Radiotherapy for children with a brain tumour

When your child is diagnosed with a brain tumour, they may be given radiotherapy as a treatment. This uses controlled and targeted doses of high energy beams of charged particles to destroy the tumour cells, whilst causing as little damage as possible to surrounding healthy cells.

Not all children diagnosed with a brain tumour will be able to receive radiotherapy as a treatment option.

Will my child have radiotherapy?

There are two main reason why your child may be given radiotherapy:

  • If your child's tumour cannot be operated on.
  • After surgery to destroy any remaining tumour cells, and so lower the chances of the tumour returning

The decision to give radiotherapy will be based on a number of factors:

  • your child's age
  • location of their tumour
  • type and size of their tumour.
  • other factors e.g. whether the tumour is growing or causing symptoms.

If your child is under three years old, it is unlikely that they will be given radiotherapy. Radiotherapy can be damaging to very young children, having a long-term impact on cognition, growth and hormone levels. However, some tumour types e.g. ependymoma, may be treated with radiotherapy in younger children, if the tumour is in the posterior fossa (the back of the skull).

At all times the type and dose of radiation needed for treatment will be taken into account and the benefits of treatment will be weighed against any immediate or long-term risks. Radiotherapy is only offered if there are no other, equally successful treatments available to your child.

What happens when my child is given radiotherapy?

Before your child is given radiotherapy treatment, a lot of planning and preparation is needed. This is to make sure the treatment is as effective as possible whilst minimising the side-effects.

Before treatment

To help prepare your child for radiotherapy, The Brain Tumour Charity has produced an animation to explain the treatment, including the noise a radiotherapy machine makes.

Other tips and help on how to prepare your child for radiotherapy and its possible side-effects can be found in the fact sheet at the bottom of this page.

Planning

Your child's radiotherapy treatment is very carefully planned by a team of medical specialists to ensure that it reaches as many tumour cells as possible, whilst avoiding as much healthy tissue as possible.

First a 'radiotherapy planning scan' will be taken. This is usually a CT scan, but sometimes an MRI scan. The scan creates a 3D image of your child's tumour, showing its shape and location in the brain. This image and measurements from the scan allow more precise planning of where the radiotherapy needs to be targeted, the dose required and how often it needs to be given.

It is important that your child lies very still during treatment, so that the radiotherapy is directed to the correct part of the brain. To help your child stay still, a treatment mask is made specifically to fit your child's face and head. This mask fixes to the treatment couch to keep their head still and in the same place each time they have treatment.

There are different types of masks, made from different materials. They are made by smoothing the warmed material onto your child's face, so that the final mask is an exact replication of the size and shape of their head. Gaps are left for the eyes, nose and mouth, so your child is always able to breathe easily.

A play therapist may work with your child to make wearing the mask less daunting.

Treatment

Your child's treatment is planned to suit their individual needs, so may be very different to the treatment of other children you may meet.

If your child is very young or extremely anxious and won't keep still, a short general anaesthetic may be given. Or a health play specialist may work with your child to keep them calm and still.

  • Your child will lie on the radiotherapy bed with the radiotherapy machine above them
  • Medical staff will place the mask over your child's head and attach it to the bed, taking some time to position them.
  • Before the radiotherapy machine is switched on, the staff will leave the room, but remain nearby. They will be able to see, hear and speak to your child, should they need them.
  • Your child won't be able to see or feel the radiotherapy beams nor feel any heat from it. They will be able to hear the machine.
  • Once the treatment session, called a 'fraction' is finished, medical staff will go back into the room, remove the mask and help your child off the bed.
  • The medial staff will keep your child's mask until the next treatment session.

How long will treatment take?

Treatment times will vary, depending on your child's individual treatment plan.

However, each treatment session (fraction) generally only lasts a few minutes. The treatment appointment will be considerably longer, due to the time taken to position your child in the correct place. If you child is having radiotherapy to their spine, this can also take longer.

A typical radiotherapy plan is once a day, Monday to Friday, with a break at the weekends.

It is common for your child to have radiotherapy for 4 to 6 weeks.

Your child's health team can tell you your child's exact treatment plan.

After treatment

If your child is having radiotherapy as an outpatient, they will be able to go home after each session. If they need to remain in hospital for another treatment, a nurse will take them back to their ward.

Your child will NOT be radioactive after treatment. It is safe for them to be around people, including other children.

After the whole course of treatment, your child will have regular check-ups to monitor the effects of the radiotherapy on the tumour and any side-effects you child may get.

What are the side-effects of radiotherapy?

These will partly depend on the area of the brain where the radiotherapy is directed, and what that area controls. Also radiotherapy works best on rapidly dividing cells, such as tumour cells, but some normal cells in the treatment area also divide rapidly, so these areas tend to have the most common side-effects. These include hair and skin cells.

Short-term side effects

  • Tiredness
    This can continue for a number of weeks after treatment
    There is also a form of extreme tiredness that can occur several weeks after finishing radiotherapy, just as you think your child is getting over the treatment. This is called 'somnolence syndrome'.
  • Hair loss
    This usually starts 2-3 weeks after treatment starts and is generally only in the areas where the radiotherapy bean enters and leaves the head. Most will grow back, but it can be permanent - see the Resources section in the fact sheet below for practical suggestions for coping with hair loss
  • Skin sensitivity - on the scalp
    Take extra care in the sun (long-term) or strong winds, or when swimming
  • Feeling nauseous
    This can start from an hour after treatment and may last some weeks. Your child may be given anti-sickness tablets
  • Reduced appetite
    Giving them several smaller, healthy snacks may be better than three regular meals
  • Myelosuppression (slower production of blood cells)
    This can lead to anaemia, increased risk of infection and/or bleeding, such as bruising or nosebleeds.

Long-term side effects

Unfortunately, because a child's central nervous system is still developing, radiotherapy can cause some long-term or delayed/late effects. These will depend on which areas of the brain have been included in the treatment area, but can include effects on:

  • Brain development and cognitive (thinking) skills
  • Emotional difficulties
  • Growth and development
  • Puberty

Other possible long-term side-effects include: cataracts, heart conditions, developing a second tumour.

For more information on these long-term side-effects, download the fact sheet at the bottom of this page.

Your child's health team will talk through any side-effects with you before treatment, and can help you with any effects your child develops.

Proton Beam Therapy (PBT) is a specialised type of radiotherapy that is suitable for some types of brain tumour and is thought to cause fewer long-term side-effects. Facilities to provide PBT in the UK, on the NHS and privately, should be available in 2018.

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