Radiotherapy for Brain Cancer
Radiotherapy uses targeted high-energy radiation to destroy brain cancer cells, slow tumour growth, and help manage symptoms while minimising damage to surrounding healthy tissue.
What is Radiotherapy?
Radiotherapy is a painless, non-invasive cancer treatment that uses high-energy external beam radiation therapy, such as X-rays or protons, to damage the DNA of cancer cells so that they can no longer grow and spread.
It is a treatment plan that does not involve surgery and aims to slow, stop, or reduce tumour growth while protecting healthy brain tissue. Although radiation is carefully directed to specifically damage tumour cells, nearby healthy cells can also be affected. While healthy cells are usually able to repair this damage, cancer cells are often much less able to do so and more likely to stop dividing or die as a result.
Radiotherapy is an effective and widely used cancer treatment. It can:
- Slow or stop tumour growth
- Shrink the tumour
- Help relieve the symptoms caused by the tumour
Unlike chemotherapy, which travels throughout the body, radiotherapy only works in the area being treated. This focused approach helps limit damage to healthy tissues, but it also means radiotherapy is less effective when cancer has spread to other parts of the body. In these cases, combining radiotherapy with chemotherapy can improve overall tumour control.
When is Radiation Therapy Used for Brain Cancer?
Brain tumour treatments are carefully tailored for each person and guided by factors such as patient age, tumour histology (studying how cancerous cells appear within the tumour tissue and how quickly they multiply), extent of disease, and overall risk profile. Management may involve surgery alone or surgery followed by radiotherapy and chemotherapy. Radiotherapy is most commonly given after surgery, known as ‘adjuvant therapy’, to target remaining tumour cells. In contrast, radiotherapy delivered before surgery, referred to as ‘neoadjuvant therapy’, has traditionally been rare in brain cancer but is now being explored as a novel treatment option.
The Limitations of Using Radiotherapy for Brain Cancer
While radiotherapy is an effective way to damage and kill cancer cells, it can also impact healthy brain tissue, which restricts the maximum dose that can be safely delivered. Higher doses can increase the risk of long-term side effects, especially in aggressive tumours. In these cases, radiotherapy may be used to slow tumour growth or reduce symptoms, rather than to cure the disease, with a strong focus on maintaining quality of life. Although radiotherapy remains a cornerstone of brain cancer treatment, some tumours are naturally less sensitive to radiotherapy. This means that combining radiotherapy with targeted agents as part of a treatment course can sensitise tumour cells to radiation and improve treatment efficacy.
Can Radiotherapy be Used on Children to Treat Cancer?
In young children, radiotherapy can harm developing brain functions (neurocognitive toxicity), including learning and memory. Therefore, chemotherapy is often used in place of radiotherapy. In some cases, a childhood brain or spinal cord tumour can also spread through the fluid surrounding the brain and spinal cord. In such cases, craniospinal irradiation (CSI) may be recommended using carefully planned doses to reduce long-term effects.
Types of Radiotherapy Used in Brain Cancer
Over the past two decades, advances in imaging and treatment delivery have allowed treatment teams using very precisely targeted radiation to treat tumours and reduce harm to surrounding healthy brain tissue. Furthermore, treatment plans today are carefully personalised based on tumour type, location, and each patient’s individual needs.
External beam radiotherapy (EBRT)
is the most commonly used form of radiation treatment used to treat brain tumours. Radiation is given from outside the body using a specialised radiation machine called the linear accelerator (LINAC). Advances in this technique now help the radiation beam fit as closely as possible to the shape of the tumour so as to avoid exposure to surrounding normal brain tissue.
Stereotactic radiosurgery (SRS)
including Gamma Knife, CyberKnife, and LINAC-based systems, is used to treat small, well-defined tumours or tumours that are hard to access through surgery. Despite the name, SRS does not involve brain tumour surgery. It instead delivers highly focused radiation beams from different angles to precisely target brain tumours.
Fractionated radiotherapy
involves dividing the total radiation dose into smaller daily fractions. This spacing gives healthy cells time to repair between treatments, while tumour cells are more likely to accumulate damage over time. The total dose prescribed and the number of fractions needed depends on the type of tumour and the individual patient.
Proton therapy machines
use charged particles that concentrate radiation within the tumour, which can reduce exposure to nearby healthy tissue. While proton therapy has been used internationally for many years, it is new to Australia. Australia’s first proton therapy facility is currently under development in Adelaide. In some cases, patients may be eligible to receive support to travel overseas for this treatment.
What to Expect: The Radiotherapy Treatment Process
Planning Your Treatment
Once radiotherapy is chosen as part of your treatment, whether for malignant or benign brain tumours, a planning appointment will be made. This appointment helps your care team decide what part of the brain will receive radiation, how much will be needed and how long the treatment will last. You will likely have a CT and/or MRI scan while lying in a position you will be in for the treatment. No treatment is given on this day.
Creating a Custom Mask
To help you stay still during the treatment, a custom mask is created that you will wear during each treatment. The mask is created by moulding a warm plastic mesh over your face; as it cools, it hardens into a personalised fit that is worn during each treatment session to prevent movement and support accurate treatment delivery. Young children may need anaesthesia to help them stay still during the treatment.
