Blood cancers like lymphoma and multiple myeloma begin in blood-forming tissue, such as bone marrow or in cells of the immune system. These cancers can be treated using different types of particles and radiation therapy. This includes photon, proton and electron therapy.
Radiation therapy treats blood cancers by destroying cancer cells in the blood to relieve pain or discomfort caused by an enlarged liver or spleen, or even swollen lymph nodes. It is also used to treat pain caused by bone damage from cancer cells growing in bone marrow.
We spoke with radiation oncologist Bouthaina Dabaja, M.D., to get answers to common questions she hears about treating these cancers with radiation therapy.
How does radiation therapy treat blood cancers?
At MD Anderson, each patient receives our personalized multidisciplinary approach to determine which therapies are needed and when. The way we treat blood cancers with radiation therapy depends on which parts of the body are affected by the cancer.
Lymphomas impacting the abdomen or chest: When this type of blood cancer occurs in the stomach, bowels or lymph nodes in the abdominal cavity, it is important to spare healthy tissue during treatment. Our team has established techniques that use an innovative mathematical algorithm to target the cancer while avoiding nearby healthy organs and tissue. Since some food and fluids can change the shape and position of the bowels and stomach, it’s important to avoid eating or drinking for three to six hours prior to treatment.
When receiving radiation in the abdomen or chest, your team will show you how to do the breath-hold technique. Holding your breath during treatment helps minimize radiation exposure to the lung and heart. This keeps the target site stable during treatment. To ensure patient safety, the machine automatically shuts off when you can no longer hold your breath. That means no radiation will be delivered unless your breath-holding is at the correct level.
Lymphomas impacting the skin and face: These are called T-cell skin lymphoma. We use electron radiation on the face. It delivers superficial radiation and controls the depth of the radiation. This also allows for safe treatment to the skin while avoiding the brain, eyes, mouth and salivary glands. A custom lead face shield is usually made for the patient to protect the areas that we do not want to treat.
Hodgkin lymphoma and head and neck cancers: For patients receiving radiation for lymphoma involving the head and neck, that could include the sinuses, nasal cavity, oral cavity or nodes in the neck. Our main goal is to deliver radiation to the target site while avoiding nearby healthy organs, such as the salivary glands, to prevent dry mouth.
What special radiation therapy options are available to lymphoma, myeloma and leukemia cancer patients?
Here are four special therapy types of radiation used during blood cancer treatment.
Total skin electron beam therapy (TSEBT) is used to treat mycosis fungoides, a type of T-cell lymphoma. Total skin electron beam therapy delivers electron beams, also known as superficial radiation, to the entire skin surface. Treatments are delivered over the course of several weeks while patients stand or lie on a treatment table.
Total body irradiation is given prior to a stem cell transplant for patients with leukemia. Radiation is delivered to the entire body, usually for a few days, depending on the protocol used by the transplant team.
Cranio-spinal radiation is used to treat patients withleukemia that affects the central nervous system. This type of radiation is used on the whole brain and spinal cord. Often it is given prior to and as part of the conditioning regimen of a stem cell transplant. The central nervous system is considered a sanctuary site. This means that it is hard for a systemic therapy like chemotherapy to reach it. Treatment is usually given over six to 12 days, depending on whether the patient also receives total body irradiation. A shorter treatment course is used if total body irradiation is also used.
Involved site radiation therapy (ISRT) is sometimes used to treat Hodgkin lymphoma. A special machine uses focused beams of radiation to target only the lymph nodes that contain cancer. This technological advancement helps us visualize internal organs so we can see what we are aiming at. As a result, our treatment fields tend to be smaller now to spare nearby healthy organs from radiation.
What’s next in radiation therapy for lymphoma and leukemia cancer?
We have clinical trials looking at potential benefits of combining radiation therapy with immunotherapy and cellular therapy. We are also looking at how we can safely lower the radiation dose for many blood cancer subtypes, such as mycosis fungoides, follicular lymphoma, marginal zone lymphoma, multiple myeloma, mantle cell lymphoma and diffuse large B-cell lymphoma.
We are also looking at the benefit of combining radiation therapy with chemotherapy or immunotherapy to treat rare lymphomas like nasal NK T cell lymphoma, mycosis fungoides and follicular lymphoma.
Patients should consider enrolling in a clinical trial, if they are eligible. This gives you access to the best treatment plans that are coming out of the world’s cancer laboratories.