Brain radiotherapy may be given to the whole or part of the brain according to the amount of brain tissues that require radiation treatment. Normal tissues that may be in the treatment area are brain tissues, hair roots and skin.

When Does Skin Reaction Happen?

Early side effects are the changes or reactions of normal tissues that happen during radiation treatment. The reactions are more serious if there are a lot of normal tissues in the treatment area and if the total radiation dose to the normal tissues is higher.

Some early effects of brain radiotherapy that may occur are displayed in the graphic diagram.

Fatigue

A person receiving whole brain radiotherapy may feel very tired, lack of energy to do any activity and wants to rest most of the time. For further explanation on fatigue and care, please refer to Radiotherapy Side Effects / Non Specific and Specific Effects / Fatigue.

Headache And Nausea

Brain tissues become swollen when exposed to radiation. This tissue swelling (edema) can increase pressure inside the skull and may produce symptoms of headache and / or feeling sick (nausea). This reaction may happen after 1 to 2 weeks of radiation treatment. These symptoms can usually be relieved with prescribed medication to reduce brain tissues swelling.

Skin Reaction

The skin may appear darkened, itchy and dry after 2 weeks of radiation treatment. Always protect the scalp by wearing a cap made from soft fabric or with a scarf. For detailed explanation of skin care please refer to Radiotherapy: Skin Reactions And Care.

Hair Fall

Hair roots are sensitive to radiation. Hair may starts to fall off after 2 to 3 weeks of radiation treatment. This reaction can be temporary or permanent depending on the amount of radiation damage at the hair roots.

If part of the brain is getting radiation, only hair in the treatment area will fall off whereas all the hair will fall off for whole brain treatment. However the hair does not fall off altogether at the same time; they come off little by little at different parts of the head.

One way of making this effect less obvious is to cut the hair very short or shave all the hair before planning and treatment procedure begin. For temporary hair fall, new hair may grow back within 3 to 6 months after treatment has completed. The color and texture of new hair may be slightly different from the original hair.

Hair Care Before Hair Loss

	Use soft hair brush or comb. Clean and wash hair gently with lukewarm water and baby shampoo; on alternate days. Dry hair with fan or soft towel gently.
	Do not use hair dryer. Do not apply hair dye, gel, cream or spray. Do not perm or straighten hair. Do not use hair pins, clips or curlers that may cause injury to the scalp.

Are There Any Late Side Effects?

Late side effects are reactions that may occur months or years after radiation treatment has stopped. Late effects of brain radiotherapy that may occur are decreased hormone production, permanent hair loss and somnolence syndrome.

If hormonal gland is in the treatment area, there may be lower production of hormones that may require regular monitoring. Medications can be given to maintain normal hormone level. If hair roots are damaged completely, hair loss can be permanent. Choose and wear a wig that is comfortable and does not hurt the scalp.

Occassionally a person may experience somnolence syndrome which is a group of symptoms (graphic), 1 to 3 months after radiation treatment to the brain has stopped. The person will usually want to rest and sleep most of the day. The symptoms may last for a few weeks but will go away by itself.

Radiotherapy is designed specially for each individual, taking into consideration the radiation effects on normal tissues in the treatment area. However, every person is unique and may react differently to the radiation treatment.

Find out information about the specific side effects that may occur with your treatment from the radiation oncologist and radiation therapist before treatment begin. Always let them know what you are experiencing and how you feel so that they can help you to minimize the symptoms, to reduce anxiety and to cope better.

References

1. http://www.cancer.org/treatment/treatmentsandsideeffects/treatmenttypes/radiation/understandingradiationtherapyaguideforpatientsandfamilies/understanding-radiation-therapy-radiation-to-certain-body-parts
2. www.cancer.gov
3. Picture from www.ishrs.org
4. Graphics from Ms Aisyah bt Zulkifli