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Overview of Radiation Therapy (XRT)
• One of the four major modalities
– Chemotherapy, surgery, biological response modifiers
• One of the earliest used treatment approaches (1899 for basal cell CA; by 1922 had become a recognized clinical therapy for cancer) • Frequency of use in treatment process is 50 – 60 % • Purpose—to destroy malignant cells within the treated volume of tissue while minimizing damage to normal tissue • Can be used for both local/regional disease, also for palliation
External Beam Radiation Therapy
Brachytherapy (Sealed sources)
Radiation Physics • Radiation: energy that is emitted & transferred through space. • Ionizing radiation: special kind of energy which causes ejection of orbiting electron from an atom when it passes through cells – Electromagnetic waves – Particulate radiation .
Radiation damages cells Molecules become agitated Chemical reactions within cells occur DNA alterations = chromosomal strand breaks Resulting cell death or degeneration .
mitosis Least radiosensitive are those in late synthesis (S) .Principles of Radiation Therapy Factors that influence radiosensitivity Rate of cell division Most radiosensitive are rapidly dividing cells Least radiosensitive are non-dividing or slowly dividing cells Cell cycle phase Most radiosensitive are late G2.
Principles of Radiation Therapy Differentiation Most radiosensitive are poorly differentiated Least radiosensitive are well differentiated Oxygentation Most radiosensitive are well oxygenation Least radiosensitive are hypoxic Tumor size Most radiosensitive are small tumors Least radiosensitive are large tumors .
cranial radiation in small cell lung cancer) .g. (e..Goals of Radiation ²Cure: Localized disease ²Neoadjuvant therapy ²Given prior to definitive therapy such as surgery ²Adjuvant therapy ²Preventive treatment to asymptomatic areas after surgery or chemotherapy ²Prophylaxis –prevention treatment to high-risk ²Sites.
Goals of Radiation Control: Disease is extensive or recurrent For example: breast. spinal for lymphoma • Palliation: Symptom control reduce pain from bone mets. colon. brain. bladder. lung. H&N cancers • Prophylaxis: Prevent spread Kill tumor cells in areas where they are likely to become apparent cranial radiation for lung cancer. ovarian. brain metastases. treat spinal cord compression. trachea. heal fungating lesions . relieve obstruction of the superior vena cava. ureters.
Radiation Terminology ²Rad = amt of radiation absorbed per dose ²Gray = international measure (1 rad = 1 cGy.gov/cancertopics/treatment/ty pes-of-treatment . ²1 Gy=100 rad) Further definitions and explanation--NCI http://cancer.
3yrs – Cyclotron: neutron beam therapy. lower dose & percentage depth. half-life of 5. in clinical trials see this website for general overview of XRT and specific information on proton beam http://www.cfm?pn . administered by machines: – Linear accelerator: deliver electron energy in precise beam with little radiation scatter – Cobalt 60: widely used radioisotope. high LET energy.org/departments/radiation/dindex. but low dose rate – Proton beam: small volume tumors. emit gamma rays.Methods of Delivery ²External beam: source is outside of body.mdanderson.
applicators: "afterload" technique – unsealed (metabolized or absorbed) .Methods of Delivery. seeds. iodine-125. cont. iridium192. ²Internal (Brachytherapy): source is placed into a body cavity or tumor bed – sealed radioactive isotopes (cobalt-60. gold-198) in form of tubes. wires. ribbons.
Brachytherapy: Sealed Internal Delivery ²Intracavitary cesium or radium implant in vagina (cervical or endometrial cancers) ²Interstitial – iridium implants in breast – iodine or gold in prostate ²On the surface – strontium for superficial ocular melanoma ²Intraluminal – cesium for esophageal. lung. bile duct – .
cityofhope.org/rit/ .cityofhope.org/radonc/spec_prog • Radioimmunotherapy http://www.• Brachytherapy approaches Specialty/novel radiotherapy approaches – Targeting margins of tumor bed-Mammosite http://www.
Radiopharmaceuticals ²Nonsealed colloidal isotopes ²Iodine 131 (po) for thyroid cancer ²Strontium (IV) for metastatic bone lesions ²Phosphorus 32 (intrapleural) for mesothelioma .
1 treatment – Computer shows exact location – Tumor treated from different angles with beam of high dose XRT .Stereotactic radiosurgery – Focused high dose radiation aimed at tumor in brain.
