Survivorship: Late Effects After Radiation for Sarcoma (Extremity)

Autor: OncoLink Team
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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 Sarcoma (of the extremity)

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.

Damage to the Bones

Radiation can cause small cracks (fractures) in the bones that are in the treatment field. Try to avoid trauma including falls or accidents. If you do get hurt, ask your provider if you need any imaging tests to check for bone damage.

Nerve Damage and Lymphedema

Chest wall radiation can damage the nerves, leading to pain or loss of strength or feeling in the arm on the side that was radiated. Damage to the drainage (lymphatic) system in the area can lead to chronic swelling, called lymphedema.

  • The risk of lymphedema is highest for people who also had surgical lymph node dissections and sentinel node biopsy. The risk of lymphedema is lower in cases of sentinel node biopsy but there is still a risk.
  • Notify your provider if you notice any swelling. If you have lymphedema and you develop pain or redness in the arm, especially with fever, you should be evaluated right away for infection.
  • Lymphedema can benefit from treatment by a physical therapist who specializes in lymphedema therapy.

Skin Changes

Radiation can lead to permanent changes in the skin.

  • There may be changes in the color or texture of your skin or new scars. It 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.
  • 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. Make sure to use plenty of sunscreen, wear a hat, and keep the skin 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

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.

National Lymphedema Network, https://lymphnet.org/

Shaitelman, S. F., Cromwell, K. D., Rasmussen, J. C., Stout, N. L., Armer, J. M., Lasinski, B. B., & Cormier, J. N. (2015). Recent progress in the treatment and prevention of cancer-related lymphedema. CA: A Cancer Journal for Clinicians65(1), 55–81. https://doi.org/10.3322/caac.21253

Stubblefield, Michael Dean. (2017). Neuromuscular complications of radiation therapy. Muscle & Nerve56(6), 1031–1040. https://doi.org/10.1002/mus.25778

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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