Chpt 6: Radiation Therapy

Nausea Diarrhea Mucositis Xerostomia Esophagitis Skin Reaction

Acute toxicity related to radiation therapy

Watch your treated skin for signs of change. After treatment, it's important to pay close attention to the skin that was treated with radiation therapy. If you see redness, a rash, or any other change, call your oncologist or dermatologist. Protect the treated area from the sun. Anyone who has had radiation treatments has a higher risk of developing skin cancer in that area. Skin cancer tends to show up many years later, so this makes sun protection essential for life. To find out how to protect your skin, go to Prevent skin cancer. Make an appointment to see a board-certified dermatologist. By having a dermatologist, you have a specialist to see if you develop a skin problem later. This is especially important since you have a higher risk of developing skin cancer.

After radiation therapy: Pay attention to your treated skin Some side effects occur weeks, months, or years after your last radiation treatment. This can happen even if you had no side effects during treatment. To catch these side effects early, dermatologists recommend the following:

alcohol free moisturizer

An ___________________can be used to minimize dryness and manage pruritus

Wear loose-fitting, cotton clothing over the treated area. Use only the moisturizers, creams, or lotions that are recommended by your doctor or nurse. Don't use makeup, perfumes, powders, or aftershave in the area being treated. You can use deodorant on intact skin in the area being treated. Stop using it if your skin becomes irritated. Don't shave the treated skin. If you must shave, use an electric razor and stop if the skin becomes irritated. Don't put any tape on the treated skin. Don't let your treated skin come into contact with extreme hot or cold temperatures. This includes hot tubs, water bottles, heating pads, and ice packs. Don't apply any patches to the treated area, including pain patches. If your skin is itchy, don't scratch it. Ask your nurse for recommendations on how to relieve the itching. If you don't have any skin reactions during the treatment, you can swim in a chlorinated pool. However, be sure to rinse off the chlorine right after getting out of the pool. Avoid tanning or burning your skin during and after you're finished with treatment. If you're going to be in the sun, use a PABA-free sunblock with an SPF of 30 or higher. Also, wear loose-fitting clothing that covers you as much as possible.

Avoid irritating your skin in the treatment area

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BREAST CANCER

A temperature of 100.4 °F (38 °C) or higher Chills Increasing pain or discomfort Increased redness or swelling or skin that is hard or hot to the touch A rash or blistering of your skin in the treated area Drainage from your skin in the treated area Any new open areas or changes to your skin Any other new symptoms or problems

Call Your Doctor or Nurse if You Have:

Bathe or shower daily using warm water and a mild unscented soap, such as Neutrogena®, Dove®, baby soap, Basis®, or Cetaphil®. Rinse your skin well and pat it dry with a soft towel. When washing, be gentle with your skin in the area being treated. Don't use a washcloth, scrubbing cloth, loofah or brush. The tattoo marks you received before your treatment are permanent and won't wash off. You may get other markings during treatment such as an outline of your treatment area with a purple felt-tipped marker. You can remove these markings with mineral oil when your radiation therapists say it's okay. Don't use alcohol or alcohol pads on your skin in the area being treated.

Caring for Your Skin During Radiation Therapy Keep your skin clean https://www.mskcc.org/cancer-care/patient-education/skin-care-guidelines-patients-receiving-radiation-therapy

G2 and M phases

Cells in the late _________and___________phases are most sensitive to RT, whereas those in the S phase are more resistant

tangential fields -medial and lateral fields that are directly obliquely at the breast and a variety of additional fields if nodal involvement exists

Common RT treatment fields to the whole breast include:

Bathing and shaving: Skin can become very sensitive during radiation therapy. You can reduce the risk of side effects by following these tips: Wash the treated skin gently every day with warm water. Washing helps remove bacteria from your skin, which can cause an infection. Be very gentle when washing your skin in the area that's receiving radiation therapy. You can easily irritate it, which can cause side effects on your skin. To avoid irritating your skin, skip the washclothes, sponges, and loofahs. Instead, use your hands to gently splash water on the treated skin. Use a gentle, low-pH cleanser if you need to cleanse. Your care team may recommend skin care products that you can use. If not, ask. When using a cleanser, gently apply it with your hands and rinse it off with warm water. Again, you don't want to use a washcloth or sponge, which can irritate your skin. Ignore the lines drawn on your skin. You may want to scrub these lines off, but trying to remove them will irritate your skin. Avoid shaving the treated skin. This can irritate your skin, which could cause a painful rash. Apply moisturizer every day as directed. This helps your skin recover more quickly from treatment, but don't apply moisturizer to a wound. Be sure to use only the moisturizer that your cancer team recommends, and apply it as directed.

