Total-Body Irradiation: Information & Specialists

Whole-body radiation therapy is part of the medical field of oncology, which primarily deals with cancer. Oncologists plan the optimal, individualized treatment for their patients. The most common treatment options for cancer are

• surgery,
• chemotherapy, and
• radiation therapy.

Conventional, or localized, radiation therapy is used to specifically destroy cancer cells in a small area. Whole-body radiation therapy is used, for example, for types of cancer that affect the entire body. These include, for example,

• lymphomas,
• leukemia, or
• bone marrow cancer.

The immune system of those affected also suffers irreversible damage. Doctors refer to this phase as the

• destruction of the body’s own bone marrow as well as
• the destruction of the immune system

as “conditioning.”

Total-body irradiation is therefore considered a particularly radical form of therapy. It is usually performed in combination with high-dose chemotherapy. This therapy forms the basis for the success of the subsequent stem cell transplant.

Total-body irradiation is part of an interdisciplinary treatment plan. Here, various disciplines are directly intertwined, requiring close collaboration among many specialists. In addition to oncologists and tumor immunologists, this includes specialists in bone marrow transplantation.

Radiation therapy to destroy cancer cells © Mark Kostich | AdobeStock

For patients with leukemia and lymphoma, total-body irradiation primarily serves as a preparatory step. Aggressive chemotherapy is also often administered at the same time.

These forms of cancer cannot be removed surgically. Therefore, the goal of treatment is to destroy all relevant cells, both benign and malignant. This increases the chance of eliminating every last cancer cell from the body.

The cells are replaced by healthy bone marrow or stem cells from unrelated donors (allogeneic transplantation). In some cases, cells from the patient’s own body may also be used (autologous transplantation).

If the treatment is successful, these cells then take over the body’s immune defense and blood production.

When deciding on conditioning, the oncologist chooses between 

• whole-body radiation,
• high-dose chemotherapy, or
• a combination of both.

The decision depends largely on the type and severity of the disease. 

The prior whole-body radiation therapy increases the likelihood that the body will accept the foreign cells.

The therapy is successful if

• the healthy donor cells are able to successfully establish themselves in the patient’s bone marrow after the procedure,
• they are accepted by the recipient’s blood cells, and
• nothing stands in the way of their unimpeded proliferation.

The whole-body radiation therapy procedure is carried out in individual sessions spread over several days. During this process, the entire body is exposed to high-energy radiation. The radiation is typically administered while the patient is seated, using the so-called “Berlin Chair technique.”

The radiation is lethal to many body cells. Sensitive organs therefore require protection. This can be achieved, for example, by using lead blocks placed on the body at appropriate locations. These blocks attenuate the radiation and thus reduce the radiation dose in the covered region.

Depending on the clinical picture, the treatment may vary slightly from case to case. For example, if necessary, individual regions can be irradiated in addition to whole-body radiation therapy.

One possible treatment schedule involves three days of treatment, with two radiation sessions each day. The total dose ranges from 4 to 12 Gray (Gy). The single dose is usually 2 Gray.

Common side effects of radiation and chemotherapy include

• hair loss,
• nausea and vomiting,
• dry mouth,
• infertility,
• pain,
• Gastrointestinal symptoms,
• damage to the mucous membranes of the mouth and throat, as well as
• a deficiency of platelets and red and white blood cells resulting from impaired blood formation.

Stress on—if not permanent damage to—organs such as

• the heart,
• kidneys, and
• liver

is also possible, though it occurs less frequently. In children, allergic reactions are also frequently observed.

However, doctors can alleviate or completely suppress many of these symptoms. This is achieved through supportive therapy.

Supportive therapy may include, among other things,

• pain relievers and antiemetics to treat nausea and vomiting,
• antibiotics to treat infections, and
• blood products to treat a deficiency of platelets and red blood cells

. Strictly following your doctor’s instructions also helps to mitigate many side effects.

To conceal the inevitable hair loss, scarves, caps, and hats are good options. In most cases, hair grows back after treatment ends.

It is essential that you discuss the side effects in detail with your oncologist. Cancer treatment can also affect fertility. If you wish to have children, you should discuss your options.

Appropriate follow-up care also prevents or reduces complications and side effects. Patients also benefit

• from expert care,
• continuous medical care, and
• prompt assistance in the event of complications.

Total-body irradiation is part of a comprehensive treatment plan. The prospects for success—and thus the chances of a cure—vary from person to person.

They depend on a variety of factors, including the type and stage of the disease and optimal conditioning.

If you have any questions or concerns, you should generally seek medical advice so that you are fully informed about the individual procedures as well as their risks and benefits.