GuidelinesEML (Adult Hospital STG)
Side Effects from Radiation and Chemotherapy
Standard Treatment Guidelines and Essential Medicines List for South Africa, Hospital Level, Adults 2019 Edition
Radiation and Chemotherapy Related Mucositis
Radiation- or Chemotherapy-induced Pneumonitis
Radiation- or Chemotherapy-induced Cystitis
RADIATION AND CHEMOTHERAPY RELATED MUCOSITIS
ICD-10 Code: K12.3
DESCRIPTION
- An inflammatory reaction where shallow ulcerative lesions occur on mucosal surfaces.
GENERAL MEASURES
- Avoid irritants (e.g.: smoke, alcohol and hot spicy food).
- Ensure adequate fluid intake e.g.: 2 L/day.
- Modify diet to include soft or pureed foods.
- Use lip care e.g. petroleum jelly, as required.
- Keep dentures clean and snug fitting. If loose, refer to dentist.
- Ensure adequate mouth care:
- Clean teeth with soft toothbrush or clean cloth.
- Avoid dental flossing.
- Rinse and gargle regularly, at a minimum after every meal.
- Simple mouth rinse:
- ½ teaspoon salt
- 3 teaspoons sodium bicarbonate
- 1 L of filtered or previously boiled water.
(Discard this mixture after 3 days).
MEDICINE TREATMENT
- Adequate pain control. See Analgesia for acute non-surgical pain.
WET DESQUAMATION OF SKIN
ICD-10 Code: R23.4
DESCRIPTION
- Acute toxicity of skin that occurs during radiation treatment and up to 2-3 weeks after completion of the radiation.
- Few or even no skin care products are effective to prevent or reduce acute radiotherapy skin reactions.
GENERAL MEASURES
- Keep skin clean and apply paraffin gauze dressings daily.
- Avoid friction and trauma from clothes, weather, etc.
- Prevent infection.
- Encourage good nutrition.
- Encourage smoking cessation.
MEDICINE TREATMENT
- Adequate pain control. See Analgesia for acute non-surgical pain.
RADIATION- OR CHEMOTHERAPY-INDUCED PNEUMONITIS
ICD-10 Code: J70.0
DESCRIPTION
- Radiation pneumonitis is inflammation of the lung caused by radiation therapy to the chest. It mostly develops 1-6 months after treatment.
- Chemotherapy-induced pneumonitis is inflammation of the lung caused by various chemotherapy agents. It mostly develops on treatment.
- Symptoms include: fever, dry cough, chest congestion, shortness of breath, and chest pain.
- The differential diagnosis includes infectious pneumonitis, pulmonary embolism, and tumor recurrence.
GENERAL MEASURES
- Symptoms generally resolve within 7-10 days following cessation of treatment.
- Maintain hydration.
MEDICINE TREATMENT
For symptomatic subacute pneumonitis:
- Corticosteroids (intermediate-acting) e.g.:
- Prednisone 1 mg/kg daily for 2-4 weeks at a maximum daily dose of 40-60 mg, and then taper slowly over 3-12 weeks. Refer to Prescribing Information for Specific Medicines, for an example of a dose reduction regimen.
REFERRAL
- All patients with symptomatic pneumonitis.
RADIATION PROCTITIS
ICD-10 Code: K62.7
DESCRIPTION
- An inflammatory process of the rectal mucosa that can present acutely (immediately after the initiation of radiation therapy or up to 3 months after) or chronically (8-12 months after completion of therapy).
- The acute process is usually self-limiting.
- Symptoms include diarrhoea, nausea, cramps, tenesmus, urgency, mucus discharge, and minor bleeding.
- Severe complications include bleeding, strictures, perforation, fistula, and bowel obstruction.
Diagnosis
- Suspect radiation proctitis when there has been previous radiation to the pelvis.
- On colonoscopy/sigmoidoscopy, pallor, friability, telangiectasia are seen localised to the area that was exposed to radiation. Do not biopsy.
- Exclude other causes, e.g.: malignancy, infection, or inflammatory bowel disease.
REFERRAL
- All patients to a radiation oncology centre.
RADIATION- OR CHEMOTHERAPY-INDUCED CYSTITIS
ICD-10 Code: N30.4
DESCRIPTION
- Symptoms include dysuria, frequency, nocturia, recurrent haematuria, and recurrent urinary tract infection.
GENERAL MEASURES
- Increase fluid intake.
- Urine microscopy, culture and sensitivity to exclude/confirm an infection.
- High dose cyclophosphamide and ifosfamide may cause severe cystitis due to excretion of acrolein into bladder.
- Acute cystitis is usually self-limiting and resolves in one to two weeks after completing radiation therapy.
- If symptoms continue, cytoscopy with biopsy is indicated.
REFERRAL
- All patients.
Standard Treatment Guidelines and Essential Medicines List for South Africa, Hospital Level, Adults 2024 Edition