Patients with leukaemia and lymphoma

Author:  Dr. med.Gesche Riabowol (geb. Tallen), Editor:  Maria Yiallouros, English Translation:  Dr. med. Gesche Riabowol (geb. Tallen), Last modification: 2025/11/29 https://kinderkrebsinfo.de/doi/e211279

Local radiotherapy

In general, cancers that originate in the blood or lymphatic system‎ and typically directly affect the entire body, are treated systemic‎ally by chemotherapy‎, rather than local therapy (surgery‎, radiotherapy‎). Until a few years ago, patients with certain forms of leukaemia‎ and Non-Hodgkin lymphoma‎ (NHL) routinely received whole-brain radiation (preventive/prophylactic cranial radiation) to prevent relapse of the disease (recurrence‎) in the central nervous system‎ (CNS).

In the years that followed, research has shown that prophylactic cranial irradiation can be dispensed with in most leukaemia and NHL patients. Instead, a combination of high-dose, systemic chemotherapy with repeated cytostatic drug administration (especially methotrexate) into the CNS – so-called intrathecal chemotherapy‎ – is just as effective and associated with fewer long-term effects.

Within the framework of today's therapy plans, radiation treatment of the head is only carried out if there is a very high risk of relapse or in case of a relapse involving the CNS‎, because for them, cytostatic treatment alone is not a feasible alternative. This applies, for example, to patients in whom an involvement of the central nervous system can already be detected at the time of diagnosis: They almost always receive radiation treatment if they have reached the age of one. Children in the first year of life should not receive radiation therapy as a matter of principle.

If, at the time of diagnosis, leukaemia cells are detected in other organs, for example in one or both testicles, radiation treatment of these organs may also be necessary.

Important: Regardless of the type of cancer, the indication for radiotherapy and its combination with other treatment methods is chosen in such a way that the therapy as a whole is as gentle as possible and as intensive as necessary for each child/adolescent.

Total body irradiation (TBI)

Total body radiation (TBI) is mainly used in the context of so-called high-dose therapy or conditioning‎ prior to a blood stem cell transplant (haematopoietic stem cell transplantation‎). It is particularly indicated in children and adolescents with severe forms of leukaemia‎ [PET2005‎], less often in those with solid tumour‎s or Non-Hodgkin lymphoma‎s [WOE2006‎] whose diseases do not respond to conventional treatments. In whole-body irradiation, the patient's entire body receives radiation‎.

For very aggressive cancers, it can be assumed that the cancer cells will spread not only in one place, but throughout the patient's body. The main goal of whole-body irradiation is therefore to completely destroy the cancer cells in the patient's entire body before they receive the healthy stem cells.

In an allogeneic stem cell transplantation‎, whole-body radiation (combined with high-dose chemotherapy‎) also serves to "paralyse" the patient's own immune system‎ for a certain period of time prior to the stem cell transplant. This is to prevent the donor cells from being recognised as "foreign" by the patient's immune defence‎ and subsequently rejected or destroyed. Photon beams are used for whole-body irradiation [see photon‎].

Children and adolescents receive a total radiation dose of usually 10 to 12 gray‎ (Gy) during whole-body irradiation, distributed over the whole body, including the skin. Only the lungs receive reduced doses. This dose is usually divided into six individual doses (fractions) over three days, with breaks (of at least six hours) between each radiation session.

Organs affected by the disease (e.g. the brain, meninges‎ and testicles in the case of leukaemia) as well as areas of the body with known residual tumour tissue are sometimes given additional doses (boost) of up to 6 Gy, which are administered prior to whole-body irradiation and also in individual doses (fractionated) (so-called saturation).