What Is a Radiation Injury?
Radiation therapy, alone or in combination with surgery and chemotherapy, is commonly used for the treatment of many cancers. Although radiation therapy can usually be delivered without resulting in long-term injury, it can occasionally lead to permanent side effects.
In severe cases the radiation leads to scarring (fibrosis) and/or damage to the blood supply of the normal tissues in the irradiated field. It is this scarring and damage that leads to the side effects seen in patients with radiation injury. When these complications occur, they become apparent six months or more after the radiation exposure. In some cases, these complications will occur many years after treatment.
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What Complications Can Be Seen After Radiation?
The chance of complications after radiation depends upon the dose and location of radiation treatment and whether or not it was combined with chemotherapy and/or surgeries in the treated region. Radiation that was given in the abdomen for gynecologic, testicular, or pediatric cancers can cause scarring of the kidney or the ureters (the urinary tubes connecting the kidney to the bladder). Radiation that was given in the pelvis for problems like prostate, bladder, colorectal, and cervical cancer can also damage the urinary structures.
Some of the more common complications from pelvic radiation include the following:
- Strictures of the urethra (about 1 in 20 persons)
- Urinary urgency and frequency (about 1 in 10)
Although often these common complications can be managed with medications, about one in 20 persons will require a surgical procedure to repair the damage.
In rare cases, a fistula (a hole between the bladder or urethra and the rectum or skin) can occur. Severe complications, like fistulas, occur in fewer than 1 in 1000 patients who receive modern external beam radiotherapy, but in about 1 in 100 patients who receive high-dose-rate brachytherapy.
How Are Radiation Injuries Treated?
The treatment of radiation damage depends upon the nature of the problem. Chronic wounds can sometimes be treated with a trial of hyperbaric oxygen. If there is a surgical problem, this can be addressed by a urologist.
Surgery
Surgery may involve a variety of procedures depending upon the nature of the problem. The damage can be so varied from radiation that each patient will need to have a thorough evaluation to find out the extent of damage and create a strategy to improve or fix the damage that has occurred. This evaluation often involves tests, like CT scans or scope procedures.
Once the extent of the problem has been fully assessed, then a surgical strategy can be developed. Having an expert specialty surgeon trained in repairing radiation injuries is required to achieve the best functional outcomes after severe radiation injury.