Cranial Irradiation

Cranial irradiation can be the primary or adjuvant treatment for brain tumors, and may be carried out prophylactically, for example, in limited-stage small cell lung cancer and some hematological malignancies. While neurons do not have the rapid dividing characteristic usually targeted by radiation, radiation has effects on their glial supports and vasculature. Leukoencephalopathy typically occurs at doses above 55 Gy and appear 1-2 years following treatment.30 As a result, slowed mentation and memory problems are well documented among these patients, and in some cases dementia, ataxia, and dysarthria also result. These effects can often best be managed with the use of accommodations such as slowing activity down, reducing multitasking, or compensatory strategies such as use of notes to aid memory.

The eyes and their surrounding structures can receive radiation in the course of brain irradiation or total body irradiation. This commonly results in dry eyes (xerophthalmia) which can lead in turn to corneal abrasions. Artificial tears can palliate this symptom. Patients whose eyes have been radiated are also at increased risk of developing cataracts. Radiation involving the ear can damage the acoustic structures, and this occurs more commonly than damage to the auditory nerve. Consequently, bone conducting hearing aids can yield effective amplification.

Radiation to the head and neck frequently destroys salivary glands. The resultant xerostomia can be very uncomfortable. It can also leave the teeth prone to bacterial overgrowth and decay as the saliva no longer effectively cleanses the mouth of normal oral bacteria. Consequently, attention to oral hygiene and prophylactic dental care is extremely important for head and neck cancer survivors.

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