Scheduled Visits During Treatment
Your radiation oncologist and radiation nurse will see you for a scheduled visit during your treatment course to talk with you about any concerns, ask about any potential side effects you may be having, and answer your questions. This visit will be before or after your treatment on __________________. You should plan on being at your appointment about 1 extra hour on this day.
If you need to speak with your radiation oncologist or radiation nurse any time between your visits, call your radiation oncologists office or ask the support staff or your radiation therapists to contact them when you come in for treatment.
Day Of Your Simulation
What to expect
A member of your radiation therapy team will check you in. Youll be asked to state and spell your full name and birth date many times. This is for your safety and part of our standard identification process. Patients with the same or similar names may be having care on the same day as you.
Youll be greeted by your radiation therapist. Theyll take a photograph of your face. This picture will be used to identify you throughout your treatment.
Your therapist will then explain the simulation to you. If you havent already signed a consent form, your radiation oncologist will review everything with you, and ask for your signature.
During your simulation
For your simulation, you may need to get undressed and change into a gown. You should keep your shoes on. If you wear a head covering, such as a wig, turban, or cap, you may have to remove it. Your therapists will help you lie down on a table and make every effort to ensure your comfort and privacy.
Although the table will have a sheet on it, its hard and has no cushion. If you havent taken pain medication and think you may need it, tell your therapists before your simulation begins. Also, the room is usually cool. If you feel uncomfortable at any time, let your therapists know.
To help pass the time, your therapists can play music for you. You may bring a CD of your own from home, if you wish.
Figure 1. Mask for your radiation
Figure 2. Chin strap for your radiation
Problems Eating And Drinking
- reduced sense of taste
Tell your care team if you have any of these problems. They may recommend painkillers or a special mouthwash that can help. Avoiding spicy, salty or sharp foods can also help.
Mucositis usually gets better a few weeks after treatment finishes, although sometimes a dry mouth can be a long-term problem.
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What Kind Of Treatment Follow
Regular follow-up treatment is extremely important after brain tumor treatment. Besides regular physical and neurological exams and blood tests, you may need periodic MRI, MR spectroscopy, perfusion or diffusion MRI, and/or CT exams. Doctors rarely use positron emission tomography scans in brain tumor patients. However, they may use PET to monitor disease outside of the brain . Your doctor may also recommend home care, occupational or vocational therapy, pain management, physical therapy, and participation in support groups.
This follow-up care will help your doctor to:
- spot any sign that the tumor is returning
- monitor the health of your brain
- identify and treat the side effects of chemotherapy or radiation therapy
- detect the presence of other types of cancer at the earliest possible stage
How Does Radiation Therapy Work In Treating Brain Cancer
Radiation therapy is used to shrink tumors and slow the growth of brain cancer. Its often used together with chemotherapy or surgery to give doctors the best chance of completely removing the tumor. Its also used for people who arent able to undergo surgery.
Radiation therapy uses high doses of radiation to kill cancer cells by damaging their DNA. Radiation is concentrated beams of energy. Its also used in X-rays in lower doses to produce an image of the inside of your body. When the DNA of cancer cells is damaged, the cells are unable to divide or grow and eventually die.
However, radiation therapy also damages the DNA of healthy cells around the part of your body where radiation is delivered. Its especially prone to damaging rapidly growing cells such as stem cells.
Stem cells have the potential to become any other type of cell. When these are damaged, your body is unable to create new cells to replace the cells in your body when they die at least temporarily. Not replacing these cells may cause you to develop side effects that usually pass after 2 to 3 weeks.
Radiation therapy can cause side effects due to damage to healthy brain tissue and cells around your head and neck. The goal is to deliver the lowest possible effective dose of radiation to minimize damage to healthy brain tissue.
Some side effects appear shortly after treatment while others may not occur for months or years.
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Discharge Instructions After Stereotactic Radiosurgery
If youre having stereotactic radiosurgery, youll need to follow special instructions.
- Youll need to have a responsible care partner take you home after your treatment. Your doctor or nurse will tell you when you can drive.
- Your care partner will need to stay with you for the first 24 hours after your treatment.
- You can resume most of your activities the day after your treatment. Ask your doctor or nurse when you can resume vigorous exercise.
