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Total Body Irradiation (NYULH-PCC)

Radiation therapy is treatment that destroys cancer cells, or suppresses or eliminates the bone marrow using high-energy rays from x-rays, electron beams, or radioactive isotopes. Total Body Irradiation (TBI) is a type of radiation treatment given to your whole body to weaken or destroy your bone marrow cells before your stem cell transplant. This is done by a radiation doctor (Radiation Oncologist).

 

Your Treatment Planning Visit: The Simulation

After the consult with your Radiation Oncologist, we will schedule you for a CT Simulation, or treatment planning visit. Your radiation therapy team will use a special CT machine to map out your treatment. Laser lights act as guides to help position your body accurately.

 

During this visit:

  • The team figures out the best position for your body. They make notes in your chart so you will be placed the same way each time.
  • You may use special devices to keep your body correctly positioned and still during treatment. These may include body molds and rice bags.
  • After the team has the imaging and data, the information is sent into the computer planning system. Your doctor and the team of physicists and dosimetrists design a treatment field.

 

Your treatments

As an admitted patient, a Patient Escort will transport you to the Radiation Department. You will need to wear a hospital gown while you get your treatment. Please make sure to remove all jewelry and hair pins.

 

During your treatments:

  • The radiation team will place you in the correct position on the treatment table behind a large plexiglass screen. This plexiglass screen will allow the radiation to be evenly distributed to your entire body.
  • The radiation team will then leave the room.
  • Lie as still as you can and breathe normally.
  • You will hear noises coming from the machine. You can talk to the radiation therapist, who watches you from the control room on a TV monitor.
  • Halfway through your treatment, the radiation team will come back into the room and rotate the treatment table so that your head is facing the other way.
  • After your treatment is complete, the therapists will help you off the table. You will then be escorted back to your hospital room.

 

Side Effects of TBI

You may experience side effects from the radiation treatments. The type of side effects and how severe they are will depend on how many treatments you receive, the dose of radiation, and your overall health.

  • Short-term side effects include:
    • Hair loss
    • Fatigue (Feeling tired)
    • Nausea and vomiting
    • Diarrhea
    • Skin reactions
    • Mouth sores
    • Low blood counts (bone marrow suppression)

Most side effects go away soon after treatment ends. But some side effects do not happen until months or even years after the treatment. 

  • Long-term side effects include:
    • Sterility
    • Secondary cancers
    • Endocrine issues
    • Infections
    • Long-term effects on your heart and lungs
       

Managing Side Effects of TBI

Skin Care

The skin in the treated area may become irritated, dry, itchy, sensitive, or red like a sunburn. Skin reactions can start to appear after your first treatment and slowly get better 2 to 4 weeks after radiation therapy is over. In some cases, the skin reaction does not start until radiation is finished.

 

To care for your skin: 

  • Use lukewarm water and a mild, fragrance-free soap. Let the water run over the treated area. Avoid scrubbing the treated area.
  • After showering, gently pat the treated area dry.
  • Do not use creams, lotions, ointments, alcohol, peroxide, baby powders or oils on the treated area. Many skin products can leave a coating on the skin that may cause irritation and may even change the dose of radiation.
  • Avoid placing anything hot or cold, such as heating pads or ice packs, on the treated area. 
  • Do not put tape directly on the treated area.
  • Avoid wearing clothing that may irritate the skin, such as wool, over the treated area.  Instead, wear loose-fitting cotton.
  • After 2 to 3 weeks, you may lose hair in the treated area. The hair usually grows back 2 to 4 months after radiation therapy is finished.
  • Do not shave the treated area unless your doctors or nurses say it is okay.
  • Avoid exposing the area to the sun during treatment and for at least ONE YEAR after your treatment is completed. When your treatment course is completed use a sunscreen with an SPF of 30 or higher, even underneath your clothing or swimwear.  Re-apply every 4 hours.
  • If you begin to experience pain, blisters, peeling or a break in your skin, notify your nurse or radiation oncologist. 

