Radiation Therapy

Aka: Radiation Therapy, External Beam Radiation Therapy, Therapeutic Radiology Procedure, Radiotherapy, Radiation Oncology

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II. Types: External Beam Radiation Therapy

  1. Three-Dimensional Conformal Radiation Therapy
  2. Four-Dimensional Radiation Therapy
  3. Intensity-Modulated Radiation Therapy
  4. Stereotactic Radiosurgery (Gamma Knife)
  5. Stereotactic Body Radiation Therapy (Cyberknife)

III. Types: Internal Radiation Therapy

  1. Brachytherapy
  2. Systemic Radiation Therapy (e.g. Iodine-131 for Thyroid Cancer)

IV. Adverse Effects: General

  1. See Cancer Survivor
  2. See Cancer Symptom
  3. See Radiation Dermatitis
  4. Adverse effects may manifest in hours to days and resolve over months
  5. Secondary cancers may not manifest for years

V. Adverse Effects: Cardiopulmonary

  1. Cardiovascular Disease Risk
    1. Hodgkin's Lymphoma
    2. Breast Cancer
    3. Lung Cancer
    4. Adams (2003) Crit Rev Oncol Hematol 45(1):55-75 [PubMed]
  2. Pneumonitis
    1. Associated cancers
      1. Breast Cancer
      2. Lung Cancer
      3. Mediastinal radiation
    2. Risk factors
      1. Increased radiation dose and Lung Volume radiated
      2. Comorbid lung disease or baseline PFT abnormalities
    3. Management
      1. Corticosteroids
      2. Pentoxifylline (Trental)

VI. Adverse Effects: Gastrointestinal

  1. See Radiation Colitis
  2. Xerostomia
    1. Saliva substitute
    2. Pilocarpine
    3. Consider amifostine (Ethylol)
  3. Mucositis or Esophagitis
    1. See Oral Mucositis
    2. Viscous Lidocaine alone or in combination with "Magic Mouthwash" agents
    3. Responds to typical GERD precautions and Proton Pump Inhibitors
  4. Diarrhea
    1. Modify diet: Low residue, decrease dairy products
    2. Consider Imodium
  5. Proctitis
    1. Consider Sulfasalazine (Azulfidine) orally for prevention
    2. Consider Sucralfate enema for chronic symptoms
  6. Vomiting
    1. See Vomiting in Cancer
    2. Zofran and other 5-HT3 Receptor Antagonists
    3. Metoclopramide (Reglan)
    4. Prochlorperazine (Compazine)
    5. Corticosteroids

VII. Adverse Effects: Genitourinary

  1. Cystitis
    1. Maximize hydration
    2. Uroprotective agents
  2. Erectile Dysfunction
    1. Consider Sildenafil (Viagra) and other phosphodiesterase type 5 inhibitors
  3. Vaginal Dryness
    1. Vaginal lubrication
    2. Consider vaginal dilation if stenosis (especially over age 50 years)
  4. Infertility and Teratogenicity
    1. Consider egg and sperm preservation prior to radiation and Chemotherapy

VIII. Adverse Effects: Patient Contacts during Radiation Therapy

  1. External beam radiation
    1. No residual radiation risk (no contact restrictions)
  2. Temporary internal radioactive implant (catheter inserted and then withdrawn)
    1. Patient typically remains in hospital until implant withdrawn
    2. Children and pregnant women should avoid visiting patient while radioactive implants are present
  3. Permanent internal (brachiotherapy, radioactive see or pellet insertion at tumor region)
    1. Avoid contact with infants and pregnant women for days to months (implant specific)
    2. Also applies to young pets (puppies, kittens)
  4. Radioactive Iodine (Hyperthyroidism Management)
    1. Avoid bodily fluid contact for infants, children and pregnant women for several days

IX. Resources

  1. Radiation Therapy Patient Education (NCI)
    1. https://www.cancer.gov/about-cancer/treatment/types/radiation-therapy

X. References

  1. Berkey (2010) Am Fam Physician 82(4): 381-8 [PubMed]
  2. Higdon (2018) Am Fam Physician 97(11):741-8 [PubMed]

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