Clinical Evaluation and Management of Radiation Fibrosis Syndrome

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Key points

  • Radiation fibrosis syndrome (RFS) describes the multiple neuromuscular, musculoskeletal, visceral, and other late effects that result from radiation-induced fibrosis.

  • 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.

  • There is no cure for RFS, but supportive treatment of its clinical sequelae can potentially

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:

  • 1.

    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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    Disclosures: The author has no disclosures.

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