Management of common radiotherapy side effects

Published on 09/04/2015 by admin

Filed under Hematology, Oncology and Palliative Medicine

Last modified 09/04/2015

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24 Management of common radiotherapy side effects

General side effects

Skin

Radiation dermatitis generally starts 10–14 days after the first fraction of radiotherapy and peaks at the end or within one week of completion of radical treatment. It progresses from skin erythema, to dry desquamation (dry, itchy, flaky), moist desquamation (raw painful area which may drain serous exudates) and finally necrosis (rare). Skin reaction is intense when skin dose is high (e.g. electrons, bolus over the field), over areas with skin folds (e.g. inframammary fold, groin, perineum etc.), when radiotherapy is given concurrently with chemotherapy (particularly with anthracyclines, methotrexate, and 5-fluorouracil) and over areas of surgical wounds.

Measures to minimize skin reaction include avoiding mechanical, chemical and thermal irritations such as pat drying rather than rubbing, using simple soap, avoiding perfumes, powders, deodorants over the irradiated area, shaving with razor blade, heat, cold and sun and using loose fitting and cotton clothes. 1% hydrocortisone cream is useful for itchy areas.

During dry desquamation, hydrophilic moisturizing ointment with no heavy metals (e.g. aqueous cream) can be applied to the skin after radiation treatment every day. For moist desquamation, dress the moist area with hydrogel, hydrocolloid or alignate dressing and continue applying aqueous cream to other areas. When radiotherapy is stopped, zinc oxide or silver sulfadiazine (flamazine) may be applied to the skin with non-adhesive dressing. Superadded infection may need antibiotics depending on culture and sensitivity.

Radiation reaction heals in 3–4 weeks followed by tanning of the skin which takes a few more days to subside. Patients are asked to protect irradiated skin with sun block when sun exposure is unavoidable.

Late skin reactions include atrophy and fibrosis of skin and telangiectasia. Radiation recall is the phenomenon of skin reaction occurring in the previous radiation field when exposed to certain chemotherapy (e.g. anthracyclines and gemcitabine). This is usually more severe than previous radiation reaction and subsides in 2 weeks.