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

Side Effects After Cancer Treatment

There are different types of side effects you may have during or after cancer treatment.

• Short-term: side effects that happen while you are on treatment and end shortly after treatment. Example: mouth sores that heal within a few weeks after treatment is finished.
• Long-term: side effects that happen while you are on treatment and last for months to years. Some of these side effects will not go away. Example: neuropathy.
• Late effects: side effects that happen months to years after you have finished treatment. Example: scar tissue forming in your bowel or bladder after radiation.

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

Late Effects After Radiation for Brain/Spinal Cord Tumors

Side effects from radiation treatment happen in areas where you had radiation treatment. Any area in the treatment field has a risk of being damaged by radiation, causing side effects. The way radiation is given has changed over the years, leading to a lower risk of late effects.

Impact on the Brain

• Radiation to the brain can change how well your brain works. Side effects depend on the area of the brain that received radiation. In some cases, the whole brain is treated.
• The most common side effects are:
  • Short-term memory loss.
  • Feeling tired.
  • Trouble concentrating or learning.
  • Problems with walking and balance.

Your provider will monitor you for these issues. If you notice any of these symptoms and they are getting in the way of your day to day activities, contact your provider.

Pituitary Gland

• The pituitary gland makes hormones that control how other glands work. The pituitary can be damaged when radiation is given to the brain.
• The most common side effects related to radiation to the pituitary gland are caused by changes in your hormone levels regulated by the pituitary gland. They include:
  • Weight gain or loss.
  • Changes in sexual function or libido (desire for sex).
  • Extreme fatigue.
  • Depression.
  •  Always feeling hot or cold.
• If you have any of these signs, you should speak with your provider. Hormone levels can be checked using a blood test.

SMART Migraines

SMART (stroke-like migraine attacks after radiation therapy) Syndrome is a late-effect of brain radiation that can happen in both children and adults who have received radiation to the brain. This is a rare side effect. Symptoms include:

• Migraine-like headaches with nausea, vomiting, and sensitivity to light. You may experience symptoms before and during the headache – these are called an aura. Aura symptoms can include seeing flashes of light or blind spots, GI symptoms, and tingling of hands/feet.
• Stroke like neurological changes like confusion, inability to speak (aphasia), vision changes or vision loss, and weakness on one side of the body.
• Seizures.

If you are having these symptoms, contact your care team right away.

Other Effects on the Brain

Radiation to the brain can increase your chance of having a stroke or brain cancer. If you have sudden weakness in a part of your body, start slurring your speech, or have trouble understanding people speaking, you should immediately call 911.

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 your ear canal, and fluid in your inner ear. These problems could cause

• A feeling that your ear is “full” or clogged.
• Dizziness.
• Ringing in the ears (tinnitus).
• Vertigo (sensation of the room spinning or losing your 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 Effects

When the spinal cord is in the field of lung radiation treatment, the nerves in your spine can be damaged. Nerve damage can cause a feeling of an electric shock spreading down the arms or legs. Signs of spinal cord damage include:

• Loss of strength, feeling, or coordination of your arms or legs.
• Paralysis (unable to move).
• Problems with bowel or bladder control (incontinence).

If you have these signs, you may need imaging tests or to be seen by a neurologist to find the cause.

Radiation can also cause damage to the bones of the spine. This can cause you to become shorter (reduction in height) or change in the shape (curve) of your 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 (feel) 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 scar tissue and/or shrink, which can cause the area to be less flexible or difficult to move. You can also have chronic swelling in this area.
• You may have ulcers on the skin in the area treated. These can be long-lasting or come back over and over. Blood vessels of the skin may become dilated (larger) and more visible. This is not harmful.
• If the skin feels tight or sore, apply vitamin E to the skin to soften it.
• 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, use 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 to be checked.

Managing Late Effects

If you experience any concerning or persistent (long-lasting) problems, contact your care team. Some side effects require specialized care from healthcare providers who have experience working with cancer survivors.

Cancer survivorship clinics are available at many cancer treatment centers. If a clinic is not available near you, talk with your oncology care team about ways to manage your late effects.

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