After Radiation Therapy

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C H R I S T O P H E R G . J O R D A N , D O , F A C O I

U N I V E R S I T Y O F N O R T H T E X A S H E A L T H S C I E N C E C E N T E R D I R E C T O R , S E C T I O N O F H E M A T O L O G Y & O N C O L O G Y

M A Y 1 , 2 0 1 5

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A brief Understanding of Radiation

 Multiple types of radiation

external beam—standard radiation and the different more focused types

stereotactic radiosurgery—still beam radiation, but with high precision and high doses brachytherapy—localized therapy (Mammosite, prostate seeds, etc…)

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Brief understanding (cont)

 Many types can have long term sequelae, which will be further discussed later

 Certainly short term sequelae during radiation and immediately post radiation are common and

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Short term sequelae

 Radiation dermatitis  Mucositis

 Pneumonitis

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Short-term sequelae (cont)

 Fatigue

 Loss of appetite

 Cytopenias (particularly with length treatments in the pelvis)  Difficulty swallowing

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Short term sequelae (continued)

 Xerostomia

 Cardiac inflammation and cardiomyopathy  Cystitis

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Short-term Sequelae (cont)

 Dehydration  Myositis

 Cerebritis  Proctitis

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Long term Sequelae

 Cognitive dysfunction  Malnutrition

 Pulmonary fibrosis  Cardiomyopathy

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Long-term Sequelae (cont)

 Lymphedema—this is not only in treatment of breast cancer, but also

can occur in lower extremities as well

 Genitourinary symptoms (increase in infections in bladder, vaginal

dryness, erectile dysfunction, etc…)

 Chronic GI symptoms—chronic diarrhea is most common, but

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Long term sequelae (continued)

 Scarring at any site

 Tissue necrosis (this is usually if radiation doses are too high)  Chronic cytopenias due to fibrosis in the bone marrow

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Long-term Sequelae (cont)

 Lack of control of tumor site—risk of any treatment for cancer  Vascular disease

 Secondary malignancies—such as breast cancer in younger women who

have had chest wall radiation for Hodgkin’s Disease as a child or adolescent

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Short-term Management

 Silvadene cream for burns (radiation dermatitis)  Anti-diarrheals

 Magic Mouthwash (Benadryl:Maalox:viscous lidocaine in 1:1:1 dilution)

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Short-term Management (cont)

 Artificial saliva preps for xerostomia

 Antacid agents such as PPI’s, H2 blockers, etc…

 IV fluids if necessary for dehydration and often this can be done in the

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Short-term Management (continued)

 PEG tube for nutrition if unable to swallow (very common in

Head&Neck cancers

 Steroids for muscle inflammation or pulmonary inflammation  Stimulants like Ritalin for severe fatigue

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Short-term Management (cont)

 Barrier treatments for proctitis (Aquaphor, Desitin, Boudreaux’s Butt

Paste, etc…)

 Antibiotics for infected sites—triple antibiotic ointments, silvadene,

etc…

 Hospitalization is sometimes necessary for IV fluids, antibiotics,

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Long-term Management

 If heart is in port of radiation, then should consider echocardiogram

every 2-3 years and Cardiology consultation if damaged

 Feeding tubes if necessary for long-term, if oral nutrition remains

difficult

 Pulmonology consultation if pulmonary fibrosis severe enough to be

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Long-term Management (cont)

 Lymphedema clinic and sleeves if lymphedema develops. The earlier it

is caught, the better the management outcomes long-term

 Long-term use of PPI’s and other like medications, especially if

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Long-term Management (continued)

 Vaginal creams, ED medications, etc… for management of GU

symptoms both short term and long term

 Periodic blood counts, frequency determined by presence or absence of

cytopenias during treatment

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Long-term Management (cont)

 Angiography for symptoms of vascular compromise (claudication, etc…)  Overall, majority of symptoms of radiation are short-lived, just as with

chemotherapy, but the medical team should be aware of many potential side effects that can occur and this should be a good starting point to

provide the best supportive care for the patient receiving or having received radiation.

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Parting Shot

 The majority of complications that arise during and following treatment

of radiation will very likely be managed by the oncology team (Radiation Oncologist, Medical Oncologist, Nurses, Case Managers, etc…)

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Parting Shot (cont)

 It is vital in 2015 and beyond for primary physicians to understand the

sequelae and management of short-term and long-term side effects, as primary physicians will be an integral part of the management of the

oncology patient in the future as health care evolves and more and more medical homes and accountable care organizations are created.