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Lymphomas- radiation, chemo, biologic, alternative therapies

Medical Treatment

Standard first-line therapy (primary therapy) for lymphoma includes radiation therapy for most early-stage lymphomas, or a combination of chemotherapy and radiation. For later-stage lymphomas, chemotherapy is primarily used, with radiation therapy added for control of bulky disease. Biological therapy, or immunotherapy, is increasingly being used in addition to or as an alternative to these standard therapies.

Radiation therapy

Radiation therapy uses high-energy rays to kill cancer cells. It is considered a local therapy, meaning that it should be used to target areas of the body involved by tumor masses.

  1. The radiation is targeted at the affected lymph node region or organ. Occasionally, nearby areas are also irradiated to kill any cells that might have spread there undetected.
  2. Depending on how and where the radiation is administered, it may cause certain side effects such as fatigue, loss of appetite, nausea, diarrhea, and skin problems. Radiation of lymph node areas may result in suppression of the immune system to varying degrees. Irradiation of the underlying bone and the marrow within the bone may result in suppression of the blood counts.
  3. The radiation is usually administered in short bursts on five days a week over the course of several weeks. This keeps the dose of each treatment low and helps prevent or lessen side effects.

Chemotherapy

Chemotherapy is the use of powerful drugs to kill cancer cells. Unfortunately, chemotherapy also affects healthy cells; this accounts for its well-known side effects.

    1. Some people, because of variability in metabolism of chemotherapy drugs, tolerate chemotherapy better than other people.
    2. The most common side effects of chemotherapy include suppression of blood counts, which could result in increased susceptibility to infection, anemia, or blood-clotting problems. Other side effects may include nausea and vomiting, loss of appetite, hair loss, sores in the mouth and digestive tract, fatigue, muscle aches, and changes in fingernails and toenails.
    3. It is very important to discuss and review the potential side effects of each chemotherapy drug in the treatment with the oncologist, pharmacist, or oncology nurse. Medications to lessen the side effects should also be reviewed.
    4. Chemotherapy may be given in pill form, but it is typically a liquid infused directly into the bloodstream through a vein.

Experience has shown that combinations of drugs are more efficient than monotherapy.

  1. Combinations of different drugs both increase the chance that the drugs will work and lower the dose of each individual drug, reducing the chance of intolerable side effects.
  2. Several different standard combinations are used in lymphoma. Which combination one receives depends on the type of lymphoma and the experiences of the oncologist and the medical center where a person is receiving treatment.
  3. The combinations of drugs are usually given according to a set schedule that must be followed very strictly.
  4. In some situations, chemotherapy can be given in the oncologist’s office. In other situations, one must stay in the hospital.
  5. Chemotherapy is given in cycles. Standard treatment typically includes a set number of cycles, such as four or six.
  6. Spreading the chemotherapy out this way allows a higher cumulative dose to be given, while improving the person’s ability to tolerate the side effects.

Biological therapy

Biological therapies are sometimes referred to as immunotherapy because they take advantage of the body’s natural immunity against pathogens. These therapies are attractive because they offer anticancer effects without many of the undesirable side effects of standard therapies. There are many different types of biological therapies. The following are some of the most promising for treating lymphoma:

  1. Monoclonal antibodies: A monoclonal antibody is an antibody that is made in a laboratory to find and attach itself to a specific antigen. Monoclonal antibodies can be used to help one’s own immune systems kill tumor cells and other pathogens directly, or they can deliver cancer-killing therapies (such as radiation or chemotherapy) directly to a specific antigen found on cancer cells.
  2. Cytokines: These naturally occurring chemicals are produced by the body to stimulate the cells in the immune system and other organs. They can also be produced artificially and administered in large doses to patients with greater effect. Examples include interferons and interleukins, which stimulate the immune system, and colony-stimulating factors, which stimulate the growth of blood cells.
  3. Vaccines: Unlike the more familiar vaccines for infectious diseases such as polio and flu, cancer vaccines do not prevent the disease. Rather, they are designed to stimulate the immune system to mount a specific response against the cancer. They also create a “memory” of the cancer so that the immune system activates very early in cases of recurrence, thus preventing the development of a new tumor.
  4. Other therapies under continuing development include drugs that target cancer cells on a molecular level, various new monoclonal antibodies, and other biologic therapies.

Other Therapy

Watchful waiting means choosing to observe and monitor the cancer rather than treat it right away. This is strategy is sometimes used for indolent recurrent tumors. Treatment is given only if the cancer starts to grow more rapidly or to cause symptoms or other problems.

Stem cell transplantation is usually not used as a primary therapy in lymphoma.

  1. Stem cell transplantation is usually reserved for lymphoma that has been previously treated into remission but has recurred.
  2. Stem cell therapy as primary therapy has been used for aggressive T-cell NHL in first remission, usually as part of a clinical trial. Stem cell therapy is also considered when standard primary treatment is unable to control the lymphoma and achieve remission.
  3. This procedure, which requires a lengthy hospital stay, involves very high doses of chemotherapy to kill the aggressive cancer cells.
  4. The chemotherapy doses are so high that the chemotherapy also stops the patient’s bone marrow from producing healthy new blood cells.
  5. The patient then receives a transfusion of healthy bone marrow or blood stem cells, either from previously collected stem cells from the patient himself or herself (called autologous transplantation) or from a  donor (called allogeneic transplantation),  “kick start” the bone marrow into producing healthy blood cells.
  6. This is a very intensive therapy with a lengthy recovery period.

Complementary/alternative therapies

Several alternative therapies have undergone preliminary testing in lymphoma. None has been found to work better than or as well as standard medical therapies. A few therapies, still felt to be experimental, have been found to be potentially helpful as complements to medical therapy, however.

  1. Acupuncture has been helpful in relieving musculoskeletal symptoms, as well as in controlling nausea and vomiting associated with chemotherapy.
  2. The supplements coenzyme Q10 and polysaccharide K (PSK) are undergoing further evaluation to determine their effects on treatment outcome. Both drugs have immune enhancing properties. PSK has been used more extensively in Japan as part of an anticancer therapy.
  3. Neither of these therapies has undergone extensive blinded studies and cannot be considered a part of any planned therapeutic endeavor.

Follow-up

After completion of primary therapy for lymphoma, all appropriate tests will be repeated to see how well the therapy worked.

  1. The results of these tests will tell the oncologist whether the patient is in remission.
  2. If the patient is in remission, the oncologist will recommend a schedule of regular testing and follow-up visits to monitor the remission and to catch any recurrence early.
  3. Keeping up with these visits and tests is very important in order to avoid advanced or widespread disease.

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