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Radiation Therapy in India for NHL treatment

30 Nov, 2023

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Non-Hodgkin Lymphoma (NHL) is a type of cancer that affects the lymphatic system, a crucial part of the immune system. Fortunately, advancements in medical science have provided several effective treatment options for NHL, with radiation therapy being one of them. In India, where healthcare infrastructure continues to improve, radiation therapy has become an essential tool in the fight against NHL. This blog will explore the role of radiation therapy in treating NHL in India, including its benefits, techniques, and the evolving landscape of cancer care in the country.


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Before delving into radiation therapy, let's briefly understand NHL. NHL is a diverse group of blood cancers that affect the lymphocytes, a type of white blood cell. These cancerous cells can accumulate in lymph nodes, spleen, bone marrow, and other lymphatic tissues, leading to various symptoms such as swollen lymph nodes, fatigue, and fever. NHL can be classified into several subtypes, each with its own unique characteristics and treatment approaches.


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Radiation Therapy: An Overview

Radiation therapy, also known as radiotherapy, is a medical technique that uses high-energy rays to target and destroy cancer cells. It can be used as a standalone treatment or in combination with other therapies, such as chemotherapy and immunotherapy. The primary goal of radiation therapy in NHL treatment is to eradicate cancerous cells while minimizing damage to healthy surrounding tissues.


When Radiation Therapy is Needed:

Radiation therapy is recommended for patients with Non-Hodgkin Lymphoma based on several factors, including the type of NHL, its stage, location, and the patient's overall health. Here are common scenarios in which radiation therapy may be prescribed:

  • Early-Stage NHL (Stage I and II): Radiation therapy is often used as a primary treatment for early-stage NHL, especially if the disease is localized to a specific area or lymph node group. It aims to eradicate cancer cells in the affected region.
  • Advanced-Stage NHL (Stage III and IV): In advanced stages, radiation therapy is less commonly used as a standalone treatment. However, it may be employed to relieve specific symptoms, such as a large tumor causing obstruction or pain.
  • Combination Therapy: Radiation therapy may be combined with other treatments, such as chemotherapy, immunotherapy, or stem cell transplantation, to enhance the overall effectiveness of treatment. This combination approach is frequently used for aggressive NHL subtypes.
  • Palliative Care: In cases where NHL is advanced and not curable, radiation therapy can be used palliatively. It helps alleviate symptoms, improve quality of life, and reduce discomfort caused by the disease.

Why Radiation Therapy is Essential:

Radiation therapy plays a crucial role in the treatment of NHL for several reasons:

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  • Localized Disease Control: In early-stage NHL, radiation therapy can effectively target and eliminate cancerous cells in a specific area, leading to a high likelihood of complete remission.
  • Symptom Relief: In advanced-stage NHL, radiation therapy can provide relief from symptoms such as pain, difficulty swallowing, or breathing problems by shrinking tumors or reducing their impact on nearby structures.
  • Combined Approach: When used in combination with other treatments like chemotherapy, radiation therapy enhances the overall chances of eradicating cancer cells and preventing recurrence.
  • Minimized Side Effects: Advancements in radiation therapy techniques, such as intensity-modulated radiation therapy (IMRT) and image-guided radiation therapy (IGRT), allow for precise targeting, minimizing damage to healthy tissues and reducing side effects.
  • Personalized Treatment: Radiation therapy plans are tailored to each patient's specific condition, ensuring that the treatment is optimized for their unique needs.
  • Palliative Care: In cases where NHL is not curable, radiation therapy can significantly improve a patient's quality of life by reducing pain, discomfort, and other distressing symptoms.

India, radiation therapy is an integral part of the comprehensive treatment approach for NHL, and it is employed judiciously to maximize its benefits while minimizing potential side effects. Patients can trust that their medical team will recommend radiation therapy when it is appropriate and necessary for their specific condition.


Radiation Techniques in NHL Treatment

  • External Beam Radiation Therapy (EBRT): This is the most common type of radiation therapy. It involves delivering radiation from a machine outside the body to the affected area. For NHL treatment, intensity-modulated radiation therapy (IMRT) and image-guided radiation therapy (IGRT) are often used to precisely target tumors.
  • Internal Radiation Therapy (Brachytherapy): In some cases, radioactive materials may be placed directly inside or near the tumor. This is known as brachytherapy and is used less frequently in NHL treatment.
  • Total Body Irradiation (TBI): TBI is rarely used in NHL treatment but may be considered in specific situations, such as before a bone marrow transplant.

