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Radiation Therapy
Aka: Radiation Therapy, External Beam Radiation Therapy, Therapeutic Radiology Procedure, Radiotherapy, Radiation Oncology
- Types: External Beam Radiation Therapy
- Three-Dimensional Conformal Radiation Therapy
- Four-Dimensional Radiation Therapy
- Intensity-Modulated Radiation Therapy
- Stereotactic Radiosurgery (Gamma Knife)
- Stereotactic Body Radiation Therapy (Cyberknife)
- Types: Internal Radiation Therapy
- Brachytherapy
- Systemic Radiation Therapy (e.g. Iodine-131 for Thyroid Cancer)
- Adverse Effects: General
- See Cancer Survivor
- See Cancer Symptom
- See Radiation Dermatitis
- Adverse effects may manifest in hours to days and resolve over months
- Secondary cancers may not manifest for years
- Adverse Effects: Cardiopulmonary
- Cardiovascular Disease Risk
- Hodgkin's Lymphoma
- Breast Cancer
- Lung Cancer
- Adams (2003) Crit Rev Oncol Hematol 45(1):55-75 [PubMed]
- Pneumonitis
- Associated cancers
- Breast Cancer
- Lung Cancer
- Mediastinal radiation
- Risk factors
- Increased radiation dose and Lung Volume radiated
- Comorbid lung disease or baseline PFT abnormalities
- Management
- Corticosteroids
- Pentoxifylline (Trental)
- Adverse Effects: Gastrointestinal
- See Radiation Colitis
- Xerostomia
- Saliva substitute
- Pilocarpine
- Consider amifostine (Ethylol)
- Mucositis or Esophagitis
- See Oral Mucositis
- Viscous Lidocaine alone or in combination with "Magic Mouthwash" agents
- Responds to typical GERD precautions and Proton Pump Inhibitors
- Diarrhea
- Modify diet: Low residue, decrease dairy products
- Consider Imodium
- Proctitis
- Consider Sulfasalazine (Azulfidine) orally for prevention
- Consider sucralfate enema for chronic symptoms
- Vomiting
- See Vomiting in Cancer
- Zofran and other 5-HT3 Receptor Antagonists
- Metoclopramide (Reglan)
- Prochlorperazine (Compazine)
- Corticosteroids
- Adverse Effects: Genitourinary
- Cystitis
- Maximize hydration
- Uroprotective agents
- Erectile Dysfunction
- Consider Sildenafil (Viagra) and other phosphodiesterase type 5 inhibitors
- Vaginal Dryness
- Vaginal lubrication
- Consider vaginal dilation if stenosis (especially over age 50 years)
- Infertility and Teratogenicity
- Consider egg and sperm preservation prior to radiation and Chemotherapy
- Adverse Effects: Patient Contacts during Radiation Therapy
- External beam radiation
- No residual radiation risk (no contact restrictions)
- Temporary internal radioactive implant (catheter inserted and then withdrawn)
- Patient typically remains in hospital until implant withdrawn
- Children and pregnant women should avoid visiting patient while radioactive implants are present
- Permanent internal (brachiotherapy, radioactive see or pellet insertion at tumor region)
- Avoid contact with infants and pregnant women for days to months (implant specific)
- Also applies to young pets (puppies, kittens)
- Radioactive Iodine (Hyperthyroidism Management)
- Avoid bodily fluid contact for infants, children and pregnant women for several days
- Resources
- Radiation Therapy Patient Education (NCI)
- https://www.cancer.gov/about-cancer/treatment/types/radiation-therapy
- References
- Berkey (2010) Am Fam Physician 82(4): 381-8 [PubMed]
- Higdon (2018) Am Fam Physician 97(11):741-8 [PubMed]