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Radiotherapy for Hodgkin lymphoma

Men and women discussing Hodgkin's lymphoma

This page tells you about radiotherapy for Hodgkin lymphoma. Radiotherapy uses high energy rays to kill cancer cells. There is information about


A quick guide to what's on this page

Radiotherapy for Hodgkin lymphoma

Radiotherapy uses high energy rays to kill cancer cells. It may be used when there are Hodgkin cells in one or two areas of lymph nodes in one part of the body (stage 1 or 2). Or for advanced Hodgkin lymphoma to shrink large lymph nodes. Radiotherapy is usually given before or after chemotherapy treatment.

Having your treatment

You have radiotherapy in the hospital radiotherapy department. Usually, you have treatment once a day from Monday to Friday, with a rest over the weekend. The length of the treatment will depend on the area you are having treated.

On your first visit, you have X-rays or scans taken. The doctor uses the scans to work out where to give the treatment. They will make marks on your skin, to help line up the radiotherapy machine when you have your treatment. The actual treatment only takes a few minutes. This type of radiotherapy does not make you radioactive.

Side effects

The most common side effects during and just after treatment are reddening of the skin in the treatment area, tiredness, and loss of hair in the treatment area. If you are having treatment to your abdomen, you may feel sick or have diarrhoea.

Most people don't have serious long term effects after radiotherapy. The most common long term effect is darkening of the skin in the treated area. Rarer long term problems include the risk of a second cancer, heart problems, changes to your thyroid gland, infertility, and inflammation of the lungs.


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Radiotherapy for Hodgkin lymphoma

Radiotherapy is a local treatment. You may have it to a small area when there are Hodgkin lymphoma cells in one or two areas of lymph nodes, in one part of the body (stage 1 or 2). Or you may have it to shrink large lymph nodes in advanced Hodgkin lymphoma. It is usually given after chemotherapy.


Where and when you have treatment

You have radiotherapy treatment in the hospital radiotherapy department. Usually, you have treatment once a day from Monday to Friday with a rest over the weekend. The length of the treatment depends on the area being treated.


Treatment planning

Before you begin your treatment, the radiotherapy team carefully plan your external beam radiotherapy. This means working out how much radiation you need to treat the cancer and exactly where you need it. 

Your planning appointment may take from 15 minutes up to a couple of hours. You will have a planning CT scan. The scan shows the cancer and the structures around it.

CT scanner

You lie on the scanner couch with the treatment area exposed. The radiographers will put some markers on your skin. You need to lie very still. Once you are in position the radiographers move the couch up and through the scanner. The scanner is a doughnut shape. 

The radiographers leave the room and the scan starts. It takes up to 5 minutes. You won't feel anything. The radiographers watch from the next door room.

Before the planning appointment you may also have other scans, such as MRI scans or PET scans. Your treatment team can feed the other scans into the planning scanner.

Ink marks

Once the treatment team has planned your radiotherapy, they may put ink marks on your skin to make sure they treat exactly the same area every day. They may also make pin point sized tattoo marks in these areas.

Moulds or masks

If you are having treatment to your head or neck, you may need to have a mould (shell) made to keep you perfectly still while you have treatment. You may also have a mould if you have to keep an arm or leg perfectly still.

After your planning session

You may have to wait a few days or up to 2 weeks before you start treatment. During this time the physicists and your radiotherapy doctor decide the final details of your plan. 

Your doctor will plan the areas that need treatment and outline areas to limit the dose to or avoid completely. They call this contouring. Then the physicists and staff called dosimetrists plan the treatment very precisely using advanced computers.

Radiotherapy fields

For early stage lymphoma, most people have radiotherapy just to a small area of the affected lymph nodes and this is called involved field radiotherapy (IFRT). If the lymphoma is in lymph nodes over a large area then they may have extended field radiotherapy (EFRT).


Having radiotherapy

Radiotherapy machines are very big. The machine may be fixed in one position or able to rotate around your body to give treatment from different directions. Before your first treatment your radiographers will explain what you will see and hear. The treatment rooms usually have docks for you to plug in music players. So you can listen to your own music.

You can't feel radiotherapy when you actually have the treatment. It takes anything from 15 to 30 minutes. It is important to lie in the same position each time, so the radiographers may take a little while to get you ready.

A photo of a linear accelerator, which gives radiotherapy

Once you are in the right position, the staff leave you alone in the room for the treatment. They watch you carefully on a closed circuit television screen.

Our page about having external radiotherapy has a video about having radiotherapy that you may want to watch.

