The radiation therapy side effects experienced by the normal body tissues during and after radiation therapy can be loosely divided into Acute and Late effects.
Acute radiation therapy side effects constitute the acute reaction occurring during radiation and in the immediate weeks and months following treatment.
Acute Radiation Therapy Side Effects
Radiation therapy is painless and without sensation, with the exception of some mechanical sounds produced by the treatment machine associated with the start and finish of the treatment. Many patients receiving radiation therapy will experience very little reaction, but in most the normal tissues will develop some degree of radiation reaction. This varies in amount and type, depending on the part of the body treated and the amount of normal tissue included in the radiation therapy.
The degree to which individuals experience
reaction varies considerably, but this section will deal with
some general principles of radiation reaction. Where large areas
of a patient are treated, such as the whole abdomen or chest,
the reaction experienced will be mainly of a general nature.
When small areas are treated the reaction will be confined to
that area of the body that is radiated and to the individual
tissues included in the treatment volume. Any general reaction
will be much less or absent altogether.
General Radiation Side Effect Symptoms
Radiation Nausea.
The degree to which patients experience nausea following treatment
is very variable. Some people will experience hardly any at all,
whereas others will be troubled by nausea or vomiting during
the early part of the treatment and, in some instances, throughout
the treatment. If it occurs, nausea is likely to be worst from
two to several hours after treatment. The patient should be encouraged
to maintain fluid intake.
The following dietary steps may prove helpful:
1.Salty foods or ice cold drinks help control
nausea
2.Avoid greasy foods, strong-smelling or overly sweet foods
3.Small, frequent meals eaten slowly
If insufficient, anti-nausea medication
may be prescribed. In most patients nausea improves as the treatment
progresses.
Hair Loss.
Hair loss will only occur within the radiation field. Scalp hair
will only be affected if the head receives radiation.
Fatigue / Malaise.
Some degree of tiredness and lack of energy is often experienced.
This will not prevent most people from working or undertaking
normal duties but, in some, reduction in activities during treatment
and immediately afterwards will be advised.
Low Blood Count.
Reduction in certain elements of the blood is often seen following
radiation therapy. This results from radiation exposure of bone
marrow, and to a lesser extent, direct damage to lymphocytes
in the blood stream and lymph nodes.
The white cell count will be reduced, particularly
the lymphocyte count, and the number of platelets will be reduced.
These drops are seldom enough to cause clinical problems, but
if they are, an interruption in treatment for a few days is usually
sufficient to allow recovery. Reduction in red cells does not
occur to any degree in radiation treatment, but may occur from
blood loss due to bleeding.
Changes in the peripheral blood count are
much more marked in patients who have also received chemotherapy.
Organ Specific Radiation Side Effect Symptoms
Localized reactions will occur in any tissues exposed to radiation therapy. The acute reactions expected for different treatments will be considered later, but in general acute reactions result from radiation of skin, mucous membranes and accessory glands.
Skin.
Where the skin receives a significant dose of radiation a reaction
will develop which progresses through erythema to dry desquamation
and moist desquamation. The reaction may only progress part way
through these steps and healing occurs through the same steps
in reverse. If desquamation has occurred, crusts will form which
protect the re-epithelialisation occurring underneath and will
only come away and not reform when the skin is healed underneath.
The reaction develops two or three weeks
after the initiation of treatment and may take four to six weeks
to heal. It is best managed by:
Avoiding irritation from clothing, deodorants, perfumes, heat, dust and trauma
Best of all, leaving the area open to the air
Using non-stick dressings
Opinions vary about moisture. If the area is bathed, dry carefully, do not rub or inflame with soaps, and dust with corn starch
Steroid creams may help
Hair loss may be temporary or permanent, depending on the amount of radiation. Hair loss only occurs in skin exposed to radiation treatment
Avoid direct sunlight on the treated area
Have patience, the reaction will heal
Mucous Membranes. Wherever mucous membranes are included in a radiation field similar reactions will be experienced: Whether in the mouth, pharynx, esophagus, trachea, bowel, bladder or rectum, mucositis may develop.