 

Radiaplex gel:  

  • We may give you a special gel called Radiaplex to use on the treated area, if indicated by your radiation oncologist.
  • Follow your nurse or doctor’s instructions about when to start using it.
  • Apply a thin layer of gel to the treated skin area.
  • Apply the gel AFTER treatments, not before.
  • You can use the gel as often as needed and on the weekends.

 

Managing Fatigue

Fatigue (feeling tired) is the most common side effect of radiation therapy. Your body is using more energy to handle the demands of treatment. Most people begin to feel tired after a few treatments and it usually gets worse as your treatment goes on. Fatigue usually improves 1 to 2 months after radiation therapy is over.

  • Stay active to keep lungs, heart, bones and muscles stronger.
  • Space out activities throughout the day. Do important activities first, when you have the most energy. Give yourself time to rest in between activities. You know yourself best. Listen to your body. Avoid exhaustion. Remember that it could take up to 6 months or more before your stamina returns.
  • Balance activity with rest and sleep. Shorter naps are better than long ones. Too much bed rest can make you feel weak.
  • Use methods to reduce stress such as deep breathing, meditation, listening to music, reading or any other activity you enjoy.
  • You may take a daily multivitamin. However, the recommended daily allowance (RDA) percentage of vitamins A, C and E cannot be more than 100%. Check the label on the bottle. Ask your doctors or nurses before taking any other supplements or herbal medications.
  • Good nutrition is vital to your recovery. When you are discharged from the hospital, you may have a smaller appetite, changes to your taste, mouth sores, dry mouth, or diarrhea. These problems slowly improve over time

 

Nausea / Vomiting

Nausea is feeling queasy or sick to your stomach. It may lead to vomiting. Some patients may also have retching, or dry heaves, which is the motion of vomiting but does not bring up stomach contents. Patients may have these symptoms 30 minutes to 2 hours after radiation treatment. Symptoms can last for several hours. A combination of both radiation and chemotherapy increases the chance of having both nausea and vomiting. Nausea and vomiting can be controlled with dietary changes and/or medication.

 

How to Manage Upset Stomach / Nausea/ Vomiting:

  • Eat small frequent meals instead of 3 large meals. Eat slowly.
  • Try to eat the most during the time of day when you feel best. Do not force yourself to eat when you feel nauseated.
  • Avoid foods that are fried, spicy, sugary or high in fat.
  • Eat and drink foods that are bland and easy on the stomach such as crackers, rice, dry toast, plain noodles, dry cereal, potatoes, broth, apple or cranberry juice, ginger ale, sport drinks, popsicles, sherbet or gelatin, especially on treatment days.
  • Eat foods and liquids that are cool or at room temperature.
  • Avoid foods that have strong odors that can increase your nausea. Ask your friends or relatives if they can prepare your meals when you are nauseated.
  • Try nutritional supplements such as Boost or Ensure to add calories and protein to your diet.
  • Some patients feel better when they eat before treatment. Other patients feel better avoiding meals several hours before treatment and then eating 1 to 2 hours later. Do what works for you.

 

Diarrhea

Bowel symptoms you may have are loose stools, diarrhea, and more frequent bowel movements that are soft and smaller.

 

How to Manage Diarrhea: 

  • Eat small frequent meals.
  • Avoid milk and milk products (ice cream, cheese) if they tend to irritate your bowels.
  • Avoid caffeine (coffee, tea, soda, chocolate).
  • Eat foods that are high in potassium (bananas, potatoes, apricots.) Potassium is an electrolyte you lose through frequent diarrhea.
  • Avoid foods high in fiber (raw fruits and vegetables), fried, greasy, sugary, spicy foods, or foods that cause gas (beans, cabbage, broccoli). Ask for a Low Residue Diet handout from the radiation nurse for further instructions, or for an appointment with the nutritionist.
  • If you are having diarrhea, try a clear liquid diet (water, broth, tea, apple juice, and popsicles.) It is important to drink more fluids so that you do not become dehydrated.
  • When the diarrhea improves, start eating small amounts of low fiber foods such as rice, bananas, applesauce, mashed potatoes, and dry toast.

 

 

© NYU Langone Health 2021. All rights reserved. Reviewed for health literacy. This information is not intended as a substitute for professional medical care. Always follow your health care provider's instructions.