Keypoints

Radiotherapy

Radiotherapy uses radiation, such as X-rays, to kill non-Hodgkin's lymphoma cells or to slow down their growth and development. So that the radiation is targeted at the lymphoma and the side effects are minimal, treatment planning plays an important part in radiotherapy. This may involve several visits to the radiotherapy department before the actual treatment can begin.

Treatment planning to target the lymphoma and make sure the side effects are minimal plays an important part in radiotherapy

The area to be treated will be carefully mapped out and the treatment machine will be adjusted so that only the lymphoma cells are exposed to a full dose of radiotherapy. Because of the need to target the radiation at exactly the right area of the body, a mould is sometimes made that will help to hold that part of the body still and in position during the treatment sessions.

Normal cells surrounding the lymphoma are spared the full dose, and these cells are usually able to repair themselves more easily than lymphoma cells. Therefore, radiotherapy can often control or destroy lymphoma cells, while causing only temporary damage to normal cells.

Radiotherapy is usually given on an outpatient basis, with the patient visiting the hospital up to five times a week. Before each treatment, the patient is carefully positioned, usually lying on a treatment table. Parts of the body that are not being treated may be covered. It is important to remain completely still during the treatment. Each treatment usually lasts only a few minutes and causes no discomfort. Although the patient is left alone during the actual treatment, the radiotherapy technicians watch from an observation room and it is possible to talk to them through a microphone.

A course of radiotherapy typically lasts for between 2 and 6 weeks, depending on the patient's individual circumstances.

• Side effects
• Coping with radiotherapy

Side effects

Radiotherapy has less effect on the body's healthy cells than it does on the lymphoma cells, but normal cells are often affected by the treatment too. For this reason, there may be side effects from radiotherapy.

Because radiotherapy is a local treatment that is given to one specific part of the body, most side effects depend on the part of the body being treated. For example:

• Treatment to the abdomen can cause nausea (feeling sick) or diarrhoea
• Treatment to the neck or upper chest can affect the lining of the mouth, throat and gullet (or 'oesophagus'), which may cause pain and make swallowing difficult
• Treatment to the head, or any other part of the body with hair on it, can cause hair loss in that area
• Sometimes, the skin that lies over the lymphoma being treated becomes burned by the radiation, turning red and sore

In addition, most people feel tired and lethargic while they are having radiotherapy, and the white cell count in their blood may be reduced, making the patient more prone to infection during the course of treatment.

These side effects may be mild and little more than a nuisance, or they may vary in intensity. Often, the side effects are mild to start with and become more of a problem as the treatment course goes on. All of these side effects are temporary, including hair loss. They may last for a few weeks or even several months after the course has finished, but they will go away.

Occasionally, there are long-term effects of radiotherapy. Radiotherapy to the pelvis or groin area can affect fertility, in both men and women. As far as possible, the testes or ovaries are shielded from the radiation during treatment.

Radiotherapy can also increase the risk of some cancers in tissues that have received doses of radiation, for example the skin. It is therefore important that patients keep any follow-up appointments and attend regular screening, as well as take positive steps to reduce their risk of cancer, such as give up smoking or always use sunscreens when in the sun.

Long-term breast cancer screening after radiotherapy is an important consideration for women who have had radiotherapy to the breast, especially in those with a history of breast cancer in their family. Men may also be affected and ought to consider screening if there is a family history of breast cancer. Thyroid cancer is also more common after radiotherapy to the neck.

Other long-term effects, for example to the lungs, occur because of scarring, which results when the tissues heal after the radiotherapy.

Coping with radiotherapy

There are things that can be done to eliminate or make more tolerable many of the potential side effects of radiotherapy. For example:

• Nausea and vomiting: modern anti-sickness medications (anti-emetics) are very effective, and it may help to take an anti-emetic before each treatment session. There are many different anti-emetics, and some work better for some people than others. So if one does not seem to work, it may well be possible to try another
• Sore mouth or throat and difficulty swallowing: warm mouthwashes with bicarbonate of soda often help. Teeth should be cleaned, gently, after each meal to prevent infection. It may be more comfortable to leave dentures out as much as possible. If swallowing is difficult, eating liquidised or semi-solid food is likely to help
• Tiredness and lethargy: it is important to have adequate rest. It might be necessary to take time off work and to adjust the daily schedule. Other people, however, find that they can continue as normal. Everyone is different