Hodgkin Disease

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Treating Hodgkin Disease TOPICS

Radiation therapy for Hodgkin disease

Radiation therapy uses high-energy rays (or particles) to destroy cancer cells.

To treat Hodgkin disease, a carefully focused beam of radiation is delivered from a machine outside the body. This is known as external beam radiation. Most often, radiation treatments are given 5 days a week for several weeks. Before the treatments start, the radiation team takes careful measurements to determine the dose needed and the correct angles for aiming the radiation beams. The treatment is much like getting an x-ray, but the radiation is more intense. Each treatment lasts only a few minutes, although the setup time – getting you or your child into place – usually takes longer. Radiation itself is painless, but some younger children may need to be sedated to make sure they don’t move during the treatment.

Radiation therapy is most useful when Hodgkin disease is only in one part of the body. For classic Hodgkin disease, radiation is often given after chemotherapy, especially when there is a large or bulky tumor mass (usually in the chest). The chemotherapy or radiation alone would probably not cure the disease, but both treatments together are usually effective in getting rid of it. Radiation therapy may also be used by itself to treat some cases of nodular lymphocyte predominant Hodgkin disease.

Radiation therapy is often very good at killing Hodgkin disease cells. Decades ago, this was the best treatment available for Hodgkin disease, but over the years doctors realized it could lead to long-term side effects. As it became clear that chemotherapy was also effective, doctors began to use less radiation. Today, if radiation therapy is used, only the involved areas are treated with radiation to try to limit side effects.

Involved field radiation

This is the preferred form of radiation therapy when it is used to treat Hodgkin disease. Only the lymph node areas that contain Hodgkin disease are treated. Chemotherapy is typically given first, and then radiation is given to areas that were initially involved.

Extended field radiation

In the past, radiation was given to the major lymph node areas that contained Hodgkin disease, as well as the surrounding “normal” lymph node areas, just in case the Hodgkin disease had spread, even though the doctors could not actually detect it in these areas. This is called extended field radiation.

  • If the Hodgkin disease was in the upper body, radiation was given to the mantle field, which included lymph node areas in the neck, chest, and under the arms. Sometimes this was extended to also include lymph nodes in the upper abdomen.
  • Inverted Y field radiation therapy included the lymph nodes in the upper abdomen, the spleen, and the lymph nodes in the pelvis).
  • When inverted Y field radiation was given together with mantle field radiation, the combination was called total nodal irradiation.

Because nearly all patients with Hodgkin disease are now treated with chemotherapy, extended field radiation is seldom used any more.

Total body irradiation

People who are getting a stem cell transplant may get radiation to the whole body along with high-dose chemotherapy, to try to kill lymphoma cells throughout the body. For more information on this procedure, see the section, “High-dose chemotherapy and stem cell transplant.

Possible side effects

The side effects of radiation therapy depend on where the radiation is aimed. Some people have skin changes similar to sunburn, which slowly fades away. Other possible short-term side effects include fatigue, dry mouth, nausea, or diarrhea. Radiation given to several areas, especially after chemotherapy, can lower blood cell counts.

Long-term side effects: Radiation therapy can also have long-term side effects. The most serious of these is the development of another cancer in the part of the body that was exposed to radiation.

Radiation to the chest or neck can damage the thyroid gland, which can affect its ability to make thyroid hormone. This can lead to fatigue and weight gain. Treatment with thyroid hormone pills can help with this. Radiation to the chest also increases the risk of heart disease (such as heart attacks) and lung problems, while radiation to the neck may increase the risk of stroke many years later.

In children, radiation that reaches the bones may slow their growth. Depending on where the radiation is given, this could result in deformities or a lack of growth to full height. Radiation to the lower part of the body in children and young adults might also affect fertility later in life.

To reduce the risk of side effects, doctors carefully calculate the exact dose of radiation needed and aim the radiation beam as accurately as they can. Shields may also be placed over nearby parts of the body to protect them from the radiation. In girls and young women, the ovaries may be moved out of the way with minor surgery before radiation is given to help preserve fertility.

For more information about long-term side effects, see the section, “What happens after treatment for Hodgkin disease?” If you or your child are getting radiation therapy, ask your doctor about the possible long-term side effects.

Last Medical Review: 12/10/2012
Last Revised: 02/07/2014