Radiation Side Effects and Syndromes
Original Editors -Alicia Dupilka & Kristin Gramling from Bellarmine University's Pathophysiology of Complex Patient Problems project.
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Definition/Description[edit | edit source]
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.[1] 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).[2]
Type of radiation used depends on:[3]
• 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)[4]
- 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):[5]
- 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[6]
- 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[edit | edit source]
Nearly two-thirds of all cancer patients will recieve radiation therapy.[7]
Characteristics/Clinical Presentation[edit | edit source]
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Associated Co-morbidities[edit | edit source]
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Medications[edit | edit source]
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Diagnostic Tests/Lab Tests/Lab Values[edit | edit source]
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Etiology/Cause[7][edit | edit source]
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[edit | edit source]
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Medical Management (current best evidence)[edit | edit source]
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Physical Therapy Management (current best evidence)[edit | edit source]
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Alternative/Holistic Management (current best evidence)[edit | edit source]
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Differential Diagnosis[edit | edit source]
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Case Reports/ Case Studies[edit | edit source]
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Resources
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Recent Related Research (from Pubmed)[edit | edit source]
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References[edit | edit source]
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- ↑ Stubblefield MD. Radiation Fibrosis Syndrome: Neuromuscular and Musculoskeletal Complications in Cancer Survivors. PM R 2011;3:1041-1054.
- ↑ National Cancer Institute. Radiation Therapy for Cancer. National Institutes of Health. http://www.cancer.gov/cancertopics/factsheet/Therapy/radiation. Reviewed May 30, 2010. Accessed April 3, 2013.
- ↑ National Cancer Institute. Radiation Therapy for Cancer. National Institutes of Health. http://www.cancer.gov/cancertopics/factsheet/Therapy/radiation. Reviewed May 30, 2010. Accessed April 3, 2013.
- ↑ National Cancer Institute. Radiation Therapy for Cancer. National Institutes of Health. http://www.cancer.gov/cancertopics/factsheet/Therapy/radiation. Reviewed May 30, 2010. Accessed April 3, 2013.
- ↑ National Cancer Institute. Radiation Therapy for Cancer. National Institutes of Health. http://www.cancer.gov/cancertopics/factsheet/Therapy/radiation. Reviewed May 30, 2010. Accessed April 3, 2013.
- ↑ National Cancer Institute. Radiation Therapy for Cancer. National Institutes of Health. http://www.cancer.gov/cancertopics/factsheet/Therapy/radiation. Reviewed May 30, 2010. Accessed April 3, 2013.
- ↑ 7.0 7.1 Goodman CC, Fuller KS. Pathology: Implications for the Physical Therapist. 3rd ed. St. Louis. Missouri: Saunders, 2009.