NCCN Guidelines for Patients® | Follicular Lymphoma Grade 1-2

30 NCCN Guidelines for Patients ® : Follicular Lymphoma, Grade 1–2, 2017 3 Overview of cancer treatments Radioimmunotherapy | Radiation therapy Radioimmunotherapy Ibritumomab tiuxetan is a radioimmunotherapy drug used for follicular lymphoma. It consists of a monoclonal antibody attached to a radioactive atom (Yttrium-90). Ibritumomab is like rituximab as far as attaching to CD20. Once attached to a cell, it releases radiation that kills the cell and nearby cells. Ibritumomab tiuxetan is sold as Zevalin ® . A course of treatment occurs in a few steps. First, you will receive one dose of rituximab. Then, you’ll receive a second dose 7 to 9 days after the first dose. Within 4 hours after the second dose, you will receive ibritumomab tiuxetan. It is slowly injected into a vein for about 10 minutes. Side effects of ibritumomab include reactions in your skin and mucous membranes. Mucous membranes are in your mouth, nose, bladder, and other areas. You may also have stomach pains, nausea, and diarrhea. Late effects include second cancers, although this is rare. Radiation therapy Radiation therapy uses high-energy x-rays to treat follicular lymphoma. The x-rays damage DNA in cancer cells. This either kills the cancer cells or stops new cancer cells from being made. A radiation oncologist will oversee your radiation treatment. A radiation oncologist is a doctor who’s an expert in treating cancer with radiation. He or she will tailor treatment to you. Involved-site radiation therapy ISRT ( i nvolved- s ite r adiation t herapy) is sometimes used to treat follicular lymphoma. It can treat lymph nodes in which the cancer first started. It may also treat cancer near to these nodes. It is given with a method called EBRT ( e xternal b eam r adiation t herapy). A large machine makes high- energy x-rays used for treatment. This machine is called a LINAC ( lin ear ac celerator). See Figure 9 . Planning and set-up sessions A planning session is needed to map out your treatment. The planning process is called simulation. It involves obtaining a scan of your body in the position that is needed for treatment. The scan is only used for treatment planning. A CT scan with contrast is used. PET/CT and MRI ( m agnetic r esonance i maging) often enhance treatment planning. For tumors near the breastbone, 4D-CT ( four - d imensional c omputed t omography) or fluoroscopy can account for tumor movement from breathing. If your breathing causes large movements, motion control methods during the scans may be used. After simulation, your radiation team will further plan your treatment. Plans are made by viewing your scans on the treatment planning computer. Your radiation oncologist will work closely with a