Leukaemia

Welcome to Cancer Care Services at the Royal Brisbane and Women’s Hospital. This video explores a specialised technique for bone marrow transplant patients offered at the Royal Brisbane and Women’s Hospital called Total Body Irradiation, or TBI for short.

Total Body Irradiation is a form of radiotherapy used primarily as part of the preparative regime for stem cell or bone marrow transplantation. As the name suggests, total body irradiation is a treatment that delivers an exact dose of radiation to your entire body. This radiation treatment is delivered six to eight times over three to four days, treating twice a day with a minimum of six hours in between.

Every patient will need to have a CT scan here at the radiation therapy department. You may have had other CT scans before, but the radiation therapy CT is very important as we are taking measurements and scanning you in the exact position you will be in for your radiation treatment with your own personalised equipment.

At your initial planning appointment, a radiation therapist will greet you in the waiting area and bring you through to our mould room. In this first session, we will make plaster casts behind your arms so that we can create wax blocks that are used for your treatment. You will be required to remove clothing from your upper body before we begin. We will also take measurements to aid in reproducing your treatment position.

The position for your radiation treatment is lying slightly elevated with your hands between your legs and your elbows close to your body. We will put cream on your skin so that the plaster doesn’t stick to you, as well as glad wrap over your clothes to keep them clean from any plaster residue. We then apply plaster strips to get a cast of your body from your shoulders down to your hips. The cast only takes a few minutes to set, during which time it is normal for it to feel warm.

When you return to the department, your personalised wax blocks will be ready for you. Comfortable clothing like activewear without any metal clips or zippers and with a light‑coloured shirt is recommended for your second planning session and subsequent treatment. No jewellery should be worn for the second planning session, which is also a requirement for treatment.

The second session begins by positioning you on the treatment couch using the measurements taken at your mould room session. Next, we place the wax blocks behind your arms and secure them using Velcro strips. We adjust our bed equipment until you are in the ideal position. You will be lying in this position for about an hour, so please let us know if you are uncomfortable. Lead strips will also be placed on your left arm and over your shoulder.

Once you are in the correct position, we take you to one of the treatment rooms where an x‑ray of your chest is taken. This x‑ray is used to check your treatment position daily. The therapists won’t be in the room with you when the x‑ray is being taken, but the process only takes a few seconds. While the staff are outside the room, you are monitored through a closed‑circuit TV. If they are satisfied with the film, you will be taken back to the CT planning room. However, it is not uncommon for the x‑ray film to be repeated.

We require two CT scans to plan your radiation treatment. The first scan is with you lying flat on the CT bed with your arms by your sides, and the second one includes you lying slightly elevated with your personalised wax blocks in place. We use a laser system to ensure you are straight and level when lying down. Do your best to remain as relaxed as possible during the planning process, because when you are tense and stressed, you will hold your body in a much different position to when you are relaxed. It is important to make sure we can position you exactly the same each day for your treatment as you were in your planning session. We move you around until we get the ideal treatment position. Do your best to allow us to do these movements for you.

A non‑permanent pen mark is drawn on your chest that is used to set your position. We then put a sticker on this mark so that it can be seen on the CT scans. You will then be moved into the CT scanner. It is important to stay as relaxed and still as possible and breathe normally throughout the scan. Throughout this planning day, we record on paper and with photos all aspects of your planning session.

Once the scan is finished, we will return to the room and remove you from the CT scanner. You will be positioned the same as you were for the chest x‑ray, with the wax blocks in place. We pack bags between your legs and over your chest and arms. These bags are used to fill any air gaps and react in a similar manner to body tissue when irradiated. The aim of this process is to turn your body shape into a block, which ensures even dose throughout your body. Once again, breathe normally throughout the second scan. We may need to come back into the room and make some adjustments based on your CT images. When the scan is finished, we will return to the room and remove you from the CT scanner.

