After Radiation Therapy

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Brian Hamilton
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1 After Radiation Therapy CHRISTOPHER G. JORDAN, DO, FACOI UNIVERSITY OF NORTH TEXAS HEALTH SCIENCE CENTER DIRECTOR, SECTION OF HEMATOLOGY & ONCOLOGY MAY 1, 2015

2 A brief Understanding of Radiation Multiple types of radiation external beam standard radiation and the different more focused types stereotactic radiosurgery still beam radiation, but with high precision and high doses brachytherapy localized therapy (Mammosite, prostate seeds, etc ) systemic therapy radioactive iodine, radiation delivered to bone mets by IV vehicles, etc

radiation, but with high precision and high doses brachytherapy localized therapy (Mammosite,

3 Brief understanding (cont) Many types can have long term sequelae, which will be further discussed later Certainly short term sequelae during radiation and immediately post radiation are common and are usually the most severe reducers in quality of life, nutrition, activities, pain, etc

during radiation and immediately post radiation are common and are

4 Short term sequelae Radiation dermatitis Mucositis Pneumonitis Diarrhea (closely related to mucositis

5 Short-term sequelae (cont) Fatigue Loss of appetite Cytopenias (particularly with length treatments in the pelvis) Difficulty swallowing

6 Short term sequelae (continued) Xerostomia Cardiac inflammation and cardiomyopathy Cystitis

7 Short-term Sequelae (cont) Dehydration Myositis Cerebritis Proctitis

8 Long term Sequelae Cognitive dysfunction Malnutrition Pulmonary fibrosis Cardiomyopathy

9 Long-term Sequelae (cont) Lymphedema this is not only in treatment of breast cancer, but also can occur in lower extremities as well Genitourinary symptoms (increase in infections in bladder, vaginal dryness, erectile dysfunction, etc ) Chronic GI symptoms chronic diarrhea is most common, but strictures and other complications can form

infections in bladder, vaginal dryness, erectile dysfunction, etc ) Chronic GI

10 Long term sequelae (continued) Scarring at any site Tissue necrosis (this is usually if radiation doses are too high) Chronic cytopenias due to fibrosis in the bone marrow

11 Long-term Sequelae (cont) Lack of control of tumor site risk of any treatment for cancer Vascular disease Secondary malignancies such as breast cancer in younger women who have had chest wall radiation for Hodgkin s Disease as a child or adolescent

malignancies such as breast cancer in younger women who have

12 Short-term Management Silvadene cream for burns (radiation dermatitis) Anti-diarrheals Magic Mouthwash (Benadryl:Maalox:viscous lidocaine in 1:1:1 dilution) for oral and esophageal mucositis

Mouthwash (Benadryl:Maalox:viscous lidocaine in

13 Short-term Management (cont) Artificial saliva preps for xerostomia Antacid agents such as PPI s, H2 blockers, etc IV fluids if necessary for dehydration and often this can be done in the cancer center infusion area without hospitalization

IV fluids if necessary for dehydration and often this can

14 Short-term Management (continued) PEG tube for nutrition if unable to swallow (very common in Head&Neck cancers Steroids for muscle inflammation or pulmonary inflammation Stimulants like Ritalin for severe fatigue Consider discontinuation of radiation if cardiac damage develops

inflammation or pulmonary inflammation Stimulants like Ritalin for

15 Short-term Management (cont) Barrier treatments for proctitis (Aquaphor, Desitin, Boudreaux s Butt Paste, etc ) Antibiotics for infected sites triple antibiotic ointments, silvadene, etc Hospitalization is sometimes necessary for IV fluids, antibiotics, surgical debridement, etc

infected sites triple antibiotic ointments, silvadene, etc

16 Long-term Management If heart is in port of radiation, then should consider echocardiogram every 2-3 years and Cardiology consultation if damaged Feeding tubes if necessary for long-term, if oral nutrition remains difficult Pulmonology consultation if pulmonary fibrosis severe enough to be chronically debilitating or severe even in short term setting

necessary for long-term, if oral nutrition remains difficult Pulmonology consultation

17 Long-term Management (cont) Lymphedema clinic and sleeves if lymphedema develops. The earlier it is caught, the better the management outcomes long-term Long-term use of PPI s and other like medications, especially if radiation to stomach, esophagus, or GE junction

18 Long-term Management (continued) Vaginal creams, ED medications, etc for management of GU symptoms both short term and long term Periodic blood counts, frequency determined by presence or absence of cytopenias during treatment Scar creams

term and long term Periodic blood counts, frequency

19 Long-term Management (cont) Angiography for symptoms of vascular compromise (claudication, etc ) Overall, majority of symptoms of radiation are short-lived, just as with chemotherapy, but the medical team should be aware of many potential side effects that can occur and this should be a good starting point to provide the best supportive care for the patient receiving or having received radiation.

medical team should be aware of many potential side effects that can occur and this should be a

20 Parting Shot The majority of complications that arise during and following treatment of radiation will very likely be managed by the oncology team (Radiation Oncologist, Medical Oncologist, Nurses, Case Managers, etc )

likely be managed by the oncology team (Radiation

21 Parting Shot (cont) It is vital in 2015 and beyond for primary physicians to understand the sequelae and management of short-term and long-term side effects, as primary physicians will be an integral part of the management of the oncology patient in the future as health care evolves and more and more medical homes and accountable care organizations are created. THANK YOU FOR INVITING ME TO PARTICIPATE!

Prostate Cancer. There is no known association with an enlarged prostate or benign prostatic hyperplasia (BPH).

Prostate Cancer. There is no known association with an enlarged prostate or benign prostatic hyperplasia (BPH). Prostate Cancer Definition Prostate cancer is cancer that starts in the prostate gland. The prostate is a small, walnut-sized structure that makes up part of a man's reproductive system. It wraps around