During radiation therapy: Be gentle and protect your skin You want to start doing the following on the day you begin radiation therapy and continue until you've stopped radiation and your skin feels normal.

45-50 gray (Gy)

For whole breast radiation, patients typically are prescribed a dose of _______________

Care for wounds as directed. Some people develop redness, sores, or scabs during radiation therapy. If you need to care for a wound, be sure to follow the directions you're given. Doing so can help your skin recover more quickly and avoid a serious reaction. Skip the antiperspirant and talcum powder. Ingredients in these products can increase the amount of radiation you get. You can use deodorant instead of antiperspirant. However, if you develop redness, swelling, or soreness where you applied the deodorant, stop using deodorant, too. Don't apply anything sticky to your skin. This includes medical supplies with adhesive, such as medical tape, stick-on bandages, and nicotine patches. The adhesive can irritate and damage skin treated with radiation. If you need to wear a patch for medical reasons, apply it to skin that has not been treated with radiation. Take a break from products that contain fragrance. Makeup and skin care products often contain fragrance, which can irritate your skin and cause a reaction. Unless a product says it's "fragrance free," it's likely to contain fragrance. Even unscented products contain fragrance. Wear loose-fitting clothes. You can develop side effects if clothing rubs against skin that been treated with radiation. Wearing loose-fitting clothing helps to prevent these side effects.

Getting dressed: Making the following changes until your skin feels normal can help reduce possible side effects:

heart block

If a patient is at risk for cardiac exposure, a ____________________ may be placed to minimize the RT dose

Centigray (cGy)

Individual doses of radiation

atrophy scaling fibrosis telangiectasia necrosis pigmentation changes

Late effects of RT to the skin include:

At the beginning of treatment, before you have any side effects, moisturize the skin after your daily treatment with an ointment such as A&D, Eucerin, Aquaphor, Biafene, or Radiacare. You also can put it on at night — wear an old T-shirt so the ointment doesn't get on your bed clothes. For mild pinkness, itching, and burning, apply an aloe vera preparation. Or try 1% hydrocortisone cream (available without a prescription at any drugstore). Spread the cream thinly over the affected area 3 times a day. If areas become red, itchy, sore, and start to burn, and low-potency cream no longer relieves your symptoms, ask your doctor for a stronger steroid cream available by prescription. Examples include 2.5% hydrocortisone cream and bethamethasone. Some people get some relief by blowing air on the area with a hair dryer set to "cool" or "air" (no heat). Don't wear a bra if there are raw areas. If your skin becomes dry and flakey during the course of your treatment, moisturize frequently and cleanse skin gently. If your skin forms a blister or peels in a wet way, leave the top of the blister alone! The bubble keeps the area clean while the new skin grows back underneath. If the blister opens, the exposed raw area can be painful and weepy. Keep the area relatively dry and wash it with warm water only. Blot the area dry and then apply a NON-ADHERENT dressing, such as Xeroform dressings (laden with soothing petroleum jelly) or "second skin" dressings made by several companies. To relieve discomfort from blistering or peeling, take an over-the-counter pain reliever, or ask your doctor for a prescription if you need it.

Manage irritation during and after your course of radiation

Start using a moisturizer when you begin treatment. This can help to minimize any skin reaction. You can use an over-the-counter moisturizer. When choosing a moisturizer pick one that does not have any fragrances or lanolin. There are a number of products that are good to use, and your nurse may suggest one of these to you. Use only one at a time unless your nurse tells you to use more. You may be prescribed a medication either at the start, or during, your radiation therapy to treat itchy skin. There are a number of products that are good to use, and your nurse may suggest one of these to you. Use only one at a time unless your nurse tells you to use more. Apply the moisturizer 2 times a day. Don't apply moisturizers to open areas on your skin.

