Radiation fibrosis syndrome

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at November 12, 2016
StartDiseasesRadiation fibrosis syndrome

Radiation fibrosis syndrome is a disease that may develop in people who have been exposed to radiation, such as through the treatment of cancer. These treatments can cause the body to produce large amounts of fibrin, a protein. As fibrin accumulates, it causes damage to the exposed tissue. Radiation fibrosis syndrome is progressive in nature and can have an affect on every organ system in the human body, greatly diminishing a person’s quality of life. Some cases may even lead to death.

Contents

Definition & Facts

Radiation fibrosis syndrome can emerge in the body anywhere from a few weeks after the conclusion of radiation therapy to decades after the last treatment. There is no cure for the disease and it will affect the patient for the rest of their life. The disease can have an affect on any tissue in the body that has come into contact with radiation. This includes the muscles, tendons and ligaments, bones, nerves, blood vessels, heart, and lungs.

Radiation fibrosis syndrome is a leading cause of disability in cancer patients once treatment has ended; however, not all patients will acquire the disease. This group includes those who have had treatment for prostate cancer or breast cancer. The therapy for those types typically uses a limited field of radiation in doses the body can tolerate. Of this group, only those that are sensitive to radiation will have complications.

Patients suffering from other forms of cancer are under a much higher risk of developing the disease. Because the effects of radiation therapy are cumulative, patients that have received more than one course of treatment have a higher risk of developing radiation fibrosis syndrome.

The disease is divided into three categories: acute, early delayed and late delayed. Acute onset occurs during or immediately following a course of radiation therapy. Early delayed onset takes hold up to three months after treatment, and late delayed onset occurs any time after three months.

Symptoms & Complaints

The symptoms of radiation fibrosis syndrome may take years to begin presenting themselves. They will vary greatly in each person suffering from the disease. Survivors of Hodgkin’s lymphoma will have differing complaints than those who suffered from head and neck cancer. The symptoms that are displayed will progressively worsen over time.

Because radiation fibrosis syndrome can affect any organ and tissue, symptoms can be displayed over a wide range of body functions. Some of the more common complaints include muscle weakness, fatigue, neck pain, shoulder pain, and an increase in the ability to perform everyday tasks.

Bones may become brittle and fracture easily. Tendons and ligaments may become stiff and contracted leading to a limited range of motion in joints. Muscle weakness and muscle spasms may also occur. This weakness may show itself in the neck extensor, leading sufferers to have difficulty holding up their head.

Nerve damage as a result of the onset of the disease leads to increased pain and decreased sensory function. Patients that do start to display symptoms run a high risk of suffering from secondary cancers and heart disease

Causes

Exposure to radiation is the root cause of radiation fibrosis syndrome. This primarily occurs during cancer treatment. Radiation is used because it attacks cancer causing cells while typically not affecting the surrounding normal cells. During treatment, toxins from the radiation accumulate in surrounding tissues. As the survivor ages, this tissue changes and side effects begin to emerge. 

Factors that determine which symptoms will form include the type of radiation therapy received as well as the dose strength and number of sessions endured. Of great importance is the size of the radiation field itself and whether the patient also received surgery or secondary treatment at the same time. Other factors include the patient’s age and overall health. Underlying medical conditions like diabetes mellitus or heart disease can greatly increase risk.

Diagnosis & Tests

A diagnosis of radiation fibrosis syndrome may be difficult for a physician to determine due to the fact that symptoms may not present themselves until decades after the completion of radiation treatment. When patients come in with complaints such as pulling or cramping muscles or stabbing and burning sensations, the physician will take into account whether the patient has endured radiation therapy.

The doctor will also look at pre-existing conditions in the patient, especially if they are neuromuscular or musculoskeletal in nature. A physical examination will be performed and imaging tests will typically be ordered. Magnetic resonance imaging (MRI)s are used to look at the spine, joint and soft tissues. For imaging of the pelvis, chest, and abdomen areas, a computed tomography (CT) scan will be used.

Treatment & Therapy

There is no cure for radiation fibrosis syndrome. Treatment of the disease focuses on improving the patient’s quality of life by relieving the symptoms that are being experienced. Regimens are personalized for the patient and include physical therapy, occupational therapy, medications, and orthotics.

Physical therapy will center around balance issues, muscle stretching and strengthening and working with sensory organs to help the patient maintain coordination. Medications are used to relieve pain and reduce spasms in muscles.

Orthotic collars are used for patients who are experiencing dropped head. Because of the progressive nature of the disease, the main goal is to allow the patient to maintain a normal ability to perform everyday activities for as long as possible. 

Prevention & Prophylaxis

There is no way that onset of radiation fibrosis syndrome can be prevented. It is an unfortunate risk of cancer treatment. Patients can help to delay the onset of symptoms by eating balanced meals, maintaining a consistent exercise routine and getting the recommended amount sleep each night.

Educating oneself about radiation fibrosis syndrome can help to open communication between doctor and patient. If symptoms begin to appear, it is of utmost importance to see a doctor promptly.

Improvements in radiation therapy are the key to eradicating radiation fibrosis syndrome. They focus on directing higher doses to the tumor itself with lower doses affecting the outlying tissue.