Swelling In Your Brain
Radiation therapy to the brain may cause brain swelling. If you had neurological symptoms before you began radiation therapy, they could return, or you could have new symptoms. These symptoms may include:
- A worsening of your original symptoms
- A headache that doesnt go away after taking acetaminophen
- Nausea and vomiting
- Changes in vision, such as double vision
- Unsteadiness when walking
- Change in mental status
If you have any new or worsening symptoms, call your doctor or nurse right away. Theyll want to evaluate you. Medication can be prescribed if needed. These may include:
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Protecting Healthy Tissue Protecting Quality Of Life
Treatment with the CyberKnife System is well-tolerated with a low risk of toxicity. Despite the high dose rate associated with SRS, the CyberKnife System has been proven to deliver radiation with sub-millimeter precision, which means minimal radiation is delivered to the healthy brain tissues that surround the lesion or tumor1. This can significantly reduce the risk of the most common side effects of traditional radiation therapy, including fatigue and cognitive impairments to memory and concentration and can protect the sensitive tissues involved in important functions such as motor control, touching, hearing and vision. Most patients can quickly return to their daily routines with little interruption to their normal activities.
How Soon Might I Have Side Effects From Radiation Therapy
There are two kinds of radiation side effects: early and late. Early side effects, such as nausea and fatigue, usually donât last long. They may start during or right after treatment and last for several weeks after it ends, but then they get better. Late side effects, such as lung or heart problems, may take years to show up and are often permanent when they do.
The most common early side effects are fatigue and skin problems. You might get others, such as hair loss and nausea, depending on where you get radiation.
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Stiff Joints And Muscles
Radiotherapy can sometimes make your joints and muscles in the area being treated feel stiff, swollen and uncomfortable.
Exercising and stretching regularly can help to prevent stiffness.
Tell your care team if joint or muscle stiffness a problem. They may refer you to a physiotherapist, who can recommend exercises for you to try.
Brain Radiation Side Effects
Generally, side effects from radiation treatment are grouped into two categories:
- Short-term side effects, which occur within six weeks of treatment
- Delayed side effects, which are rarer than short-term effects and can start months or even years later
Short-term side effects of brain tumor radiation include:
The risk for these side effects depends on your age, the radiation dose used and the size of the area treated, and the location. Some tumors can be treated with focal radiation, which targets a smaller area than whole brain radiation. Larger treatment areas are generally associated with greater risk of long-term effects.
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Late Effects Of Brain Radiotherapy
Radiotherapy may cause side effects that develop months or, more often, some years after treatment. These are called late effects. Newer ways of giving radiotherapy are better at protecting healthy brain tissue so late effects are becoming less common.
Your doctor will talk to you about the risk of late effects before your radiotherapy starts. Tell them if you are worried about any side effects. The benefits of having radiotherapy usually far outweigh the risk of late effects.
Possible late effects depend on the area of the brain being treated. They may include the following:
- Changes to your memory, thinking and reasoning. This is called cognitive impairment.
- A cataract, if you have radiotherapy close to your eye. The clear lens of the eye becomes cloudy and blurred and you cannot see as well. Cataracts can usually be easily treated with a small operation.
- Changes in hormone levels if your treatment involves the pituitary gland or part of the brain called the hypothalamus. This can cause different symptoms, including changes to periods , changes to your sex drive or severe tiredness.
- A second cancer in the treated area years later. This is rare.
After treatment, you will have regular check-ups with your doctor and nurse. Tell them about any side effects so they can help.
Radiotherapy For A Brain Tumour
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Radiotherapy uses high-energy rays to destroy tumour cells, while doing as little harm as possible to normal cells. Newer ways of giving radiotherapy to the brain are designed to limit the damage to healthy brain tissue.
You may have radiotherapy:
- after surgery, if a tumour cannot be completely removed
- after surgery, to reduce the risk of the tumour coming back
- with chemotherapy, if you have a high-grade glioma
- if a tumour comes back.
There are different types of radiotherapy. They can be used in different ways to treat a brain tumour. Your treatment is carefully planned by a radiotherapy team. This includes a clinical oncologist and radiographers, who are experts in giving radiotherapy treatment. Your team will explain your treatment plan, the dates and times of your appointments and what to expect.
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Wearing An Immobilisation Mask
Youll need to wear a plastic mask during radiation therapy to the brain. This is known as an immobilisation mask. It will help keep your head still and make sure the radiation is targeted at the same area during each session. The mask is made to fit you. It is fixed to the table while the treatment is delivered.
The mask is made of a tightfitting mesh, but you will wear it for only about 10 minutes at a time. You can see, speak and breathe through the mask, but it may feel strange and confined at first. Tell the radiation therapists if wearing the mask makes you feel anxious. With the support of the radiation therapy team, many people find that they get used to wearing the mask. The team may suggest you try breathing or relaxation exercises, or you may be offered medicine to help you relax.
