1. RTT 335 Patient Care in Radiation Therapy
Acute complications

2. 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.

3. 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

4. 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.

5. Skin reactions
Erythema
Dry desquamation
Moist desquamation
Necrosis

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

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

10. 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

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

12. 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.

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

14. 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.

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

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

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

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

20. Brain
Brain edema – steroids
Alopecia – treat as before

21. 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

22. 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.

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

24. 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.

26. 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.