Survivorship: Health Concerns After TBI

Autor: Carolyn Vachani, RN, MSN
Contribuidor de contenido: Jacqueline Smith, MSN, CRNP, AOCNP
Fecha de la última revisión: December 14, 2023

Total body irradiation (TBI) may be used to treat leukemias and lymphomas or may be given to patients who are undergoing bone marrow transplant. Although radiation is given to every part of the body during TBI, doses are much lower than those used to treat some other cancers. As a result, the side effects may be different.

Head & Neck Issues

TBI can affect the organs and glands in your head and neck. It may damage the salivary glands, causing dry mouth. This increases your risk of getting cavities in your teeth. You should see a dentist for cleanings every 6 months, exams, fluoride treatments, and x-rays yearly. Artificial saliva may also be helpful. You may also have dry eyes. Artificial tears can be used for comfort. TBI also puts you at risk of developing cataracts, so you should see an ophthalmologist (eye doctor) yearly.

Thyroid Health

TBI can result in thyroid problems, including hypothyroidism (low thyroid levels), hyperthyroidism (high thyroid levels), and thyroid nodules or tumors. Symptoms of hypothyroidism (the most common issue) include fatigue, weight gain, constipation, dry skin, brittle hair, or cold intolerance. You should have your thyroid checked/examined and have thyroid function testing (TSH level) done each year.

Liver Health

TBI can also cause long-term damage to the liver. Signs of liver damage include abdominal (belly) pain, swelling of the abdomen (ascites), weight gain, and/ or yellowing of the skin (jaundice). You should notify your provider if you have these symptoms. You should have blood tests done to evaluate liver function each year and should be seen by a specialist for any issues. You should avoid alcohol use, as this may increase the risk of liver disease.

Kidney Health

TBI may cause long-term damage to the kidneys. This can result in renal insufficiency (decreased kidney function) and hypertension (high blood pressure). This risk is increased if you have diabetes or if you have received cisplatin or carboplatin chemotherapies. At your annual physical, you should have your blood pressure checked. Kidney function should be checked using blood tests. If you have hypertension, it should be treated with medication. If you have diabetes, you should have strict control of blood sugar levels.

Lung Health

TBI can cause scarring of the lungs. You are strongly encouraged not to smoke, as this increases the risk of lung issues. A yearly history and physical by a healthcare provider should include a pulmonary (lung) exam and ask about possible symptoms (cough, shortness of breath, wheezing). You should get a flu vaccine each year and the pneumococcal vaccine. You may need chest X-rays or pulmonary function tests if you are at high risk or have a change in how your lungs are working.

Fertility

TBI almost always causes damage to the reproductive organs.

Fertility & Sexuality for Men

For men, infertility is caused by damage to germ cells (which become sperm) and Leydig cells, which produce testosterone. Without testosterone, a young boy may not achieve puberty or an adult male may lose secondary sex characteristics (facial hair, mature genitals, deep voice) or loss of sexual function. If you are experiencing any of these changes, you should be seen by an endocrinologist (hormonal specialist).

Fertility & Sexuality for Women

For women, damage to the ovaries may cause infertility and premature ovarian failure. When the ovaries do not make enough hormones, you may experience symptoms of menopause, such as loss of periods, hot flashes, vaginal dryness, and loss of bone density (osteoporosis). Female survivors who experience these symptoms should be counseled about their risk of developing osteoporosis.

Skin Health

After radiation, the skin is more sensitive to sunlight. You should use sunscreen, wear hats, and protect yourself from sun exposure when outdoors.

Cancer Screening after TBI

TBI and chemotherapy can increase your risk of developing a second cancer. You should have all cancer screening tests recommended by your providers. These include breast and cervical cancer screening for women, and colorectal cancer screening for men and women.

If you were treated with abdominal (belly) radiation before you were 18 years old, you should start colon cancer screening with colonoscopy or DNA stool testing 5 years after radiation or at age 30, whichever occurs later. The American Cancer Society recommends that the general public begin colon cancer screening at age 45. You and your provider should discuss these recommendations and the risks and benefits of these tests and decide when you should begin screening. Report any new, unusual, or persistent symptoms to your provider.

Daly, P. E., Samiee, S., Cino, M., Gryfe, R., Pollett, A., Ng, A., … Hodgson, D. C. (2017). High prevalence of adenomatous colorectal polyps in young cancer survivors treated with abdominal radiation therapy: Results of a prospective trial. Gut, 66(10), 1797–1801.
Levy, J. M., Tello, T., Giller, R., Wilkening, G., Quinones, R., Keating, A., & Liu, A. K. (2013). Late Effects of Total Body Irradiation and Hematopoietic Stem Cell Transplant in Children Under Three Years of Age. Pediatric Blood & Cancer, 60(4), 700–704.

Majhail NS, Rizzo JD, Lee SJ, et al. Recommended screening and preventive practices for long-term survivors after hematopoietic cell transplantation; Center for International Blood and Marrow Transplant Research (CIBMTR), American Society for Blood and Marrow Transplantation (ASBMT), European Group for Blood and Marrow Transplantation (EBMT), Asia-Pacific Blood and Marrow Transplantation Group (APBMT), Bone Marrow Transplant Society of Australia and New Zealand (BMTSANZ), East Mediterranean Blood and Marrow Transplantation Group (EMBMT) and Sociedade Brasileira de Transplante de Medula Ossea (SBTMO). Co-published in Biol Blood Marrow Transplant, 2012; 18(3): 348-371; Bone Marrow Transplant, 2012; 47(3): 337–341; and Hematol Oncol Stem Cell Ther, 2012; 5(1): 1-30.

Pearlman, R., Hanna, R., Burmeister, J., Abrams, J., & Dominello, M. (2021). Adverse effects of total body irradiation: a two-decade, single institution analysis. Advances in Radiation Oncology, 6(4), 100723.

Teepen, J. C., Kok, J. L., van Leeuwen, F. E., Tissing, W. J. E., Dolsma, W. V., van der Pal, H. J., … Zsíros, J. (2018). Colorectal Adenomas and Cancers After Childhood Cancer Treatment: A DCOG-LATER Record Linkage Study. JNCI: Journal of the National Cancer Institute, 110(7), 758–767.

Thomas, O., Mahé, M.-A., Campion, L., Bourdin, S., Milpied, N., Brunet, G., … Cuillière, J.-C. (2001). Long-term complications of total body irradiation in adults. International Journal of Radiation Oncology • Biology • Physics, 49(1), 125–131.

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