Transcript RTT 335 Patient Care in Radiation Therapy

RTT 335 Patient Care in
Radiation Therapy
Acute complications
Curative doses
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20 – 30 Gy: seminoma, ALL
30 – 40 Gy: Wilm’s, neuroblastoma
40 – 50 Gy: HD, lymphosarcom, skin cancer
50 – 60 GY: lymph nodes, SCC, breast, ovarian,
medulloblastoma, H&N.
60 – 80GY: prostate, H&N, glioblastoma,
osteogenic, melanoma, uterus and cevix, lung,
bladder.
Skin
• Skin reactions are not as common today as they
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used to be, because of the skin sparing effects
of megavoltage linear accelerators.
Skin reactions are still seen in:
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Intentional treatment of skin
Tangential areas
Neutrons and electrons
With certain chemotherapy agents
Electron or low photon comtamination
Skin
• A transient erythema may be seen after
one tretment
• True erythema occurs around the third or
fourth week of treatment
• Appearance time will depend on energy,
field size, fraction size, skin type.
Skin reactions
• Erythema
• Dry desquamation
• Moist desquamation
• Necrosis
Treatment guidelines
• Protect area from mechanical trauma
• Protect from sunlight
• Avoid chemical irritation
Treatments for skin reactions
• Erythema: cream or lotion
• Dry desquamation: aquaphor or cream
• Wet desquamation: protect from infection,
warm wet soaks.
Generic instructions for skin
• No heat
• No ice bags
• Don’t scratch
• Don’t rub soap on area
• Do not shave area
• Prevent rubbing of straps
• No tight undewear
Generic instructions for skin
• No deodorants and perfume in area
• Keep out of sun
• Don’t apply irritating liquids like iodine,
alcohol.
Alopecia
• Hair loss occurs only in treated areas.
• Hair loss on head can cause emotional
distress.
• Usually begins about three weeks into
treatment.
• Regrowth only occurs about three months
after treatment.
• Changes in texture and color might occur.
Alopecia
• Patient should be told where to obtain
wigs, scarves and hats.
Oral cavity
• This is one of the most demanding areas
to have treated.
• Nutritional support is necessary.
• Prior to treatment, a program for oral care
and hygiene must be set up.
Oral cavity reactions
• Reddened mucosa
• Pain(odynophagia) – patient eats less
• Patchy areas of exudate
• Xerostomia
• Loss of taste
Before treatment
• Patient informed of possible problems
• Complete dental evaluation
• Oral prophylaxis – brushing flossing,
fluoride treatments
• No smoking or alcohol
• Dietary counselling
During treatment
• No hot, cold or spicy foods
• Aspirin
• Codeine
• xylocaine
As reactions get worse
• Mouth washes
• Artificial saliva
• Jaw exercises for TMJ
Brain
• Brain edema – steroids
• Alopecia – treat as before
Nausea and vomiting
• Can be caused by the treatment or the
tumor.
• Radiation induced nausea usually occurs
shortly after treatments and patients feel
better during weekends.
• Sight and smell of the treatment room can
cause nausea
Nausea
• Caused mostly by irradiation of small
bowel.
• Affected by volume and doserate.
• Treat with Compazine or similar anti
nausea drugs.
• Daily dose may need to be reduced.
Radiation cystitis
• Mild symptoms are treated with
antispasmodics
• Drinking lots of fluids helps – cranberry
juice is believed to help.
Diarrhoea
• Usually accompanies pelvic radiation.
• Temporary diarrhoea is controlled with
Lomotil.
• The diarrhoea should be controlled to
avoid electrolyte imbalance.
• Perianal care to avoid irritation and
heorrhoids; keep clean and dry as
possible, no tight clothes, topical steroids.
Hematologic support
• Lymphocytes respond early
• WBC should be kept above 2000/ml
• RBC are important in radiation therapy because
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of the oxygen effect, so anemia should be
corrected before the start of treatment.
Thrombocytopenia is usually not a problem
unless the patient is receiving chemo.