Royal Prince Alfred Hospital Royal Prince Alfred Hospital
Radiation Oncology

Total Body Irradiation

Total Body Irradiation (TBI) is a form of Radiotherapy used in the treatment of blood related cancers such as some types of leukaemia. TBI is often given in conjunction with chemotherapy as part of the preparation for a blood stem cell or bone marrow transplant.

A course of TBI treatment is usually given twice a day over 2-3 days, with the treatments being at least 6 hours apart. The Radiation Oncologist will discuss this with each individual patient and then prescribe the dose and the number of treatments most suitable.
The purpose of TBI is to:
  • eradicate remaining cancer cells
  • cause depression of the immune system (immunosuppression) to help reduce the risk of transplanted tissue being rejected by the body
  • to treat body areas where chemotherapy alone may not eradicate disease (for example; the fluid around the brain and spinal column)
What happens prior to Treatment?
TBI patients are admitted into hospital (typically the haematology ward at RPAH) before treatment begins. Often patients are escorted over to the Radiation Oncology department by the haematology staff to familiarise themselves with the treatment staff and equipment prior to the first TBI treatment.
Prior to each treatment the patient must have their temperature checked. This is done by the Nursing staff in Radiation Oncology. Each day a team of Radiation Therapists and Medical Physicists will place a number of small measuring devices called thermoluminescent dosimeters (TLDs) at various points on the patient’s body in order to ensure that the dose prescribed by the Radiation Oncologist is received at every treatment. These TLDs will be taped to the skin before each treatment. An additional radiation measuring device called an ion chamber will also be placed between the patient’s legs and secured with tape. The patient will then be placed in the treatment position inside a custom built TBI box/bed. 

Patient lying on the Total Body Irradiation bed 

To ensure the radiation dose is distributed throughout the body evenly, the Radiation Therapists and Medical Physicists will place plates of perspex plastic around the body - particularly in the head and neck region. These plates may be close to the head but will not touch the patient.
What happens during Treatment?
Once inside the treatment room, the TBI bed is raised to the correct treatment height and moved into position. When the treatment setup is complete, the Radiation Therapists and Physicists will leave the room and monitor the patient via a close circuit TV. As with all Radiotherapy treatments it is very important that the patient is as still as possible during the actual treatment.
When the treatment machine is turned on, the machine will make a buzzing noise but will not cause the patient to see or feel anything. When the treatment reaches half-way the treatment machine will stop and the treatment bed will be turned around so the other side of the body can be treated.
Each treatment lasts approximately 40-60 minutes. However, the radiation beam will not be on the whole time the patient is in the room. Most of the time is used to set up the measuring devices and set the treatment bed into position.
Treatment Side effects
Due to individual treatment regimes and medical circumstances, side effects will vary from person to person. Individuals should speak to their Radiation Oncologist or Radiation Therapist should they experiences any problems.
     Side effects
     What can help?
     Patients may experience nausea and vomiting, during and      immediately after treatment. It is important to discuss      these symptoms with your doctor, nurse or radiation      therapist.
     Anti-emetic medications may be prescribed to relieve nausea      and the patient may be given anti-nausea medication to take      before each treatment to help you manage this side effect.
     It is also advised that you try to eat small amounts of food as      often as can be tolerated.
     Fatigue (tiredness)
     Most patients experience reduced energy levels, tiredness      and lack of motivation soon after starting treatment. Just      listen to your body and rest if needed. Treatment related      fatigue will gradually subside once the treatment is      completed.
      Mild skin reaction
     Skin may become dry, pink, and feel warm to touch with mild      discomfort.
     Patients who experience a skin reaction are encouraged to:
  • Avoid sun exposure
  • Use moisturising mild soap
  • Bathe using lukewarm water
  • Avoid irritant products containing alcohol, perfumes or additives and products containing Alpha Hydroxy Acids (AHA) as this can increase skin irritation.
  • Apply simple body lotions or creams on affected area at least once daily. Sorbolene with Gylcerin moisturiser is recommended. 
     Sore mouth and      throat (mild mucositis)
     Sore mouth may arise from ulcers caused by radiotherapy or      from thrush - a fungal infection.
     Mucositis usually occurs 2-3 days after the first treatment.
     Patients may be given mouth washes, and lozenges to suck      regularly to try and help prevent soreness. It is important to      maintain dental hygiene, both for comfort and to prevent      infections developing.      
     Commercial mouthwashes are not recommended as these      are often too harsh or may contain alcohol.
     Pain in the       jaw (Parotitis)
     Pain in the jaw is a result of swelling in the parotid glands.      This may occur anywhere from 12- 48 hours after the first      treatment and may continue for up to 3 days following      treatment. This should be discussed with the Radiation      Oncologist to help manage any discomfort.  
[Any further concerns speak to your doctor or nursing staff in the department]

Useful Links

The Leukaemia Foundation