Logan Steele
Radiation therapy is a standard treatment for over 50% of cancer patients. While it is an effective treatment, it can also have negative consequences on healthy tissues, leading to debilitating long-term side effects. These side effects can vary depending on the area being treated, and may include nausea, vomiting, hair loss, fatigue, skin changes, and bowel or urinary incontinence. One of the late effects of radiation therapy is its impact on skeletal muscle morphology and progenitor cell content, which can result in long-term muscle decrements and a reduced quality of life. This is characterized by muscle atrophy and fibrotic tissue accumulation, and can be influenced by factors such as obesity and exercise training. Radiation exposure during muscle development can also contribute to these long-term effects, with preclinical models showing an immediate reduction in muscle content and loss of muscle mass.
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What You'll Learn
Radiation therapy and muscle atrophy
Radiation therapy can cause long-term damage to muscles, tendons, and bones. Radiation-induced muscle pathology, characterised by muscle atrophy and fibrotic tissue accumulation, is the most common late effect of therapeutic radiation exposure, particularly in juvenile cancer survivors. This can result in a progressive condition called radiation fibrosis syndrome (RFS). It is a serious lifelong disorder that can be improved if identified and rehabilitated early enough.
Radiation exposure during muscle development can induce long-term damage to skeletal muscle health, reducing the quality of life of cancer survivors. Myogenic stem cells, called satellite cells, contribute to muscle growth and repair. Irradiated skeletal muscles lose the capacity to regenerate or respond to hypertrophic stimuli due to radiation-induced satellite cell depletion. Satellite cells are regulated by trophic factors released from non-myogenic, muscle-derived stem/progenitor cells, called fibro/adipogenic progenitors (FAPs). In healthy skeletal muscles, paracrine factors derived from FAPs promote satellite cell differentiation. However, under pathological conditions, FAP dysregulation can lead to increased fibro/fatty tissue accumulation in skeletal muscle.
The role of FAPs in radiation-induced muscle pathology has not been previously explored. Studies have shown that radiation exposure alters the bone marrow. Future studies should address the crosstalk between bone and muscle and find potential circulatory mediators that may contribute to skeletal muscle atrophy following radiation exposure.
Physical therapy is usually the first line of treatment for radiation-induced muscle damage. In the case of muscle loss, synergistic muscle exercises can be introduced to compensate. Although these muscles are impaired, they often respond well to rehabilitative efforts, and even small gains in muscle stamina coupled with improved posture can translate into large functional improvements for the patient.
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Radiation cystitis and bladder problems
Radiation cystitis is a complication of radiation therapy to pelvic tumours. It is a side effect of inflammation and subsequent destruction of the normal anatomy of the urinary bladder at the cellular level after radiation treatment. It is more common in males than females.
The urinary bladder can be irradiated intentionally for the treatment of bladder cancer or incidentally for the treatment of other pelvic malignancies, such as tumours in the colon, rectum, ovaries, uterus, and prostate. When the primary tumour is not located in the bladder, this leads to unintentional radiation exposure to healthy bladder tissue.
Radiation cystitis can be acute or delayed. Acute radiation cystitis occurs less than six months after radiation therapy and is usually self-limiting. It is generally managed with conservative symptomatic therapy or observation. Delayed radiation cystitis occurs more than six months after radiation therapy, with an average onset of 31.8 months. It may develop anywhere between six months and 20 years after completing radiation therapy.
The symptoms of radiation cystitis include:
- Increased frequency of urination
- Urgent need to urinate
- Dysuria (painful urination)
- Urinary incontinence
- Gross hematuria (blood in the urine)
- Fistula formation
- Necrosis
The treatment for radiation cystitis depends on the severity of the symptoms. Mild cases can be treated with anti-inflammatory medications, while severe cases may require numbing medications. Hyperbaric oxygen therapy has shown success in severe or refractory cases. It is important to avoid drinks and foods that irritate the bladder, such as acidic juices, spicy foods, and acidic foods.
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Radiation pneumonitis and lung damage
Radiation pneumonitis is inflammation of the lungs caused by radiation treatment to the chest or, less frequently, the breast. It may occur 3 to 6 months after radiation therapy, with acute symptoms lasting from 4 to 12 weeks. The risk of radiation pneumonitis is higher in patients with pre-existing lung diseases, such as emphysema. The severity and likelihood of radiation pneumonitis are directly correlated with the amount of radiation exposure.
Radiation pneumonitis can manifest in two phases: acute and chronic. During the acute phase, patients may experience an exacerbation of previous respiratory symptoms or new clinical manifestations, such as dyspnea and coughing, occurring in 20-40% of cases. Less common acute symptoms include hemoptysis, airway obstruction, pulmonary vascular damage, bronchitis, respiratory infections, and pleuritic chest pain.
