The following article features coverage from the 46th Annual Oncology Nursing Society (ONS) Congress. Click here to read more of Oncology Nurse Advisor‘s conference coverage.

Adverse effects of radiation typically develop at approximately 2 weeks or at a cumulative dose of 20 Gy, and severity can worsen with further treatment. Their occurrence are dependent on treatment site, daily dose, concurrent therapy, and patient characteristics, according to an oral presentation by Annette Quinn, RN, MSN, of the University of Pittsburgh Hillman Cancer Center in Pennsylvania, at the 46th Annual Oncology Nursing Society (ONS) Congress.

One of the most common adverse effects of radiation therapy is radiodermatitis, with a moderate to severe skin reaction occurring in 85% to 87% of patients who undergo external beam radiation. The condition begins with an inflammatory response upon radiation, and it can be acute or chronic.

Guidelines for managing radiodermatitis are limited, but ONS recommendations include topical steroid creams, standard washing and skin care, semipermeable dressings, silver sulfadiazine, and use of antiperspirant or deodorant. Severity can peak approximately 7 to 10 days after treatment, and improvement should be significant by 4 to 6 weeks.

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Oral mucositis is another common complication of multiple forms of cancer therapy, including radiation therapy. “It is often described as one of the most debilitating side effects of cancer therapy,” Ms Quinn said. Pain, infections, and treatment interruptions can result from oral mucositis. ONS guidelines recommend cryotherapy, photobiomodulation therapy, oral care, and sodium bicarbonate.

Although novel radiation techniques have decreased risks to lungs, lung pneumonitis or fibrosis can develop in the months following radiation. Pneumonitis usually occurs around 3 months after treatment, and fibrosis appears more often after a year. A treatment algorithm Ms Quinn presented included glucocorticoids for pneumonitis and best supportive care for pulmonary fibrosis.

Acute brain injury may occur in the days to weeks after radiation treatment, and early delayed brain injury can arise months later. Both conditions are often reversible and show spontaneous resolution, Ms Quinn explained. Late delayed brain injury, occurring more than 6 months after irradiation, however, is associated with multiple potentially serious consequences. “Cognitive impairment is reported to occur in 50% to 90% of adult brain tumor patients who survive [more] than 6 months postradiation,” Ms Quinn said.

Quinn said that it can be difficult to Distinguishing between tumor growth and damage from radiation, such as in the lungs or the brain, can be difficult; however, positron emission tomography (PET) may help in determining this in the lungs.

Read more of Oncology Nurse Advisor‘s coverage of the 46th Annual ONS Congress by visiting the conference page.


Quinn A. Beyond the beam: radiation therapy side effects. Oral presentation at: 46th Annual ONS Congress; April 20-29, 2021. Accessed May 3, 2021.