Having radiotherapy for Hodgkin lymphoma
Radiotherapy is a common treatment for Hodgkin lymphoma. It uses high energy x-rays to kill cancer cells.
You can have radiotherapy as a single treatment or a series of daily sessions. A single treatment of radiotherapy is called a fraction. A series of sessions make up a radiotherapy course.
The amount of radiotherapy you have (the dose) depends on what stage of Hodgkin lymphoma you have, and how well your chemotherapy works.
When you might have radiotherapy
You have radiotherapy treatment in the hospital radiotherapy department.
You usually have treatment once a day from Monday to Friday with a rest over the weekend. The length of the treatment depends on the area being treated. It is usually over a few weeks.
You might have:
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radiotherapy after chemotherapy
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radiotherapy on its own
Radiotherapy after chemotherapy
Radiotherapy after chemotherapy is called chemoradiotherapy. Most people will have chemoradiotherapy to treat Hodgkin lymphoma.
Radiotherapy on its own
You might have radiotherapy on its own if you have early stage nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL).
Types of radiotherapy
For early and intermediate stage Hodgkin lymphoma, most people have radiotherapy directed just at the 
or area where you have lymphoma and a small area (margin) around it. You usually have radiotherapy after chemotherapy.
For advanced stage Hodgkin lymphoma you might not need any radiotherapy after chemotherapy. You usually have a scan to see how well your chemotherapy has worked. You may have localised radiotherapy to any areas that still have lymphoma.
The radiotherapy room
Radiotherapy machines are very big and could make you feel nervous when you see them for the first time. The machine might be fixed in one position. Or it might rotate around your body to give treatment from different directions. The machine doesn't touch you at any point.
Before your first treatment, your will explain what you will see and hear. In some departments, the treatment rooms have docks for you to plug in music players. So you can listen to your own music while you have treatment.
If you need to wear a mask for your radiotherapy treatment, your radiographers will position the mask over your face and attach it to the table. The mask keeps your head completely still while you have treatment.
You have a radiotherapy mask made during your radiotherapy planning appointment.
Before each treatment
Your radiographers help you to get onto the treatment couch. You might need to raise your arms over your head.
They line up the radiotherapy machine using the marks on your body, which were made during your planning appointment. Once you are in the right position, your radiographers leave the room.
During the treatment
You need to lie very still. Your radiographers might take images (x-rays or scans) before your treatment to make sure that you're in the right position. The machine makes whirring and beeping sounds. You won’t feel anything when you have the treatment.
Your radiographers can see and hear you on a CCTV screen in the next room. They can talk to you over an intercom and might ask you to hold your breath or take shallow breaths at times. You can also talk to them through the intercom or raise your hand if you need to stop or if you're uncomfortable.
The video below shows how you have radiotherapy. The video lasts around 2 minutes.
Dan (radiographer): Before your treatment starts your doctor will need to work out exactly where the treatment needs to go and also which parts need to be avoided by the treatment. To have radiotherapy you lie in the same position as you did for your planning scans. We then line up the machine based on your tattoo marks. It is really important that you stay very, very still when you are having treatment it is also important to let the radiographers know right at the beginning if you are not comfortable so they can adjust your position
Radiographer: Ok all done, we’ll be back in a couple of minutes
Dan (radiographer): We leave the room and control the room from a separate room This is so we aren’t exposed to radiation. Treatment takes a few minutes and you will be able to talk to us using an intercom. We can see and hear you while you are having your treatment and will check that you are ok. When your treatment starts you won’t feel anything; you may hear the machine as it moves around you giving the treatment from different angles. Because we are aiming to give the same treatment to the same part of the body everyday then the treatment process is exactly the same everyday so you shouldn’t notice any difference. You’ll see someone from the team caring for you once a week while you are having treatment they’ll ask how you are and about any side effects.
Patient: They get you from one sitting area to another and then take you into the room where you undress to the waist and then lie down and line you up by either moving you or asking you to shuffle a little and they check the dimensions and they talk to one another and they say I am fine this side how are you ...yes fine...ok, stay where you are Jeff and that was it. There were a few little clicks and lights go on and off and you can see a green laser beam which lines up with certain things on your body uh so no, no real noise and no discomfort.
Breathing techniques
You might be asked to hold your breath at times during treatment if you have radiotherapy to your chest area. This is to protect your heart and lungs from the radiotherapy.
Your radiographer talks to you over the speaker. They tell you when to hold your breath. It could last around 20 seconds and they may ask you to do several breath holds. This technique is called deep inspiration breath hold (DIBH).
You won't be radioactive
This type of radiotherapy won't make you radioactive. It's safe to be around other people, including pregnant women and children.
Travelling to radiotherapy appointments
You might have to travel a long way each day for your radiotherapy. This depends on where your nearest cancer centre is. This can make you very tired, especially if you have side effects from the treatment.
You can ask your radiographers for an appointment time to suit you. They will do their best, but some departments might be very busy. Some radiotherapy departments are open from 7 am till 9 pm.
Car parking can be difficult at hospitals. Ask the radiotherapy staff if you are able to get free parking or discounted parking. They may be able to give you tips on free places to park nearby.
Hospital transport may be available if you have no other way to get to the hospital. But it might not always be at convenient times. It is usually for people who struggle to use public transport or have any other illnesses or disabilities. You might need to arrange hospital transport yourself.
Some people are able to claim back a refund for healthcare travel costs. This is based on the type of appointment and whether you claim certain benefits. Ask the radiotherapy staff for more information about this and hospital transport.
Some hospitals have their own drivers and local charities might offer hospital transport. So do ask if any help is available in your area.
Side effects
Radiotherapy can kill and slow the growth of cancer cells, but it can also affect healthy cells that are in the area. Some side effects happen while you are having radiotherapy. They gradually go away in the weeks or months after treatment. But some side effects can continue or might start months or years later.
The most common side effects of radiotherapy during and just after treatment are:
- red and sore skin in the treatment area
- tiredness (fatigue)
- loss of hair in the treatment area