Early And Late Effects Of Radiation Therapy
- Early side effects happen during or shortly after treatment. These side effects tend to be short-term, mild, and treatable. Theyre usually gone within a few weeks after treatment ends. The most common early side effects are fatigue and skin changes. Other early side effects usually are related to the area being treated, such as hair loss and mouth problems when radiation treatment is given to this area.
- Late side effects can take months or even years to develop. They can occur in any normal tissue in the body that has received radiation. The risk of late side effects depends on the area treated as well as the radiation dose that was used. Careful treatment planning can help avoid serious long-term side effects. Its always best to talk to your radiation oncologist about the risk of long-term side effects.
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Radiation Therapy For A Metastatic Brain Tumor: 3 Things You Should Know
You may have been told that radiation therapy is your best treatment optionfor ametastatic brain tumor, also referred to as metastatic brain cancer. If youre worried about theside effects of radiation therapy, youre not alone.
Johns Hopkins neurosurgeonMichael Lim, M.D.,of theJohns Hopkins Comprehensive Brain Tumor Centerhears these concerns often. Heres what he wants you to know aboutradiation therapy for brain metastases:
How Fertility Might Be Affected
For women: Talk to your cancer care team about how radiation might affect your fertility . Its best to do this before starting treatment so you are aware of possible risks to your fertility.
Depending on the radiation dose, women getting radiation therapy in the pelvic area sometimes stop having menstrual periods and have other symptoms of menopause. Report these symptoms to your cancer care and ask them how to relieve these side effects.Sometimes menstrual periods will return when radiation therapy is over, but sometimes they do not.
See Fertility and Women With Cancer to learn more.
For men: Radiation therapy to an area that includes the testicles can reduce both the number of sperm and their ability to function. If you want to father a child in the future and are concerned about reduced fertility, talk to your cancer care team before starting treatment. One option may be to bank your sperm ahead of time.
See Fertility and Men With Cancer to learn more.
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Compare The Risks And Benefits Of Radiation Therapy
There are two main types of radiation therapy used at the Comprehensive Brain Tumor Center to treat metastatic brain tumors:
- Whole-brain radiation therapy targets the entire brain, treating even microscopic tumors that cant be seen on an MRI scan. Common side effects include fatigue, hair loss and memory problems.
- Stereotactic radiosurgery is a more focused therapy that aims a very high dose of radiation at only the tumor itself. Sometimes, it can be completed in a single day. The more focused dose minimizes radiation exposure to the rest of the brain. That also means the potential for fewer side effects.
With either type of radiation therapy, you will probably need follow-up appointments. This is the best way to detect any new disease early so it can be treated effectively right away.
What Happens During Treatment
About a week after the simulation you will return to the center for your first treatment. The nurse or radiation therapist will escort you to a holding room, where you may need to change into a gown.
Step 4: position the patient After the radiation machine is calibrated and prepared for your specific treatment plan, you will lie on the table. The mask is placed over your face and secured to the table. If you have a head frame, it is secured to the treatment table.
Alignment lasers and x-rays help to position you correctly. Stereoscopic x-rays are taken and compared to the treatment plan. Any misalignments are corrected before treatment.
Step 5: deliver the radiation The therapist leaves the room and operates the machine from the control room. The team watches you through video monitors and speaks to you over an intercom. The machine and treatment table move every so often to deliver radiation beams from one or more directions .
The machine is large and makes a humming noise as it moves around your head. Its size and motion may be intimidating at first. It may pass close to your body, but it will not touch you. You do not have to hold your breathâjust breathe normally. Treatment may take 30 minutes or longer, depending on the complexity of the target.
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If Treatment Does Not Work
Recovery from a brain tumor is not always possible. If the tumor cannot be cured or controlled, the disease may be called advanced or terminal.
This diagnosis is stressful, and for some people, an advanced brain tumor is difficult to discuss. However, it is important to have open and honest conversations with your health care team to express your feelings, preferences, and concerns. The health care team has special skills, experience, and knowledge to support patients and their families and is there to help. Making sure a person is physically comfortable, free from pain, and emotionally supported is extremely important.
People who have an advanced brain tumor and who are expected to live less than 6 months may want to consider hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life. You and your family are encouraged to talk with the health care team about hospice care options, which include hospice care at home, a special hospice center, or other health care locations. Nursing care and special equipment can make staying at home a workable option for many families. Learn more about advanced care planning.
After the death of a loved one, many people need support to help them cope with the loss. Learn more about grief and loss.