Radiotherapy for Hodgkin's lymphoma

Radiotherapy is a local treatment. You may have it to a small area when there are Hodgkin's 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's lymphoma. It is usually used with chemotherapy.

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.

Radiotherapy treatment has to be carefully planned. On your first visit, you have scans taken or lie under a special machine called a simulator. This takes normal X-rays. The doctor uses the scans or X-rays to work out where to give the treatment to kill the most lymphoma cells and miss as much healthy body tissue as possible.

The doctor or radiographer make marks on your skin during the planning session. These skin marks are used to line up the radiotherapy machine every day when you have your treatment so it is important not to wash them off. Don't worry about this though. You may have a small pinprick tattoo done that the radiographers can use too. This is just a single blue dot. They will also draw your skin markings back in as necessary if they fade.

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). 

Occasionally people have ‘mantle field’ or ‘inverted Y’ radiotherapy treatment. Mantle field treatment is for lymphoma above the diaphragm. The treated area is a T shape, that runs across the shoulders, the neck and the breastbone area. Inverted Y radiotherapy is for Hodgkin’s lymphoma in the nodes around the spine or groin area. The treatment area is the shape of an upside down Y and treats the spine and both groins.

The actual treatment only takes a few minutes. The radiographer will help you to lay in the correct position on the radiotherapy couch and make sure you are comfortable. You will be left alone while you have your treatment, but the radiographer will be able to hear you and see you through an intercom.

Radiotherapy does not hurt. You will not be able to feel it, but will have to lie very still for a few minutes while you have treatment.

This type of radiotherapy does not make you radioactive. It is perfectly safe to be with other people, including children, throughout your course of treatment.

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. There is detailed information about skin care during radiotherapy in the main radiotherapy section of CancerHelp UK.

Tiredness usually comes on towards the end of a course of treatment. It may take some weeks to go completely after your course of treatment is over. There is more about radiotherapy tiredness in the radiotherapy section.

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.

Most people don't have serious long term effects from radiotherapy. But because Hodgkin's 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's 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
• Infertility from 'inverted Y' radiotherapy
• Inflammation of the lungs (pneumonitis)

Risk of a second cancer

People treated for Hodgkin's 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 treated area is now smaller and 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's lymphoma also have an increased risk of developing another cancer later in life. For some people it may be possible not 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 treated as children or before the age of 35 can have breast cancer screening if they had radiotherapy to the chest for Hodgkin's lymphoma. 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. There is detailed information about Hodgkin's lymphoma and breast cancer risk in our lymphoma question and answer section.

Heart problems

Radiotherapy to the chest for Hodgkin's 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's 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 'inverted Y' radiotherapy

If you have 'inverted Y' radiotherapy, you may become infertile. There is information about radiotherapy and fertility for men and fertility for women in the radiotherapy side effects section of CancerHelp UK.

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.

You can find more information in the radiotherapy section of CancerHelp UK, including

• What radiotherapy involves
• How treatment is planned
• Possible side effects

If you would like more information about anything to do with radiotherapy, contact our cancer information nurses.  They will be happy to help.