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Long term side effects of radiotherapy

Find out about possible long term side effects of external radiotherapy and what you can do about them.

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

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

Skin changes

The most common long term side effect is a change to the skin where you have had radiotherapy treatment. The skin may look permanently sunburnt or develop a network of tiny blood vessels near the surface. It may always be more sensitive to the sun than it was before your treatment.

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 developing 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. For men and women who had chest radiotherapy, there is also a smaller risk of:

  • thyroid cancer
  • lung cancer
  • cancer of the food pipe (oesophagus)

The total radiation dose used in chest radiotherapy 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. 

Children with Hodgkin lymphoma

Children treated with radiotherapy for Hodgkin lymphoma also have an increased risk of developing another cancer later in life. Researchers and doctors are currently doing research trials to see which children need radiotherapy after chemotherapy and which children don't need it. 

Breast screening

Some women who have had radiotherapy to the chest for Hodgkin lymphoma before the age of 30 will have earlier and more frequent breast screening. This is the group with the largest cancer risk.

These women might have yearly breast screening from 8 years after treatment, or from the age of 30 (whichever is later). This involves an MRI scan or a mammogram or both, depending on the age of the woman and their situation. 

It is possible for men treated with radiotherapy to the chest to get breast cancer, but it is much rarer.

If you are worried at all, speak to your specialist. You can also call the Cancer Research UK nurses on freephone 0808 800 4040. The lines are open from 9am to 5pm, Monday to Friday.

Heart problems

Radiotherapy to the chest for Hodgkin lymphoma can increase the risk of heart disease in later life. 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 you might 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.

It can be extremely distressing to find that the treatment you need means you will not be able to have children. It can seem very unfair to have to cope with this as well as with your cancer.

Even for people who had not yet thought about having children, losing fertility can be very difficult to come to terms with. It can affect the way you feel about yourself. It will take time to come to terms with this change in your life. It is important to give yourself time to adjust and feel sad. Talking to someone close can help. But it can take time to be able to do this.

You may want to talk to someone other than your partner, family or friends. Some people find it helpful to talk to a therapist or counsellor.

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.

Last reviewed: 
08 Feb 2018
  • A comparison of mantle versus involved-field radiotherapy for Hodgkin's lymphoma: reduction in normal tissue dose and second cancer risk
    ES Koh and others
    Radiation Oncology, 2007. Volume 2, Issue 13

  • Developments in the management of Hodgkin's lymphoma
    L Lowry and others
    The Lancet, 2010. Volume 375, Issue 9717

  • Hodgkin’s Lymphoma: ESMO clinical practice guidelines for diagnosis, treatment and follow-up
    DA Eichenauer, A Engert and M André
    Annals of Oncology, 2014. Volume 25 (Supplement 3)

  • Hodgkin's lymphoma in adults
    W Townsend and D Linch
    The Lancet, 2012. Volume 380, Issue 9844

  • Protocols for the surveillance of women at higher risk of developing breast cancer. Version 4
    NHSBSP Publication no 74 - June 2013

  • The information on this page is based on literature searches and specialist checking. We used many references and there are too many to list here. Please contact patientinformation@cancer.org.uk with details of the particular issue you are interested in if you need additional references for this information.

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