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Acute Lymphocytic Leukemia (ALL): Radiation Therapy

Acute Lymphocytic Leukemia (ALL): Radiation Therapy 

What is radiation therapy?

Radiation therapy is a treatment for cancer that uses high-energy X-rays. A machine directs the rays of energy to the area of cancer. Radiation therapy is also called radiotherapy. Its goal is to kill or shrink cancer cells.

When might radiation therapy be used for acute lymphocytic leukemia (ALL)?

Radiation therapy is usually not part of the main treatment for people with ALL. But it may be used in certain situations. Your doctor may recommend radiation therapy for these reasons:

  • You’re having a stem cell transplant. This is rarely done for CLL, but may be used in certain cases. Radiation therapy kills not only leukemia cells, but also normal bone marrow cells. This helps prevent the rejection of stem cell transplants. If you need to have a transplant, you may have total body irradiation (TBI). This sends radiation in equal doses to all parts of your body.

  • You need radiation to help manage symptoms. For example, radiation can help with bone pain caused by the growth of leukemia cells in bone marrow.

  • ALL cells have spread to your brain, spine, or another organ. Radiation can give focused treatment on the leukemia cells in these parts of your body. In rare cases, a tumor may grow that causes problems with the function of an organ. Radiation can be used to shrink the tumor.

How is radiation therapy given?

You will receive radiation treatments either as an outpatient or as an inpatient. Outpatient means you go home the same day. Inpatient means you stay overnight in the hospital. For treatment directed at just a small part of your body, you can likely do this as an outpatient. If you’re getting ready for a stem cell transplant, you will have the treatments as an inpatient.

Preparing for radiation therapy

To prepare for your treatment, you will have a session called a simulation. During this session, your radiation therapist decides which position you’ll need to be in during treatments. The radiation needs to be pointed at the exact same spot on your body each time. This is called your treatment field or port. After you lie in a comfortable position, the therapist will see where the radiation needs to go. Then he or she marks your body with ink that won’t wash off easily in the shower.

During a radiation treatment session

The treatment is a lot like getting an X-ray. You stay in the radiation room for about an hour. The radiation will take about 15 minutes.

You’ll lie on a table while the machine is placed over you. The radiation therapist will line up the machine exactly with your marked treatment fields. The radiation therapist will leave the room to turn on the machine. You will be able to talk to each other over an intercom. You may hear whirring or clicking noises. During the session, you will be able to talk to the therapist over an intercom. The procedure is painless. You will not be radioactive afterward. 

During total body irradiation (TBI)

If you’re having total body irradiation as part of a stem cell transplant, you will stand in a special machine or lie down on either your stomach or your back. Special shields protect your organs, such as your lungs, heart, and kidneys, from high-dose radiation.

Possible side effects of radiation therapy

Radiation affects normal cells as well as leukemia cells. Because of this, you may have side effects from this treatment. The severity of side effects depends on the dose, frequency, and location of the treatments. Some people have no side effects.

Short-term side effects may include:

  • Loss of appetite

  • Diarrhea, if your abdomen is treated

  • Tiredness

  • Hair loss

  • Nausea

  • Sore mouth (mucositis), if the head and neck are treated

  • Skin irritation

  • Infection

Long-term side effects may not show up for several years after treatment is over and may include:

  • Chronic skin problems, such as redness

  • Inflammation of the lungs (interstitial pneumonitis)

  • Decreased bone and soft tissue growth, which mostly affects the long bones in children

  • Slow intellectual development in children who receive TBI

  • Clouding of the lenses of the eye (cataracts)

  • Decrease or loss of fertility

  • Growth of another kind of cancer 

The immediate side effects of total body irradiation (TBI) can be more severe. They include an increased risk for infection, due to a decrease in your white blood cells, and damage to skin and mucous membranes.

If you have side effects, your doctor may change the dose of your radiation or stop treatment until your side effects improve. Tell your doctor about any side effects you have. They will usually go away when your treatment ends.

Working with your healthcare providers

Talk with your healthcare providers about what symptoms to watch for, and when to call them. Make sure you know what number to call with questions, even on evenings and weekends.

It may be helpful to keep a diary of your side effects. Write down any changes you notice, how severe they are, and when they happen. A written list can make it easier for you to remember your questions when you go to your next appointment. It can also make it easier for you to work with your medical team to make a plan to manage your side effects.

 

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