As the only National Cancer Institute-designated Comprehensive Cancer Center in Georgia, Winship is a at the forefront in lymphoma cancer treatments, conducting innovative research and clinical trials that are transforming how these cancers are identified, treated, and survived.
The radiation oncologists at Emory Proton Therapy Center work with the multidisciplinary Lymphoma radiation therapy team at Winship, which includes experts in hematology, transplant, radiology, pathology, supportive oncology, speech- language pathology, dieticians, social workers, physical therapy, and cancer rehabilitation. Your lymphoma radiation therapy oncologist will work closely with these other specialists to customize your treatment plan and coordinate your care. We can also partner with a patient’s existing care team, whether they are across town or around the world.
Proton Therapy for Lymphoma
A lymphoma diagnosis can be one of the biggest challenges you and your family will ever face. Our team is dedicated to helping you meet that challenge through supportive care using the most advanced lymphoma treatment options available. Proton therapy may be a more precise radiation option for treatment of your lymphoma to help protect the function of important nearby organs like the heart and lungs, as well as reducing the risk of developing a future cancer.
Our cancer specialists will work with you to develop a personalized lymphoma cancer treatment plan which aims for fewer side effects and improved quality of life.
What We Treat
- Hodgkin’s lymphoma
- Non-Hodgkin’s lymphoma
- Diffuse large B-cell lymphoma
- Anaplastic large-cell lymphoma
- Burkitt lymphoma
- Mantle cell lymphoma
- Marginal zone B-cell lymphoma
- MALT lymphoma
- Follicular lymphoma
- Natural killer (NK) cell lymphoma
Benefits of Proton Therapy
Lymphomas may occur anywhere in the body. Potential benefits of proton therapy depend on the type of lymphoma and location in the body. Click below to see the benefits for proton therapy for each body site.
Benefits for Head & Neck Lymphomas
- Reduced risk of painful sores in the mouth (mucositis) during treatment
- Reduced risk of dry mouth (xerostomia) after radiation.
- Reduced risk of dental decay after radiation.
- Reduced risk of problems swallowing (dysphagia or aspiration) during or after therapy.
- Reduced risk of hoarseness during treatment and problems swallowing (dysphagia or aspiration) after therapy.
- Reduced risk of hearing loss after radiation. This is relevant for tumors near the cochlea, such as those in the nasopharynx, paranasal sinuses, or skull base.
- Reduced risk of hormone imbalances (endocrine dysfunction) which can particularly affect growth and development in children and young adults. This is relevant for tumors near the pituitary and hypothalamus, such as those in the nasopharynx, paranasal sinuses, or skull base.
- Reduced radiation to the bone marrow and circulating lymphocytes, which may help support the function of the immune system in taking on cancer.
- Reduced risk of developing a future second tumor or cancer, which is most relevant in younger patients, those with a good prognosis and a long life expectancy, and those patients who may have genetic conditions putting them at higher risk for developing other cancers.
Benefits for Thoracic Lymphomas
- Reduced risk of inflammation of the heart (pericarditis) and future heart problems like hardening of the arteries (atherosclerosis), stiffening of the heart muscle (fibrosis, cardiomyopathy), and heart attacks.
- Reduced risk of inflammation of the lungs (radiation pneumonitis) and problems with lung function (lung fibrosis).
- Reduced risk of difficulty or pain with swallowing (dysphagia or odynophagia) or chronic narrowing of the esophagus (stricture).
- Reduced radiation to the bone marrow and circulating lymphocytes, which may help support the function of the immune system in taking on cancer.
- Reduced the risk of low blood counts (anemia, neutropenia) which may support the body’s tolerance of chemotherapy.
- Reduced risk of developing a future second tumor or cancer, which is most relevant in younger patients, those with a good prognosis and a long life expectancy, and those patients who may have genetic conditions putting them at higher risk for developing other cancers.
Benefits for Pelvic Lymphomas
- Reduced risk of inflammation of the heart (pericarditis) and future heart problems like hardening of the arteries (atherosclerosis), stiffening of the heart muscle (fibrosis, cardiomyopathy), and heart attacks.