On your first day of treatment, we will guide you inside the treatment machine. We are required to ask you for your full name, date of birth, and what you are here for prior to each of your treatments. There will be music playing in the room, but if you prefer no music or music of your own choice, please let us know.

Some of your treatment sessions may start with your boost treatment, where you are lying on your back on the treatment bed. This is not applicable to all patients, as not everyone requires a boost treatment. As we raise the treatment couch, we dim the lights and use lasers to reproduce your position. The adjustments to your position are very small, so do your best not to help and allow us to perform these movements for you.

Once happy with your setup, we will advise you that we are exiting the room. This will also be signified by doorbells that sound. You may be in the room by yourself for up to 10 minutes. However, we are watching you on closed‑circuit cameras while delivering your treatment. If you need us for any reason, carefully raise one hand and we will come in straight away.

We take x‑rays that we use to accurately target your treatment site. It is also not uncommon for the radiation therapists to re‑enter the treatment room to manually adjust your position. The machine will make a buzzing noise while delivering the radiation. You will not feel or see anything during the treatment, and be sure to breathe normally at all times. Once completed, we immediately return to the treatment room. Please stay as still as possible until you are instructed that it is safe to move.

The radiation therapist will now reproduce your setup from your simulation session where you were lying on the foam wedges. Bags are then placed between your legs and over your chest and arms. Finally, we will place a blanket over your body.

To achieve total body irradiation, we treat one side of your body at a time. We dim the treatment room lights and raise and move the treatment bed until we have your entire body in the middle of the light beam from the machine. Next, we place a perspex screen along one side of you. We mount important pieces of shielding for your head and lungs on that screen. We will place our hands around your head and chin to ensure that the head shielding is in the correct position.

Prior to delivering your treatment, we take an x‑ray film. This is used to confirm the position of your lung shielding. Adjustments to the lead shielding may be required. Therefore, it is not uncommon for the radiation therapist to repeat this x‑ray. If you need us for any reason, carefully make the facial expression that you and the radiation therapists have agreed upon to get their attention—for example, sticking your tongue out—and we will immediately come in. Just like when taking the film, you will not feel anything while the treatment is delivered.

When the first side is completed, we will come back into the treatment room, move the perspex screen, then spin the treatment bed and repeat the process from the other side. After delivery of the radiation, we immediately return to the treatment room and remove all of the equipment. Your treatment is now complete.

It is important to discuss with the treatment team any concerns or issues you may have experienced during your treatment. For further information regarding your radiation treatment, please feel free to speak with any member of our Cancer Care team.

Radiotherapy or radiation therapy kills cancer cells using high energy X-rays that are generated electrically.

The radiation is directed to the specific area of your body that requires treatment.

Radiation therapy is normally given daily, but can be delivered as a single treatment or over a period of up to six weeks

Treatment each day can take from ten minutes to up to an hour, depending on what area of your body is receiving the treatment.

There are two different ways that radiation therapy can be given, externally and internally.

The most common method is delivered externally using machines called linear accelerators. These machines are like X-ray machines on steroids.

In our department, we also have TomoTherapy machines, and we have a specialised technique called total body irradiation for bone marrow transplant patients.

All radiation therapy machines target the radiation into the specific area being treated in your body.

With external radiation therapy as soon as the machines are turned off the radiation is no longer being produced.

You are not radioactive, so it’s safe to shower, use shared bathrooms, kiss, hug, have protected sex.

It didn’t really feel like anything. It was kind of like an MRI, if you have one of those before. I just laid there with my eyes closed, chilled out. It smelt kind of weird, and it’s hard to explain kind of like a metallic smell.

Radiation therapists are the people who in conjunction with the radiation oncologist, design and deliver your radiation therapy treatment.

Our department is located on level three of the Cancer Care Precinct within the Joyce Tweddell building of the RBWH.

The Sony You Can Centre, located on level six of our building, is a purpose built recreational space for AYA patients.

So if you feel like taking a break away from the waiting areas or wards, there is a space specifically designed for our young people.

