Survivorship: Late Effects After Radiation for Brain/Spinal Cord Tumors

Autor: OncoLink Team
Fecha de la última revisión: 10 de febrero de 2020

What is a late effect?

A late effect is as a side effect related to a cancer diagnosis or treatment that happens months to years after treatment. Some side effects that you develop during treatment can last for months to years after treatment is completed (for example, fatigue or neuropathy). These are often called long term side effects.

Late effects can be health issues or psychological, emotional and practical challenges.

Late Effects After Radiation for Brain/Spinal Cord Tumors

Side effects from radiation treatment are directly related to the area of the body being treated. Any area in the treatment field has a risk of being damaged, causing side effects. As radiation techniques have improved over the years, the risk of late effects has decreased.

Impact on the Brain

  • Radiation to the brain can change how well your brain functions. The side effects you have often depend on the area of the brain that received radiation. In some cases, the whole brain is treated.
  • The more common side effects include short term memory loss, dementia, feeling tired, trouble concentration or learning, and issues with walking and balance. Your provider will monitor you for these issues. If you notice any changes in how your brain is working you should call your provider.
  • The pituitary gland makes hormones that regulate how other glands work. It can be damaged when radiation is given to the brain. Weight gain or loss, changes in sexual function or libido, extreme fatigue, depression and always feeling hot or cold are a few signs of abnormal levels of hormones. If you have any of these symptoms, you should speak with your provider. Hormone levels can be checked using a blood test.
  • Radiation to the brain can increase your risk of a stroke or a secondary brain cancer. If you develop sudden weakness in a part of your body, start slurring your speech or have trouble understanding those around you, you should immediately call 911. If you notice any changes in how your brain works you should contact your provider. They will determine if further testing is needed.

Damage to the Ears

Radiation to the head can damage the cochlea (a part of the inner ear), and/or the ear canal. This can lead to hearing loss, dryness of the ear canal and fluid collection in the inner ear. These problems could result in:

  • A full or clogged ear feeling.
  • Dizziness.
  • Ringing in the ears (tinnitus).
  • Vertigo (sensation of spinning or loss of balance).

If you are having any of these issues, you should call your provider. An audiogram (hearing test) or consult with an audiologist can help decide how these side effects can be managed.

Spinal Cord Damage

  • When the spinal cord is in the field of lung radiation treatment, the nerves in the spine can be damaged. Symptoms include loss of strength, feeling, or coordination of the arms or legs, paralysis, or problems with bowel or bladder control. Sometimes nerve damage can cause a sensation of electric shock spreading down the arms or legs. If you develop these symptoms, you may need imaging tests or to be seen by a neurologist for further workup.
  • Radiation can also cause damage to the bones of the spine. This can result in a reduction in height or change in the curvature of the spine. Radiation to these bones can also put them at risk for fracture. If you have any new back pain you should call your provider right away. You may need x-rays or other imaging tests.

Skin Changes

Radiation can lead to permanent changes in the skin.

  • You may develop new scars or notice changes in the color or texture of your skin. Radiation can also change the color and texture of your hair or can cause permanent hair loss in the treated area.
  • The soft tissue and muscles under the skin can develop scarring and/or shrinkage, which can lead to a loss of flexibility and movement or chronic swelling in this area.
  • You may develop chronic or recurring ulcers of the skin in the area treated. Blood vessels of the skin may become dilated and more visible, although this is not harmful.
  • If the skin feels tight or sore, you can apply vitamin E to the skin.
  • Use fragrance and dye-free soaps and moisturizers in the area if your skin is sensitive after radiation.
  • After radiation, the skin in the treated area is more sensitive to sunlight. This sensitivity will last for your lifetime. Practice sun safety, using plenty of sunscreen, wear a wide-brimmed hat, and keep skin in the treated area covered with clothing. Try to avoid being out in the sun between the hours of 10 am-4 pm when it is the strongest.

If you notice any new or worsening skin issues anywhere on your body, you should contact your provider for an assessment.

Managing Late Effects

If you experience any concerning or persistent symptoms, contact your care team. Some side effects require specialized care from healthcare providers experienced in working with cancer survivors. 

Interdisciplinary survivorship clinics are available at many cancer treatment sites. If a clinic is not available near you, talk with your oncology care team about resources for managing your late effects.

After treatment, talk with your oncology team about receiving a survivorship care plan, which can help you manage the transition to survivorship and learn about life after cancer. You can create your own survivorship care plan using the OncoLife Survivorship Care Plan.

Referencias

Bates, A., Gonzalez-Viana, E., Cruickshank, G., & Roques, T. (2018). Primary and metastatic brain tumours in adults: summary of NICE guidance. BMJ362, k2924.

Dietrich, J., Gondi, V., & Mehta, M. (2018). Delayed complications of cranial irradiation. UpToDate.Edelstein, K., Richard, N. M., & Bernstein, L. J. (2017). Neurocognitive impact of cranial radiation in adults with cancer: an update of recent findings. Current opinion in supportive and palliative care11(1), 32-37.

Feuerstein, M., & Nekhlyudov, L. (2018). Handbook of Cancer Survivorship, 2nd. Ed. Springer,  https://doi.org/10.1007/978-3-319-77432

Koontz, B. F. (2017). Radiation Therapy Treatment Effects: An Evidence-based Guide to Managing Toxicity. Springer Publishing Company.

Wei, J., Meng, L., Hou, X., Qu, C., Wang, B., Xin, Y., & Jiang, X. (2018). Radiation-induced skin reactions: Mechanism and treatment. Cancer Management and Research11, 167–177. https://doi.org/10.2147/CMAR.S188655

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