Radiotherapy to the mediastinum (chest) for children
This page has been written to give you general information and answer some of the questions you may have about the side effects of radiotherapy.
We hope you will find this helpful.
We give radiation treatment (radiotherapy) in addition to surgery and or chemotherapy because the disease may come back if we do not. The mediastinum is between the lungs in the centre of the chest. It may be affected by Hodgkin’s lymphoma or other lymphomas or occasionally by other tumours. The treatment has to be planned with great care and it is successful for many, but unfortunately not all patients.
The total radiation dose has to be spread out to make the individual treatments safe. We give treatment every day for about three to four weeks (usually excluding weekends and bank holidays). At each session, the patient spends about ten minutes in the treatment room but most of this time is spent getting him/her into the right position.
Radiotherapy does not hurt, the machine does not touch the patient and it is rather like having an ordinary x-ray. We have to treat the whole area accurately, which means that the patient must lie very still, usually on their back. Lying still can be very difficult for some children, particularly young ones, so occasionally we have to use a general anaesthetic. A buzzing noise may be heard when the machine is working.
There are usually some side effects. We can relieve most of them but sometimes not completely. Some of the side effects happen immediately, some of them happen soon after we finish treatment and some take a longer time to show.
A mild discomfort in the gullet (oesophagus) may occur when eating or drinking. This can be treated and will go away within a few days of finishing treatment.
Nausea and vomiting only occasionally occur with this treatment and can usually be well controlled with anti-sickness drugs.
Side-effects after treatment
- A course of radiotherapy often makes patients tired. This is most noticeable near the end of the treatment and just afterwards.
These are the hardest to predict and unfortunately, when they do happen, they are permanent.
It is possible for lung function to be affected by radiation treatment. Special lung studies might show some abnormality even after a low dose of irradiation. Symptoms may never occur. It is very important that anyone who has received this treatment never smokes.
The radiation may affect the growth of the back bones and ribs in the radiation area. As only a small part of the spine is treated it is unlikely to have a significant effect on final height.
Both radiation and some chemotherapy drugs (doxorubicin) can affect the heart. Some treated children show a tendency to suffer heart failure, particularly under the stressful conditions of pregnancy, labour or hallucinogenic drugs. It is important that in the future, the medical staff in the Maternity Unit know about the previous cancer treatment and that the maternity care is given in hospital. The heart is also damaged by smoking and it is very important to avoid smoking.
The thyroid gland (in the lower neck) can be affected by radiation. It may become underactive or occasionally overactive even many years after treatment. Both these conditions are detectable on blood tests and can be treated.
Breast development may be reduced by the treatment. This will occur in a symmetrical way. The exact effect will depend on how much breast tissue is treated and the age of the child. Surgery to build up breast tissue may be possible in later life if this is a problem. We also know that lactation (milk production) can be reduced by radiotherapy which can affect breast feeding. Some patients run a slightly increased risk of breast cancer in later life. Referral for early breast screening may be advised.
We are finding that, very rarely, children who have had treatment for one tumour can develop another type of tumour some years later. Smoking significantly increases the risks of developing many tumours and should definitely be avoided.
During follow-up we will be looking out for all of these problems.