Lymphoma Radiotherapy - Late Effects

Late effects are side effects of treatment that occur months or years after the treatment has ended. The effects of treatment 5 or more years ago are now becoming more pronounced and the medical community is now gathering to address this issue.

With modern treatments, true complications from radiotherapy are rare. Older orthovoltage x-ray generators prior to the mid 1970's were less precise in their delivery of radiation, raising the chances of problems. Any effects vary according to the field of radiation exposure.

Some long term effects include fatigue, lung fibrosis, gastrointestinal problems, neurological (nerve) problems, cardiac (heart) problems, osteoporosis, and thyroid function problems. Radiation to the head and neck can destroy salivary function while radiation in the pelvic area can cause reproductive problems, sterility, and early menopause.

Radiation can lead to increased risk for developing other types of cancer, especially near radiation ports. Young women are more at risk for breast cancer, for example, if radiation was given to the chest.

Some common late effects of radiotherapy

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.

Getting more rest may help reduce fatigue. Rest may mean a nap, a rest period, a lower level of activity, or less contact with others. You may wish to rearrange activities to allow for rest periods or schedule strenuous or high priority activities at the time of day when you have the most energy. Some people choose to alter their work schedule or work part-time.

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 you are having difficulty sleeping because of pain or any other reason you should tell your doctor. The doctor may prescribe medication to reduce pain, induce sleep, or relieve anxiety that may interfere with sleep or rest.

Trouble swallowing

Radiation to the throat area can cause problems with swallowing.

Thyroid problems

Thyroid disease is common in patients who are irradiated in the mantle field (neck, chest and armpit areas). Studies show that approximately a third of patients who received radiotherapy between 1961 and 1989 had evidence of thyroid disease with an actuarial risk of 52% at 20 years and 67% at 26 years. Hyperthyroidism is the most common problem and the incidence of Grave´s Disease small but still 7 to 20 times more common than in people not receiving radiation therapy. Thyroid nodules appeared in a small percentage with a very small percentage of papillary or follicular cancers forming. The risk of thyroid cancer was over 15 times the general population. The best course of action for these patients is continued follow-up by physicians (preferably specialists who know the effects of radiation therapy).

Lung damage

Radiation to the lungs can cause scarring and stiffness. This is known as radiation fibrosis.

Heart problems

Studies on large numbers of Hodgkin's Disease survivors notes several risks associated with radiation to the heart area. The radiation may affect the arteries, heart valves, pericardium (heart sac), and myocardium (the heart muscle itself). This can cause heart attacks, problems with heart valve function, and pericarditis (inflamation of the heart sac) or pancarditis (general inflammation of the heart). Studies have shown the risk at 5 to 11% and increases with typical heart disease risk factors including smoking, high cholesterol, obesity, family history of heart disease, hypertension, and diabetes.

Healthy diet, exercise, and careful follow-up may help the health of those treated with heart irradiation. Continued follow-up by physicians (preferably specialists who know the effects of radiation therapy and the heart) is important.

Effects on Fertility

Effects on fertility are possible because the testes in men and the ovaries in women may be exposed to radiation.

Depending on the dose of radiation received, sperm production may be reduced or stopped. Sperm production may return to normal in 3 to 5 years or sterility may be permanent. If radiation was not directly at the lower body current literature suggests waiting 1 to 2 years before trying to have children.

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 hot flashes and vaginal dryness.

Summary

Radiation late effects are not well documented outside medical journals and a good number of medical centers are not able to correctly diagnose or treat these problems. The reader is encouraged to search for medical personnel familiar with late effects and their treatment.

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