Radiotherapy for a brain tumour

Radiotherapy uses high-energy rays to destroy the tumour cells and control the tumour, while doing as little harm as possible to normal cells. Radiotherapy machines are designed to limit the damage to healthy brain tissue.

You may have radiotherapy:

• as your main treatment
• after surgery, if a tumour cannot be completely removed
• after surgery, to reduce the risk of the tumour coming back
• with chemotherapy
• if a tumour comes back.

Radiotherapy is always carefully planned by a team of experts. This includes a clinical oncologist and radiographers, who are experts in giving radiotherapy treatment. They will explain your treatment plan and what to expect.

Radiotherapy can be given in different ways to treat a brain tumour.

Stereotactic radiosurgery (SRS) gives radiotherapy as a single higher dose of radiotherapy, to a small area. SRS does not involve any surgery.

There are different types of radiotherapy machines which can deliver SRS. These include:

• Gamma Knife^™
• CyberKnife^™
• linear accelerator (LINAC).

The amount of time it takes to have the treatment depends on the type of machine that is used. A session of treatment can take from about 15 minutes up to 4 hours. Sometimes, it may take longer.

SRS is not suitable for everyone with a brain tumour. It is usually only used to treat small tumours. The most common type of tumours treated with SRS are brain metastases. These are tumours which have travelled to the brain from other parts of the body. SRS is also used for other types of tumours, including small benign (non-cancerous) tumours.

Your doctor can explain which treatment is best for you and how long the treatment may take.

Sometimes, you may have this type of radiotherapy in smaller doses over a number of days or weeks. This is called stereotactic radiotherapy (SRT). Each daily dose is called a fraction.

We have more information about having SRS for a brain tumour.

Proton beam therapy is a type of external beam therapy that uses protons instead of high-dose x-rays. Protons are parts of atoms. The protons are shaped into a beam that is targeted at the cancer.

Proton beam therapy is not used for all types of brain tumours. It is only used for a small number of people with certain types of brain tumour. For adults, these may include some tumours affecting the base of the skull and a rare type of tumour called medulloblastoma. Your doctor will explain if this treatment might benefit you.

You have proton beam therapy using specialised equipment that is not available in all UK hospitals. You may be referred to a specialist hospital if you are having this type of treatment.

We have more information about having proton beam therapy.

During your planning appointment, you will have a scan of your brain. You wear the mask or frame while having a CT scan. Most people will also have an MRI scan.

Your radiotherapy team uses information from the scans to plan your treatment. They will explain your treatment plan and how many times you need to visit the radiotherapy department.

The radiographers help you get into position for the scan. You lie on a treatment couch in the same position you will be in for treatment. If you need a mask or head frame, the radiographers gently fix this to the couch.

The radiographers may make a few ink marks on the mask or head frame. These marks help make sure you are in the correct position for each session of radiotherapy.

During the scan you will be alone in the room. The radiographers can see and hear you from outside the room. There is usually an intercom, so you can talk to them if you need to.

You may develop side effects during or after your treatment. These can depend on:

• the area of the brain that has been treated
• the amount of radiotherapy given.

Your radiotherapy team will explain what is likely with your treatment. Some side effects are mild and easy to cope with. Others may be managed with drugs or other treatments.

Side effects usually improve over a few weeks or months after your treatment ends. Sometimes side effects or symptoms of the brain tumour get worse for a while after treatment has finished. If this happens, you may worry that the treatment is not working. But it is usually a normal reaction to the radiotherapy. Side effects may also happen if the amount of steroids you have been taking have been reduced or stopped.

Tell your radiotherapy team straight away if your side effects get worse during or after treatment. They can give you advice on how to manage them.

Radiotherapy often makes people feel tired. Tiredness (fatigue) may get worse as treatment goes on. If you are having radiotherapy alongside other treatments, such as surgery or chemotherapy, you may feel more tired. But there are things you can do to help, such as:

• get plenty of rest
• do some gentle exercise, such as short walks, for about 30 minutes a day
• eat a healthy diet and drink plenty of fluids
• ask others for help with everyday jobs.

Radiotherapy to the brain can cause extreme tiredness 4 to 8 weeks after treatment. You may have very little energy, feel drowsy and spend a lot of time sleeping. It usually gradually gets better over a few weeks. But some people may continue to feel tired for weeks or months. Or sometimes longer.

We have more information about coping with tiredness (fatigue).

Tell your radiotherapy team if you get headaches during radiotherapy. They can give you painkillers or steroids to help.

Your radiotherapy team can explain how your treatment may affect your hair. You may lose some hair in the area being treated. You may also lose hair on the opposite side of your head. This is where the radiation beams exit. Your hair will usually start to grow back within 2 to 3 months after treatment ends. Sometimes it grows back a slightly different colour or thinner than before.

We have more information about coping with hair loss.

Your skin in the treated area may become sore or itchy.

If you have white skin the treated area may become red. If you have black or brown skin, the area might get darker.

Your radiographer or specialist nurse will give you advice on taking care of your skin. Tell your radiotherapy team straight away if you have these symptoms. They can give you advice and treatments if needed.

Skin reactions should get better within 4 weeks of treatment finishing.

During your treatment, you are usually advised to do the following: 

• Wash your hair or scalp gently with lukewarm or cool water. Use non-perfumed shampoo or soap.
• Pat your hair or scalp dry gently with a soft towel. Avoid rubbing it or using a hair dryer.
• Follow the advice your radiotherapy team gives you about using moisturisers.
• Wear a scarf or hat to protect your head from the sun or cold.
• If you shave your head, use an electric razor instead of wet shaving.

Your skin in the treated area may be more sensitive to the sun after treatment. You may find that this area burns more easily. Take extra care in the sun during treatment and for at least 1 year afterwards. Cover up or use suncream with a sun protection factor (SPF) of at least 30.

If you feel sick, your doctor can give you anti-sickness drugs to help. If you do not feel like eating, try having nutritious, high-calorie drinks. You doctor may be able to arrange these for you, or you can buy them from most chemists.

We have more information about coping with nausea and a loss of appetite.

Radiotherapy can cause some swelling in the brain. This can make it more likely to have a seizure. This may depend on the area you are having treatment, or if you were already having seizures before treatment. Medication to control seizures can help reduce the risk of seizures. These are called anticonvulsants. It is important to talk to your doctor, nurse or radiographer about any symptoms you have.

Your doctor or nurse can tell you if treatment is likely to affect your fertility. Radiotherapy to the pituitary gland at the base of the brain may sometimes affect fertility.

We have more information about fertility.

Macmillan is here to support you. If you would like to talk, you can do the following:

• Call the Macmillan Support Line for free on 0808 808 00 00.
• Chat to our specialists online.
• Visit our radiotherapy and side effects forum to talk with people who have been affected by radiotherapy, share your experience, and ask an expert your questions.