Total Body Irradiation (TBI)

Author: OncoLink Team
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What is it?

Total Body Irradiation (TBI) is when the whole body receives radiation treatment. It is done to prepare you for a bone marrow or stem cell transplant. Your whole body (front and back) will get radiation treatment. The radiation given is a low dose so that normal tissues can repair (heal) themselves. The radiation is still able to kill the bone marrow and remaining cancer cells. This prepares your body for a bone marrow or stem cell transplant so that your own cells do not attack the transplanted cells.

How is a treatment plan created?

You will have a CT scan of your entire body. In some cases, measurements of certain areas of your body will be done, instead of a CT scan, to create a treatment plan.

Who creates my treatment plan?

  • A dosimetrist (a provider who makes the plan).
  • Physician (radiation oncologist who approves the plan).
  • Physicist (a provider who checks the plan).

How can I prepare before arriving to my radiation treatment?

  • Use the bathroom - Treatment takes about 30-45 minutes. You will need to lie still during that time.
  • Remove all jewelry and piercings - Metal cannot be in the radiation treatment area.
  • Change into a gown - It is important to not have any metal in or on your clothing (underwire bra, metal buttons, zippers). Your care team may ask you to change into a hospital gown for treatment. 
  • Take your medication - Make sure that you take all of the medications that you need before you leave your hospital room to come for treatment.

How is TBI given?

You will either stand or lie down for the treatment. You will be far away from the treatment machine where the radiation dose comes from. The radiation is given to the front of your body first. Then the radiation therapist will help you turn 180 degrees so that they can deliver the radiation dose to your back. 

The radiation dose is given over 1-3 days. You will receive radiation twice a day 4 to 6 hours apart. You and the members of your radiation care team will decide which treatment dose and schedule are best for you. 

The patient stands on a platform and holds on to handles during treatment. If the patient is too tired to stand there is a seat. 

In the lying position, the patient is lying on the stretcher with her arms across her chest and her knees bent. During treatment, a belt is placed around the patient to insure they don’t roll off the stretcher.

Why is this treatment dose used?

This treatment dose is used to destroy your bone marrow and suppress your immune system prior to having a bone marrow or stem cell transplant. The bone marrow or stem cells to be transplanted are given back to you through an IV (intravenous) following the last dose of radiation therapy. The transplant team and the radiation therapy team will work together to coordinate the delivery of your radiation treatment and stem cell/bone marrow transplant. 

What treatment devices are used?

Head and Neck Compensators 

Head and neck compensators are thick lead devices that are placed on a plastic tray. The head and neck compensator will be placed in front of your head and neck for treatment if the radiation team decides it is needed. These are used to even out the treatment dose for differences in size between your head and neck.

Side view of compensator. 

Front view of compensator.

The head and neck compensator is placed in front of the patient’s head and neck in this picture.

TLD - Thermoluminesent dosimeters

On the first day of treatment small circular measuring devices called TLD will be placed on your skin by one of the members of the radiation physics team. They are placed on the skin to make sure the radiation dose is being equally given to the front and back of your body. The devices are taped on the skin for treatment in the following areas:

Thermoluminescent Dosimeters

  • Ankles.
  • Knees.
  • Thighs.
  • Back. 
  • Head.
  • Neck.

What if I have concerns during treatment?

You will see the radiation therapist every day for treatment and can ask them any questions or report any concerns. Your radiation oncologist will see you between your 1st and 3rd treatment, depending what your treatment plan is. Report any concerns about side effects to your team.

What are the possible acute side effects of TBI?

Acute side effects are those that you experience right away or soon after treatment. Side effects can vary from person to person. Make sure to talk to your team about any new or concerning side effects you have. 

Nausea and Vomiting: Nausea and vomiting can be a common side effect. You may be given medications to help manage this side effect. Eat foods that you feel you can tolerate and try to get enough fluids so that you stay hydrated.

Diarrhea: The radiation may cause diarrhea since radiation is being given to the whole body. It is important to stay hydrated. You may be given medications to help manage this side effect. 

Mouth Sores (Mucositis): These sores can make it hard to eat and drink. Changes to your diet and medications can be used to treat and lessen the pain caused by mucositis.  

Fatigue: It is normal to feel tired from treatment. You may feel the need to take a nap. Listen to what your body is telling you and rest when you can.

Skin: Your skin may become red, irritated, dry, and darker in color. It may look or feel like a sunburn. It is important to keep your skin clean. Ask your provider which soaps and lotions you can use but in general, fragrance and dye-free soaps and lotions work best.

Hair: You will lose all the hair on your body. This includes your head, eyebrows, pubic hair, and legs/arms, etc. Hair typically grows back several months after treatment ends. 

Bone marrow suppression (low blood counts): It is normal for blood counts to become low. Whole body radiation targets suppressing the bone marrow so that the body is prepared for the bone marrow/stem cell transplant. 

What are the possible long term side effects of TBI?

Long-term or late side effects of TBI are those that you experience months to years after treatment. 

Cataracts: It is important to visit the eye doctor each year to be monitored for cataracts. You may also have dry eye and using artificial tears can help. 

Thyroid Issues: TBI can result in thyroid problems, including hypothyroidism (under reactive), hyperthyroidism (over reactive), and thyroid nodules/tumors. During your yearly physical your provider will feel your thyroid for changes, and you will have blood drawn to see how your thyroid is working. 

Liver Damage: TBI can also cause long-term damage to the liver. Signs of liver damage are abdominal pain, swelling of the abdomen (ascites), weight gain, and/ or yellowing of the skin and eyes (jaundice). If you have any signs of liver problems, you should call your provider right away. Once a year your primary care provider should order blood work to check your liver enzymes. You should also avoid excessive alcohol consumption. 

Kidneys: TBI may cause long-term damage to the kidneys. This can result in decreased kidney function and high blood pressure. During your yearly physical exam your primary care provider will check your blood pressure and you will have blood drawn to check your kidney function. 

Lungs: TBI treatments can cause scarring to the lungs. If you are a smoker or have smoked in the past, seeing a pulmonologist can help you manage late side effects from treatment. If you do smoke, you should quit. If you have any new or worsening shortness of breath or cough, you should contact your provider right away. 

Fertility problems: TBI can cause permanent sterility in both men and women. It is important to talk to your care provider before starting radiation about fertility options such as harvesting and freezing eggs and sperm. 

If you have any questions or concerns about TBI you should contact your provider. 

References

Leaver, D., Washington, C.M. Principles and Practice of Radiation Therapy, St. Louis, Mosby, 2004. 

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