Episode 429: Radiation Site-Specific Side Effects: CNS Cancers

“They’re really worried that radiation is going to be painful. So they come in for that first day of treatment very anxious. With our patients with brain cancer, we’re using the masks on the table, and those masks are very tight and hold their heads very, very still. So they’ll be very worried about being claustrophobic. We may start out the first day or two with a little bit of [lorazepam]. And they’ll come to me and they’ll say, ‘This really hasn’t been as bad as I thought it was going to be,’” ONS member Catherine McCluskey, BSN, RN, OCN^®, ROCN™, radiation oncology staff nurse at Atrium Health Wake Forest Baptist in Winston-Salem, NC, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS^®, who was the manager of oncology nursing practice at ONS at the time of the recording, during a conversation about radiation side effects in central nervous system (CNS) cancers.

Music Credit: “Fireflies and Stardust” by Kevin MacLeod

Licensed under Creative Commons by Attribution 3.0 

Earn 0.5 contact hours of nursing continuing professional development (NCPD) by listening to the full recording and completing an evaluation at courses.ons.org by August 21, 2027. The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center’s Commission on Accreditation.

Learning outcome: Learners will report an increase in knowledge related to the side effects of radiation to treat CNS cancer.

Episode Notes 

• Complete this evaluation for free NCPD. 
• ONS Podcast™ episodes:
• Radiation Site-Specific Side Effects series
• Episode 306: Cancer Symptom Management Basics: CNS Toxicities
• ONS Voice articles:
• Augmented Reality Simulations Reduce Patient Anxiety by Teaching Them About Radiation Therapy
• CNS Survivorship Needs More Research, Funding, and Training, Expert Panel Says
• Here’s What the Updated CTCAE Version 6.0 Means for Oncology Nurses
• Highly Localized, Precision Radiation Therapies Require Nurses to Drive Care Coordination, Patient Education
• Hyperbaric Oxygen Therapy Shows Promise for Certain Radiation Side Effects
• ONS book: Manual for Radiation Oncology Nursing Practice and Education (fifth edition)
• ONS courses:
• Indications of Targeted Radiotherapy to the Brain and Spine: 2025 ONS Congress^® Session
• ONS ROCN™ Certification Review™
• ONS/ONCC^® Radiation Therapy Certificate™
• Supporting Radiation Side Effect Management Through ONS Evidence-Based Resources: 2025 ONS Congress^® Session
• Clinical Journal of Oncology Nursing articles:
• Implementing a Standardized Educational Tool for Patients With Brain Tumors Undergoing Concurrent Temozolomide and Radiation Therapy
• Radiation Necrosis: A Differential Diagnosis Dilemma
• The Neurocognitive Late Effects of Cranial Radiation Therapy: The Often-Unrecognized Outcomes
• Oncology Nursing Forum article: Symptom Clusters in Patients With Brain Tumors Undergoing Proton Beam Therapy
• ONS Huddle Cards:
• External Beam Radiation
• Proton Therapy Proton Therapy
• Radiation
• ONS Guidelines™ and Symptom Management Resources
• Cognitive impairment
• Fatigue
• Mucositis
• Radiodermatitis
• ONCC resources:
• Big List of CE
• Radiation Oncology Certified Nurse (ROCN™)
• Common Terminology Criteria for Adverse Events (CTCAE v6.0)
• Patient Health Questionnaire (PHQ-9 and PHQ-2)

To discuss the information in this episode with other oncology nurses, visit the ONS Communities.

To find resources for creating an ONS Podcast club in your chapter or nursing community, visit the ONS Podcast Library.

To provide feedback or otherwise reach ONS about the podcast, email [e-mail].

Highlights From This Episode

“With primary tumors—glioblastomas, astrocytoma, all of those types of cancerous primary CNS tumors, the tumors are not very well-defined. They have little tentacles that kind of go out, so doing something like Gamma Knife, which is very precise, is not as effective as an external beam because the external beam will deliver radiation to all those little tentacles that are out there in the brain. And with Gamma Knife, you really can’t effectively do that.” TS 2:34

“When we’re doing radiation to the brain, fortunately there aren’t that many acute toxicities involved. Sometimes they’ll have some mild dermatitis. Usually, it’s not very significant. They, like everyone else who gets radiation, will have fatigue. Usually once we get to the end of the second week of radiation, into the third week for our patients with primary CNS tumors—the hair loss—they’ll start to notice hair loss just in the treatment area. But those are typical, the things that we’ve seen most. Sometimes we’ll have patients who will experience some nausea, maybe a few headaches, but really the acute toxicities are not severe typically with our patients with brain tumors.” TS 8:30

“[For] the fatigue, I tell patients to just listen to their bodies. We don’t want them to be sedentary, and we want them to go out and continue living their lives. But I do warn them that the fatigue is pretty much common to all patients receiving radiation at various degrees, depending on the patient. I just tell them to do what they feel like doing, and then when they’re tired to rest, and if they find themselves having a nap in the afternoon, that’s okay.” TS 13:51

“What I find with these patients in particular is that a lot of times, their first symptoms related to any type of cancer are CNS symptoms from brain metastasis. Our patients with lung cancer or melanoma—they come in through the emergency room for altered mental status or seizures or something like that. They find a mass in their brain, and then they find a mass on their lung, or they find masses everywhere. Typically, they want to treat the brain masses first before they start them on any kind of systemic treatment. And so, they’ll come to us, and they’re in shock. Everything’s happened very quickly. They haven’t had a chance to really catch their breath. They’re overwhelmed. And so I try to make sure they understand that everyone that they see here is part of their team and is with them through this journey and they’re not alone.” TS 25:36

“A couple of years ago, ONS put out an email asking for people to volunteer to do a delineation study about the feasibility of doing a radiation oncology certified nursing exam. And I, just on a whim, responded to that email. It’s not something I’ve ever done before, and thinking that I would not be put on the team. … And I thought, ‘I don’t have enough experience, I don’t know what I’m doing, and they won’t choose me.’ And lo and behold, they put me on this role delineation study. … I have met so many incredible nurses with all kinds of experience. I’ve learned so much. It has opened up a lot of things for me and it’s been really exciting, so all I can do is say take advantage of those opportunities when they come. Don’t think that you don’t know enough, because you know more than you think you do.” TS 32:38