Procedure

1. Diagnosis and Staging:

Diagnosis: The process begins with the diagnosis of NHL, which involves a series of comprehensive steps:
  • A detailed medical history and physical examination are conducted.
  • Blood tests, including complete blood count (CBC) and blood chemistry, help identify abnormalities.
  • Imaging studies, such as CT scans, PET scans, and sometimes MRI, provide a detailed view of the affected lymph nodes or organs.
  • In some cases, a biopsy of the affected lymph nodes or tissues is performed to confirm the presence of NHL.

Staging: Once NHL is confirmed, staging is essential to determine the extent of the disease. Staging typically includes:

  • Imaging studies to identify the size and location of tumors.
  • Bone marrow biopsy to check for cancerous involvement.
  • Lymph node examination to determine if cancer has spread to nearby nodes.
  • Staging is typically classified from stage I (early stage) to stage IV (advanced stage) and helps in treatment planning.

2. Treatment Planning:

Multidisciplinary Team: A multidisciplinary team of medical professionals, including radiation oncologists, medical oncologists, hematologists, radiologists, and pathologists, collaborates to create an individualized treatment plan.

Target Area Assessment: The radiation oncologist works closely with radiologists to precisely assess the target area and surrounding healthy tissues using advanced imaging techniques, ensuring the highest level of accuracy.

Plan Details: The treatment plan includes specific details such as:

  • The type of radiation therapy to be used, which may include external beam radiation therapy (EBRT), brachytherapy, or total body irradiation.
  • Determination of the radiation dose and schedule, taking into consideration the type and stage of NHL, as well as the patient's overall health.

3. Simulation and Treatment Mapping:

  • Simulation Session: Before treatment begins, patients undergo a simulation session where they are positioned precisely as they will be during treatment. This helps ensure accurate radiation delivery.
  • Imaging and Mapping: Advanced imaging techniques, such as CT scans and MRI, are used to create detailed maps of the treatment area. These maps guide the radiation therapy process, ensuring that radiation is targeted accurately.

4. Treatment Delivery:

a. External Beam Radiation Therapy (EBRT):

  • Outpatient Treatment: Most patients receive EBRT on an outpatient basis, allowing them to return home after each session.
  • Treatment Machine: A linear accelerator, a sophisticated machine, delivers high-energy X-rays or electrons to the precise location of the cancerous tissue.
  • Patient Positioning: Patients lie on a treatment table, and the machine is adjusted to deliver radiation precisely to the cancerous site.
  • Session Duration: Each radiation session is typically brief, lasting only a few minutes.

b. Brachytherapy:

  • Placement of Radioactive Sources: In some cases, brachytherapy may be used, involving the placement of radioactive sources directly into or near the tumor. This is performed in a controlled environment.
  • Hospital Stay: Depending on the specific treatment plan, brachytherapy may require a brief hospital stay.

5. Monitoring and Side Effects Management:

  • Close Monitoring: Patients are closely monitored throughout their radiation therapy course. This includes regular check-ups and discussions with the medical team to track progress and address any concerns.
  • Side Effects Management: Potential side effects, such as fatigue, skin irritation, and mild nausea, are managed by the medical team. Medications and supportive care measures are provided to alleviate discomfort.
  • Treatment Adjustments: The patient's overall well-being is continuously assessed, and any necessary adjustments to the treatment plan are made promptly to optimize the therapy's effectiveness and minimize side effects.

6. Post-Treatment Evaluation:

Follow-up Appointments: After completing the prescribed course of radiation therapy, patients undergo a series of follow-up appointments and imaging studies to assess the treatment's effectiveness and monitor for any signs of recurrence.


7. Supportive Care and Rehabilitation:

  • Comprehensive Support: Patients receive ongoing support from a team of healthcare professionals, including oncology nurses, nutritionists, and social workers. This support helps manage side effects and maintain their overall quality of life.
  • Rehabilitation: Depending on the individual's needs, rehabilitation and physical therapy may be recommended to address any treatment-related physical challenges, such as mobility issues or weakness.