- Reduced risk of new or worsening problems with liver function (radiation- induced liver dysfunction). This is relevant for patients with large liver tumors and/or small remaining size of normal liver, for those with poor liver function (liver cirrhosis), or who have had prior radiation treatments including prior liver radioembolization.
- Reduced risk of nausea and diarrhea.
- Reduced risk of new or worsening kidney function.
- Reduced risk of frequent urination or stinging or burning with urination during treatment, or of chronic urinary problems after treatment.
- Reduced risk of diarrhea and rectal soreness (proctitis) during treatment and of chronic rectal problems after treatments such as rectal bleeding or ulceration.
- Reduced radiation to the bone marrow, spleen, and circulating lymphocytes, which may help support the function of the immune system in taking on cancer.
- Reduced risk of low blood counts (anemia, neutropenia) which may support the body’s tolerance of chemotherapy.
- Reduced risk of developing a future second tumor or cancer, which is most relevant in younger patients, those with a good prognosis and a long life expectancy, and those patients who may have genetic conditions putting them at higher risk for developing other cancers.
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What to Expect With Proton Therapy
The first step in your care is a consultation. During consultation, we review your medical history, perform a physical exam, decide if any additional tests are needed, discuss all radiation options that may be appropriate for your treatment plan, make recommendations, and answer questions.
To plan your treatment, you will undergo a “simulation” or planning session. During this visit our radiation therapists will help position you the way you will be treated each day. For patients receiving radiation treatment to the head and neck, a custom plastic mesh mask is made. This mask helps to get you in the correct position for treatment and fits snugly to remind you to hold still during treatment. You can see and breathe through the mask. A CT scan will be done to create a picture of you in the treatment position to design your radiation plan. Some patients also undergo an MRI during this visit to help identify the target for treatment. It normally takes 10 days for the team to design the proton treatment plan and perform the quality assurance checks before treatment begins.
Proton therapy is typically delivered once daily during weekdays, Monday through Friday. Most patients with lymphomas receive three to five weeks of daily radiation. While some conditions are treated with radiation alone, proton therapy may be integrated with chemotherapy, immunotherapy, or other treatments as part of a comprehensive plan of care.
Like other types of radiation, proton therapy treatments are invisible and painless. Most lymphoma treatments average 30 minutes each day in the treatment room.
Patients are seen by the radiation oncology physician team weekly during treatment to monitor progress, answer questions, address concerns, and manage any side effects from treatment. Your radiation oncologist will discuss a plan to assess response to treatment and for long-term follow-up after therapy.
Studies on Proton Therapy in Lymphoma
Our team has identified these studies as examples of the clinical benefits of proton therapy in lymphoma.
Proton therapy for adults with mediastinal lymphomas: the International Lymphoma Radiation Oncology Group guidelines
The International Lymphoma Radiation Oncology Group (ILROG) offered their expert recommendations on three groups of lymphoma patients who are most likely to benefit from proton therapy: (1) patients with disease in the center of the chest (mediastinum) that extends in front of the heart, (2) young women with lymphoma who require radiation, and (3) heavily pretreated patients (often those with relapsed or refractory disease) who are at a higher risk for radiation-related toxicities.
Evidence-based Review on the Use of Proton Therapy in Lymphoma From the Particle Therapy Cooperative Group (PTCOG) Lymphoma Subcommittee
This consensus paper and expert recommendations from the Particle Therapy Cooperative Group reviews the many potential side effects and risks of radiation in patients with lymphoma, who are often young and have many decades of life ahead of them in which they may develop these side effects. These risks include second cancers, cardiovascular disease, stroke, inflammation of the lungs (pneumonitis), and hormone problems (endocrinopathies), among others. This paper reviews the extensive body of evidence that proton therapy is able to reduce or avoid unnecessary radiation to the critical normal structures that reduces the risk of developing these side effects when radiation is needed for treatment of a wide variety of lymphomas.
