the tumour is in an area of the brain that is difficult for doctors to operate on, such as the brainstem.

You may also have radiotherapy after surgery to:

treat any tumour that your surgeon couldn't remove
lower the risk of the brain tumour coming back in the future

Some people might have radiotherapy and chemotherapy together (chemoradiotherapy).

Radiotherapy can only start once the wounds from the operation have fully healed, which takes a few weeks. You might feel anxious about waiting to start your treatment. Your doctor is the best person to talk to if you have any concerns about the timing of your radiotherapy treatment.

How often you have radiotherapy

The full dose of radiotherapy is usually divided into a number of smaller doses called fractions. This allows the healthy cells to recover between treatments. For some types of tumour, you might be able to have the full dose of radiotherapy over a single fraction (radiosurgery).

You usually have one treatment (fraction) a day, from Monday to Friday, for between 3 to 6 weeks. This means that you have between 15 and 30 treatments of radiotherapy in total.

You might have radiotherapy to help with symptoms or slow down the growth of your tumour. This is called palliative radiotherapy and is usually a shorter course of treatment. This might be for around 2 weeks.

Types of radiotherapy

You usually have external radiotherapy to treat a brain or spinal cord tumour. External radiotherapy destroys cancer cells by using radiation aimed at a cancer from a machine. The most common type of machine used is called a linear accelerator machine (LINAC). This uses electricity to create the radiotherapy beams.

You can have different types of external radiotherapy:

conformal radiotherapy
stereotactic radiotherapy (SRT)
proton beam therapy (PBT)

Conformal radiotherapy

Conformal radiotherapy shapes the radiation beams to closely fit the tumours. This means that the tumour receives a high dose of radiation and healthy tissues around receive a lower dose.

You have conformal radiotherapy on a LINAC machine. This is the most common type of radiotherapy for brain and spinal cord tumours.

Stereotactic radiotherapy (SRT)

Stereotactic radiotherapy gives high doses of radiation from different angles around the body. This means that your treatment team can direct a very high dose of radiation to the tumour and a much lower dose to the tissues around it.

Stereotactic radiotherapy isn’t suitable for everyone. You might have it for a tumour that measures less than 3 cm across.

Some people have radiosurgery. This is a very high dose of stereotactic radiotherapy over a single treatment.

Proton beam therapy (PBT)

This treatment uses high energy proton beams to destroy cancer cells. It is only suitable for certain types of cancer. For adults, this includes cancers that started in the base of the skull or near the spine.

Before your radiotherapy treatment

Your head needs to be kept as still as possible during radiotherapy. This is so the treatment is as accurate as possible. Keeping the head still is called immobilisation. So, before you start radiotherapy you have a radiotherapy mask made or a head frame fitted. The type of immobilisation you have depends on the type of radiotherapy you have.

Before treatment you also have a planning CT scan. This helps your doctors map where the radiation needs to go.

The radiotherapy room

Radiotherapy machines are very big and could make you feel nervous when you see them for the first time. The machine rotates around you to give the treatment. But it doesn't touch you at any point.

Before your first treatment, your radiographers will explain what you will see and hear. In some departments, the treatment rooms have docks for you to plug in your music player. So you can listen to your own music.

Having external radiotherapy treatment

To have treatment you lie on the treatment table. Because your position is so important, the radiographers may take a little while to get you ready. The radiographers attach your mask or head frame into the treatment table. They then leave the room before your treatment starts. This is so they are not exposed to the radiation

Your radiographers watch and listen to you on a CCTV screen in the next room. Tell them if you need to move or want the machine to stop.

You need to lie very still. The machine makes whirring and beeping sounds. You can't feel the radiotherapy when you have the treatment.

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Transcript

Daniel (radiographer): Before your treatment starts your doctor will need to work out exactly where the treatment needs to go and also which parts need to be avoided by the treatment.

To have radiotherapy you lie in the same position as you did for your planning scans.

To stop you moving and to make sure your treatment is directed at the cancer you wear a custom mask over your face which is attached to the couch.

We line up the machine using marks on your mask and then leave the room. We control the machine form a separate room this is so we aren’t exposed to radiation.

Treatment takes a few minutes and you’ll be able to talk to us using an intercom. We can see you and hear you while you’re having treatment and we will check that you’re OK.

When your treatment starts you won’t feel anything. You may hear the machine as it moves around you giving the treatment from different angles.

Because we’re aiming to give the same treatment to the same part of the body every day the treatment process is exactly the same everyday so you shouldn’t really notice any difference.

You’ll see someone from the team caring for you once a week while you’re having treatment. They’ll ask how you are and ask about any side effects.

You won't be radioactive

This type of radiotherapy won't make you radioactive. It's safe to be around other people, including pregnant women and children.

Travelling to radiotherapy appointments

You might have to travel a long way each day for your radiotherapy. This depends on where your nearest cancer centre is. This can make you very tired, especially if you have side effects from the treatment.

You can ask your radiographers for an appointment time to suit you. They will do their best, but some departments might be very busy. Some radiotherapy departments are open from 7 am till 9 pm.

Car parking can be difficult at hospitals. Ask the radiotherapy staff if you are able to get free parking or discounted parking. They may be able to give you tips on free places to park nearby.

Hospital transport may be available if you have no other way to get to the hospital. But it might not always be at convenient times. It is usually for people who struggle to use public transport or have any other illnesses or disabilities. You might need to arrange hospital transport yourself.

Some people are able to claim back a refund for healthcare travel costs. This is based on the type of appointment and whether you claim certain benefits. Ask the radiotherapy staff for more information about this and hospital transport.

Some hospitals have their own drivers and local charities might offer hospital transport. So do ask if any help is available in your area.

Side effects

Radiotherapy for a brain tumour can make you feel tired. There are other possible side effects.