Mucositis
Radiation therapy (RT) causes mucositis as an early side effect.
The mucosa becomes ulcerated about 3 weeks or so after the start of RT and will heal up roughly 1 - 2 weeks after RT is completed.
Mucositis of the oral, pharyngeal and esophageal mucosa becomes painful and can affect oral intake of fluids and food.
Supportive care involves:
- Analgesics
- Mouth wash (Seattle mouthwash or Tantum work well)
- Maintenance of fluid and food.
Chemotherapy
Several agents are associated with significant mucositis:
- High dose Methotrexate
- Cytosine arabinoside
- Etoposide
Infection
Mucosal ulceration can be associated with infection.
Oncology patients are more prone to mucosal disruption from infection with agents such as herpes simplex and CMV.
Skin Effects
Radiation therapy (RT) causes early and long term skin problems.
- Skin irritation usually first becomes visible after 2-3 weeks of fractionated XRT.
- First acute symptom is often erythema, while several other skin changes may follow:
- edema
- alopecia
- desquamation
This is a picture of very severe moist desquamation at the end of a radical RT course combined with chemotherapy. The skin healed completely, but remained hyper-pigmented within the RT field.
Hyperpigmentation, desquamation, and epilation generally occur only after high dose RT.
Some chemotherapeutic agents make the skin effects induced by radiation worse:
- Methotrexate
- Actinomycin D
- Doxorubicin.
Doxorubicin can cause radiation "recall" effects - skin becomes red again within the previous RT field after drug administration.
After acute changes disappear, it may be several years before late effects become apparent. These later skin changes include:
- xerosis
- atrophy
- telangiectasia
- subcutaneous fibrosis
- necrosis
Symptom Management
Management of acute symptoms involves symptomatic treatment (pain control) and wound care to promoting re-epithelialization.
Early on skin reactions can become itchy and low dose topical steroids may be helpful.
If the skin reaction becomes severe with moist desquamation then topical Flamazine
(Silver Sulfadiazine) 3X daily provides some symptomatic relief.
Recommendations to protect skin after RT include:
- avoid sunlight exposure during treatment
- avoid exposure to extreme temperatures
- avoid lotions and creams on the skin, except if recommended by a physician
- use lukewarm water on the skin, avoid scrubbing, pat dry
- wear loose-fitting clothing over affected areas
