Whole Brain Radiotherapy

Whole brain radiotherapy uses external radiation to treat cancer cells throughout the brain.

It treats the whole brain rather than aiming radiation only at one visible tumour. It may be considered when there are multiple brain metastases, when disease is spread through areas that are difficult to target individually, or in selected care plans for small cell lung cancer. The treatment is planned to protect nearby structures as far as possible while treating the intended area.

A planning appointment usually includes a fitted head mask to help you keep the same position, followed by a planning scan. The radiation team uses this information to design treatment. Each visit involves lying still on the treatment couch while the machine moves around you; radiation itself is not felt. Treatment is delivered over a course set by your radiation oncologist, and staff can help with symptoms between visits.

Tiredness, scalp irritation, hair loss in the treated area, nausea, headache and temporary worsening of existing neurological symptoms can occur. Changes in memory, concentration or thinking may develop later. Seek urgent clinical advice for a new seizure, rapidly worsening weakness, severe or persistent headache, repeated vomiting, marked confusion, sudden vision change or difficulty speaking. These symptoms need prompt assessment, whether related to the tumour, swelling or another cause.

The goal may be to control brain disease, ease symptoms, reduce the chance of neurological problems, or support a broader cancer treatment plan. Results differ according to the type of original cancer, the amount and location of disease in the brain, symptoms, treatments used alongside radiotherapy and overall health. Your oncology team reviews scans and your day-to-day function to decide whether further treatment or supportive care is appropriate.

Whole brain radiotherapy is planned and delivered by a radiation oncology team. You do not become radioactive after external-beam treatment, so it is safe to be around other people after a session.

The treatment may be offered to people with brain metastases, which are cancer deposits that have spread to the brain from elsewhere in the body. It may also be part of selected treatment plans for small cell lung cancer. Your team considers the number and distribution of lesions, symptoms, prior treatments, general health and personal priorities before recommending it.

Tell the team about headaches, seizures, implanted devices, pregnancy, medicines and any difficulty lying flat or wearing a mask. At each session, radiographers check your identity and position, then leave the room to operate the machine while watching and speaking with you. You can usually go home after the session unless another part of your care requires observation.

Fatigue can build during treatment and may continue after the course ends. Hair and scalp changes can become noticeable after treatment has started. Rest, fluids, gentle activity when able and practical help at home can make this period easier. The team may prescribe medicines for swelling, nausea or seizures and will tell you how to use them safely.

Possible effects include skin changes, hair loss, fatigue, nausea, swelling in the brain and later cognitive changes. The balance of benefit and possible harm is individual. Ask how the plan accounts for existing memory difficulties, prior brain treatment, work or caring responsibilities and the symptoms that matter most to you.

For selected people, alternatives or additional treatments can include stereotactic radiosurgery, surgery, systemic cancer treatment, medicines to manage symptoms, or supportive care. The choice depends on the disease pattern and treatment goals. Read more about Brain Metastases, Small Cell Lung Cancer and Stereotactic Radiosurgery.

A radiation oncology service can coordinate planning with medical oncology, neurosurgery, neurology, specialist nursing and palliative care when needed. Bring current scans, pathology information, medicine lists and a support person if possible. Ask who to contact outside clinic hours if neurological symptoms change.