External radiotherapy doesn't make you radioactive. It is perfectly safe to be with other people, including children, throughout your course of treatment.


Side effects

The most common side effects of radiotherapy during and just after treatment are

  • Reddening of the skin in the treatment area
  • Tiredness
  • Loss of hair in the treatment area

Your skin may look slightly sunburnt in the area that has been treated. Don't use any creams or lotions unless the radiotherapy centre has given them to you.

Tiredness usually comes on towards the end of a course of treatment. It may take some weeks or even months to go completely after your course of treatment is over.

Other side effects of radiotherapy vary depending on which part of the body is being treated. If your treatment is to the abdomen, you may feel sick or have diarrhoea. These effects can get worse towards the end of your treatment and will then gradually clear up after it has finished.

If you are having extended field radiotherapy, you will probably find that tiredness and sickness are the most troublesome side effects. Ask your doctor for anti sickness medicines to take before your treatment. They do help.


Possible long term side effects

Most people don't have serious long term effects from radiotherapy. But because Hodgkin lymphoma treatment is so successful and people are living such a long time after treatment, we are beginning to see problems emerging many years later. 

Doctors and researchers are continually changing and developing treatments to reduce the risk of side effects while giving the best chance of curing the lymphoma. So the risk of long term side effects is going down.

The most common long term side effects of radiotherapy for Hodgkin lymphoma are changes to the skin in treated areas. The skin may look permanently sunburned or may develop a network of tiny blood vessels near the surface. It may always be more sensitive to the sun than before your treatment.

Other possible long term problems include

  • Risk of a second cancer
  • Heart problems
  • Changes in the way your thyroid gland works
  • Risk of infertility
  • Inflammation of the lungs (pneumonitis)

Risk of a second cancer

People treated for Hodgkin lymphoma with radiotherapy have an increased risk of developing another cancer later in life. The highest risk is of breast cancer, caused by radiotherapy to the chest. Doctors usually only treat the centre of the chest these days, rather than a large T shape across the chest and shoulders, as they used to do. 

The total radiation dose used is lower. So the risk of a second cancer is lower than it used to be. For some people it may not be necessary to have radiotherapy after the chemotherapy. Your doctor will discuss with you the different treatment options in your case. 

Children treated with radiotherapy for Hodgkin lymphoma also have an increased risk of developing another cancer later in life. For some children it may not be necessary to have radiotherapy after chemotherapy treatment. 

Researchers and doctors are currently doing research trials to see which children need radiotherapy after chemotherapy and which children don't need it. Your child's doctor will discuss this with you and your child. If you had radiotherapy for lymphoma as a child and are worried about your possible cancer risk, you can make an appointment to see your lymphoma specialist to talk about this issue. Or if you've lost touch with your specialist, you can see your GP.

Women who have had radiotherapy to the chest for Hodgkin lymphoma, including as a child, may have yearly breast screening from 8 years after treatment, or from age 25 years (whichever is later). This is the group with the largest cancer risk at the moment. It is possible for men treated with radiotherapy to the chest to get breast cancer, but it is much, much rarer.

 For men and women who had chest radiotherapy, there is also a smaller risk of thyroid cancer, lung cancer, or cancer of the food pipe (oesophagus). If you are at all worried, speak to your specialist. 

Heart problems

Radiotherapy to the chest for Hodgkin lymphoma can increase the risk of heart disease in later life. Nowadays, doctors use reduced treatment fields and doses as much as possible to reduce any effects on the heart. But it is important to be aware of this side effect, particularly if there is heart disease in your family. 

You can help to reduce your risk by having a healthy diet, exercising regularly, and not smoking.

Changes in the way your thyroid gland works

After radiotherapy to the neck for Hodgkin lymphoma, some people can develop a condition of the thyroid gland, called hypothyroidism. The thyroid gland stops producing enough thyroid hormones and people need to take thyroid hormone (thyroxine) tablets.

Infertility after radiotherapy to the pelvis

If you have radiotherapy to your groin or pelvis you may become infertile.

Inflammation of the lungs (pneumonitis)

Radiotherapy to the chest can cause inflammation of the lungs called radiation pneumonitis. The inflammation can cause a long term cough, and sometimes breathlessness.


More information about radiotherapy

Find out about


Specific side of radiotherapy to different areas in the body

Stages of hodgkin lymphoma

Radiotherapy moulds and masks

Radiptherapy skin markings

Cancer and fertility

Radiation pneumonitis

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Updated: 6 January 2015