Radiation therapy for lymphoma and leukemia

Radiation therapy is the use of high-dose X-rays to treat cancer cells that may remain after surgery, especially if all of the cancer cannot be removed. Radiation therapy is often used for the treatment of cancer, such as non-Hodgkin's lymphoma (NHL), Hodgkin's lymphoma, and all types of leukemias. Radiation therapy may be used alone or in combination with other treatment options, such as chemotherapy.

For lymphoma, treatments are given once a day, 5 days a week, for 4 to 6 weeks. The area of the body affected by the cancer determines which area of the body receives radiation therapy. The duration of treatment for leukemia is usually much shorter.

Side effects are common but generally go away when treatment is finished. They include:

• Low blood counts, which may increase the risk of infection and bleeding.
• Fatigue.
• Redness and itching of the skin in the radiation field. The skin may look as though you have a bad sunburn.
• Hair loss in the area inside the radiation field.
• Nausea, vomiting, or diarrhea if the abdomen or pelvis is radiated.

When used during early-stage or nonaggressive NHL, radiation therapy is used to treat cells that may remain after surgery, especially if all of the cancer cannot be removed. Radiation may be used alone or in combination with other treatment options, such as chemotherapy. Radiation is also used for palliative care if chemotherapy is not working.

When used to treat chronic lymphocytic leukemia (CLL), radiation therapy is usually given to relieve pain from either an enlarged spleen or lymph nodes.

Radiation therapy is used to help keep an acute leukemia from spreading to the central nervous system (CNS prophylaxis). It is also used to treat recurrent leukemia that has spread to the brain or spinal cord.¹

Traditionally, radiation therapy was the primary treatment for patients with stage I and some stage II aggressive non-Hodgkin's lymphoma (NHL). Radiation therapy alone can limit the spread of lymphoma within the radiation fields in approximately 90% of people.

Radiation treatments to the brain (cranial irradiation) lower the risk of relapse when used to treat acute leukemia.¹

When used for the treatment of chronic lymphocytic leukemia, radiation therapy may reduce the total white blood cell count and reduce the size of the lymph nodes, liver, or spleen.²

Depending on the type and the stage of the cancer, radiation therapy may be used alone or in combination with chemotherapy.

There are few risks involved with radiation therapy for lymphoma or leukemia. However, radiation therapy to the pelvis may cause permanent sterility.

Side effects of radiation therapy are common but usually get better and go away when treatments stop. Side effects depend on the area of the body affected by treatments and may include:

• Low blood counts, which may increase your risk of infection or bleeding.
• Redness and irritation in the mouth.
• A dry mouth and difficulty in swallowing.
• Changes in taste.
• Nausea or vomiting.
• Diarrhea.
• Fatigue.
• Hair loss in the treatment area. Whether your hair grows back depends on the area treated, the dose of radiation, and the type of radiation used.
• Irritation of the skin.

Radiation therapy to the pelvis may cause permanent sterility. Discuss fertility options with your health professional before beginning pelvic radiation for NHL or CLL.

Unlike general radiation therapy, targeted radiation therapy uses monoclonal antibodies, which deliver radiation directly to the lymphoma cells.

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Citations

1. Thai MC, Coutre SE (2004). Acute lymphoblastic leukemia in adults. In JP Greer et al., eds., Wintrobe's Clinical Hematology, 11th ed., vol. 2, pp. 2077–2096. Philadelphia: Lippincott Williams and Wilkins.

2. Johnston JB (2004). Chronic lymphocytic leukemia. In JP Greer et al., eds., Wintrobe's Clinical Hematology, 11th ed., vol. 2, pp. 2429–2463. Philadelphia: Lippincott Williams and Wilkins.