| Coping
with side effects from head and neck irradiation – Prevention
is better than cure
By:
Dr Goh Choo Beng, Registrar, Dept of Therapeutic Radiology, NCC
Mr Tan, who was diagnosed with NPC
four years ago, underwent radiotherapy for a head and neck tumour.
He remains disease-free today, but is still bothered by dryness
in his mouth and he has to carry a bottle of water with him everywhere.
Like many head and neck cancer survivors, Mr Tan also faced many
problems after radiation treatment (RT).
These problems can present early
or late. Prior to radiotherapy, doctors would inform patients of
the possible problems of RT and advise them on the preventive measures,
as well as the drugs that would be prescribed during and after treatment.
Patients often have questions on complementary or alternative medicine
but most of these benefits are still unproven.
How
You Can Help Your Treatment
|
Do
not smoke and avoid alcohol. |
|
Eat a balanced
meal. Nutrition is optimised with protein supplements. |
|
Maintain
good oral hygiene. Use an alcohol free antiseptic mouthwash
to prevent mouth dryness (xerostomia). Brush your teeth with
a soft bristle toothbrush. You will also need to see a Dentist
before RT to check for dental caries and non-viable teeth. |
|
Jaw exercises
can reduce spasm of jaw muscle (trismus). |
| |
Continue
to maintain good nasal hygiene with sodium bicarbonate during
and after treatment. |
Preventative
drugs like pentoxyfylline (to improve microcirculation and reduce
soft tissue fibrosis), tocopherol (megadoses of vitamin E as an
antioxidant may slow cognitive sequelae and fibrosis), pilocarpine
(to reduce xerostomia) may be prescribed.
Like
Mr Tan, patients learn to modify their lifestyle and diet. Follow-up
consultations with doctors are important to detect serious problems
such as osteoradionecrosis, infections, endocrinopathies, disease
recurrence and second cancers.
Below
is a table that illustrates some of the common problems and ways
of coping with them:
Early
side effects
| SITE
|
PROBLEM |
PREVENTION
|
TREATMENT |
| Skin |
Redness,
desquamation, infection. |
Avoid
aftershave, alcohol-based cosmetics, wet shaving, collared clothes
that chafe skin, scratching. Wash gently, pat dry. |
Moisturisers,
mild steroid cream, antibiotics. |
| Mucosa |
Mucositis,
painful eating and swallowing. Ulcers. Weight loss. |
Stop
smoking, avoid hot and spicy foods, alcohol. Drink plenty of
clear fluids and maintain oral hygiene. |
Mouth
washes, antibiotics. Analgesics. Diet supplements. Bland and
soft diet. |
| Larynx |
Hoarseness
and loss of voice. |
Rest
voice. Speak slowly and softly. Avoid smoky areas. Avoid excessive
coughing and hawking. |
Local
anaesthetic gargles, analgesics, steroids, antibiotics. |
Late
effects
The onset of these is months to years after treatment.
| SITE
|
PROBLEM |
PREVENTION
|
TREATMENT |
| Salivary
gland |
Xerostomia,
viscous saliva. Taste changes. |
Pilocarpine,
sugar- free candy and gum. |
Pilocarpine,
artificial saliva, acupuncture. |
| Oral
Cavity |
Dental
caries |
Pre
RT dental evaluation and clearance. Fluoride supplements and
oral hygiene. |
Dentures,
dental cleansing and review. |
| Neck
soft tissue and muscle. Joints. |
Fibrosis
and limitation of movements. Trismus. |
Jaw
exercises.
Pentoxyfylline.
Tocopherol. |
Hyperbaric
oxygen. |
| Bone |
Osteoradionecrosis |
Avoid
dental extractions |
Debridement,
|
| Nerve
tissue |
Cranial
neuropathies, temporal lobe necrosis, L’Hermittes syndrome
(temporary paraesthesia) |
Tocopherol. |
Neuropsychiatry
Steroids L’Hermittes is
is self-limiting |
| Ears |
Deafness,
blocked ears. |
|
Hearing
aids |
| Eye |
Cataracts,
dry eyes, blindness. |
|
Surgery
Eye drops |
| Thyroid
and pituitary gland |
Hormone
deficiency |
|
Hormone
Replacement therapy |
| Irradiated
site |
Secondary
cancer (rare) |
|
Individualised
treatment |
|
