Hi Standard first-line therapy (primary therapy) for lymphoma includes radiation therapy for most early-stage lymphomas, or a combination of chemotherapy and radiation. For later-stage lymphomas, chemotherapy is primarily used, with radiation therapy added for control of bulky disease. Biological therapy, or immunotherapy, is routinely used alongside chemotherapy. Radiation therapy Radiation therapy uses high-energy rays to kill cancer cells. It is considered a local therapy, meaning that it should be used to target areas of the body involved by tumor masses. A radiation oncologist will plan and supervise therapy. The radiation is targeted at the affected lymph node region or organ. Occasionally, nearby areas are also irradiated to kill any cells that might have spread there undetected. Depending on how and where the radiation is administered, it may cause certain side effects such as fatigue, loss of appetite, nausea, diarrhea, and skin problems. Radiation of lymph node areas may result in suppression of the immune system to varying degrees. Irradiation of the underlying bone and the marrow within the bone may result in suppression of the blood counts. The radiation is usually administered in short bursts on five days a week over the course of several weeks. This keeps the dose of each treatment low and helps prevent or lessen side effects. Chemotherapy Chemotherapy is the use of powerful drugs to kill cancer cells. Chemotherapy is a systemic therapy, meaning that it circulates through the bloodstream and affects all parts of the body. Unfortunately, chemotherapy also affects healthy cells; this accounts for its well-known side effects. The side effects of chemotherapy depend partly on the drugs used and the doses. Some people, because of variability in metabolism of chemotherapy drugs, tolerate chemotherapy better than other people. The most common side effects of chemotherapy include suppression of blood counts, which could result in increased susceptibility to infection (low white blood cell count), anemia (low red blood cell count that may require a blood transfusion), or blood-clotting problems (low platelet count). Other side effects may include nausea and vomiting, loss of appetite, hair loss, sores in the mouth and digestive tract, fatigue, muscle aches, and changes in fingernails and toenails. Medications and other treatments are available to help people tolerate these side effects, which can be severe. It is very important to discuss and review the potential side effects of each chemotherapy drug in the treatment with the oncologist, pharmacist, or oncology nurse. Medications to lessen the side effects should also be reviewed. Chemotherapy may be given in pill form, but it is typically a liquid infused directly into the bloodstream through a vein (intravenous). Most people who receive intravenous chemotherapy will have a semi-permanent device placed in a large vein, usually in the chest or arm. This device allows the medical team quick and easy access to the blood vessels, both for administering medications and for collecting blood samples. These devices come in several types, usually referred to as a catheter, port, or central line. Experience has shown that combinations of drugs are more efficient than monotherapy (use of a single medication). Regards DR DE