Total Body Irradiation (TBI)

Total body irradiation or TBI refers to radiotherapy to the entire body.
.

Why Do I Need Total Body Irradiation?

TBI is carried out alongside chemotherapy to kill off cancer cells such as those in leukaemia, lymphoma, or myeloma. TBI, together with chemotherapy,  is often done to prepare your body for either a stem cell or bone marrow transplant as it suppresses the immune system and prevents potential rejection of a donor organ or stem cells.
.

Undergoing Total Body Irradiation

Typically, patients will need to undergo TBI treatment once or twice daily for a period between 1-4 days.
.

The Radiotherapy Room

Radiotherapy machines are massive, and they rotate around you to administer the treatment. The device does not touch your body at any point.
.

Planning For Total Body Irradiation

To make you more comfortable, prior to your course of treatment, a therapy radiographer will walk you through what to expect during treatment.
..

To begin, there will be a planning session that lasts 90 minutes to create your treatment plan. You should remove all jewellery, watches, glasses, and any other items containing metal such as false teeth.
..

You will be asked to either lay down on the treatment couch or stand in the specially designed frame.
..

Total Body Irradiation Treatment Sessions

A radiographer will aid in positioning you as you were during the preparation sessions. During the treatment, you will be alone in the room, but your radiographers will be watching via CCTV to ensure everything is running smoothly.
.

During the treatment, you will not feel anything, and you will only hear the beeping from the machine. There is a buzzer that you can press at any time to pause the treatment.
.

You need not worry about you, or your clothes will become radioactive after your treatment.
.

What are the Side Effects of Total Body Irradiation?

The possible side effects depend on several factors, including:

• The dosage administered
• The combination of cancer drugs you have that have been prescribed, such as chemotherapy and targeted cancer drugs.
  .

Short-Term Side Effects

Below are some typical side effects of TBI – you may experience them days or weeks after your treatment, and they do not last long.

• Headaches
• Fatigue
• Nausea and vomiting – our doctor will prescribe anti-nausea medication.
• Diarrhoea
• Skin sensitivity – your skin may turn pink or darken and become itchy and sensitive to the sun.
• Dry or sore mouth – our nurse will prescribe both mouthwashes and painkillers to help.
• Bone marrow suppression (low blood counts)
• Swelling of your salivary glands, causing pain at the front of your ear and jaw.
• Complete hair loss on the head and body. Your hair should grow back once you have ceased treatment.
  .

Long-term Side Effects

Below are some side effects of TBI – you may experience them months or years after your treatment.
.

Fertility problems

Due to TBI and high doses of chemotherapy, you may become unable to get pregnant or father a child.
.

In female patients, the treatment is likely to induce early menopause. Female patients may freeze their eggs or embryos prior to the treatment. However, it can take time to stimulate ovaries to collect the eggs, which would delay the beginning of your cancer treatment.
.

Male patients can opt to bank sperm prior to starting any treatment.
.

Underactive Thyroid

Your thyroid gland is responsible for producing the hormones that regulate your metabolism. If your thyroid is underactive, it can mean low levels of these hormones and weight gain, dry skin, tiredness, and constipation. Our doctor will monitor your thyroid and the levels of these hormones through blood tests, prescribing thyroid hormone tablets if these levels are low.
.

Sensitive skin

Patients are advised to be extra careful about being in the sun in the months following their treatment. You are recommended to use a PABA-free sunblock of SPF 30 or higher.
.

Lung Changes

Thickening or scarring of the lung tissue, known as fibrosis, is a possible side effect of TBI. Fibrosis may result in coughing, wheezing, and breathlessness – breathing exercises can help with this. Our doctors will schedule regular tests to ensure your lungs are working correctly. Antibiotics may be prescribed to prevent infection.
.

Cataracts

Cataracts refer to the clouding of the lens of your eye, making it difficult for you to see. Cataracts may develop years after your treatment. However, this is a less common side effect as your exposure to radiotherapy is limited to a period of a few days.
.

Should you develop cataracts, our doctor will refer you to an ophthalmologist to have them removed. It is treated relatively easily with surgery.
.

The Development of a Second Cancer

Both bone marrow and stem cell transplants can increase your risk of developing a second cancer. It is essential to remember that it is a very small risk, and it is less of a threat to your health than if the leukaemia, lymphoma or myeloma was not treated.
.

Disclaimer:
The information on the Centre For Clinical Haematology website is intended for educational use.  It should not be considered or used as a substitute for medical advice, diagnosis or treatment from a qualified health professional.