#26 What’ the deal with Radiation Oncology?

February 13, 2017 | By Matthew Watto, MD

Anticipate, and dominate the side effects of radiation therapy. On this episode we interview Dr. John J. Cuaron, Radiation Oncologist from Memorial Sloan Kettering Cancer Center in New York to better understand, “What’s the deal with radiation oncology?”.

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Clinical Pearls:

1. Consider history of radiation therapy as a CV risk factor, especially left sided radiation for breast cancer
2. Brain radiation side effects
   1. Cerebral edema (nausea, vomiting, headache, gait ataxia, seizures)
   2. treated with dexamethasone (usually effective in 24-48 hours)
   3. hair loss and skin erythema can occur (reversible)
3. Lung cancer side effects
   1. direct radiation to esophagus causes irritation requiring sucralfate, and/or oral narcotic pain meds
   2. PEG tubes less commonly used
4. Fatigue is a systemic effect from radiation, but etiology unknown
5. Skin burns
   1. utilize over-the-counter emollients
   2. hydrocortisone (low potency) if itching
   3. silvadine if skin blistering
   4. rarely surgical consult warranted
6. Take him points from Dr. Cuaron
   1. Radiation doesn’t hurt
   2. Radiation Oncologists closely monitor patients during treatment

Goal: Listeners will anticipate and recognize the short and long term side effects of radiation therapy.

Learning objectives:
By the end of this podcast listeners will:

1. Anticipate long term side effects of radiation therapy
2. Recognize and manage short term side effects of radiation therapy

Disclosures:
Dr. Cuaron reports no relevant financial disclosures.

Time Stamps

00:00 Intro

02:45 Rapid fire questions

06:19 Initial office visit with radiation oncology

08:40 Discussion of custom molds and restrains

11:14 Long term CV effects of radiation

14:52 Short term side effects brain radiation

20:08 Short term side effects lung radiation

23:00 Short term side effects GI radiation

23:55 Fatigue from radiation

26:49 Treatment for localized skin burns

29:35 Take home points

Links from the show:

1. Wool by Hugh Howey https://www.amazon.com/Wool-Omnibus-Silo-Hugh-Howey-ebook/dp/B0071XO8RA
2. EQD2 app on Itunes https://itunes.apple.com/us/app/eqd2/id536224535?mt=8
3. Example of custom mask for radiation therapy https://mdbcancerjourney.com/tag/mask/
4. Do Apollo Astronaut Deaths Shine a Light on Deep Space Radiation and Cardiovascular Disease? JAMA 2016. http://jamanetwork.com/journals/jama/article-abstract/2583565
5. Risk of Ischemic Heart Disease in Women after Radiotherapy for Breast Cancer. NEJM 2013. http://www.nejm.org/doi/full/10.1056/NEJMoa1209825#t=article

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