Radiation complications

Question 1

acute radiation pneumonitis is

Answer 1

seen after 4-12 weeks after neck or thoracic radiation tx.

See this as antibiotic non responsive pna with pulmonary infiltrate

Question 2

fever, dypsnea, cough pleuritic chest pain and leukocytosis

Answer 2

presentation of radiation pneumonitis

Question 3

CXR findings of radiation pneumonitis

Answer 3

perivascular haziness, chest CT with patchy ground glass alveolar infiltrates or consolidative opacities.

affected tissue is confined to the radiation treatment port (line of tx) and may form a distinct boundary with normal agent parenchyma called a “straight line effect”.

Can progress in 6-12 months of fibrotic radiation pneumonitis.

Question 4

volume loss and coarse reticular dense opacities which happen 1 yr after radiation tx.

See dypsnea, cough and pleuritic chest pain without fever.

Answer 4

fibrotic radiation pneumoniits

Question 5

diagnosis of acute radiation pneumoniits is based on:

Answer 5

exclusion, bronchoscopy to rule out other diagnoses like infection or malignancy

Question 6

treatment of acute radiation pneumonitis:

Answer 6

prednisone 60 mg for 2 weeks and gradual taper of 3-12 weeks

Question 7

xerostomia is

Answer 7

dry mouth

Question 8

large radiation doses side effects to the neck:

Answer 8

causes dry mouth or xerostermia, can have permanent damage if parotid glands are not spared and so see:

oral pain, dental caries, oral infections, anorexia and difficulty walking and chewing and swallowing

treat with cevimeline or pilocarpine to stimulate salivary muscarinic receptors and increase saliva production.

Question 9

treatment of radiation induced xerostomia is:

Answer 9

removing medications that can worsen xerostomia (anticholinergics and antidepressants)

nonpharmacological: salt water rinses, water soluble water lubricants, regular dental care and surveillance, frequent chewing (sugarless gum) to mechanically stimulate salvation

Pharmacologic therapy: cholinergic medications (pilocarpine, cevimeline) stimulates salivary muscarinic receptors and increase saliva production,

adverse effects include: increased parasympathetic activity like sweating, nausea, vomiting and wheezing.

Question 10

treat Sjogren’s xerostomia with this medication:

Answer 10

cholinergic medications that can increase pilocarpine and cevimeline

Question 11

treatment of radiation therapy from Hodgkin’s lymphoma

Answer 11

• constrictive pericarditis
• accelerated CAD, irrespective of age (so can see at age 30)
• solid tumors (breast cancer, lung cancer, thyroid cancer)
• radiation pneumonitis
• thyroid dx