The chronic phase is characterised by progressive respiratory insufficiency or the increased severity of previous symptoms, particularly dyspnea. Non-specific signs and symptoms include tachypnea, cyanosis, crackles or pleural rub under thorax examination, malaise, and occasional fever.
In some cases, radiation pneumonitis may lead to pulmonary fibrosis, resulting in stiffening or scarring of the lungs. This can cause permanent respiratory impairment, as the lungs may no longer fully inflate and take in air. However, with treatment, most people recover from radiation pneumonitis without any long-term effects. Steroids like prednisone are typically used to manage the condition.
Radiation therapy can also cause other side effects, such as skin changes, fatigue, hair loss, and bladder problems. It is important to monitor for any signs or symptoms of radiation pneumonitis and seek medical advice if necessary.
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Radiation proctitis and bowel problems
Radiation therapy to the pelvis or rectum can cause several side effects, including nausea, vomiting, abdominal cramping, and belly cramping. One of the most common side effects of radiation therapy to the pelvic area is radiation proctitis, which is rectal inflammation that develops after radiation therapy. Symptoms of radiation proctitis include diarrhoea, sudden urges to defecate, rectal bleeding, and stool incontinence. In addition, patients may experience belly or pelvis pain, difficulty absorbing nutrients, and a stricture (narrowing) of the rectum. In rare cases, radiation proctitis can lead to large bowel obstruction, fistulas, or perforation, which may require surgery.
Radiation proctitis is caused by damage to the lining of the rectum from radiation therapy. This damage can cause inflammation and swelling, known as proctitis. The inflammation can be further worsened by fibrosis of the serosa, which is the build-up of scar-like tissue in the rectum or surrounding tissues. This can lead to a loss of elasticity in the blood vessels, inhibiting their growth into tissues that need to be healed.
The symptoms of radiation proctitis can range from mild to severe and may last a long time. Mild cases may heal on their own without treatment, but there are measures to alleviate discomfort, such as rehydration therapy and stool softeners. For more severe cases, medications can be used to treat the condition, and in some cases, different therapies or surgery may be required.
It is important to note that radiation therapy can also cause other bowel problems, such as bowel incontinence or urgency. This may lead to an inability to control bowel movements and potential leakage. These side effects usually go away shortly after radiation treatment ends, but they can sometimes continue.
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Radiation fibrosis syndrome (RFS)
The exact causes of RFS are unknown, but several factors influence the risk of developing this condition. These factors include the radiation dose, duration of radiation treatment, patient characteristics (such as age, smoking history, body mass index, and other medical conditions), and genetic predisposition. Patients treated with radiation for head and neck cancer are at a higher risk of developing RFS due to the high doses of radiation to crucial structures.
The symptoms of RFS can vary depending on the affected area. Common symptoms include restricted range of motion, pain, skin changes, tightness, and other physical limitations. RFS can also cause specific problems like decreased ability to fully open the mouth (trismus) and shoulder pain and dystonia. These symptoms may occur anywhere from a few weeks to years after radiation treatment and will progress over time.
Currently, there is no strong evidence that medications can effectively prevent or treat RFS. However, early intervention with physical therapy, occupational therapy, stretching, exercise, skincare, and massage therapy can help reduce symptoms and improve quality of life. In severe cases, experimental treatments such as botulinum toxin (Botox) injections, hyperbaric oxygen therapy, or laser therapy may be considered.
Research has shown that radiation exposure during muscle development can induce long-term negative effects on skeletal muscle health, contributing to a reduced quality of life in childhood cancer survivors. This suggests that RFS may also impact muscle health and function, leading to muscle tightness and other related symptoms.
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Frequently asked questions
Radiation therapy can cause long-term muscle fibrosis, which is associated with muscle tightness. This is a result of the obliteration of normal tissue components and their replacement by disorganized collagen fibrils. This leads to a loss of organ function and tissue contraction. Radiation-induced muscle pathology is characterized by muscle atrophy and fibrotic tissue accumulation.
Radiation-induced muscle fibrosis can cause a range of symptoms, including fatigue, skin irritation, hair loss, and cognitive changes. It can also lead to more serious issues such as coronary artery disease, stroke, and myocardial infarction.
Physical therapy is usually the first line of treatment for radiation-induced muscle fibrosis. This includes postural retraining, core strengthening, and flexibility exercises. Swallowing exercises have also been shown to improve long-term swallowing function outcomes.
