Radiation Therapy

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Contents 1 More Specific Terms 2 Introduction 3 Complications 4 More General Terms 5 Additional Terms 6 References

More Specific Terms

• brachytherapy
• hyperfractionated radiotherapy

Introduction

• Tolerance of normal tissues for radiation:

*  brain ........ 6000 cGy  ->  necrosis 
*  spinal cord .. 4500 cGy  ->  myelitis 
*  heart ........ 4500 cGy  ->  pericarditis, myocardial injury 
*  intestine .... 4500 cGy  ->  stenosis, perforation 
*  liver ........ 3000 cGy  ->  hepatitis, hepatic vein thrombosis 
*  lung ......... 2000 cGy  ->  pneumonitis, fibrosis 
*  kidney ....... 2000 cGy  ->  nephropathy, renal failure 
*  bone marrow ..  250 cGy  ->  aplasia 
*  ovary ........  200 cGy  ->  sterilization 
*  testes .......  100 cGy  ->  sterilization

Complications

• immediate effects

• nausea, vomiting, diarrhea
• enteritis (rare)
• esophagitis
• dermatitis
• cystitis

• delayed effects

• radiation necrosis
• radiation-induced heart disease

• occurs months to years after radiation therapy
• pericarditis
• coronary artery disease
• valvular heart disease

• radiation-induced pulmonary disease

• interstitial fibrosis (6-12 months)
• acute radiation pneumonitis (6-12 weeks)

• neurologic

• transverse myelitis (very rare)
• shingles is common
• Lhermitte's sign

• hypothyroidism (check thyroid function)
• xerostomia
• secondary malignancies

• myelodysplasia
• acute leukemia
• malignant lymphoma
• breast cancer

• especially women treated with chest irradiation during adolescence or young adulthood
• lifetime risk may be > 30% [1]

• rectal cancer ( prostate irradiation)

• excess 10-year risk ~ one case per 100 men [7]

• chronic bladder fibrosis

• prevention of complications

• radioprotective agent(s)

• CBLB502 [5] {investigational, animal models}

More General Terms

• oncology
• clinical procedure

Additional Terms

• electromagnetic radiation
• radiation necrosis
• radiation oncology
• radiation pneumonitis
• radiation-induced heart disease
• radiology

References

1. Medical Knowledge Self Assessment Program (MKSAP) 11, 15 American College of Physicians, Philadelphia 1998, 2009
2. Principles of Ambulatory Medicine, 4th edition, Barker et al (eds), Williams & Wilkins, Baltimore, 1995, pg 104
3. Harrison's Principles of Internal Medicine, 14th ed. Fauci et al (eds), McGraw-Hill Inc. NY, 1998, pg 526
4. Journal Watch 25(11):87, 2005 Baxter NN, Tepper JE, Durham SB, Rothenberger DA, Virnig BA. Increased risk of rectal cancer after prostate radiation: a population-based study. Gastroenterology. 2005 Apr;128(4):819-24. PMID: [1]
5. Burdelya LG et al, An agonist of toll-like receptor 5 has radioprotective activity in mouse and primate models. Science 2008, 320:226 PMID: [2]
6. PRACTICE GUIDELINE FOR THE PERFORMANCE OF TOTAL BODY IRRADIATION (American College of Radiology) [3]
7. Margel D et al. Radiation therapy for prostate cancer increases the risk of subsequent rectal cancer. Ann Surg 2011 Dec; 254:947 PMID: [4]
8. Cancer Radiation Therapy: NIH Institute and Center Resources [5]
9. National Guideline Clearinghouse
   - The prevention and management of acute skin reactions related to radiation therapy. ngc-guideline: [6]
   - Practice guideline for the performance of total body irradiation. American College of Radiology ngc-guideline: [7]
   - American Society of Clinical Oncology 2008 clinical practice guideline update: use of chemotherapy and radiation therapy protectants ngc-guideline: [8]
   - Palliative radiotherapy. Alberta Health Services, Cancer Care ngc-guideline: [9]

radiation therapy (XRT)