INFORMATION  FOR  PATIENTS RECEIVING TOTAL BODY IRRADIATION (TBI)

Author:
Maria Werner-Wasik, MD

Department of Radiation Oncology
Bodine Center for Cancer Treatment
Thomas Jefferson University Hospital

Welcome to the Department of Radiation Oncology at Thomas Jefferson University Hospital.  Our Department is housed in the Bodine Center for Cancer Treatment, at the corner of the 11th and Sansom Streets.

If you are scheduled to receive a bone marrow or stem cell transplantation for the treatment of your disease, you may need total body irradiation (TBI) as part of your conditioning (= preparatory) regimen.  TBI may be given either following chemotherapy, or before chemotherapy, depending on the circumstances.

The purpose of TBI is to kill any remaining malignant tumor cells and to cause immunosuppression (= depression of your immune system, in order to minimize the chance of donor tissue rejection).  Since the cells of the immune system are widely dispersed everywhere throughout the body, the entire body has to be included in the radiation beam.  That is accomplished by positioning the patient upright in the special TBI stand (see picture).  In it, you will be in half-sitting position, with arms, hands and head supported by a system of bars and straps.  A special lucite pane will be placed in front of you to assure a full dose to the skin.

 Before TBI can be administered, a planning session will be necessary, mostly so we can identify the position of your kidneys and design appropriate shielding.  During the session, intravenous dye (contrast) will be given and the entire session will take an hour or an hour and a half.

TBI treatments are given twice daily, usually in the early morning and early afternoon.  The total number of treatments (= fractions) may vary anywhere from six to nine (i.e. three to five days), depending on your situation.  Each treatment is divided into two parts (from front and back), each lasting approximately eleven minutes. Customized blocks will be placed next to your body in order to protect your lungs and kidneys from excessive doses of radiation.  Following a TBI treatment, additional radiation may be administered to the chest wall and ribs underneath the blocks with electron fields.  Those are administered in the sitting position and last only a minute or two each.  A radiation oncology physician will be present throughout the entire TBI procedure.  

Occasionally, you may require additional courses of radiation therapy to the spleen, central nervous system or other organs prior to TBI.

TBI may cause some immediate side effects, such as nausea, vomiting or fainting episodes.  Therefore, you will receive a medication to prevent nausea before each fraction of TBI.  Usually, the medication is very successful.

Upon completion of the TBI, once maximal immunosuppression is achieved, a donor bone marrow or stem cell infusion takes place and completes the first part of your transplant course.

We hope that this information is helpful.  You will certainly have more questions later on and we would be happy to answer them.  Your physician can be reached under the phone numbers provided on his/her business card.  After hours or on weekends, you should call our answering service, which will connect you to the radiation oncologist on call: 215 - 955 - 6702.

Thank you for your attention.

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