Tailoring Your Radiation Plan
Your radiation doctor works with a specialist team in order to tailor the radiation plan according to your tumour type and location. Imaging is routinely used during treatment to confirm positioning and ensure radiation is delivered as accurately as possible. In some cases, the treatment plan may be adjusted if there are significant changes.
What a Treatment Session is Like
Radiotherapy cancer treatment is usually given as an outpatient treatment, meaning you can go home on the same day of the treatment. During each session, you will lie on a treatment bed, with the machine slowly moving around you while it delivers radiation. It may make a whirring sound, but it does not make any contact with you.
Duration and Frequency
Each treatment session usually lasts between 5 and 30 minutes. Treatment is painless and you can talk to the staff at all times who are monitoring you while you are undergoing the treatment. Radiotherapy is typically given from Monday to Friday over several weeks, although the exact schedule will depend on the treatment plan.
Can Radiotherapy Cure Brain Cancer?
We’re often asked ‘can radiation cure brain cancer?’ The goal of radiotherapy depends on the type of tumour and the individual patient. For some tumours, radiotherapy aims to completely eliminate the tumour tissue and achieve long-term control. For other tumour types, radiation may be used to control tumour growth, relieve symptoms, and improve quality of life.
Advances in radiotherapy now allow treatment to be tailored to tumour risk. For selected small, low-stage, or less aggressive tumours, radiation dose may be reduced or, in some cases, omitted altogether, with the aim of maintaining good tumour control while minimising the long-term side effects of radiation therapy. For more advanced or aggressive tumours, radiotherapy is often used to slow tumour growth rather than cure it. This is because higher radiation doses could damage important parts of the brain and affect quality of life.
Doctors carefully consider the tumour’s size, location, how close it is to the vital brain areas, the tumour’s biology, and the patient’s age before they start treating patients. New tests can now look at the tumour’s genetic and molecular features, helping doctors better decide which radiotherapy treatment to use and how the tumour will respond to it. This allows radiotherapy to be more precisely tailored. Tumours associated with a better outcome are often treated with lower radiation doses, reducing the risk of long-term side effects.
Side Effects of Radiotherapy
While an effective treatment for controlling tumour growth, side effects of radiotherapy can occur. This happens because while high-dose radiation damages or kills cancer cells, it can also affect nearby healthy cells. However, many short-term side effects such as headache or nausea improve or go away once treatment finishes as inflammation and swelling settle and normal tissues recover.
Some tissues, including the brain, recover more slowly because brain cells have limited capacity for renewal. As a result, certain side effects may persist or emerge months or years after treatment. These are referred to as long-term or late effects.
The type and severity of side effects can vary from person to person. This depends on a number of factors such as the amount of radiation dose; the area being treated and the patient’s overall health status.
Short-term side effects
These commonly occur during or shortly after treatment, including fatigue, headaches, nausea, and swelling. These symptoms are usually manageable with supportive care, such as corticosteroids to reduce inflammation.Long-term or late effects
These may develop months to years after treatment and include cognitive changes, hormonal dysfunction due to pituitary involvement, and radiation necrosis. Regular follow-up and early discussion with the care team are essential for timely detection and management.Your care team and radiation oncologist will carefully plan and monitor your treatment to protect healthy tissue as much as possible. If needed, the treatment plan may be adjusted to help manage side effects while still effectively treating the tumour. Throughout treatment, your medical team will work closely with you to manage symptoms and support your safety and quality of life.
Accessing Radiotherapy in Australia
Radiotherapy availability in Australia is supported by the Radiation Oncology Health Program Grants Scheme, which ensures patients receive high-quality and safe radiation services no matter where they live. This funding helps support the cost of employing people and of running radiotherapy services and works alongside Medicare to support patient care.
Australia’s Medicare system plays a major part in covering the cost of radiotherapy:
- In public hospitals, the cost of radiotherapy is covered by Medicare, with no out-of-pocket fees.
- In private hospitals, Medicare may help cover a large portion of the cost, but some patients may need to pay the gap fee.
- Private insurance usually does not cover outpatient services such as radiotherapy. However, private insurance may assist with hospital accommodation or other costs if treatment is provided during a hospital stay, depending on the policy.
Your care team can help explain any possible costs before treatment begins.
Questions to Ask Your Healthcare Team
Radiotherapy is a big commitment, and you want to be sure you understand exactly what you’re signing up for. Asking direct, informed questions helps you get a clear picture of why this approach is being recommended, what outcomes are realistic, and how the treatment will affect your day-to-day life.
Here are some recommended questions to ask your care team:
What happens if I delay or choose not to have radiotherapy?
If I opt for radiotherapy, what type of radiotherapy will I receive?
What are the expected benefits and limitations?
What are realistic expectations for managing the tumour?
How will my side effects be monitored and managed and how will they impact my day-to-day life?
How will long-term side effects be managed and how will they affect quality of life?
Are there complementary treatments (chemo, surgery) or other treatment options I should consider? Am I likely to be undergoing radiation again?
References
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