Sunday, February 25, 2024

Long Term Side Effects Of Radiation To The Spine

How You Have Radiotherapy

What Are the Long-Term Effects of Radiation?

You are usually admitted to hospital urgently for radiotherapy for spinal cord compression. You stay in hospital while you have the treatment.

You have the radiotherapy as a single treatment or a series of daily treatment sessions called fractions. Normally you have one a day. But occasionally you may have 2 fractions a day, for example, just before a weekend.

Whether you have a plastic mould made to keep you still while you have treatment depends on the part of the spine that has cancer. You’re likely to have a plastic mould made if the cancer is in the upper part of your spine.

Causes And Risk Factors

Radiation therapy works by damaging DNA in cells. This damage isn’t isolated to cancer cells, though normal cells can be damaged as well. While radiation therapy has improved significantly such that less damage occurs to healthy cells than in the past, some healthy tissues are inevitably exposed.

Several variables can increase or decrease your risk of developing long-term side effects of radiotherapy. Some of these are:

  • Your age at the time of radiation
  • The dose of radiation you receive
  • The number of treatment sessions
  • The type of cancer treated
  • The area of the body that receives radiation
  • Other cancer treatments, such as chemotherapy
  • Other health conditions, such as heart disease or diabetes

Late Effects After Radiation For Brain/spinal Cord Tumors

Side effects from radiation treatment are directly related to the area of the body being treated. Any area in the treatment field has a risk of being damaged by radiation, causing side effects. The way radiation is given has changed over the years, leading to a lower risk of late effects.

Impact on the Brain

Damage to the Ears

Radiation to the head can damage the cochlea , and/or the ear canal. This can lead to hearing loss, dryness of your ear canal, and fluid in your inner ear. These problems could cause:

  • A feeling that your ear is full or clogged.
  • Ringing in the ears .

If you are having any of these issues, you should call your provider. An audiogram or consult with an audiologist can help decide how these side effects can be managed.

Spinal Cord Damage

Skin Changes

Radiation can lead to permanent changes in the skin.

If you notice any new or worsening skin issues anywhere on your body, you should contact your provider to be checked.

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How Can I Manage Skin Changes

Avoid excessive temperatures

Avoid exposing the treatment area to excessive temperature including direct sunlight, heat packs, ice packs, saunas or hot spas during the course of your radiation therapy. Do not use talcum powder or sunscreen in the treatment area.

Wear loose fitting clothing

Avoid wearing tight fitting clothing that could potentially rub or irritate the skin. Loose cotton underwear is best.

Wash with warm water and pat dry

You may wash the skin that is being treated with warm water and a mild non-perfumed soap. Pat dry the skin do not rub.

Moisturise twice a day

Your care team will recommend a cream to help manage any skin changes. At the start of your treatment, apply cream to the area being treated twice a day. As treatment progresses, you may need to apply the cream three to four times per day. Do not apply cream within the hour prior to your treatment, as cream needs to be well absorbed. Let your nursing team know if you continue to experience skin changes.

Prevention And Mitigation Of Radiation Enteropathy

Radiation Therapy Contouring

Strategies or interventions for protecting normal tissues from radiation injury may be divided into two conceptual categories . The first approach is to directly protect against or mitigate the oxygen free radical injury that occurs during and after radiotherapy. Examples of mitigators of this type include antioxidants, free radical scavengers, and various cytoprotectors . The second approach is to target downstream tissue responses from radiation exposure. Examples include immune-modulators , enterotrophic drugs , compounds that regulate intraluminal contents , drugs that inhibit key signal transduction pathways , and alteration of fibroblast metabolic radiotherapy response . It is not possible to discuss all agents under development in this review. We summarize studies that provide quantitative data on extent of protection for preclinical and clinical studies .

Two important issues should be addressed when considering potential mitigators of radiotherapy damage. These two issues are relevant to all drugs: scheduling of mitigators with radiotherapy and verifying that mitigators do not protect tumor against radiotherapy damage. Examples of these considerations are shown below.

