Royal Prince Alfred Hospital Royal Prince Alfred Hospital
Radiation Oncology

Radiotherapy for Brain Tumours

Radiotherapy can be used alone or in combination with surgery for the treatment of brain tumours. 
 
The treatment course received by a patient depends on a variety of factors; including the type of tumour (histology), location, stage of the disease, your general health and age.
 
Your Radiation Oncologist will advise you what regime is most suitable for you, how effective the therapy will be and how the treatment will affect you.
 
 
What should you bring to your Radiotherapy Planning appointment?
 
  • A referral letter from your doctor (if not already submitted)
  • Medicare card
  • All private scans relating to your current diagnosis 
  • A list of your current medications (including any medication allergies)
 
What happens during Planning?
 
 
When you come into the Radiation Oncology Department, please report to the reception area. You will be guided to the waiting room where you will be met by your Radiation Therapists. The Radiation Therapists will introduce themselves and ask you to confirm your identity by asking you to state:
  • your full name,
  • date of birth, and
  • the body site you will be having treatment to
You will find that this identification process is repeated multiple times during your treatment. This is because correct identification of patients is crucial to ensure that the correct treatment is given to the correct patient.
 
After correct identification, your Radiation Therapist will briefly explain the planning procedure and give you the opportunity to ask questions. You will then be shown to the change rooms to change into a gown. You will then be escorted to the Radiotherapy Simulation and Planning area where your Radiation Therapists will position you on the CT scanner bed.
 
Typically you will be lying on your back with the aid of a neck rest and knee support.

Immobilisation mask 

Your Radiation Therapists will also ensure that you are lying as straight as possible on the CT scanner bed. They will do this using the lasers situated in the CT scanner room. This process will also be repeated at each of Radiotherapy sessions. 

You will then have a customised mask made for you. Making the mask is a painless 5-10 minute process. You will wear your mask during your planning CT scan and then everyday during treatment. The mask helps reduce any movement of your head during treatment so that the planned treatment course can be delivered accurately and precisely.

You will then undergo a CT scan in the treatment position. It is very important that you breathe normally and lie very still during the CT scan as any movement can affect the quality of the scans and you may then need to have the scans repeated.
  
Once the scan is complete, your Radiation Therapists will take photos of the area to be treated and your face for identification purposes. These will be attached to your treatment plan and medical records. 
 
Your Radiation Oncologist will be present during the planning session which takes approximately 30-45 minutes.
 
At the end of the Radiotherapy Planning session you will be given an appointment card which will contain details of your first treatment (date and time).
 
Your Radiation Therapist will then escort you back to the change rooms. When you have collected all of your belongings, your Radiation Therapist will show you the location of the treatment waiting room. This is where you will wait for your treatment every day once Radiotherapy starts.
 
You will also be shown how to scan your card at the front desk barcode scanner which you will use every day when you arrive for treatment. This is how you will notify the treatment staff of your arrival in the Department.
 
 
 
Patient lying with mask in place for the CT scan
 
 
What happens during treatment?
 
 
When you come in for your first treatment, you will need to scan your card at the front desk and take a seat in the waiting room.
 
One of your Radiation Therapists will call your name when they are ready to treat you.
 
Your Radiation Therapist will introduce themselves and ask you to confirm your identity by asking you to state:
  • your full name,
  • date of birth, and
  • the body site you will be having treatment to.
Your Radiation Therapist will then sit down with you to discuss the treatment process, and expected side effects relating to your treatment. You will have already discussed side effects with your Radiation Oncologist but if you have any questions please feel free to ask your Radiation Therapist who will answer your questions to the best of their knowledge. If necessary they will refer you to the appropriate member of your treatment team who can provide you with further information. 
 
 
 
 
Your Radiation Therapist will take you to your treatment room and you will be asked to lie on the treatment bed in the same position as you were in your planning session.
 
Your mask will then be placed and secured.
 
Your Radiation Therapists will then dim the lights so that the laser beams in the room can be seen clearly. These will be used to guide the them in setting you up in the exact same position every day.
 