Radiation therapy is designed personally for you.

A radiation oncologist worked with a team of specialists across the entire health service to provide you with recommendations regarding the best treatment for you.

As your radiation treatment is custom designed, you will be seen in the radiotherapy department a few weeks before your treatment starts.

At this appointment, a CT scan of the area of your body is a must, and sometimes personalised equipment is created for you to help you stay still and make your treatment precise.

It is very important for you to be as comfortable as possible, and therefore, if it isn’t, please let us know.

So I had full body irradiation. So I was put on a bed lying flat, and I had, they made a cast of my body and I was wrapped in that, and had a lot of sand bags put on top of me.

I don’t know the technical names because I do not care to know. First lot of treatment, a face cast was used with a vacbag behind me just to make sure that I’m held nice and secure in place. And for the second lot of treatment, none of that was used and the machine rather spun around me, which provided me with a little bit more ease.

So the linear accelerator, which is the radiation machine and I had a mask made. So this one here, which is my little face and my favorite piece of equipment used was the speaker. So you can use that to like, play your own music. Which was really awesome.

Just like an x ray, you should not feel anything when you’re having your treatment.

The way radiation works, it also affects the cells around the area of the body being treated.

You may experience some side effects after your first week of treatment.

Your radiation oncologist will discuss your potential side effects before your treatment starts.

Side effects experienced are usually dependent on where you’re having treatment.

If you begin to experience any of them, make sure to tell the radiation oncologist, radiation therapists or the nursing team within your centre.

With the first intensive radiation therapy I experienced very intense side effects, muscle pain. It burnt the inside of my throat and I couldn’t swallow. But as I was getting ready for a transplant, that was all to be expected and kind of, you know, exacerbated by other chemotherapy treatments.

With the second lot of treatment that I had that was daily for a month, the side effects were a lot less, you know, that was just a bit of tiredness, fatigue and joint pain, but no severe burns or discomfort when swallowing was experienced.

Just the soreness of where the radiation was targeted towards me, which in my case was my chest, and that was really it. There’s no other side effects, which was great.

So my side effects were I was sick after every single treatment. And because I was getting it on my head as well, I lost my hair.

So going into it, I kind of just accepted the fact that my body may not react nicely to treatment, so I didn’t put any pressure on myself to uphold my lifestyle. And looking back like, I’m really glad I did that because I was really fatigued throughout the whole thing. I would say, if you’re getting it five days a week to maybe plan for weekends, maybe a Sunday, because I was still quite tired on a Saturday. And I think like really just like think about your body and if you wake up feeling ready for it and energised, then organise something then, but yeah, just listen to your body.

So during radiation, I made sure to go at my own pace. I made sure that any activities that were planned with me and my friends or family were less high energy and more socializing and just chilling.

I just kept it at one day at a time often to prepare yourself mentally and emotionally for the next session. I also tried to bribe myself with fun activities, lunches, coffees, anything that would work.

I kind of just had to power through it, realise that this is really going to help you in the future and that a small like couple of hours of uncomfortableness is going to result in you being able to hopefully be happy and healthy for a long time in the future.

I’d probably tell myself, you don’t need to be so strong, you know you can let yourself take it all in. Tt’s not a scary time, it’s something that you need to get better.

Just to look again, pay attention to your body, do whatever makes you happy, comfortable and gets you through it, whatever that is. I had Maccas after every single treatment, just do whatever works for you. Yeah, and this don’t put pressure on yourself. It’s a lot to go through. So mindfulness, self-care, eat whatever food you want, do whatever you can to get through.

I think for me, it, you know, I would tell myself that it’s so important to understand that it will pass. You know, the treatment cycle will finish, you know, your body will slowly recover. And even in the worst parts of it, you can get through by looking at the fact that you will be healthy and stronger again. And those feelings and smells and senses they will stop.

For more information about radiation therapy, please visit the Cancer Council website.

For more information about adolescent and young adult support services, please visit these websites.