As with the skin, the mucosa is reddened
at first but then may be covered with a plaque-like fibrin similar
to crusting of the skin. The mucous membrane remains moist and
the surface covered by fibrin until the underlying mucosa is
healed, when the fibrinous plaque is lost and the reaction healed.
The symptoms resulting from the inflammation, irritation and dysfunction caused by the mucosal reaction depend on the site of the reaction. There may be discomfort and dysphagia or cough, hoarseness and tracheitis, or dysuria and frequency, or diarrhoea and abdominal cramps. The management varies from site to site, but depends on the same principles as the care of skin reaction.
Avoid irritation by keeping food or stools soft and preventing trauma of any kind.
Local analgesic mixtures, antibiotics where indicated, and steroids may help.
Maintain hydration by encouragement and intravenous fluids if necessary.
Low fibre diet for those with bowel reaction.
Best of all, have patience, the reaction will heal.
Accessory Glands.
The acute effects of radiation will be felt by accessory glands
producing saliva and mucous for example. This leads to a degree
of stickiness, leading to oral discomfort, dryness and change
in taste, irritating cough and discomfort, and urinary or bowel
symptoms, depending on the site of radiation.
Management consists of providing replacement
lubricants such as frequent small drinks, adequate urinary and
bowel fluid, cough suppressants, soothing creams or lotions and
patience.
Late Radiation Therapy Side Effects
The late effects of radiation therapy develop gradually over several months or years. The changes that result may be sufficiently slight as to cause no clinical symptoms, or so rare as to present minimal risk to the individual. Nevertheless, the late changes that do occur warrant notice and care in all patients who have received radiation therapy. In those few individuals with serious late effects (generally less than 5% of patients who have received high-dose radiation) the results are often disastrous and treatment extremely difficult.
Scarring. Radiation therapy results in increased connective tissue, fibrosis and scarring often associated with atrophy of accessory tissues. This leads to some increased rigidity of tissues, less suppleness and less resistance to injury.
In addition, the walls of small blood vessels
may be thickened and distorted, leading to reduction in blood
supply to some tissues. This particularly leads to less ability
to deal with injury or trauma such as that resulting from infection
or surgery.
Any area of the body that has received radiation therapy should be treated "gently" for the rest of the patient's life.
Carcinogenicity.
Radiation is one of the causes of cancer. Very rarely leukemia
may result some five to twenty years after radiation exposure,
due to bone marrow cells being damaged during radiation therapy.
Similarly cancer can result in the area treated twenty or more
years later.
The chances of either of these occurring
are very small indeed.
The patient's risk of dying of the original
disease, unless successfully treated, are much higher than the
risk of developing cancer from the treatment.
Nevertheless, the risk is there and is
one of the reasons why benign diseases are not treated by radiation
unless absolutely necessary.
Genetic Effects.
Exposure of the gonads to radiation increases the risk of abnormal
mutations and genetic changes. Most chromosome damage from radiation
results in a failure of conception and not an abnormal child.
Even if both parents have been exposed to radiation, the risks
of abnormal children being produced are so small as to be almost
negligible. Late genetic effects in the individual are much less
important than the increased risk of inducing cancer or the late
vascular changes produced by radiation treatment.
IMMUNIZATION DURING CANCER TREATMENT (e.g. radiation)
When a child or adult has cancer and is receiving treatment which may be suppressing their immune system, such as whole body irradiation, "live" vaccines should not be given until six months after treatment is completed- "Killed" vaccines may be given although it is unclear as to their effectiveness in the immunosuppressed patient.
Immunosuppressed cancer patients should avoid changing diapers of infants or children for six weeks, who have recently been immunized with live (oral) polio vaccine. Immunosuppressed grand-parents are particularly at risk if they have never been immunized for polio. The risk is eliminated if the polio vaccine is given by injection (killed vaccine).
There is no risk from "flu" vaccines as they are not live vaccines.
Advice should be sought from the Infection Control Service or the Transplant Service of the Children's or Vancouver General Hospitals or family physician.
Travel Immunizations: The same rules apply as in 1-2 above.
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