8. Survivorship Care:

  • Long-term Health: Advances in NHL treatment have resulted in many patients achieving remission or long-term disease control.
  • Care Plans: Survivorship care plans are developed to provide guidance on long-term health, follow-up appointments, and managing potential late effects of treatment. These plans are tailored to each patient's unique needs and help ensure their ongoing well-being.

The process of radiation therapy for NHL in India involves a highly detailed and structured approach, with a strong emphasis on personalized care and precision in treatment delivery. Patients can expect comprehensive support and monitoring throughout their journey to achieve the best possible outcomes.


Benefits of Radiation Therapy in NHL Treatment

  • Targeted Treatment: Radiation therapy precisely targets the affected lymph nodes or other cancerous areas, sparing nearby healthy tissues. This precision minimizes side effects.
  • Curative Intent: Radiation therapy can be curative for early-stage NHL. It offers an excellent chance of complete remission when the disease is localized.
  • Palliative Care: In advanced-stage NHL, radiation therapy can alleviate symptoms such as pain, discomfort, and difficulty swallowing, improving the patient's quality of life.
  • Combined Approaches: Radiation therapy can be used in conjunction with other treatments, enhancing the overall effectiveness of cancer care.


Risks and complications

1. Skin Irritation and Radiation Burns:

Risk: Radiation therapy can cause skin irritation and, in some cases, radiation burns. This is more common in areas where the skin is exposed to radiation.
Tips to Manage:

  • Keep the treated area clean and dry.
  • Use mild, unscented soap and lukewarm water when washing the treated skin.
  • Avoid exposing the treated area to direct sunlight, and wear loose-fitting, soft clothing to minimize friction.
  • Consult your healthcare team if you notice any signs of skin irritation or discomfort.

2. Fatigue:

Risk: Radiation therapy can lead to fatigue, which may persist for several weeks after treatment.
Tips to Manage:

  • Prioritize rest and sleep. Ensure you get adequate rest to help your body recover.
  • Maintain a balanced diet and stay hydrated to combat fatigue.
  • Engage in light physical activity, such as short walks, to help improve energy levels.
  • Don't hesitate to communicate with your healthcare team about your fatigue, as they may be able to offer strategies for managing it.

3. Nausea and Digestive Issues:

Risk: Some patients may experience mild nausea or digestive issues during radiation therapy, especially if the treatment area is near the stomach or gastrointestinal tract.
Tips to Manage:

  • Eat smaller, more frequent meals to prevent overloading your stomach.
  • Opt for bland, easily digestible foods, and stay hydrated.
  • If nausea persists, your healthcare team can prescribe anti-nausea medications to alleviate symptoms.

4. Swelling and Lymphedema:

Risk: In cases where lymph nodes are treated, there is a risk of swelling and lymphedema (a condition where excess lymph fluid accumulates and causes swelling).
Tips to Manage:

  • Follow any specific instructions provided by your healthcare team regarding limb or body part elevation and gentle massage techniques.
  • Avoid tight clothing or jewelry that may constrict the treated area.
  • Report any unusual or persistent swelling to your healthcare team for evaluation and management.

5. Long-Term Effects:

Risk: Radiation therapy may lead to late effects, such as tissue fibrosis or secondary cancers, though these risks are relatively low.
Tips to Manage:

  • Attend follow-up appointments and screenings as recommended by your healthcare team to monitor for potential late effects.
  • Maintain a healthy lifestyle, including regular exercise and a balanced diet, to minimize the risk of secondary health issues.

6. Emotional and Psychological Impact:

Risk: Coping with a cancer diagnosis and undergoing treatment can lead to emotional distress, anxiety, or depression.
Tips to Manage:

  • Seek support from friends, family, or a mental health professional to address emotional and psychological challenges.
  • Join support groups or engage in activities that promote relaxation and stress reduction, such as mindfulness or meditation.

Radiation therapy plays a crucial role in the treatment of Non-Hodgkin Lymphoma in India. With advancements in technology, expertise, and a patient-centered approach to cancer care, patients diagnosed with NHL in India have access to effective and increasingly personalized treatment options. As the country continues to make strides in healthcare infrastructure, the future looks promising for NHL patients seeking quality care in India.


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Non-Hodgkin Lymphoma (NHL) is a type of cancer that affects the lymphatic system, a critical part of the immune system. It includes a diverse group of blood cancers characterized by abnormal lymphocyte growth.