Intraoperative radiotherapy • Intraoperative radiotherapy – Deliver dose directly to tumor bed – Minimize injury to adjacent structure and tissue .
number of fields. CT – immobilization devices. xray. 2004 . retrieved Feb 1.Treatment planning ²Multidisciplinary consultation ²Simulation to tailor to volume and location of tumor bed – localization by fluoroscopy. masks – marks on skin to outline field – computerized coordination ²Calculation of total dose. time schedule Image from City of Hope website. fractionation. blocks.
fractionating (dividing) – The radiation dose spares normal tissue by allowing repair and repopulation between fractions – Increases tumor kill by • Common fractionation schemes – – – – – • allowing for reoxygenation of hypoxic cancer cells • Facilitating reassortment of cells into more sensitive phases of cell cycle. and Class (2001) Clinical Oncology.Fractionation • Concept of balancing dose-time-number of treatments considerations with the effect on a given tumor • Based on fundamentals of radiobiology. Brady. Standard—5 equal fractions weekly Hyperfractionation—larger # of smaller doses (2x per day) Hypofractionation—smaller number of larger fractions Accelerated fractionation—multiple daily fractions Split course irradiation—larger daily fractions with planned break in the middle of course Mieszkalski. Yaiger. American Cancer Society .
Markings for Radiation Treatments .
Radiosensitizers • These are compounds that potentiate effects of XRT by – Increasing susceptibility of cells to XRT damage – Decreasing cells’ ability to repair damage • Agents: – – – – – – 5 FU Taxol Cisplatin CPT II Gemcitatbine oxaliplatin .
Radioprotectors • Goal is to – Modify effects of radiation on normal tissue while allowing effects on tumor – Decrease incidence and severity of toxicities – Enable increased XRT dose to tumor with fewer or same toxicities to normal tissue • Agents – Example is Amifostine (Ethyol) – Only agent FDA approved at present .
xerostomia • IV administration prior to daily XRT. 2004) • Reduced SE such as mucositis. evaluation of the subcut route (Bruce. 2004) .Toxicity prevention • Strategies to reduce toxicity – Multiple fields – Small bowel exclusion – Surgical techniques to move organs (ovaries) • Chemical approaches – Amifostine (Bruce.
Protection of Health Care Professionals ²External XRT can be harmful ONLY during time pt actually being treated ²use lead-lined gloves & apron ²Internal XRT: Gamma rays ²Consider: –Time –Distance –Shielding .
Planning Nursing Care to Minimize Exposure: For implants, internal radiation
²Objective is to deliver quality care in least amount
²Patients are usually Self-care ²Prepare food tray before entering room ²Change linens PRN only ²Wear monitoring device ²Long-handled forceps, lead lined container available for
possibility of dislodged radiation source ²Limit visitors ²Do not care for pt if pregnant or possibly so
²DO NOT need to follow these guidelines if patient is receiving
Classification of Side Effects
During, or about 2 wks into rx ²Intermediate: Near end of and in 1st few wks after rx ²Long-term (chronic): months-years post-rx
Common patient problems
elimination, diarrhea ²Potential impaired skin integrity ²Knowledge deficit ²Altered protective mechanisms ²Fatigue
gov/cancertopics/radiationtherapy-and-you • .Nursing management: Patient education • Patient education is crucial to successful management of radiotherapy to – Ensure successful treatment outcomes – Minimize side effects – Maximize patient comfort • Excellent sources of information regarding patient education: – radiation therapy patient ed • http://cancer.
Site-Specific Side Effects
Mucositis Xerostomia Dental Caries Trismus Esophagitis Pericarditis Pleuritis
Cystitis Diarrhea Vaginal fibrosis Sterility
Local Side Effects Integumentary
²Generally self-limiting ²Skin: most common SE, though severe
reactions rarely occur
²Alopecia: thinning over 2-3 wks,
permanent with doses > 4500 rads
Skin Reactions • Acute – – – – Erythemia Folliculitis Dry desquamation Moist desquamation – Hyperpigmentation – epilation • Late – – – – – – Atrophy Fibrosis Telangiectasia Xerosis Hypopigmentation necrosis .
broken areas of skin Evidence of infection Location & Character of pain/itching • Notify MD for: – – – – Deterioration in skin integrity at radiation site Rash Pain & itching at radiation site unrelieved by meds.Skin Care • Assessment – – – – Visibility of marks Dryness. scaling. Decreased visibility of radiation markings .
• Care of skin Skin Care – Cleanse irradiated areas gently each day with tepid water & nonalkaline soap – Do not remove markings – Expose irradiated area to the air as much as possible – Do not use tape within the radiated area – Maintain room environment at a comfortable temperature – Can add oil-free emollients to the bath water (e. Aveeno) – Use topical medications to control dry skin (alcohol free. May increase skin reactions – Use an electric razor instead of wet shaving .g. water based such as Aquaphor) Avoid lotions that contain heavy metals.
