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.

Fatigue

Fatigue (a subjective feeling of tiredness) is a common side effect of radiotherapy and the exact cause is not known. Fatigue may increase progressively during the radiotherapy and may take weeks or months to subside after radiotherapy treatment. Measures to improve fatigue include frequent periods of rest, regular minimal aerobic exercise, and stress management. A study showed that 20–30 minutes of brisk walking 4–5 times per week improved fatigue level, symptom intensity and physical functioning.

Anorexia

Some patients experience anorexia and the exact cause is not known. A number of factors such as the primary cancer itself and its systemic treatment as well as concurrent medications can influence the degree of anorexia. Measures to improve anorexia include frequent small meals, high energy high protein diet, and sometimes appetite stimulants like megestrol acetate (400–800 mg daily) or steroids. Anorexia can cause clinically significant weight loss (loss of ≥10% prediagnosis weight loss) in which case enteral feeding is advised, particularly to those receiving radical radiotherapy.

Bone marrow suppression

Irradiation of a large area of marrow bearing bones can result in bone marrow suppression. The degree of bone marrow suppression is high if concurrent myelosuppressive chemotherapy is used. All patients at risk of bone marrow suppression need weekly blood counts and appropriate action.

Site-specific side effects

Brain

Cerebral oedema

Radiotherapy can cause cerebral oedema which manifests as headache, vomiting, seizures, neurological deficit and altered mental function. Steroids are the treatment of choice.

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