Your Radiation Therapists may feel for your bones and move you slightly when they are setting you up. It is important that you do not try to help unless asked as usually only millimetre adjustments will be made.
 
The bed and machine will then be moved into the treatment position. The machine may come close to you, but will not touch you at any point during the treatment process.
 
When your Radiation Therapists are ready to treat you, they will let you know and then leave the room. You will hear a doorbell sound as they leave.
 
Just stay nice and still and breathe normally.
 

Radiation therapists monitoring a patient's radiotherapy treatment

 

There are cameras and a microphone inside the room and your Radiation Therapists will use these to monitor you throughout the treatment. If you need your Radiation Therapists for any reason, wave your hand or call out and your Radiation Therapists will come straight in.
 
When the treatment is over, your Radiation Therapist will come back into the room and assist you off the bed.
 
Although the actual treatment only takes a few minutes, the whole treatment session (from positioning to finishing treatment) may take about 10-20 minutes each day.
 
During the course of Radiotherapy, you will see your Radiation Oncologist or another doctor on your treatment team once a week on a set review day. This is important as it allows them to monitor your progress and address any concerns you may have about your treatment. Please allow for more time on this review day as your visit to the hospital will be slightly longer.
 
 
 
 
Due to individual treatment regimes and medical circumstances, side effects will vary from person to person and are specific to your customised plan.
 
Your Radiation Oncology medical team will see you once a week during your treatment to monitor your progress and to help manage any side effects.
 
If you have any problems between these visits please speak to your Radiation Therapist who will contact your doctor for you as needed.
 
Some of the possible side effects are listed in the table below. Most side effects usually occur one to two weeks into treatment or may appear during the course of your treatment.
 
Many of these side effects can be managed and will gradually disappear after your treatment has finished.
 
Please let your treating team know if you develop any of these symptoms so they can be managed and you are more comfortable.
 

     Side effects
     What can help? 
 
     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.  
 
     Dry, red, itchy skin      (in the treatment area)
 
     Skin reactions tend to appear after about two weeks of      treatment and may develop even further to become itchy and      tender as the treatment  continues.
 
     The skin reaction is similar to that of sunburn; it may become      pink, and may feel warm to touch with mild discomfort.
  • Avoid sun exposure – wear a hat if in the sun
  • Use a mild soap in the treatment area
  • Bathe using lukewarm water, and avoid scrubbing in the treatment area.
     Headaches
 
  • Rest
  • Medication may be prescribed by your doctor or nursing team
  • Drink plenty of fluids
     Nausea (feeling sick)      and/or vomiting
 
     Patients may experience nausea and vomiting, during and      immediately after treatment
 
     It is important to discuss these symptoms with your doctor.
  • Nausea and vomiting may be due to swelling of the brain in the area being treated causing increased pressure in the brain. Your doctor may prescribe medication including steroid medication to reduce the swelling.
  • Maintain your fluid intake and nutrition; it is advised that you try to eat small amounts of food as often as can be tolerated.
  • Avoid greasy fatty foods
  • Avoid foods with strong odours
     Loss of appetite
 
  • Consume foods that taste good to you
  • Add more flavour to food if food tastes is dull or metallic
  • Eat small meals and snacks as tolerated
     Hair loss (in the      treatment area)
 
     Hair loss normally occurs after about two weeks of treatment.      Usually temporary but may be permanent.
 
     Excessive drowsiness
 
  • Sleep a few hours longer at night to avoid excessive sleepiness during the day.
  • If possible, exercise daily during the morning or early afternoon.
  • Try to go to sleep and wake up at the same time every day.
  • Get out of bed and stay out of bed until bedtime.
  • Avoid caffeine
  • Your doctor might prescribe medication to relieve the symptoms which may be due to increased swelling and pressure in the brain.
     Short term memory      loss, difficulty      concentrating, difficulty      doing complex tasks
 
  • Medication may be prescribed
  • Rehabilitative therapies may be helpful

 
 
[Any further concerns speak to your doctor or nursing staff in the department]
 
 
 
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