Radiation Side Effects and Syndromes

Welcome to PT 635 Pathophysiology of Complex Patient Problems This is a wiki created by and for the students in the School of Physical Therapy at Bellarmine University in Louisville KY. Please do not edit unless you are involved in this project, but please come back in the near future to check out new information!!

Original Editors -Alicia Dupilka & Kristin Gramling from Bellarmine University's Pathophysiology of Complex Patient Problems project.

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Definition/Description

Radiation therapy is when radiation is delivered to a specific area of the body to try and treat a disease, usually cancer.  The goal of the radiation is to kill rapidly dividing cancer cells while sparing slower dividing somatic cells. Radiation is usually used in conjuction with surgery or chemotherapy. 

The radiation may be delievered by a machine outside the body (external-beam radiation therapy) or it may come from radioactive material placed in the body (internal radiation therapy, also called brachytherapy).

Type of radiation used depends on:
• Type of cancer
• Size
• Location
• How close the cancer is to normal tissues
• How far the radiation needs to travel
• General health and medical history
• Other types of treatment
• Age and other medical conditions

External-beam radiation therapy: most often delivered in the form of photon beams (x-rays or gamma rays)

 3-Dimensional Conformal Radiation Therapy (3D-CRT): most common type

Intensity-Modulated Radiation Therapy (IMRT)

     • Dosage is chosen for different areas of the tumor and surrounding tissues
     • High-powered computer program calculates the required number of beams and angles
     • Goal: increase the dose to areas that need it and reduce exposure to sensitive areas
     • Can reduce the risk of some side effects
     • Larger volume of normal tissue overall is exposed

 Image-Guided Radiation Therapy (IGRT)

     • Repeated imaging scans performed during treatment
     • Can increase the accuracy and may allow reduction in planned volume of tissue to be treated
     • Decreasing total radiation dose to normal tissue

Tomotherapy

     • Type of image-guided IMRT
     • Hybrid between a CT and an external-beam radiation therapy machine
     • Sparing normal tissue from high radiation doses

Stereotactic Radiosurgery

     • Can deliver one or more high doses of radiation to a small tumor
     • Extremely accurate image-guided tumor targeting and positioning
     • High dose of radiation can be delivered without excess damage to normal tissue

Stereotactic Body Radiation Therapy

     • Radiation therapy in fewer sessions
     • Uses smaller radiation fields and higher
     • Treats tumors that lie outside the brain and spinal cord
     • Usually given more than one dose
     • Can treat only small, isolated tumors; including cancers in the lung and liver

 Proton Therapy

     • Deposit much of their energy at the end of their path (Bragg peak) and deposit less energy along the way
     • Should reduce the exposure of normal tissue

Internal-beam radiation therapy (Brachytherapy):

Interstitial: uses radiation source placed within tumor tissue

Intracavitary: uses a source placed within a surgical cavity or a body cavity

Episcleral: used to treat melanoma inside the eye, uses a source that is attached to the eye

Low-dose: recieve continuous low-dose radiation over a period of several days

High-dose: robotic machine attached to delivery tubes placed inside the body, can be given in one or more treatment session, cause less damage to normal tissue

Placement is either permanent or temporary

Permanent
•Surgically sealed within the body and left
• Remaining material does not cause any discomfort or harm
• Low-dose rate

Temporary

    • Carrier and the radiation sources are removed after treatment
    • Can be either low-dose or high-dose

Systemic Radiation Therapy

Swallows or receives an injection of a radioactive substance or a radioactive substance bound to a monoclonal antibody

Examples: radioactive iodine, ibritumomab tiuxetan (Zevalin®), combined tositumomab and iodine I 131 tositumomab (Bexxar®), samarium-153-lexidronam (Quadramet®), and strontium-89 chloride (Metastron®)

Prevalence

Nearly two-thirds of all cancer patients will recieve radiation therapy.

Characteristics/Clinical Presentation

Early (acute) and late (chronic)
Depend on the area of the body being treated, dose given per day, total dosage, general medical condition, other treatments being given

Side Effects

Acute
     • Skin irritation
     • Damage at regions exposed (salivary glands or hair loss if head or neck treated)
     • Urinary problems (lower abdomen treated)
     • Fatigue
     • Nausea with or without vomiting
     • Most disappear after treatment ends (some may be permanent)

Chronic
     • May or may not occur
     • Fibrosis (replacement of normal tissue with scar tissue)
     • Damage to the bowels
     • Memory loss
     • Infertility
     • Second cancer (rare); highest in those treated for cancer as a child or adolescent
     • Some chemotherapy drugs, genetic risk factors, and lifestyle factors can also increase risk of late side effects

Associated Co-morbidities

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Medications

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Diagnostic Tests/Lab Tests/Lab Values

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Etiology/Cause

Risk Factors:

Dependent on organ radiated, individual tolerance, tumor type, volume radiated and fraction size/dosage.

Neurotoxicity

- High total dose and fractionation dose

- Large volume radiated

- Increased edema

- Age <12 or >60 years

- Concurrent chemotherapy

- Underlying diseases affecting the vascular structures (Diabetes, HTN)

- Stereotactic radiation surgery and brachytherapy (internal radiation)

Dermatitis

- Total dose/volume and fractionation dose

- Surface area exposed

Acute Enterocolitis

- Large volume

- High total dose and fractionation dose

- Concurrent chemotherapy

Chronic Entercolitis

- Older age

- Postoperative radiation

- Presence of collagen vascular disease

- Concurrent chemotherapy

- Poor radiation technique

Pulmonary

- Older age

- Lower performance status

- Lower pulmonary baseline function

- Large volume treated

Systemic Involvement

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Medical Management (current best evidence)

Clinical trials to learn how to use radiation therapy more safely and effectively are being conducted by doctors and scientists.

Working on improving image-guided radiation.

Research is also being done on radiosensitizers and radioprotectors.

The use of carbon ion beams is still being investigated and remain experimental. This type of therapy are not currently available in the US.

Physical Therapy Management (current best evidence)

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Alternative/Holistic Management (current best evidence)

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Differential Diagnosis

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Case Reports/ Case Studies

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Resources

Radiation Therapy and You: Support for People with Cancer

http://.www.cancer.gov/cancertopics/radiation-therapy-and-you)

Recent Related Research (from Pubmed)

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References

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