Radiation:

Radiation uses high-energy x-rays to kill cancer cells and shrink tumors. Radiation is commonly used to treat indolent lymphomas and may also be used palliatively to relieve symptoms. It is very often the sole therapy for early stage (stage I or II) lymphomas. The dose administered ranges from 35 - 50 Gy and depends on a number of factors: The type of lymphoma, the age of the patient, whether the intent is to cure or relieve symptoms, how close sensitive organs are to the diseased area, and whether radiation is being combined with chemotherapy.

Radiation is tailored to the individual and usually limited to the diseased areas and possibly nearby regions:

• If the lymphoma is confined to tissues above the diaphragm, radiation is delivered to the neck, chest, and under arms (called the mantle-field) and sometimes to lymph nodes in the upper abdomen or spleen or both.
• If the lymphoma is below the diaphragm, subtotal nodal radiation may be used, which is directed to other regions, including lymph nodes in the upper abdomen, spleen, and pelvis, in addition to the mantle-field.
• Radiation to the brain is called cranial radiation.
• Total body irradiation is sometimes performed, although it is not clear whether its high toxicity outweighs any advantages.

Side Effects and Complications

Side effects and complications of radiation generally depend on the target site in the body. They include:

• Dental problems
• Lung damage and difficulty breathing may occur with chest radiation
• Hypothyroidism
• Infections
• Long-term risk for heart disease
• Long-term risk for certain cancers -- of particular concern is a possible increased risk for breast cancer among females treated with chest radiation. Studies indicate that young women and adolescent girls are at highest risk, with the incidence increasing significantly 15 years after treatment. The risk is greater in those who had higher radiation doses. Radiation may also increase the risk over time for other cancers, including lymphoma and thyroid, lung, and colon cancers, although the risk is still low.
• Impaired bone growth -- children and adolescents are at special risk for bone problems caused by radiation. Some doctors believe that radiation should play no role in the treatment of young people, except in special cases, such as lymphomas that require radiation to the brain.
• Infertility -- the negative effects on fertility may be worse in women than in men; sperm usually recover within 5 years. To protect the ovaries, a technique called ovarian transposition is sometimes used. Transposition may sometimes be performed through a laparoscope, a thin tube containing tiny instruments and cameras, which is introduced through a small incision. The doctor uses the laparoscope to move the ovaries out of the range of areas being treated with radiation.