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What Is A Late Effect

A late effect is a side effect that is caused by cancer treatment but happens months to years after cancer treatment has finished. Some side effects that you develop during treatment can last for months to years after treatment is completed . These are called long-term side effects.

Late effects can be health issues or psychological, emotional, and practical challenges.

What Are The Benefits Of The Gamma Knife Procedure Compare With Traditional Surgery

There are many benefits of Gamma Knife surgery over traditional surgery. Gamma Knife surgery:

  • Doesnt require incisions or general anesthesia.
  • Can target tumors/lesions deep in the brain that cant be safely reached by traditional surgery.
  • Can target multiple tumors/lesions at the same time.
  • Avoids other risks and complications of surgery .
  • Limits damage to the surrounding healthy tissue.
  • Results in little to no post-treatment discomfort or pain.
  • Is usually performed as an outpatient procedure .
  • Allows return to usual activities in a day or two.
  • Usually doesnt require physical therapy or other rehabilitation.

Its covered by most insurance and Medicare .

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Further Pushing The Limits

It isnt surprising that a higher radiation dose is better, but SBRT technology is what allowed that dose to be delivered safely, said Dr. Buchsbaum. In short, careful patient selection and a higher dose yielded the expected results.

Moving forward, its important that practitioners apply this treatment approach on patients with limited spinal metastases, and not the general population of all patients with spinal metastases, he added.

This isnt for the patient who has pain everywhere , which is unfortunately the majority of patients, agreed Dr. Sahgal. But if you have a defined region of metastatic disease in the spine, and you can pinpoint the pain to that region, that’s going to be who benefits.

His team hopes to test if further pushing the limits of spinal SBRT could help a greater number of patients with limited spinal metastases. They plan to test both 28 Gy in two fractions, and an ultra-high single dose of 24 Gy, to see if either regimen can reduce pain in more patients while maintaining the level of safety seen in the current trial.

They are also designing trials to see if SBRT can eliminate pain from bone metastases in other parts of the body, such as the arms or the ribs, Dr. Sahgal explained.

Theres data that suggests it will, but we need to prove it, he said. If it can, that will change the game overall for patients with bone metastases.

Whats The Outlook After Undergoing The Gamma Knife Procedure

Radiation Treatment: Managing Your Side Effects

The success of the Gamma Knife procedure depends on the size, location, type of lesion, your personal medical history, and other factors. Discuss your expectations and outlook with your neurosurgeon and your radiation oncologist before treatment.

The goal of Gamma Knife surgery is for the radiation to stabilize, shrink or destroy the tumor or lesion. Depending on your condition, you may or may not need additional Gamma Knife treatment or traditional now-more-manageable surgery. You will have follow-up CT and/or MRI scans to check on treatment progress.

It may take weeks, months, a year to see the full effects of treatment. For example, pain relief if you have trigeminal neuralgia can occur anytime between one day and six months, with most people improving within one month. Cancerous tumors typically become stable or get smaller over a period of weeks to months. Many noncancerous tumors stop growing immediately , but may not get smaller in size. Arteriovenous malformations may take two to three years to resolve after treatment.

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Cavernous Sinus And Skull Base Meningiomas

In a large series of 255 patients with skull base meningiomas treated with Gamma Knife, the actuarial progression-free survival at 5 and 10 years was 96% and 79%, respectively , while Igaki documented actuarial local tumour control rates of 86.9% and 78.9% at 5 and 10 years, respectively . Higher local control was seen in smaller tumours and in meningiomas treated with prescription doses above 14 Gy . New cranial neuropathies occurred or worsened in 8.6% and decline in cognition or memory or cerebellar deficits, etc. in 2%, with petrous or clival location being predictive factors for side effects versus parasellar, petroclival and cerebello-pontine angle location . In cavernous sinus, meningiomas local tumour control rates were 99% at 5 years and 90.4% at a mean follow-up of 82.0 months with a resulting 10-year actuarial tumour growth control rate of 83.8% . The complication rate of 6% included optic neuropathy, worsened diplopia or pituitary dysfunction while 21.0% of patients experienced improvement of symptoms .

