Radiotherapy to the Brain

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1 The Beatson West of Scotland Cancer Centre 1053 Great Western Road, Glasgow, G12 OYH Patient Information Sheet Radiotherapy to the Brain

2 This leaflet is for patients who will have a course of radiotherapy to the whole head (brain) and describes the radiotherapy planning and treatment. It also explains the effects you may experience during and after radiotherapy and how best to cope with them. The side effects of treatment vary from one patient to another; therefore, the information given here is intended as a general guide and does not mean that you will have all of those described. Your health care team at the Beatson will explain specific aspects of your treatment to you. Before having treatment, it is important that you understand about it and some of its possible effects. If you are in any doubt about anything or have any questions or problems, do let us know as soon as possible.

3 preparation for treatment Before you can begin your radiotherapy, the treatment must be carefully planned at the simulator unit. This is a special x-ray machine similar to the treatment units used to give your radiotherapy. Your doctor and radiographers will plan your treatment together. Your radiographers will help you to lie on your back on the treatment couch. They will place a headrest under your head instead of a pillow and they will use a plastic positioning aid to help keep your head still in the correct position. The couch is hard but you will not be there too long. Let the radiographers know if you find it difficult to lie back and they will help you as much as possible. It is important to stay as still as you can but you should try to relax as much as possible and breathe normally. The radiographers will monitor you closely and assist you if necessary so please let them know if you are worried about anything. Once you are lying in the correct position the radiographers will move the simulator slowly round to the side of your head. Although it may seem quite close, it will not touch you. They will then leave the room and have a look at your head on the x-ray screen outside. They can see you through the window the whole time, so if you need them you can raise your hand and they will come straight in. While this is happening, you may feel the couch move gently and hear the simulator move at the side of you until we have the correct position for the treatment. This will only take a few minutes and after we have checked a printed picture of the treatment area, the radiographers well help you from the couch. You will usually start treatment within a few days of your simulator appointment. This depends on the availability of the machines.

4 treatment You will have treatment on a linear accelerator, which is a type of x-ray machine. The staff who operate these machines are called therapy radiographers. They are specially trained professionals who are responsible for delivering your treatment accurately. They will explain everything before treatment starts and check you know what to expect and how many treatments you will have. This can vary, but as a guide it is usually between 4 and 20 treatments. Your radiotherapy will be given in small daily doses, Monday to Friday but not at the weekend. When you start treatment your radiographers will position you just as you were in simulator. The lights in the room will dim for a few minutes while the radiographers move the machine round to the side of your head and ensure you are in the correct position for treatment. They leave the room while the machine is switched on but this is only for a minute or so and they will watch you the whole time on closed circuit TV. When the machine switches off the radiographers will come back into the room and move the machine over to the other side for the next part of your treatment. The whole process only takes about 10 minutes. The treatment is painless and you will feel no differently afterwards. Please speak to the radiographers if you have any questions or problems.

5 Effects of Treatment Everyone is an individual and may experience some of the side effects to a differing degree. These are a general guide to what you may expect. Hair loss: unfortunately you will lose your hair because we are treating your head. This often does not happen until after the course of treatment is finished. Your hair will usually grow back in approximately a few months. Sometimes it grows back differently to how it was. It may not be as thick or have the same texture as before. You may feel quite tired (fatigued) and a bit washed out for a few weeks after your treatment has finished. This is normal. Some people experience a headache, particularly after the first treatment. This usually settles down quite quickly and you can take any painkillers you would normally use for it. You may occasionally feel a bit sick (nauseous). Your doctor can prescribe something to help with this and it should settle within a couple of weeks. Some people lose their appetite and do not feel like eating. You should try to eat small amounts more often rather than facing a full meal. We can also arrange for you to talk to one of our dietitians at the Beatson. Some patients feel that their ears are blocked or their hearing becomes dull after radiotherapy but this usually gets better over time.

6 Washing your hair While you are having your radiotherapy and for a week or two after it is finished you should- Wash your hair with baby shampoo or Simple shampoo. Do not have the water too hot and gently towel dry. Do not dry your hair with a hair dryer as this could irritate your scalp. Do not use any hair products such as gel, mousse, hair spray or conditioner Some people find that their scalp gets hot and itchy with the treatment. Often this happens after the treatment is finished. You can apply aqueous cream, which you can obtain from your family doctor (GP) or chemist to soothe your scalp. This should settle fairly quickly but if you have any concerns please see your GP.

