Radiation Therapy for Non-Hodgkin Lymphoma in Children

Radiation therapy uses high-energy rays to kill cancer cells. This was once a very common treatment for children and teens with non-Hodgkin lymphoma (NHL). But as doctors have developed more effective chemotherapy (chemo) and other drug treatments, radiation therapy has been used less.

When might radiation therapy be used in childhood NHL?

Radiation therapy might be used in a few instances.

• Sometimes it is used along with chemo. This might be done if the lymphoma has reached the brain or spinal cord.
• It may be used as a form of urgent treatment in children with symptoms caused by large tumors in the chest.
• It may be used as part of treatment for children who are getting high-dose chemo and a stem cell transplant.
• It can be used to relieve symptoms from lymphoma, such as pain from a tumor that's pressing on nerves.

How is radiation therapy given?

Radiation focused on a cancer from a machine outside the body is called external beam radiation. This is the type of radiation therapy most often used to treat childhood NHL.

Before the radiation treatment starts, the team will take careful measurements to determine the correct angles for aiming the radiation beams and the proper dose of radiation. This planning session, called simulation, often includes getting imaging tests such as CT or MRI scans.

The treatment itself is much like getting an x-ray, but the radiation is stronger. It is painless, but some younger children might need to be sedated to help make sure they don’t move during the treatment. Each treatment lasts only a few minutes, although the setup time – getting your child into place for treatment – usually takes longer. The number of treatments will depend on the reason they're being given.

Possible risks and side effects of radiation therapy

Short-term side effects of radiation therapy depend on where it is aimed. For example:

• It may cause sunburn-like skin problems or hair loss in the area being treated.
• Radiation therapy over large parts of the body can cause fatigue.
• Radiation to the abdomen (belly) can sometimes cause nausea, vomiting, or diarrhea.

Often these effects go away after a short while.

Possible long-term side effects of radiation therapy in children and teens can be more serious, and some may not occur until many years later.

• Radiation therapy to the chest may damage the lungs or heart, which could raise the risk of lung or heart problems later in life. In the long term, radiation to the chest may also increase the risk of lung cancer (especially in people who smoke) and of breast cancer.
• Radiation therapy to the brain might cause headaches and problems such as memory loss, personality changes, and trouble learning at school.
• Radiation to the abdomen in girls can damage the ovaries. This might lead to abnormal menstrual cycles or problems getting pregnant or having children later on.
• Radiation to other parts of the body may slow a child’s growth or increase the risks for certain other cancers, such as those of muscle or bone (called sarcomas) or of the digestive tract.

Because of these possible long-term effects, doctors try to avoid using radiation therapy in children or limit the doses used whenever possible. For more on possible long-term effects, see Late and Long-term Effects of Treatment for Non-Hodgkin Lymphoma in Children.