Skin Care • Care of skin – Implement mouth care for those patients receiving radiation to the head and neck region. – Encourage adequate fluid intake (2-3 liters/day) and well-balanced diet high in protein. – Encourage patient to wear non-constricting clothing & 100% cotton material in areas that come into contact .
deodorants. & oilbased products • Scratching of radiated area • Exposure to sun – use sun screen • Check with HCP about . soaps. cosmetics.Skin Care • Care of skin – Do not use hot/cold stimuli to radiation site • Patient Education – Instruct in effects of radiation on skin – Instruct to avoid: • Use of perfumed lotion.
fluoride rx ²TMJ stretching exercises ²Nutritional interventions . frequent oral care ²Artificial saliva ²Dental evaluation.Nursing Management : H&N ²Avoid irritants ²Gentle.
Xerostomia • RT damage to salivary glands • Prevention – amifostine • Management – – – – – – – Pilocarpine (Salagen) Modify diet as needed Take frequent sips of water Humidification Salvia substitute Dental follow-up Fluoride treatment .
Do 10 times with each hand. Hold open as wide as possible for 2 seconds then relax. and repeat 4 times a day.Trismus • RT tonic contraction of the jaw muscles as a result of fibrosis • Management – Physical therapy or speech therapy consult – Mouth exercises – jaw opening devices • Open mouth as wide as possible 20 times in succession = three times a day • Place heels of both hands under jaw. . push up with hands while stretching mouth wide open • Place middle and index fingers on mandibular teeth & thumb on maxillary pry the mouth open.
WBC. ESR ²Oxygen support ²Administer steroids .Nursing Management: Chest ²Monitor cough- increase fluids ²Monitor lab .
continue intercourse ²Sperm banking . low residue diet ²Management/prevention of sexuality alterations ²Use of vaginal dilator.Nursing Management: Abdomen/Pelvis XRT ²Prevention of nutritional alterations: ²Lite foods prior to tx. alcohol. small frequent meals. tea ²Managing elimination alterations ²Antispasmodics. antidiarrheal meds. avoid coffee. antiemetics ²High fluid intake.
vertebrae. BM replaced by fibrous ²Limits future chemotherapy options .Bone Marrow Effects ²Stem cells highly radiosensitive ²Leukocytes & platelets most affected ²Increased if previous chemotherapy ²Largest amt of bone marrow in the ilia. skull. metaphyses of long bones ²Depends on dose and volume treated: >3000 rads. sternum.
prevention of bleeding .Nursing Management: BM Effects ²Inform pt of site/dose ²Monitor counts ²Avoid exposure to infection ²S&S.
pain. possibly R/T tumor breakdown waste products ²Multifactorial: previous cancer treatment.Fatigue ²Systemic effect. frequency of treatments ²Nursing: – encourage rest periods – nutritional interventions – pt/family education – energy conservation . malnutrition. anemia.
Late Effects of Radiation Therapy ²Brain: Cognitive impairment. leg or scrotal edema. hearing loss. esophageal stricture. osteonecrosis of mandible. skin necrosis ²Chest Wall/Lung: Lung fibrosis. infertility. vaginal retraction . bladder fibrosis. impotency. pericarditis ²Abdomen/Pelvis: Colon perforation or obstruction. arm edema. fistulas. cataracts ²H&N: Hypothyroidism.
while inducing reversible and tolerable toxicity in the host.Purpose of Chemotherapy s Administer the largest dose possible. to kill the largest number of cancer cells. "therapeutic index" s s s .
Cell Kill Theory .
M G2 G1 S .
cells dividing – s Cell cycle non-specific drug acts at any point in the cell cycle – dose-dependent – .Relationship to Cell Cycle s Cell cycle specific drug interrupts cell division at specific points – schedule-dependent – effective if large no.
Cancers Highly Sensitive to Chemotherapy Hodgkin's Disease s ALL s Non-Hodgkin's Lymphoma (children) s Burkitt's Lymphoma s Testicular Cancer s Gestational Trophoblastic Tumors s Wilms tumor s Osteogenic Sarcoma s Rhabdomyosarcoma s .
Cell Kill Fraction Depends On: Tumor sensitivity s Tumor growth rate s Tumor size s Vascular supply s Host immunity s Nutrient supply s .
Increased Survival with Adjuvant Chemotherapy Breast Cancer s AML s SCC Lung s Prostate Cancer s Hairy Cell Leukemia s Chronic Granulocytic Leukemia s .
Combination Therapy s Multiple agents Greater cell kill Fewer resistant cell lines s s .
Uses of Chemotherapy – Induction – Adjuvant – Primary for advanced disease to local treatment treatment administration – Local/regional .