Comparative Effectiveness of Proton Therapy versus Photon Radiotherapy in Adolescents and Young Adults for Classical Hodgkin Lymphoma
This report from several institutions evaluated outcomes of 94 patients with stage I and II classical Hodgkin lymphoma treated with either proton or x-ray radiotherapy as part of their treatment course. Patients treated with either modality did quite well. At 2-years after treatment, 94% of patients treated with proton therapy had not experienced progression of disease, compared to 83% of patients treated with x-rays, a difference which was borderline but not statistically significant (p = 0.07). This is strong evidence that proton therapy is at least equally effective in the treatment of Hodgkin lymphoma as conventional x-ray based radiation.
Second cancer risk after primary cancer treatment with three-dimensional conformal, intensity-modulated, or proton beam radiation therapy
This study used the National Cancer Data Base (NCDB) to examine the frequency of developing a second cancer following radiation treatment for 9 different tumor types – including lymphomas – in 450,373 patients treated with x-rays or proton therapy. After adjusting for differences in patient age, follow-up duration, radiotherapy dose, use of chemotherapy, sociodemographic differences, and other factors, patients treated with proton therapy had a statistically significantly lower risk of developing a secondary cancer than those treated with x-ray therapy. This significant reduction in risk was seen despite the average follow-up time after radiation being only 5 years. The risk of secondary cancers increases with longer follow-up time after radiation, and it is encouraging to see this signal of reduced risk with proton therapy at an early time point.
Therapy-Related Cardiac Risk in Childhood Cancer Survivors: An Analysis of the Childhood Cancer Survivor Study
Heart damage – which can develop years after treatment – is among the top concerns in long term survivors of lymphoma as both radiation and chemotherapy drugs (especially anthracyclines) can increase the risk of cardiac disease. This large retrospective study used the Childhood Cancer Survivor Study to evaluate what radiation doses are associated with an increased risk of heart damage in lymphoma survivors. The authors found that an average dose to the heart above 10 Gy was associated with increased risk, but also that lower doses to the heart and small volumes receiving high doses were also associated with an increased risk. In other words, there was a strong signal to avoid unnecessary radiation to the heart as much as possible to reduce the risk of heart disease down the road. he study found that the benefit of protecting the heart was seen not just in young children but in adolescent and young adult patients with cancer as well. These findings influence how radiation plans are designed to protect the heart and are part of the reason why proton therapy may be helpful in treatment of lymphoma to minimize the risk of long-term complications from radiation.
Patient Stories
I’ve been through it, and I can’t say enough about the amazing care I received. The team who handled my treatments was absolutely wonderful, making a difficult time so much easier to navigate.
My experience at Emory was incredible—it was as easy as drinking water! The therapy sessions only took about 5 to 10 minutes, and right after, I’d go for a 4-mile walk every single day. I had no side effects whatsoever—I can’t even tell that I had the treatment. Emory truly saved my life, and I couldn’t be more grateful.
Stephen, a 36-year old father from Columbus, Georgia, is one of the almost 2000 patients who have been treated at the Emory Proton Therapy Center since it opened in December 2018. He completed six weeks of proton therapy to treat a brain tumor.
Dusty was diagnosed with prostate cancer, an uncontrolled growth of cells in the prostate gland. Upon further consultation and research, he was treated with proton therapy and is excited to see an advanced form of radiation therapy is available at the Emory Proton Therapy Center.
Proton therapy gave Zack his best shot at treating a spinal tumor that had come back. Zack was one of the first patients treated at the Emory Proton Therapy Center after it opened in 2018. The treatments, every weekday for six weeks, took less than one hour of his day and gave Zack the greatest odds of a long life with his wife and children.
Tony was diagnosed with prostate cancer in 2019 and sought care from experts at Emory Proton Therapy Center. He’s confident that the advanced radiation therapy gave him the best cancer treatment possible and says the comfort and care he got from Winship doctors and staff were unmatched. “There were many great solutions here in Atlanta, but the best to me was Emory Proton Therapy Center,” says Tony.