Chronic Myeloid Leukemia (CML): Radiation Therapy

What is radiation therapy?                

Radiation therapy is a treatment for cancer that uses high-energy X-rays. A machine directs the rays of energy to the area of cancer. Radiation therapy is also called radiotherapy. Its goal is to kill or shrink cancer cells.

When is radiation therapy used for chronic myeloid leukemia (CML)?

Radiation therapy is not a common treatment for CML. Your doctor may advise it for these reasons:

• Your symptoms aren't being helped by other treatments. For example, you may have a swollen spleen pressing against another organ, such as your stomach. This can make it hard to eat. In this case, radiation can be used to reduce the size of the spleen and ease pressure on the stomach.

• You have bone pain. Radiation can help with bone pain caused by the growth of leukemia cells in the bone marrow.

• You’re getting ready for a stem cell transplant. Radiation therapy kills not only cancer cells, but also normal bone marrow cells. If you’re having a stem cell transplant, you may have total body irradiation (TBI). This sends radiation in equal doses to all parts of your body. The radiation kills off the bone marrow cells. After chemotherapy destroys the cancer cells, you can have an infusion of healthy cells. But most stem cell transplants for CML are done without radiation. Talk about the options with your doctor. 

How is radiation therapy given?

A doctor who specializes in cancer and radiation is called a radiation oncologist. This doctor will work with you to determine what kind of radiation you need. This doctor will also determine the dose and how long you need the therapy.

Radiation treatments are not painful. They are a lot like getting a chest X-ray or dental X-ray. You will get radiation treatments either as an outpatient or as an inpatient. Outpatient means you go home the same day. Inpatient means you stay overnight in the hospital. For treatment directed at just a small part of your body, you can likely do this as an outpatient. If you’re getting ready for a stem cell transplant, you will have the treatments as an inpatient.

Possible side effects of radiation therapy

Radiation affects normal cells as well as leukemia cells. Because of this, you may have side effects from this treatment. The severity of side effects depends on the dose, frequency, and location of the treatments. Many people have no side effects. Side effects get better and go away when the treatment ends.

Tell your doctor if you have side effects. He or she may give you medicine to prevent or ease any side effects.  

Short-term side effects may include: 

• Nausea, vomiting, or diarrhea if your abdomen is treated

• Tiredness

• Hair loss in the area being treated

• Skin irritation in the area being treated

• Sore mouth (mucositis) if the head and neck are being treated

• Low levels of blood cells

• Easy bruising and bleeding 

Long-term side effects may not show up for several years after treatment is over. Long-term side effects may include:

• Growth of another type of cancer in the treated area

• Chronic skin problems, such as redness

• Low blood counts. After treatment with radiation (and chemotherapy) your bone marrow may not completely recover.  You may have low blood counts and need careful monitoring.

The immediate side effects of total body irradiation can be more severe than for targeted radiation. They include an increased risk for infection from a rapid reduction in white blood cells and from damaged skin and mucous membranes. 

Working with your healthcare providers

Talk with your healthcare providers about what symptoms to watch for, and when to call them. Make sure you know what number to call with questions, even on evenings and weekends.

It may be helpful to keep a diary of your side effects. Write down any changes you notice, how severe they are, and when they happen. A written list can make it easier for you to remember your questions when you go to your next appointment. It can also make it easier for you to work with your medical team to make a plan to manage your side effects.