Moisturize your skin often

accelerated partial breast irradiation

Partial breast irradiation (PBI) is commonly referred to as ___________________ and can be performed using the MammoSite treatment device, on a linear accelerator, or via a high dose rate (HDR) brachytherapy.

hydrocolloid dressing

Patients experiencing moist desquamation may benefit from the use of a __________________________ to minimize the risk of infection, promote healing, and enhance comfort

corn starch

Patients should be cautioned against the use of _________________to manage moisture, as once an area develops moist desquamation, this product can lead to a yeast infection

clean and dry

Patients should be encouraged to bathe as the normally would and to keep the skin __________and_________

boost field -this field usually is treated alone once the patient has completed treatment to the entire breast -the treatment field is around the surgical scar, and treatment is aimed at local tissues, as this area has a high chance of recurrence

Patients undergoing BCT commonly receive treatment to what is known as a ___________________

DCIS or Invasive breast cancer

Patients who receive BCT may have a diagnosis of _________________or________________

BCT

Patients who require RT after mastectomy typically have similar fields and treatment doses as those who elect to undergo ____________

four to five weeks

Photons are administered the first __________to______________weeks after treatment

-lumpectomy -mastectomy --metastatic disease

Radiation may be used after:

four hours

Skin products should be applied no sooner than _____________prior to treatment, although this varies from institution to institution

Don't put anything hot or cold on your treated skin. A heating pad or ice pack may seem like a good idea, but anything that's hot or cold can irritate your skin. Protect your treated skin while doing chores. If you're getting radiation treatments on your hands or lower arms, you'll want to protect your skin with gloves while doing chores, such as doing dishes.

Spending time at home: Until therapy is over and your skin feels normal, dermatologists recommend the following:

Cover your treated skin with sun-protective clothing. The sun can irritate skin that's been treated with radiation. Before going outdoors, put on sun-protective clothing. You can find sun-protective clothing online, but any clothing that you hold up to a bright light and cannot see through offers sun protection. Just make sure that the clothing is loose-fitting. A wide-brimmed hat can protect your head and neck. Use the sunscreen that your care team recommends. Your care team will recommend skin care products that you can use, including sunscreen. If you don't remember getting a recommendation for sunscreen, ask someone on your care team which sunscreen you should use. Seek shade when outdoors. This helps to protect your skin from the sun's UV rays. Don't use a tanning bed or other tanning device. These tend to emit more UV rays than the sun, so they can seriously damage your skin. Skip the hot tub. The heat can irritate your skin. If the hot tub hasn't been properly cleaned, you could also develop a serious infection. Bundle up when the temperature nears (or falls below) freezing. The cold can irritate your skin. To prevent this, bundle up when it's cold outdoors and limit your time outside in the cold.

Spending time outdoors and leisure time: Being outside can help relieve stress, but you want to protect your skin from harmful ultraviolet (UV) rays, heat, and cold. This is what dermatologists recommend:

-Metastatic disease to the brain -Lung -Spinal Cord -may be used as a primary treatment for prostate cancer using more than one treatment

Stereotactic radiosurgery treatment can be used in patients with?

Fractionation

The total dose of RT is divided into equal fractions. This is one of the common methods of delivering RT, with treatments given once daily, Monday through Friday, for a prescribed number of weeks

CT and simulation

The treatment planning process for the management of breast cancer includes:

-fatigue and -skin reaction (Dermatitis)

The two most common side effects related to RT for breast cancer are _________________and_________________

1.8-2 Gy five to six weeks

This dose is divided into daily doses of ______________ which are administered five days a week over the course of ______________to______________weeks

Boost

This term commonly is used to describe a smaller field within the larger filed of radiation that typically is treated at the end of radiation

stereotactic radiosurgery

This type of treatment is used to treat tumors that are intracranial or extracranial and primary or metastatic in origin

Gray (Gy)

Total dose of radiation

second

Typically, skin reactions occur in the _________________week of treatment and is dose and time dependent

42-59%

Women who under went breast conserving surgery and RT had a ___________________% decrease in ipsilateral local recurrence compared to women who are treated with BCT alone

Mometasone

___________________, a topical corticosteroid, may also be used to minimize pruritus

Radiosensitivity

______________________ is concerned with how sensitive tumor cells and other structures and tissues respond to the radiation. It is an important consideration, as acute and late toxicities are related to this concept