Oral side effects of Radiotherapy

Taken from Lancet Oncology

Because of typical tissue reactions to ionising radiation, radiotherapy in the head and neck region usually results in complex oral complications aff ecting the salivary glands, oral mucosa, bone, masticatory musculature, and dentition. When the oral cavity and salivary glands are exposed to high doses of radiation, clinical consequences including hyposalivation, mucositis, taste loss, trismus, and osteoradionecrosis should be regarded as the most common side-eff ects. Mucositis and taste loss are reversible consequences, usually subsiding early post-irradiation,
whereas hyposalivation is commonly irreversible. Additionally, the risk of rampant tooth decay with its sudden onset and osteonecrosis is a lifelong threat. Thus, early, active participation of the dental profession in the development of preventive and therapeutic strategies, and in the education and rehabilitation of patients is paramount in consideration of quality-of-life issues during and after radiotherapy.

Apology

First I apologise for going into hibernation without informing.

RADIOTHERAPY IN BREAST CANCER

In Breast Conserving Surgery patients;

After breast-conserving surgery (BCS), a particularly common site of local recurrence is the conserved breast itself (or the axilla, if this has not been treated effectively). The risk of recurrence in a conserved breast can be substantial even in node-negative disease that has
been confirmed by axillary clearance, and it can be greatly reduced by radiotherapy. Hence, the recent National Institutes of Health (NIH) consensus conference on early breast cancer recommended that after BCS there should be radiotherapy to the conserved breast.


Post-mastectomy radiotherapy:

Even after mastectomy, an appreciable risk of local recurrence (eg, in the chest wall or lymph nodes) can remain unless some reliable method of investigation, such as axillary clearance, has found no evidence of nodal involvement. If axillary investigation reveals nodal involvement (or if the axilla has not been adequately investigated), post-mastectomy radiotherapy can produce
a substantial absolute reduction in this risk of local recurrence, and previous trials and meta-analyses have shown that although it has little effect on breast cancer mortality during the first few years, it can produce a moderate, but definite, reduction in longer-term breast
cancer mortality. Hence, the NIH consensus conference recommended radiotherapy after mastectomy for women at high risk of locoregional recurrence (eg, those with four or more involved lymph nodes).
Any doubts or queries, you can mail or leave your question here.

Effective Palliation and Medical Records

The tongue cancer patient from Indore did visit me today. She was operated in May and took radiation after surgery. They had brought lot of medical documents but only few had relevant information.
I could not make out from the records what was her pre therapy staging, what kind of operation was done etc. From the histopathology I learnt that the cancer was of squamous cell type infiltrating one-third of tongue. The radiotherapy paper let me know that she has received 6000cGy. Apart from this there was no greater detail.
I could not decipher why a neck dissection was not done and why even though the patient was on regular follow up the neck node was allowed to grow to a size of cricket ball. The surgeon at Indore , supposed to be very reputed and above 60 years, adviced endoscopy for her complaint of inability to swallow. His attention on side effects of radiotherapy prevented him from addressing the neck nodes. Ofcourse I counselled the patients that the treatment at Indore was appropriate and the situation is bad becuse biologically the tumor is bad.
The patient had come with great hopes of getting treated at Mumbai but as she is having advanced malignancy,because of a large matted neck node engulfing the carotid , I adviced them palliative care at Indore itself. It is much better to be at home and take treatment than to struggle in an alien city. I tried to guide them to the best. Hope they heed my advice and take supportive care at Indore or at the maximum palliative cisplatin based chemotherapy.

Tongue cancer

Today morning I got a phone call from a patient at Nashik. The patient is a female less than 40 years of age who has been treated for tongue cancer at Indore. She was operated at Indore and also took post operative Radiotherapy at Indore itself. At present her complaints are that she is not able to take even liquids properly. She has been investigated at Nashik and the doctor over there opined that it is a recurrence which is not salvageable. She has been offered palliative chemotherapy. They also have been given an impression that if chemotherapy would have been given after surgery then she had a better chance of disease control.
The lady is coming tomorrow for consultation to Mumbai. i will get a better summary of the case tomorrow.
The problems she is facing can be due to Radiotherapy or because of tumor recurrence. If it is a tumor recurrence it is bad for her.
i wanted to tell them that it is going to be a futile attempt coming to Mumabi as Indore also has excellent doctors. Also the second opinion in this treated case probably is not going to change much for her. But who am I to deny hope. They will feel better after they have consulted a premier hospital at Mumbai.
Let hope prevail.

Radiotherapy

Treatment of cancer by radiation.