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What Is A Cyberknife

The first thing prostate cancer patients should know about ground-breaking CyberKnife Radiotherapy Treatment, is that it doesnt involve a knife or any surgical procedure. Patients rest on a manoeuvrable seat or table each fifteen seconds their x-rays are taken, as a robotic arm manoeuvres around them, accurately delivering beams of radiotherapy from numerous angles.

Traditionally, radiotherapy treatments allow for a small margin of error this is due to basic inaccuracies or unavoidable movements of the prostate or patient. The CyberKnife vastly reduces this margin of error, bringing it down from between five and fifteen millimetres to just two or less with this high level of precision.

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Things To Report Immediately

  • Pain in your back, which may move to the side. The pain may be worse when you lie down, cough, sneeze, or move.
  • Band-like pain that wraps around your chest and/or midsection
  • Numbness, tingling, or loss of feeling in toes or fingers
  • Weakness in your legs or a change in the way you walk
  • Change in your bowel or urinary habits, such as constipation or being unable to empty your bladder
  • Loss of bowel or bladder control

If Youre Getting Radiation Therapy To The Head Or Neck

A Current Review of Spatial Fractionation: Back to the Future ...

People who get radiation to the head and neck might have side effects such as:

  • Soreness in the mouth or throat

How to care for your mouth during treatment

If you get radiation therapy to the head or neck, you need to take good care of your teeth, gums, mouth, and throat. Here are some tips that may help you manage mouth problems:

  • Avoid spicy and rough foods, such as raw vegetables, dry crackers, and nuts.
  • Dont eat or drink very hot or very cold foods or beverages.
  • Dont smoke, chew tobacco, or drink alcohol these can make mouth sores worse.
  • Stay away from sugary snacks.
  • Ask your cancer care team to recommend a good mouthwash. The alcohol in some mouthwashes can dry and irritate mouth tissues.
  • Rinse your mouth with warm salt and soda water every 1 to 2 hours as needed.
  • Sip cool drinks often throughout the day.
  • Eat sugar-free candy or chew gum to help keep your mouth moist.
  • Moisten food with gravies and sauces to make it easier to eat.
  • Ask your cancer care team about medicines to help treat mouth sores and control pain while eating.

If these measures are not enough, ask your cancer care team for advice. Mouth dryness may be a problem even after treatment is over. If so, talk to your team about what you can do.

How to care for your teeth during treatment

Radiation treatment to your head and neck can increase your chances of getting cavities. This is especially true if you have dry mouth as a result of treatment.

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Risk Of Neurological Deficits

As a matter of fact, both current neurological function and potential neurological compromise based on the amount of epidural disease or cord compression must be considered. A disease limited to bone, actually, poses relatively little immediate risk for the patient neurological status, and the treatment for this as compared to spinal cord compression is clearly different.

Assessment of the degree of epidural disease is crucial to determine the most suitable treatment. Bilsky et al. proposed a systematic grading of the degree of epidural spinal cord compression , which is now widely used amongst spinal oncologists.

The ESCC scale consists of six grades: grade 0, bone involvement alone grade 1, epidural impingement grade 2, the retention of cerebrospinal fluid is visible despite spinal cord compression and grade 3, cerebrospinal fluid is not visible due to marked spinal cord compression. Grade 1 is classified into three subgroups: grade 1a, epidural impingement without deformation of the thecal sac grade 1b, compression of the thecal sac without spinal cord abutment and grade 1c, deformation of the thecal sac with spinal cord abutment in the absence of spinal cord compression .

Figure 1. Bilski classification of epidural spinal cord compression .

Definition Of Types Of Recurrences

The radiation field was defined as the tumour volume contained within the prescription dose. Tumour recurrence was defined as a progression of tumour volume within the initial radiation field, i.e. within the prescription dose. Out-of-field recurrence was defined as tumour progression immediately adjacent to the radiation field and hence outside the initial prescription isodose. The occurrence of a new meningioma was defined as a distant tumour unrelated to the radiation field.

