Radiation therapy for non-Hodgkin lymphoma

Radiation therapy uses high-energy rays or particles to destroy cancer cells. It is sometimes used to treat non-Hodgkin lymphoma (NHL). Your healthcare team will consider your personal needs to plan the type and amount of radiation, and when and how it is given. You may also receive other treatments.

Radiation therapy is given in different ways for different reasons. It is often used as the main treatment for slow-growing (indolent) NHL that is in an early stage (stage 1 or 2). You may also have radiation therapy after or during chemotherapy to treat fast-growing (aggressive) types of NHL, to treat large tumours and to lower the risk that the NHL will come back (recur).

Radiation therapy may be given to the entire body (called total body irradiation or total marrow irradiation) in preparation for a stem cell transplant.

It may be used to prevent NHL from spreading to the brain. Radiation to the brain is also used to treat certain types of NHL, such as primary CNS lymphoma, or NHL that has spread to the brain.

Radiation therapy may also be given to relieve pain or control the symptoms of advanced NHL (called palliative therapy). It is used to shrink large tumours or larger than normal lymph nodes that are pressing on other organs or tissues. It can also be used to treat NHL that has spread to other tissues and is causing symptoms.

External beam radiation therapy

During external beam radiation therapy, a machine directs radiation through the skin to the tumour and some of the tissue around it. The part of the body that receives radiation is called the radiation field. Depending on where cancer is in the body, the radiation field used to treat NHL can include:

  • only the areas of lymph nodes that have lymphoma cells in them (called the involved field radiation therapy, or IFRT):
  • lymph nodes in the neck, chest and underarms (called the mantle field)
  • lymph nodes around the heart and the aorta (a large artery that takes blood from the heart to the rest of the body)
  • lymph nodes in the pelvis and groin
  • lymph nodes in the upper abdomen and pelvis
  • the spleen


Radioimmunotherapy may also be called radiolabelled immunotherapy or radioimmunoconjugate drugs. It combines radiation therapy with targeted therapy. A radioactive material is attached to a substance that targets specific molecules (such as proteins) on the surface of cancer cells. The drug attaches to the cancer cells so the radiation is delivered directly to them, which may mean fewer or less severe side effects.

Ibritumomab (Zevalin) is the radioimmunotherapy used to treat some types of NHL. It contains a radioactive substance, so you may need to take special precautions to protect others from being exposed to radiation for 1–2 weeks after treatment. Talk to your healthcare team about any special precautions that you need to take.

Side effects

Side effects can happen with any type of treatment for NHL, but everyone’s experience is different. Some people have many side effects. Other people have few or none at all.

During radiation therapy, the healthcare team protects healthy cells in the treatment area as much as possible. Damage to these healthy cells may cause side effects. Side effects can happen any time during, immediately after or a few days or weeks after radiation therapy. Sometimes late side effects develop months or years after radiation therapy. Most side effects go away on their own or can be treated, but some side effects may last a long time or become permanent.

Side effects of radiation therapy will depend mainly on the size of the area being treated, the specific area or organs being treated, the total dose of radiation, the type of radiation and the treatment schedule.

Some common side effects of external beam radiation therapy for NHL are:

Some common side effects of radioimmunotherapy for NHL are:

  • skin problems, including a rash and itching
  • chills
  • fever
  • nausea
  • fatigue
  • headaches

Tell your healthcare team if you have these side effects or others you think might be from radiation therapy. The sooner you tell them of any problems, the sooner they can suggest ways to help you deal with them.

Questions to ask about radiation therapy

Find out more about radiation therapy and side effects of radiation therapy. To make the decisions that are right for you, ask your healthcare team questions about radiation therapy.

Expert review and references

  • American Cancer Society. Non-Hodgkin Lymphoma. 2014: http://www.cancer.org/acs/groups/cid/documents/webcontent/003126-pdf.pdf.
  • American Society of Clinical Oncology . Lymphoma Non-Hodgkin Overview . 2014 : https://www.cancer.net/.
  • BC Cancer Agency (BCCA). Non-Hodgkin Lymphoma. 2014: http://www.bccancer.bc.ca/.
  • Faber EA, Vose JM, Armitage JO, Bierman PJ . Diagnosis and treatment of non-Hodgkin's lymphoma of adults. Wiernik PH, Goldman JM, Dutcher JP, Kyle RA (eds.). Neoplastic Diseases of the Blood. 5th ed. Springer; 2013: 47: 1027-1047.
  • Haas ML . Radiation therapy: toxicities and management. Yarbro, CH, Wujcki D, & Holmes Gobel B. (eds.). Cancer Nursing: Principles and Practice. 7th ed. Sudbury, MA: Jones and Bartlett; 2011: 14: 312-351.
  • Manson SD & Porter C . Lymphomas. Yarbro, CH, Wujcki D, & Holmes Gobel B (eds.). Cancer Nursing: Principles and Practice. 7th ed. Sudbury, MA: Jones and Bartlett; 2011: 60: pp. 1458-1512.