Radiation Therapy for Non-Hodgkin Lymphoma

While the most common treatment for non-Hodgkin lymphoma, especially initially, is chemotherapy, many non-Hodgkin lymphoma patients with different types, and at different stages of the disease may benefit from radiation therapy as well.

Radiation therapy, also called radiotherapy or irradiation, works by targeting and damaging cancer cells' DNA (genetic material), which stops them from growing. As with many other cancer treatments, radiation may also unavoidably damage nearby healthy cells, but radiation is constantly being improved to be more precisely targeted so that fewer healthy cells are affected.

The most common type of radiation used to treat non-Hodgkin lymphoma is called external beam radiation, in which the radiation is administered from a machine that moves around the body to deliver the correct radiation dose to precise areas.

In this type of treatment, a medical team first takes careful measurements of your body to find the right angle and placement for aiming the radiation beams. This is usually done with the help of imaging tests such as CT or MRI scans. This prep work helps ensure that as few healthy cells as possible are affected by radiation exposure. The treatment itself is painless, and similar to getting an x-ray, but the radiation that is delivered to the body is stronger.

Patients receiving external beam radiation do not become radioactive during or after their treatment. They may, however, experience side effects that include:

• Red or blistered skin
• Fatigue
• Nusea
• Diarrhea

Precise targeting helps to minimize these side effects.

Radiation for Early Stage or Slow-Growing Disease

Early stage tumors or certain types of slow-growing non-Hodgkin lymphoma respond very well to radiation therapy. “Patients who have stage I and stage II disease are often treated with radiation, and have an option of combined-modality therapy,” says Dr. Pinnix.

Radiation after Chemotherapy for More Advanced or Aggressive Disease

When NHL is more advanced or more aggressive, radiation may be recommended along with or after cycles of chemotherapy to give patients the best chance of remission.

"The largest group of patients we think about [recommending radiation therapy for] are diffuse large B-cell lymphoma patients."  Dr. Pinnix explains that in these patients, radiation may enhance treatment after chemotherapy cycles are completed. This type of therapy — as a treatment following another treatment to kill any cancer cells that remain — is called consolidation therapy.

When radiation is used as consolidation therapy, the typical dose is 30 Gy, "which is considered a low to moderate dose of radiation," says Dr. Pinnix. "And that's given after a complete response to upfront therapy.”

She says that many of the criteria used to determine which patients will benefit from radiation are similar to those used in Hodgkin lymphoma: patients who have builky disease (meaning tumors greater than 3 or 4 inches large) at the time of diagnosis. "Also, patients who have bone involvement have been shown to benefit from radiation as consolidation."

Radiation after Relapse

For patients who have relapsed after previous treatment for non-Hodgkin lymphoma, radiation can be administered to help relieve symptoms or target specific areas of cancer growth.

Doctors are still learning new ways to use radiation therapy to treat non-Hodgkin lymphoma. Dr. Pinnix explains that there are many clinical trials underway to try and identify the patients who would most benefit from radiation therapy, and to exclude those who won’t.  If you’re considering radiation therapy for non-Hodgkin lymphoma, make sure you carefully review the pros and cons with your doctor.

 

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