RTT 335 Patient Care in Radiation Therapy Acute complications

Curative doses 20 – 30 Gy: seminoma, ALL 30 – 40 Gy: Wilm’s, neuroblastoma 40 – 50 Gy: HD, lymphosarcom, skin cancer 50 – 60 GY: lymph nodes, SCC, breast, ovarian, medulloblastoma, H&N. 60 – 80GY: prostate, H&N, glioblastoma, osteogenic, melanoma, uterus and cevix, lung, bladder.

Skin Skin reactions are not as common today as they used to be, because of the skin sparing effects of megavoltage linear accelerators. Skin reactions are still seen in: Intentional treatment of skin Tangential areas Neutrons and electrons With certain chemotherapy agents Electron or low photon comtamination

Skin A transient erythema may be seen after one tretment True erythema occurs around the third or fourth week of treatment Appearance time will depend on energy, field size, fraction size, skin type.

Skin reactions Erythema Dry desquamation Moist desquamation Necrosis

Treatment guidelines Protect area from mechanical trauma Protect from sunlight Avoid chemical irritation

Treatments for skin reactions Erythema: cream or lotion Dry desquamation: aquaphor or cream Wet desquamation: protect from infection, warm wet soaks.

Generic instructions for skin No heat No ice bags Don’t scratch Don’t rub soap on area Do not shave area Prevent rubbing of straps No tight undewear

Generic instructions for skin No deodorants and perfume in area Keep out of sun Don’t apply irritating liquids like iodine, alcohol.

Alopecia Hair loss occurs only in treated areas. Hair loss on head can cause emotional distress. Usually begins about three weeks into treatment. Regrowth only occurs about three months after treatment. Changes in texture and color might occur.

Alopecia Patient should be told where to obtain wigs, scarves and hats.

Oral cavity This is one of the most demanding areas to have treated. Nutritional support is necessary. Prior to treatment, a program for oral care and hygiene must be set up.

Oral cavity reactions Reddened mucosa Pain(odynophagia) – patient eats less Patchy areas of exudate Xerostomia Loss of taste

Before treatment Patient informed of possible problems Complete dental evaluation Oral prophylaxis – brushing flossing, fluoride treatments No smoking or alcohol Dietary counselling

During treatment No hot, cold or spicy foods Aspirin Codeine xylocaine

As reactions get worse Mouth washes Artificial saliva Jaw exercises for TMJ

Brain Brain edema – steroids Alopecia – treat as before

Nausea and vomiting Can be caused by the treatment or the tumor. Radiation induced nausea usually occurs shortly after treatments and patients feel better during weekends. Sight and smell of the treatment room can cause nausea

Nausea Caused mostly by irradiation of small bowel. Affected by volume and doserate. Treat with Compazine or similar anti nausea drugs. Daily dose may need to be reduced.

Radiation cystitis Mild symptoms are treated with antispasmodics Drinking lots of fluids helps – cranberry juice is believed to help.

Diarrhoea Usually accompanies pelvic radiation. Temporary diarrhoea is controlled with Lomotil. The diarrhoea should be controlled to avoid electrolyte imbalance. Perianal care to avoid irritation and heorrhoids; keep clean and dry as possible, no tight clothes, topical steroids.

Hematologic support Lymphocytes respond early WBC should be kept above 2000/ml RBC are important in radiation therapy because of the oxygen effect, so anemia should be corrected before the start of treatment. Thrombocytopenia is usually not a problem unless the patient is receiving chemo.