7 Coping with your hair loss Your doctor will have told you that you will lose your hair as a result of the radiotherapy treatment to your head. Although this is temporary it can still be very distressing for some people, male or female. Because of this you can be supplied with a wig if you wish. Your radiographers will arrange for you to speak to one of our radiotherapy assistants who can talk to you about the different wig suppliers. They will let you see some catalogues to help you choose a supplier you think will suit you best. The radiotherapy assistant will then arrange an appointment so that you can visit the shop in your own time, giving you the chance to try on different styles before making your choice. If you have longer hair you might think about having it cut shorter before the treatment starts. People sometimes find this helps slightly, ease the shock of hair loss. Some men consider having their head shaved for this reason. There are alternatives to wearing a wig. Some ladies might prefer to wear scarves tied around the head or towelling turbans. Our staff will be happy to discuss this with you and can provide you with the towelling turbans. If you have any questions or concerns or are finding it difficult to come to terms with losing your hair please speak to your radiographers or radiotherapy assistant who can put you in touch with further help or support. To begin with some people decide not to have a wig but change their mind once their hair starts to come out. If you change your mind, it is not a problem. You can contact one of our information and support radiographers on the number at the end of this leaflet and they will arrange things. Cancerbacup produce a useful booklet on coping with hair loss. You can obtain a free copy by calling the number at the end of the booklet or by popping in to the Maggie s Centre.

8 Steroid treatment Some people who are having radiotherapy treatment to the whole brain will need to take steroid tablets (dexamethasone). The steroids help with any symptoms that you may have which can sometimes become slightly worse with radiotherapy. Your family doctor (GP) or specialist will prescribe the steroids after discussing dosage and side effects with you. If you are unsure about anything or want more information about the steroids please ask the radiographers who will contact your doctor for you. Prophylactic Cranial Irradiation (PCI) Some patients will be having radiotherapy to their whole brain at the same time as or a few weeks after treatment to the chest. Your doctor will have discussed this with you and explained the reasons for having the treatment to your brain. You will not normally need to take steroids when you are having the treatment. what do I do if I feel ill? If you suddenly feel unwell and unable to come for treatment, contact your family doctor (GP) and let the staff at your treatment room know. If you feel able to come to the department, tell your radiographers that you are unwell as soon as you arrive and they can arrange for a doctor to see you. If you become unwell after your treatment has finished you must contact your GP.

9 after treatment ends As we have said above any symptoms that have developed because of the treatment will gradually settle down. The tiredness can take a good few weeks to leave you so please don t worry as this is perfectly normal. If you are taking steroids you will continue to take them after the treatment has finished. Your oncologist (hospital doctor) will write to your GP about reducing the dose of steroids you are taking. You should not stop taking them suddenly as this can cause problems and make you feel unwell. The dose should be gradually reduced before you stop and your doctor will work with you on this Your doctor will arrange to see you about 4 to 6 weeks after your treatment has finished.

10 Where can I get help? Many people already have had a lot of information and support with their own district, Macmillan or oncology or nurse at another hospital or in the community. Remember that they can also help you with any worries or concerns at this time, and because you know them already, they can provide invaluable help and support during and after your treatment. So please remember to give them a call if you need to. Information and support All our staff are here to make sure your treatment goes as smoothly as possible and will try to help with any questions or problems you may have. Further specialist help and information in the Beatson is available from: Information & support Radiographer Tel: Macmillan Information Radiographer & Counsellor Tel: The Beatson Oncology Centre has a Radiotherapy Advice Line available for patients who have completed treatment. It is an answerphone service and if you leave your name and telephone number with a short message a radiographer will contact you. Tel:

11 counselling and clinical psychology service This leaflet deals with the physical aspects of your treatment, but your emotional well being is just as important to us. Being diagnosed with cancer can be a deeply distressing time for you and those closest to you. Within the department we have a counselling and clinical psychology service that can help with worries and difficulties you might be having. If you think this may be helpful to you, please ask staff to put you in touch. There are also voluntary organisations providing information and support. These include: Cancerbackcup Offers telephone information and advice and provides free information booklets about particular cancers and also about how to cope. Macmillan Cancer Support Provides an information line and financial help through grants. They can advise of where you can get support from Macmillan nurses and other relevant health care professionals. Maggie s Centre A homely, relaxing place where you can drop in any time for a coffee and a chat or some quiet time alone. It provides support and advice and runs a programme of courses which look at living with cancer. Tak Tent Providing information and support groups. Benefits Enquiry Line Tel: Provides information on benefits and social security.

12 This leaflet is for general information only. For personalised information please ask a member of clinical staff. Leaflet reviewed by L. Webster Contact: L.Webster : Nov Review Date: Nov Designed & Produced by Medical Illustration Services Tel.:

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