The following content is offered by the moderators and is adapted from text that appears in several different posts and discussion threads on this topic.
Side effects can be somewhat variable, but most seem to tolerate it pretty well. Hair loss does not occur in every patient and does not occur to the same degree in the patients that experience this. There is also the sensation that people get “ear stuffiness”, and this probably results from some of the ear wax becoming “drier” than pre treatment. There are a few people who experience some nausea after just 1 or 2 treatments. The good news is that this nausea seems to disappear and not return during the remaining treatments.
The most common complaint is tiredness/fatigue. This is, of course, difficult to assess, because it is such an individual complaint and might be an effect of previous treatments, or treatments received after WBR.
With regard to late effects, most patients seem to function at a normal level more than a year or two out from treatment. The scientific studies of the incidence of cognitive or functional impairment are very difficult to interpret because of all the other variables that come into play. For example, in one study of patients that had not been treated with WBR yet, the incidence of cognitive impairment was just as high as another series reported after the patients had been treated with WBR. The other factors that might have something to do with explaining cognitive decline include general aging, the underlying cancer process, the presence of brain metastases (meaning the existence of clinical or subclinical spread of cancer to the brain), the effect of chemotherapy received before or after the WBR, and other possible factors (strokes, etc).
Unfortunately, there are rare patients who simply don’t tolerate brain radiation very well. For some of these patients, we need to simply quit the radiation altogether. There are also rare patients who simply don’t recover very well after treatment, and the effects of fatigue can be long lasting in this group.
Another way of assessing tolerability has been from reviewing work on prophylactic cranial irradiation (PCI). This work has generally shown it to be quite well tolerated, with the main side effects being headache in just over 40% of patients, nausea and/or vomiting in about 1/3, and a smaller proportion of around 10% or less with fatigue. Skin reactions like a local burn were rarely seen as well. About 2% of the total getting PCI in a pivotal study experienced long-term significant headaches or neurologic problems, the big fears about brain radiation.
Commentary from faculty (opinion): …my opinion is that fears about WBR leading to dementia are really overstated and that the fear of it exceeds the true risk, even if it’s not risk-free. Yes, the risk is generally understood to be higher in older patients, who have fewer compensatory neurologic pathways and a lower threshold to exhibit cognitive problems, and I would be judicious about WBR and would prefer gamma knife for one or a few lesions. But dementia is far from inevitable, and the vast majority of my patients who have received WBR have also done well and exhibited either no cognitive deficits or ones subtle enough that they may perceive a change, but they wouldn’t be obvious to anyone around them, and far from becoming oblivious and unable to ambulate. Plus, having brain metastases not managed effectively isn’t a picnic either in terms of the problems this can cause.
For further discussion, visit:
Whole brain radiation immediate side-effects
Whole brain RT/Prophylactic Cranial Radiation
Prophylactic Cranial Irradiation (PCI) for ED-SCLC
Discussion: What about WBR for 71 year old?