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Radiation Toxicity

Jayden Gracie

Radiation pneumonitis

  • 6 weeks to 6 months after RT to chest
  • Presents like pneumonia with cough and SOB, so need to rule out PNA
  • Imaging: chest X-ray or CT
  • Treatment: steroids

Radiation dermatitis

  • Onset during or shortly after treatment
  • Variable: redness, dry desquamation (peeling, dry skin), or wet desquamation (blistering and oozing)
  • Treatment
    • Aquaphor or Aquaphor + lidocaine
    • Lidocaine can sometimes burn over wet desquamation. For wet desquamation (especially if looks potentially infected), start on Silvadene until it dries up. Then add non-adhesive barrier dressings.
    • Topical corticosteroids are helpful for itching (e.g. OTC hydrocortisone)
    • Sitz baths and peri bottles useful for perineal skin reaction after RT to chest.

Mucositis

  • Treatment
    • Salt water and baking soda rinses to help clear debris out of mouth.
    • Magic mouthwash, swish and spit if mouth only (as many times a day as they want) or swish and swallow up to every 4h. Can give viscous lidocaine if pt prefers.
    • For weight loss >15lbs during treatments: consider G-tube but want to avoid if possible since slows swallowing function recovery
    • Can try soft or liquid diet, protein drinks
    • For esophagitis, can order carafate liquid formulation (to coat esophagus). May require prior auth, indication is radiation esophagitis. Consider PPI

Secretions and mouth dryness

  • Glycopyrrolate or Mucinex can help with thick secretions but can be drying.
  • Baking soda and salt, sugarless gum
  • Can try Levsin, scopolamine patches.

Nausea

  • Evaluate for and treat constipation, secretions, and acid reflux
  • Zofran is 1st line followed by compazine

Pain Flares

  • Present with treatment of bony mets in up to 40% of pts. Spikes in pain usually occur either toward the end of treatment or a few days after due to inflammation.
  • Treat with steroid taper per Rad-Onc

Radiation-associated dysuria

  • Presents with UTI-like symptoms during treatment.
  • Rule out UTI
  • Treatment: Hydration. Can try NSAIDs and phenazopyridine (note urine color change). Consider short steroid course next.

Bowel toxicity

  • Upper: nausea/vomiting, loose/watery stools.
  • Lower: loose/watery stools, cramping, tenesmus, urgency
  • Treatment: Try low residue diet, anti-diarrheal agents (Imodium, Lomotil), sucralfate, protozoa/5-ASA enemas
  • Consider cessation or break of RT