Lymphoma Radiotherapy - Side Effects

Jane Yolan:

Dr. Bernie Siegel:

Other Radiation Therapy Topics

Side effects of radiation therapy can be either generalized (systemic) or localized.  What the side effects are and how troublesome they are depends on the area(s) being treated, the daily dose rate, the total dosage being delivered, and your response to treatment.

Fatigue - One of the most common side effects of radiation therapy is fatigue.  Fatigue is a feeling of discomfort or tiredness with little exertion.  This is common side effect among lymphoma patients who receive treatments to large areas of the body.  The stress related to illness, daily trips for treatment, and the effects of radiation on healthy tissues all may contribute to fatigue.  Usually most people begin to experience fatigue after a few weeks of radiation therapy.  This generally gets better a few weeks after radiotherapy is completed.

Getting more rest may help reduce fatigue during and after treatment.  Rest may mean a nap, a rest period, a lower level of activity, or less contact with others.  The patient may wish to rearrange activities to allow for rest periods or schedule strenuous or high priority activities at the time of day when they have the most energy.  Some people choose to alter their work schedule or work part-time during treatment.  Others ask family members or friends to help with activities such as shopping, cooking, yard work, housekeeping, childcare, etc.  Other sources of help may be available in the community.

Exercise can be an important part of maintaining ones energy level.   It may seem impossible to exercise when you feel so worn out, but lack of exercise may just make the feeling worse, becoming a vicious cycle.  Even a ten minute walk may enhance a sense of well-being.  Exercise may also help to strengthen the immune system, improve outlook, increase appetite, and help one sleep better.

More nighttime sleep may help relieve fatigue for some people.   If the patient is having difficulty sleeping because of pain or any other reason they should tell their doctor.  The doctor may prescribe medication to reduce pain, induce sleep, or relieve anxiety that may interfering with sleep or rest.

The fatigue will not disappear immediately after treatment ends but should gradually subside during the weeks and months following treatment.  Energy saving techniques should be continued during this time - the body needs time to heal.

Loss of Appetite - Radiation can cause a loss or change in appetite and taste.  Foods the patient once liked may no longer be appetizing.  However studies show that patients who were able to eat well and take in enough calories generally do better throughout treatment compared to those who could not.   Many patients find that eating small meals throughout the day is easier than eating three large meals.  The US National Cancer Institute publishes the booklets Radiation and You & Eating Hints which offer many good ideas for maintaining nutrition throughout treatment.

Localized Side Effects

Skin - The skin in the treatment area will usually become red like a sunburn and will eventually become tan or peel.  During treatment the patient should be very gentle to the skin in the treatment area - do not rub, scratch, or scrub.  Wash with lukewarm water and mild soaps.  Avoid any soap that contains fragrances, deodorant or any type of metal which may increase adverse skin reactions.  Deodorants or antiperspirants should not be used in the treatment area.   A light dusting of cornstarch may be used as a deodorant substitute but talcum powder should be avoided (it contains metal).  After a few weeks the skin may become very dry and start to itch.  Ask the doctor or nurse for their recommendations on how to relieve this.  Avoid using any type of cream, lotion, or home remedy without their approval.

Throat and Esophagus (Mantle Field) - After 2 to 3 weeks of radiation therapy the patient may develop a dry, sore throat and difficulty swallowing and eating.  This is caused by irritation of the membranes lining the throat and esophagus.  This discomfort usually peaks at the end of treatment and may continue for six months or more following therapy.  If the patient has pain or difficulty swallowing, a soft, bland, moderate diet may be easier to eat.  Putting food in the blender may make it easier to swallow.  It may also be easier to eat small meals more frequently instead of three larger meals.  Commercial dietary supplements may help provide additional calories and protein when other foods are difficult to swallow.  The flavor of these supplements can be varied by adding fruit flavorings or other items.  Heartburn-like symptoms may also occur - ask your medical team on the use of liquid antacids to help.

Lungs (Mantle Field) - Radiation pneumonitis is an uncommon type of lung inflammation that occurs in 1% or less of patients.  It usually occurs 6 to 18 months after treatment.  Symptoms include a dry cough, shortness of breath, and low-grade fever.  This condition may resolve itself or a doctor may prescribe a short course of steroids (ask your medical team).  There are usually no long-term side effects from this type of pneumonitis.

