Non-Hodgkin's lymphoma
Description
An in-depth report on the causes, diagnosis, and treatment of non-Hodgkin's lymphoma.
Alternative Names
Lymphoma - non-Hodgkin's; NHL; B-cell lymphomas
Radiation
Radiation is commonly used to treat indolent lymphomas. The dose administered ranges from 35 - 50 Gy and depends on a number of factors: The type of lymphoma, the age of the patient, whether the intent is to cure or relieve symptoms, how close sensitive organs are to the diseased area, and whether radiation is being combined with chemotherapy.
Radiation is tailored to the individual and usually limited to the diseased areas and possibly nearby regions:
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If the lymphoma is confined to tissues above the diaphragm, radiation is delivered to the neck, chest, and under arms (called the
mantle-field
) and sometimes to lymph nodes in the upper abdomen or spleen or both.
-
If the lymphoma is below the diaphragm,
subtotal nodal radiation
may be used, which is directed to other regions, including lymph nodes in the upper abdomen, spleen, and pelvis, in addition to the mantle-field.
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Radiation to the brain is called
cranial radiation
.
-
Total body irradiatio
n is sometimes performed, although it is not clear whether its high toxicity outweighs any advantages.
Devices called
planning simulators
allow doctors to plan x-ray treatments that accurately conform to the patient's anatomy so that protective shields can be created to precisely protect the regions outside the treatment areas.
Side Effects and Complications
Side effects and complications of radiation generally depend on the target site in the body. They include:
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Dental problems
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Inflammation in the lungs -- with carefully conducted therapy, the risks for lung complications are small. Lung impairment may not even be evident, and the lungs usually recover after 2 - 3 years.
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Hypothyroidism
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Infections
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Long-term risk for heart disease
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Long-term risk for certain cancers -- of particular concern is a possible increased risk for breast cancer. Studies indicate that young women and adolescent girls are at highest risk, with the incidence increasing significantly 15 years after treatment. The risk is greater in those who had higher radiation doses. Radiation may also increase the risk over time for other cancers, including lymphoma and thyroid, lung, and colon cancers, although the risk is still low. Smoking, of course, increases the risk for lung cancer. Radiation of bone marrow increases the risk for leukemia.
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Impaired bone growth -- children and adolescents are at special risk for bone problems caused by radiation. Experts are finding that radiation for many children and young adults in early stages or NHL is no more effective and has more serious long-term effects than chemotherapy. Some believe that radiation should play no role in the treatment of young people, except in special cases, such as lymphomas that require radiation to the brain.
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Infertility -- the negative effects on fertility may be worse in women than in men; sperm usually recover within 5 years. To protect the ovaries, a technique called ovarian transposition is sometimes used. Transposition may sometimes be performed through a laparoscope, a thin tube containing tiny instruments and cameras, which is introduced through a small incision. The doctor uses the laparoscope to move the ovaries out of the range of areas being treated with radiation.
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Review Date: 1/17/2007
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Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital.
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