1.

Skin - Mild to moderate erythema develops during the last days of treatment and will continue to progress for eight to ten days following treatment after which it will subside quickly. Moist desquamation may occur in the axilla or in the inframammary fold in large breasted women.

If the reaction becomes uncomfortable the skin should be kept dry. It may be powdered with cornstarch and 0.5% hydrocortisone cream may be used over small areas where the reaction is particularly troublesome but without moist desquamation, e.g., the nipple.

Follow this link to read more about the care of radiation skin reactions.

2.

Esophagitis - If an en-face internal mammary field is used the esophagus is directly irradiated and esophagitis may develop during the third week but usually settles within two to three weeks of the completion of treatment. It is rarely troublesome unless there is a pre-existing hiatus hernia and in these patients cimetidine or a similar agent should be used. Symptomatic relief of the esophagitis in the absence of a hiatus hernia may be achieved by the use of acetaminophen or viscous local anaesthetics such as Xylocaine gel. These are rarely necessary.

3.

Lung - Some part of the lung is always included in the irradiated volume. It is least in the "breast only" tangent pair technique and is maximal when nodal areas are irradiated, particularly the apex of the lung. Late radiological changes of radiation fibrosis are common but symptomatic pneumonitis is uncommon. Patients with pre-existing pulmonary disease and who are symptomatic may need treatment with steroids (prednisone 30-50 mg daily for two weeks and then very slowly tapered over the next two weeks). In patients with a prior history of tuberculosis there is a possibility of reactivation and these patients should be seen in consultation by the physicians at the Willow Chest Clinic. Frequently prophylactic INH is advised.

4.

Heart - Symptomatic cardiac toxicity with these techniques is rare, but patients treated with regional radiation, especially the older techniques, have an increased risk of coronary artery disease.

5.

Fatigue - A variable amount of generalized tiredness may begin after the first one to two weeks of treatment and last for several months thereafter. The cause is not known. Getting adequate rest, reducing stress and having an afternoon "nap" are recommended.