What is the role of radiation therapy in the treatment of pediatric non-Hodgkin lymphoma (NHL)?

Updated: Jun 14, 2018
  • Author: J Martin Johnston, MD; Chief Editor: Max J Coppes, MD, PhD, MBA  more...
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Answer

In general, radiation therapy has a limited role in the treatment of pediatric non-Hodgkin lymphoma, and it is applied almost exclusively in situations deemed to be real or potential emergencies.

Mediastinal irradiation may be helpful in patients with impending airway obstruction, especially if the use of general anesthesia is being contemplated for biopsy or central line placement.

For patients with lymphoblastic lymphoma, low-dose radiation therapy is often used to treat neurologic involvement (eg, cranial nerve palsies, intracerebral extension of tumor, paraplegia).

Irradiation has minimal efficacy in patients with SNCCL, presumably because of the rapid growth of these cells. Although a dose of radiation may result in significant cell kill, rapid regrowth of surviving cells between doses largely negates the benefit. Hyperfractionated radiotherapy (ie, >1 dose daily) offers a theoretic advantage, as does low-dose continuous irradiation. However, the unfeasibility of the latter all but precludes its use. [81]

Finally, consider radiotherapy in any patient with documented residual disease after chemotherapy and in patients with bulky disease at the time of relapse.


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