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Radiation fibrosis syndrome (RFS) describes the multiple neuromuscular, musculoskeletal, visceral, and other late effects that result from radiation-induced fibrosis.
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Radiation can damage the spinal cord, nerve roots, plexus, local peripheral nerves, and muscles within the radiation field. This phenomenon is known as a “myelo-radiculo-plexo-neuro-myopathy” and results in multiple clinical manifestations.
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There is no cure for RFS, but supportive treatment of its clinical sequelae can potentially
Physical Medicine and Rehabilitation Clinics of North America
Clinical Evaluation and Management of Radiation Fibrosis Syndrome
Section snippets
Key points
Radiation therapy delivery
Understanding radiation injury requires a basic knowledge of what radiation is and how it is, and has historically been, delivered. The basic unit currently used in radiation oncology is the gray (Gy). One gray is defined as the absorption of 1 J of radiation per 1 kg of matter. Radiation dosing was previously expressed in absorbed radiation dose or rads (1 rad = 0.1 J/kg = 0.01 Gy = 1 cGy). Therefore, a total dose of radiation of 5000 rad is equivalent to 5000 cGy or 50 Gy.
In general, as total
Radiation Fibrosis
Radiation fibrosis (RF) is the term used to describe the insidious, progressive, and immortalized process that occurs in tissues as a result of RT. Although the pathophysiology of RF has not been definitively elucidated, microvascular injury seems to be an important component in nerve injury.10 Injury to the nervous system, and other tissues, progresses indefinitely. RF can be characterized by 3 distinct histopathological phases11:
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Prefibrotic phase: This usually asymptomatic phase is
Clinical evaluation and treatment of radiation fibrosis syndrome
Hodgkin lymphoma (HL) survivors are frequently affected by RFS and can manifest an extraordinary variety of neuromusculoskeletal and visceral late effects due to radiation. Understanding the late effects in this complicated group of cancer survivors will facilitate accurate identification, informed evaluation, and effective rehabilitation of RFS in other groups, such as HNC survivors.
HL has been potentially curable with RT since the middle of the twentieth century.22 This susceptibility to
Treatment of radiation fibrosis syndrome
The primary role of the rehabilitation physician in the care of patients with RFS is the identification, evaluation, and rehabilitation of neuromuscular, musculoskeletal, pain, and functional disorders. RFS is an immortalized process that will progress indefinitely. We currently have no technology to slow or reverse this phenomenon and, therefore, RFS signs and symptoms will progress over time. Although all treatment is supportive, we have the potential to significantly improve and maintain
Summary
RFS is a common complication of radiation used in the treatment of cancer. Meaningful evaluation of RFS requires an understanding of how a given patient’s RT was delivered, including total dose, dose per fraction, and the field treated. With this knowledge in hand, the clinician can accurately determine the structures involved in the radiation field and, thus, if the patient’s signs and symptoms are in fact due to RT. Additionally, such knowledge can allow the clinician to predict which
Acknowledgments
Special thanks to Brett Lewis, MD, PhD, for generously providing many of the radiation oncology images presented in this article.
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Sulforaphane regulates Nrf2-mediated antioxidant activity and downregulates TGF-β1/Smad pathways to prevent radiation-induced muscle fibrosis
2022, Life SciencesCitation Excerpt :Radiation-induced fibrosis (RIF) is a common adverse event characterized by massive proliferation of fibroblasts and deposition of collagen fibers [9,10], which reduces tissue elasticity. Its incidence and severity are related to the RT dose, location, and whether other treatments are used together [11]; in addition, genetic susceptibility and inherent radiation sensitivity can also affect the occurrence of RIF. Most tissues or organs, including the lung, skin, and muscle, exhibit different degrees of fibrosis after RT.
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2021, Cancer/RadiotherapieLocalized peripheral autonomous neuropathy and dysfunctional myoepithelial cells: A novel hypothesis for xerostomia in oral submucous fibrosis
2020, Medical HypothesesCitation Excerpt :In an animal model study, Lemke et al. [15] demonstrated a measurable loss of neural functional capabilities caused due to glutaraldehyde-containing glue related fibrosis. Moreover, radiation-induced fibrosis in cancer patients involves peripheral nerves causing a variety of dysfunctional symptoms [16]. Peripheral nerve injuries resulting from trauma also known to cause peripheral fibrosis as one of the complications leading to a total or partial loss of motor or sensory functions [17].
Cancer Rehabilitation:: Acute and Chronic Issues, Nerve Injury, Radiation Sequelae, Surgical and Chemo-Related, Part 2
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2020, Medical Clinics of North AmericaCitation Excerpt :Another clinical manifestation is trismus, which is impaired mouth opening, and results from involvement of the trigeminal nerve, masseter, and pterygoid muscles, as well as associated tendons, ligaments, fascia, and skin24 affecting feeding, oral hygiene, and pulmonary function.92,93 Although at this time there is no treatment to reverse the mechanisms underlying radiation fibrosis, treatment is targeted at managing the sequelae and improving and maintaining function and quality of life.94 Physical therapy is recommended to improve posture, range of motion, strength, endurance, and balance.
Clinical Evaluation and Management of Cancer Survivors with Radiation Fibrosis Syndrome
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Disclosures: The author has no disclosures.