Total body irradiation

Total body irradiation (TBI) delivers a low dose of radiation to the entire body. It’s typically used as part of a bone marrow or stem cell transplant regimen for blood cancer treatment. This type of radiation therapy prepares a transplant recipient to receive donor cells in two ways:

• It can eliminate cancer throughout the body, especially in parts of the body that are difficult to treat, to help clear the body of cancer cells and create a healthier baseline prior to a transplant procedure.
• It suppresses a recipient’s immune system to lessen the risk of rejecting a donor’s cells.

TBI is one of many specialized radiation therapies offered at Penn Medicine. Our expert staff is highly skilled in treating many types of cancers, including blood cancer. You’ll work closely with a radiation oncologist, who specializes in using radiation to treat cancer, along with radiation therapists, nurses, and other providers who’ll prepare you for TBI treatment and answer any questions you have so you feel confident in your treatment.

If you are receiving a bone marrow or stem cell transplant as part of blood cancer treatment, you are a candidate for full body radiation. This radiation treatment is effective because it can reach cancer cells within scar tissue or other areas of the body that chemotherapy may not reach, helping to eradicate cancer throughout the body to help prepare you for a transplant of new cells.

With TBI, you’ll receive a dose of radiation that’s low enough so that the body’s healthy cells can recover. For this reason, TBI radiation isn’t used alone to destroy large numbers of cancer cells. Instead, your transplant preparation regimen will likely include full body radiation along with high-dose chemotherapy. In some cases, transplant regimens use chemotherapy only. Talk to your doctor about your transplant preparation and whether TBI will be included in your treatment plan.

Full body radiation is a carefully planned procedure. You’ll have imaging scans (x-rays or CT scans) to fully analyze and identify treatment areas on your body. Your skin may be marked with tattoos or other markings to help guide the radiation beams during treatment. You’ll also have a simulation procedure, or “dry run,” to position you properly for treatment and verify machine settings that match the treatment plan. During simulation, you may be fitted with boards or blocks placed on different areas of your body to shield them from certain kinds of radiation doses.

Once your simulation is successfully completed, you’ll start your actual treatments. Typically, you’ll have a few treatments each day for up to five days. Each treatment usually lasts about an hour. Your doctor will create a schedule for your treatments, and you may stay in the hospital during the treatment period. You’ll want to avoid wearing jewelry or clothes with metal during treatment since this can increase the amount of radiation absorbed in those areas. While you may be alone in the treatment room, you’ll be able to communicate with your radiation therapists in an adjacent room. They can answer any questions you have and make sure you are comfortable during each treatment session.

Since whole body radiation is done in preparation for a bone marrow or stem cell transplant, you’ll continue to be seen by a team of cancer doctors after your TBI treatment. It remains important that you keep follow-up appointments with your radiation oncologist so they can help address any short-term or long-term side effects related specifically to your radiation treatment. Be sure to discuss how your treatments have impacted you physically and emotionally, so you can get the support you need.

While TBI treatments themselves are typically pain-free, you may experience short-term or long-term side effects after receiving whole body radiation. Side effects often depend on your radiation dosage and number of treatments, along with your health history and use of other medications.

Short-term side effects can include:

• Fatigue
• Headaches
• Loss of hair on the head or body
• Skin sensitivities or reactions
• Nausea, vomiting, or diarrhea
• Loss of taste or appetite
• A sore or dry mouth
• Changes in blood counts

In the longer term, your skin can be sensitive for many months after treatment. Be sure to use proper protection when you are in the sun as you may be more prone to sunburn. Other longer-term side effects can include changes in your lung capacity, fertility issues, cataracts, changes in thyroid hormone levels, and a small risk of developing a second cancer. Your doctor will monitor you for these side effects and provide care to treat any symptoms you have. They’ll also suggest additional tests and screenings to help you stay healthy.

Penn Medicine’s radiation therapies include external and internal radiation treatments to treat a wide variety of cancerous and benign tumors. Our radiation oncologists are often recognized as national or international leaders in the field. They’ve all completed an American Council for Graduate Medical Education-accredited residency program, so you can count on them to offer treatment with the highest level of skill and care.

In addition, every member of the Penn Radiation Oncology team has developed expertise in treating cancer in a specific area of the body. We have doctors who are experienced in using total body irradiation before bone marrow or stem cell transplants. They have the skills to guide you throughout your treatment journey to produce the best possible outcome.