Prophylactic cranial radiotherapy (PCR)

PCR is sometimes used to treat people who have:

• small cell lung cancer (SCLC)  – usually if the cancer has responded well to treatment with chemoradiation
• acute lymphoblastic leukaemia (ALL)
• lymphoblastic lymphoma.

Chemotherapy may not always be effective at treating cancer cells that have spread to the brain. This is because the brain is protected by a membrane called the blood-brain barrier. This stops a lot of chemotherapy drugs from getting to the brain.

Each person’s reaction to radiotherapy is different. Some people have very few side effects, and other people have more. Usually the side effects of PCR are mild.

You will lose your hair when you have PCR, but this is usually temporary. Your hair may start to fall out about 3 weeks after your first treatment. It usually starts to grow back 2 to 3 months after you finish treatment. Sometimes it grows back a slightly different colour and texture than it was before, and it may not be as thick.

Radiotherapy can make you tired, especially if you have to travel a long way for treatment each day. You may feel tired for several months after treatment has finished.

Some people get somnolence after radiotherapy to the brain. This is extreme tiredness that happens about 4 to 8 weeks after treatment finishes. If you get somnolence, you may:

• have very little energy
• feel sleepy
• spend a lot of time sleeping.

This slowly gets better over a few weeks.

Some people have headaches during treatment. You may get headaches in the first few days after starting PCR. It is important to tell the staff looking after you if you have a headache. Your doctor may prescribe painkillers, or sometimes steroids.

You may feel sick (nauseous), but this is not common. Sickness can usually be treated with anti-sickness drugs (anti-emetics). Your doctor can prescribe these. Tell your doctor if your sickness does not get better. They can prescribe other anti-sickness drugs that may be more effective, or steroids.

Your healthcare team will advise you on how to look after your skin. Do not put anything on the treated area of your skin before checking with your nurse or radiographer.

Wash your hair or scalp gently with lukewarm or cool water. Gently pat your hair or scalp dry with a soft towel. Do not rub it, and do not use a hairdryer.

You may have a mild skin reaction after PCR. Your skin may become red and itchy and sore behind the ears. It may also become darker. Staff in the radiotherapy department will check your skin for a reaction. Tell them if you notice any changes or feel any soreness.

If you have a skin reaction, wear a scarf or hat to protect your head from the sun or cold until it gets better. Avoid exposing your head to the sun during treatment and for at least 1 year afterwards. Cover your head or use suncream with a sun protection factor (SPF) of at least 30.

Radiotherapy to the brain may affect your memory and ability to think or reason (cognitive function). After treatment, you may have memory loss or difficulty concentrating.

Your doctors can explain more about this. They will discuss with you the risk of this happening compared to the benefit of having PCR. The effects on memory are more likely to happen in older people who have PCR.

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