radiotherapy and chemotherapy Flashcards
name some chemotherapy drugs (up to 5)
- bleomycin (antibiotic)
- doxorubicin
- 5-fluorouracil
- methotrexate (antifolate)
- mercaptopurine (purine antagonist)
what are some oral complications of chemotherapy? (6)
- mucositis (and malnutrition)
- infections
- thrombocytopaenia and bleeding
- xerostomia
- caries (xerostomia and flora changes)
- dysgeusia, poor taste
what are some acute complications of radiotherapy? (7)
- mucositis
- skin reactions (overlying neck LNs)
- difficulty eating/drinking
- loss/change in taste
- change in voice
- fatigue (esp 5th and 6th week)
- psychosocial
what are some late complications of radiotherapy? (6)
- xerostomia
- skin tightening/fibrosis = jaw stiffness
- voice changes
- underactive thyroid
- osteoradionecrosis
- secondary tumour
describe the WHO oral toxicity scale for grading mucositis
grade 1 = soreness and erythema
grade 2 = erythema, ulcers, able to swallow solid food
grade 3 (severe) = ulcers with extensive erythema, cannot swallow food
grade 4 (severe) = alimentation not possible, ice chips soothing
what is meant by “acute” complication of radiotherapy? (2)
- occurs during radiotherapy or within 6 weeks after treatment
- predictable and often resolve
what is meant by “late” complication of radiotherapy? (2)
- after 6 weeks after treatment, may be years later
- less predictable
mucositis management (4)
- reassurance (tends to resolve 2 weeks post-RT)
- analgesia
- early treatment of any infections
- MW, sprays, Gelclair (LA effect)
what is oral mucositis and how may this present?
- inflammation of mucous membranes in the mouth
- red, burn-like sores or ulcer-like sores
possible complications following mucositis (4)
- pain
- infection
- bleeding (chemotherapy)
- difficulty breathing and eating
management of skin reactions from radiotherapy (3)
- reassurance (tends to resolve 2 weeks post-RT)
- analgesia
- creams, dressings
management of difficulty eating/drinking from radiotherapy (4)
- reassurance
- analgesia
- dietician = nutritional supplementation, energy drinks
- feeding tubes (NG, PEG)
describe osteoradionecrosis (what, presentation, risk)
- small vessel damage from RT reduces bone’s ability to withstand trauma and avoid infection
- may be spontaneous or post-trauma
- non-healing ulcers in soft tissue, bone lesions
- risk does NOT decrease with time
management to reduce risk of osteoradionecrosis (6)
- see dentist BEFORE high dose RT = remove unsalvageable teeth, maximise perio health, fluoride
- good OH
- smoking cessation
- xerostomia-reducing RT techniques (eg IMRT), salivary stimulants/replacements
- specialist for any extractions after RT, GDP for non-invasive tx
- regular dental review post-RT
management of suspected/confirmed osteoradionecrosis (6)
- confirm it is not cancer
- OHI
- analgesia
- antibiotics if persistent infection
- antioxidant therapy (pentoxifylline + vit E)
- localised surgical excision of exposed necrotic bone