Heart (Mantle Field) - Cardiac side effects following radiation therapy are rare but isolated cases have occurred.  See Late Effects for additional information.

Stomach and Abdomen (Middle Field) - Radiation therapy in the area of the stomach and abdomen may cause upset stomach, nausea, vomiting, or diarrhea.

Nausea can occur one to two hours after treatment and can last four hours or more.  Nausea and vomiting occur most often after the first treatment.   There is a tendency for the nausea to be persistent but less intense as treatment progresses.  Some patients have less nausea and vomiting if they do not eat for several hours before treatment.  For others the reaction may be the same whether they have eaten or not.  For some people certain smells or odors can cause nausea.

Some people begin to feel nauseated or vomit before a treatment session begins.  This is called anticipatory nausea and is caused by anxiety or recalling past experiences.  Relaxation techniques may be helpful for reducing this.   The doctor can prescribe medication to help prevent nausea and vomiting and to treat it when returning home after treatment (anti-anxiety drugs like ativan or anti-nausea drugs like zofran or kytril).

It may be helpful to eat light, easily digested foods and avoid sweet, spicy, or fatty foods.  Saltine crackers and herbal teas may be well tolerated.  It is important to drink plenty of fluids.  these may include water, juices, broth, gelatin, or whatever sounds good. It is helpful to eat and drink slowly and to rest before and after meals to help prevent nausea and vomiting.

If the patient plans to continue working during therapy they may wish to schedule treatment at the end of the working day so they can be home when nausea occurs.

Diarrhea (Middle and/or Lower Field) - If diarrhea occurs, it usually begins in the third or fourth week of radiation therapy.  Some people have an increase in the number of bowel movements while others have loose, watery stools and intestinal cramping.  For most people, a low residue diet and doctor approved anti-diarrhea medications will usually control the problem.  Creamed soups, eggs, cheese, cooked vegetables, potatoes, and broiled meats are examples of low residue foods.  Call your doctor or nurse if you are unable to control diarrhea with diet and medication.  Prolonged diarrhea can cause dehydration, weight loss, and increased fatigue.

Effects on Fertility (Lower Field) - Effects on fertility are possible because the testes in men and the ovaries in women may be exposed to radiation.  If you are a woman of childbearing age, you should discuss birth control measures with your doctor.  Becoming pregnant during treatment would complicate the treatment and possibly injure the fetus.  Men should also consider birth control during treatment.

Depending on the dose of radiation received, sperm production may be reduced or stopped during therapy.  Sperm production may return to normal in 3 to 5 years or sterility may be permanent.  Sperm banking prior to starting radiation therapy may be an option for men who wish to have children prior to starting radiotherapy.   Freezing embryos prior to radiation or chemotherapy may be an alternative for women.  Many clinics specialize in cryonic storage.  This should be considered and done prior to treatment.

It is especially important that teenagers and young adults be aware of these options.  Often fertility issues seem too far in the future to deal with, especially when the current situation - battling lymphoma - is overwhelming.  However the effects of treatment on fertility can be permanent and this may not sink in until it is too late.

Depending on the radiation dose, most women who have radiation therapy to the pelvic area stop menstruating.  they may also have other symptoms of menopause, including vaginal dryness.  A reduction in the exposure of radiation to the ovaries may be accomplished through a procedure called oophoropexy.  In this surgery the ovaries are sutured close to the uterus so that they are not in the direct line of radiation.  A limited number of successful pregnancies have been reported in patients who have had this procedure.

Summary

Radiation therapy can have serious health consequences, both short term and long term.  Patients should be informed of the risks and be on the alert for side effect symptoms to take appropriate action.  Patients should maintain communication with their medical team and consult them on options they might take during treatment.

Resources:

• Radiation Therapy Effects - American Cancer Institute
• Guide: Radiation Therapy and You (NCI) 

Additional Radiation Therapy Topics:

[General]  [Fields/Ports]  [Delivery]  [Dosage]  [Late Effects]
[Resources]

• Adult Hodgkin's Lymphoma
• Adult Non-Hodgkin's Lymphoma
• Childhood Hodgkin's Lymphoma
• Childhood Non-Hodgkin's Lymphoma

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This page is a work in progress - if you have more complete information, references, or other information please contact us.  The author is not in the medical field, please refer to qualified medical personnel for information specific to your diagnosis or treatment.

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Updated November 24, 2005