Oesophagus (serial)
ACUTE SIDE EFFECTS:
- Oesophagitis @ 20Gy (dysphagia). Treatment = soft foods, gargle aspirin, nasogastric or PEG tube, lignocaine viscous gel
ENDPOINT:
- Increased risk of stricture, ulceration (perforation & fistula) @ 55Gy. Treatment = surgical repair
- During RT or months post treatment
Spinal Cord (serial)
ACUTE/CHRONIC SIDE EFFECTS:
- Lhermitte’s syndrome @ 35Gy (electrical sensation running down spine & limbs). Treatment = none
- Post treatment
ENDPOINT:
- Radiation induced myelitis necrosis (paralysis & inconsonance). Treatment = none
Heart (serial & parallel)
ACUTE SIDE EFFECTS:
- Asymptomatic pericarditis @ 20Gy
- Acute pericarditis @ 40Gy (shortness of breath, chest pain). Treatment = analgesics & prednisone
ENDPOINT:
- Late myocardial infarction & fibrosis (reduced output). Treatment = heart transplant
Ribs (serial)
ENDPOINT:
- Osteonecrosis @ 50Gy (leading to pathological fracture). Treatment = surgical removal
- Years post treatment
Breast (parallel)
ACUTE SIDE EFFECTS:
- Radiation induced dermatitis @ 14Gy < (see skin reactions)
CHRONIC SIDE EFFECTS:
- Telangiectasia. Treatment = none
ENDPOINT:
- Fibrosis causing ulceration & atrophy @ 60Gy
- Years post treatment
Brachial Plexus (serial)
ENDPOINT:
- Brachial plexopathy due to nerve damage @ 66Gy. Treatment = physiotherapy
- Months to years post treatment
Lung (parallel)
ACUTE SIDE EFFECTS:
- Acute pneumonitis (dry cough & shortness of breath). Treatment = prednisone (corticosteroid)
ENDPOINT:
- Chronic radiation pneumonitis & fibrosis (decreased lung capacity leading to hypoxia) @ 20Gy. Treatment = prednisone (corticosteroid)
Skin (parallel)
ACUTE SIDE EFFECTS:
- Temporary alopecia @ 10 - 15Gy
- Faint erythema @ 14-16Gy (slight reddening of skin)
- Erythema @ 20Gy (reddening of skin)
- Dry desquamation @ 30Gy (dry, itchy, flaky, peeling skin)
- Moist desquamation @ 40Gy (weeping, blistering skin)
- Permanent alopecia @ 50Gy
CHRONIC SIDE EFFECTS:
- Telangiectasia @ 50Gy (10x10cm field). Treatment = none
- 1-2yrs post treatment
ENDPOINT:
- Gangrene, necrosis & ulceration @ 55Gy (10x10cm field). Treatment = skin graft
- Months to years post treatment
Femoral heads & neck (serial)
ENDPOINT:
- Osteoradionecrosis @ 50Gy (V50<50%). Treatment = artificial hip replacement
- Years to decades post treatment
Small bowel (serial)
ACUTE SIDE EFFECTS:
- Enteritis (abdominal pain, cramping, diarrhoea, nausea, vomiting, dehydration, constipation, fever) @ 20-25Gy. Treatment = small frequent meals, fluids, Maxalon, Cyclizine, Tropisetron, Ondansetron (anti-nausea)
- Diarrhoea @ 25Gy. Treatment = low residue diet, fluids, loperamide, codeine phosphate
- Constipation @ 25Gy. Treatment = high fibre diet, Laxol, Metamucil, coloxyl with Senna
ENDPOINT:
- Obstruction, perforation & fistula @ 45Gy. Treatment = surgical removal & repair
- Months to years post treatment
Bladder (parallel)
ACUTE SIDE EFFECTS:
- Cystitis, dysuria & increased frequency @ 25Gy. Treatment = Ural sachets, cranberry juice, increased fluids, mid-stream urine test for infection (treated with antibiotic)
ENDPOINT:
- Severe frequency & dysuria, severe generalised telangiectasia, frequent haematuria, decrease in bladder capacity @ 65Gy
- Months to years post treatment
Rectum (serial)
ACUTE SIDE EFFECTS:
- Proctitis & tenesmus @ 25-30 Gy. Treatment = Ultraproct, low fibre diet, increased fluids, codeine phosphate, suppositories
ENDPOINT:
- Obstruction or bleeding requiring surgery @ V50<50%, V60<35%, V65<25%
Anus (serial)
ACUTE SIDE EFFECTS:
- Inflammation & moist desquamation of the skin @ 14-16Gy. Treatment = keep area dry & clean, loose underwear, salt water baths
ENDPOINT:
- Chronic ulcers, loss of sphincter function & stenosis @ 60Gy. Treatment = surgical removal + colonoscopy bag
- Months to years post treatment
Testes (serial)
ACUTE SIDE EFFECTS:
- Transient aspermia @ 0.5Gy. Management = advised to have protected sex (may have mutated sperm)
ENDPOINT:
- Permanent sterility @ 1.5Gy. Management = sperm banking
- Weeks to months post treatment
Ovaries (parallel)
ACUTE SIDE EFFETS:
- Persistent amenorrhea @ 2Gy
ENDPOINT:
- Permanent sterility @ 2.5Gy
Vagina (serial)
ACUTE SIDE EFFECTS:
- Vaginal adhesions @ 10Gy. Management = encouraged to use vaginal dilator or gentle sex
- Vaginitis @ 30Gy. Treatment = salt baths
ENDPOINT:
- Ulcer, fistula & fibrosis @ 120Gy (upper vagina), 80-90Gy (mid vagina), 60Gy (lower 1/3 vagina)
- Months to years post treatment
Stomach (parallel)
ACUTE SIDE EFFECTS:
- Gastritis @ 15-20Gy (nausea & vomiting). Treatment = Maxalon, cyclizine, tropisetron, ondansetron prior to treatment, frequent small meals, non-odorous food, favourite foods
ENDPOINT:
- Ulceration, mucosal erosion & perforation @ 45Gy (less than 7% chance). Treatment = analgesics, surgical repair of perforation
Kidneys (parallel)
ENDPOINT:
- Clinical dysfunction, nephritis & kidney failure @ 28Gy (V28<20% = less than 20% chance). Treatment = dialysis
- Months to years post treatment
Liver (parallel)
ACUTE SIDE EFFECTS:
- Jaundice (if 75% + is irradiated), anorexia & fatigue @ 20-25Gy. Treatment = small colourful meals, ensure plus, high fat meals, gentle exercise
- Acute radiation hepatitis & ascities @ 25Gy. Treatment = interferon (hepatitis), sodium restriction, diuretics (ascities), drainage of site & shunt (ascities), low fat & alcohol diet
ENDPOINT:
- Radiation-induced liver disease @ 30-32Gy (V30-32
Spleen (parallel)
ACUTE SIDE EFFECTS:
- Altered blood counts & poor immune function @ 30-40Gy. Treatment = blood transfusion & isolation from crowds + sick people
Blood
- White cells effected first
- Drop in blood count may occur @ 10Gy (week 2/3)
