Total body irradiation (TBI) is a form of radiation therapy in which – as the name suggests – a patient’s whole body is treated with radiation. However, it is not used in the same way as most other types of radiation treatment. For instance, while targeted radiation therapy is designed to shrink one or more tumors in a specific part of the body, whole-body radiation therapy is used to prepare the body for a stem cell or bone marrow transplant. Rather than delivering the highest possible dose of radiation to a tumor site, TBI is given in very low doses, several times per day, over a period of three to five days. Cancerous cells can be destroyed through TBI, but its primary goal is to suppress the patient’s immune system, which can increase the likelihood of a successful transplant.

Total body irradiation followed by transplantation can be an effective treatment for several types of cancer, including:

• Leukemia
• Lymphoma
• Multiple myeloma

Why you might have TBI

Radiotherapy is a treatment that uses high energy rays, similar to x-rays. You might have TBI alongside high dose chemotherapy drugs as part of your preparation for a stem cell or bone marrow transplant. 

It is a treatment for some people with:

• lymphoma (cancer of the lymphatic system)
• leukaemia (cancer that develops in the white blood cells of the immune system)
• myeloma (cancer that develops in white blood cells called plasma cells)

TBI alongside chemotherapy helps to kill off leukaemia, lymphoma or myeloma cells in the bone marrow. In a transplant using donor stem cells, TBI also suppresses the immune system. This helps to prevent a rejection of the donor stem cells.

Having total body irradiation

You usually have TBI treatment twice a day for 3 or 4 days. Or it may be just 1 or 2 radiotherapy treatments. Radiographers give the treatment. They will explain to you how they plan the treatment and how you have radiotherapy.

Treatment sessions

Your radiographers help you get into exactly the same position as in your planning appointment. This can take up to half an hour. They tape small radiation monitors to some areas of your body to monitor the dose.

The lights in the room dim for a few minutes while the radiographers position you. They leave the room while the machine is on but they can watch you closely on closed circuit TV during the treatment. It is important that you stay as still as you can but you can breathe normally. The treatment takes up to 15 minutes on each side of your body.

You have a buzzer that you can press at any time if you need the treatment to be stopped. You don’t feel anything but when the machine is on you will hear a beeping noise.

Side effects

During the treatment and for some time afterwards you are likely to have:

• sickness – you have anti sickness medicine to help prevent and treat this
• tiredness – you might feel particularly tired about 6 to 12 weeks after your treatment and this could become severe for a couple of weeks
• diarrhoea – tell you medical team if you have diarrhoea
• a dry and sore mouth – your nurse will give you drinks, mouthwashes and painkillers to help
• loss of taste and appetite
• sensitive skin – your skin may go pink, darken and be itchy and more sensitive to the sun
• complete head and body hair loss – this is usually temporary and will grow back gradually when treatment has finished

TBI and chemotherapy causes your blood levels to become low. So you are more at risk of infection, anaemia (low red blood levels) and bleeding. For example, bleeding gums and nose bleeds. You have treatment with antibiotics, blood transfusions and platelet transfusions if you need them.

Due to a high risk of infection, you may be looked after in a single room (isolation) in hospital