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Late Vertebral Side Effects In Long

  • Miro-Pekka Jussila,

    Roles Conceptualization, Data curation, Formal analysis, Investigation, Visualization, Writing original draft, Writing review & editing

    Affiliations Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland, Medical Research Center, University of Oulu, Oulu, Finland

  • Contributed equally to this work with: Tiina Remes, Julia Anttonen

    Roles Conceptualization, Data curation, Funding acquisition, Investigation, Writing original draft, Writing review & editing

    Affiliations Department of Pediatrics and Adolescence, Oulu University Hospital, Oulu, Finland, PEDEGO Research Unit, Oulu University Hospital and University of Oulu, Oulu, Finland

  • Contributed equally to this work with: Tiina Remes, Julia Anttonen

    Roles Data curation, Formal analysis, Investigation, Visualization, Writing original draft, Writing review & editing

    Affiliations Department of Pediatrics and Adolescence, Oulu University Hospital, Oulu, Finland, PEDEGO Research Unit, Oulu University Hospital and University of Oulu, Oulu, Finland

  • Roles Conceptualization, Investigation, Resources, Writing review & editing

    Affiliation Department of Womens and Childrens Health, Uppsala University, Uppsala, Sweden

Permanent Hearing Loss A Reasonable Price To Pay

Dr. Gieschen on the Side Effects of Radiation Therapy in NSCLC

An acoustic neuroma is also called a vestibular Schwannoma. Gamma Knife treatment may be delivered as a single event or in multiple smaller events .

Gamma Knife works by stopping tumor growth, and in some cases it even shrinks over time.

Why would you want to undergo Gamma Knife surgery for acoustic neuroma treatment if a common side effect is permanent hearing loss? Some benefits:

Facial and trigeminal nerve function can be preserved for most patients.

No post-operative pain no post-operative rehabilitation. Patients can immediately resume activities.

No hair is shaved.

Eliminates risk of infection, blood clots, hemorrhaging, brain swelling, prolonged facial weakness/paralysis and permanent facial weakness/paralysis.

The cost is often 20% to 35% less than conventional neurosurgery.

The downside is as follows:

Slight risk of tumor regrowth, requiring periodic MRI surveillance.

Non-successful treatment usually means a micro-surgical removal rather than more Gamma Knife attempts.

Very low to non-existent risk of malignant transformation triggered by the treatment.

Good chance of permanent hearing loss.

Before you begin panicking that Gamma Knife for your acoustic neuroma will cause permanent hearing loss, you should know that micro-surgery as well can yield this side effect. Its actually the most common complication.

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Mouth And Throat Changes

Radiation therapy to the head and neck can cause mouth changes. Radiation not only kills cancer cells but can also harm healthy cells in the glands that make saliva and the moist lining of your mouth. You may have:

  • Loss/change in taste
  • Thickened saliva

Some problems, like mouth sores, may go away after treatment ends. Others, such as taste changes, may last for months or even years. Some problems, such as dry mouth, may get better but never go away.

Mouth Care After Radiation

Your Throat

Radiation therapy to the neck or chest can cause the lining of your throat to become swollen and sore. Your risk for throat changes depends on how much radiation you are getting, whether you are also having chemotherapy, and whether you use tobacco and alcohol while getting radiation therapy. You may notice throat changes in 23 weeks after starting radiation. These will likely get better 46 weeks after you have finished treatment.

Nutrition During Head, Neck or Chest Radiation

Hair Loss Or Thinning

Radiotherapy to the brain can cause hair loss or thinning. If you are having treatment to a particular part of the head, your hair usually falls out in that area. You might also have some hair loss on the opposite side of the head, where the radiotherapy beams pass through. This area is called the exit site.

Whether or not your hair grows back depends on the type of radiotherapy you’re having. For example, if you’re having radiotherapy to treat your symptoms, it’s likely that your hair will grow back. Whereas treatment to try to cure your cancer uses a high dose of radiation and so permanent hair loss is much more common.

You might like to cover your head with a soft hat, scarf or wig until your hair grows back.

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