Radiation therapy can be used to treat obstructive/bulky nodes or massive symptomatic splenomegaly, or to reduce symptoms during palliative treatment (e.g. pain resulting from lytic bone lesions).

Timeframe for starting treatment

Where organ preservation is the goal (e.g. hydronephrosis) radiation should be commenced within 72 hours of recognition of the issue.

Where applied with symptomatic/palliative goals, appropriate timing is guided by the severity of the relevant symptoms but is rarely urgent and can be commenced within two weeks in most cases. This is due to the chronic nature of the underlying process.

Training and experience required of the appropriate specialists

There are no specific sub-specialty skill needs required for the delivery of palliative radiation in CLL beyond those generally required for registration and practice as a radiation oncologist.

The training and experience of the radiation oncologist should be documented.

Health service unit characteristics

To provide safe and quality care for patients having radiation therapy, health services should have these features:

• linear accelerator (LINAC) capable of image-guided radiotherapy (IGRT)
• dedicated CT planning
• access to MRI and PET imaging
• automatic record-verify of all radiation treatments delivered
• a treatment planning system
• medical physicists, radiation therapists and nurses with radiation therapy experience
• coordination for combined therapy with systemic therapy, especially where facilities are not co-located
• participation in Australian Clinical Dosimetry Service audits
• an incident management system linked with a quality management