Preoperative Chemotherapy s Rationale – effectiveness can be measured – less extensive local treatment required .
of cells needed for metastasis .Adjuvant Therapy s Rationale – microscopic – goes disease where the cancer is – decrease minimum no.
Primary Treatment s Hematological Malignancies Advanced Stage Solid Tumors Palliative Treatment s s .
hormones) s Subcu (biological agents) s Intramuscular (Depo leuprolide) s Intravenous s .Routes of Administration Topical (cutaneous lymphoma) s Oral (alkylating agents.
Central Venous Tunneled Catheter .
Implanted Port .
methotrexate) Intrapleural (etoposide. platinum) Intraperitoneal (as above. FUDR) s s s . IL.Routes of Administration (continued) s Intrathecal (ARAC. often cisplatin) Intraarterial (5FU. INF.
Ommaya Reservoir .
and sicker All chemo is the same All chemo makes your hair fall out Side effects are expected and uncontrollable s s s .MYTHS? s All chemo makes you sick.
esophagitis.SIDE EFFECTS Kills all cells which are dividing rapidly s Mucous membranes. and hair follicles most acutely affected s Stomatitis. bone marrow. enteritis s Neutropenia s Alopecia s Nausea & vomiting (also chemicallymediated) s Skin changes s .
recovery day 28) s absolute granulocyte counts < 1.000/mm3 s duration of neutropenia as important as degree . chemo s High negative nitrogen balance s Neutropenia most significant s at nadir (usually day 7-14.BONE MARROW SUPPRESSION s Proliferating progenitor cells s Risk factors: s Marrow tumor involvement s Prior treatment with radiotherapy.
POTENTIAL FOR INFECTION s 80% arise from endogenous org. or chills s need immediate antibiotic treatment s multi-agent IV antibiotics s sepsis s Patient/family education s Thorough physical assessment . Increased when AGC < 500/mm3 s Fever >100.4 deg. trac facilitate entry of org. s Chemo-induced damage to GI & resp.
Low White Blood Cell Counts • Leukopenia < 2000 – decreased level of white blood cells predisposing the person to infections • Neutropenia < 500 -1000 • Generally defined as “immunocompromised” when 3 .
50 + . 50% = .50.08 .G.Absolute Neutrophil Count (ANC) • ANC = (% neutrophils + % bands) X WBC • 100 • Example: patient has following lab work – neutrophils = 50%. WBC = 4000 • ANC = 50% + 8% X 4000 • 100 • ANC = (.08) X 4000 = 2320 • Another way to calculate is to convert % straight into a decimal. bands = 8%. 8% = . E.
• What does the ANC tell? • • • • • Risk for infection Not significant Minimal Moderate Severe ANC 1500-2000 ANC 1000-1500 ANC 500-1000 ANC < 500 .Interpretation of the ANC • Chemotherapy is frequently held if the WBC’s are between 1000-3000/mm3 or if the ANC is below 1500 cells/mm3.
swelling. exudate formation – May not be present • Fever . Immunocompromised Patient • Normal signs of infection: heat.• Neutropenic patient can not mount an adequate inflammatory response to an infecting organism.the only indicator of an infection – Progression from localized infection to life-threatening sepsis is so rapid fatality rate is 18% to 40% in the first 48 hours. redness. .
• • • • • • • Mucous membranes Lungs Skin Venipuncture sites Catheter sites Perineal area Perirectal area Most Frequent Sites of Infection .
Most Common Organisms • Bacteria – – – – E. aeruginosa K. pneumoniae Staphylococci • Viruses – Herpes virus – Varicella-zoster virus – Cytomegaloviru s • Fungus – Candida – Aspergillus . coli P.
wound sites . Factors that compromise immune function ANC Vital signs comprehensive physical exam Patient hx. swelling. Recent trauma to skin.Assessment: Early Detection of Infection • Potential for systemic infection • • • • • • Skin integrity Patient hx. Assess for redness. suspicious lesions – Skin folds – PIV/ central lines – Peri rectal area • . Examine skin folds. discoloration. pain.
Assessment: Early Detection of Infection • Pulmonary system • Pt Hx. diminished gag reflex. DOE. exposures. tobacco use. • Respiratory rate. • Auscultation of chest • Recent changes in pulmonary status cough. Dysphagia. effort. and depth of respiration. SOB . Use of accessory muscles. pattern. chest tightness or pain.
Chemotherapy. radiation to head/neck.color. lesions. ETOH use. periodontal disease. tobacco. ulcerations. moisture.Assessment: Early Detection of Infection • Oral mucosa • Pt hx. amount and character of saliva • – dysphagia or retrosternal pain • Patients routine for oral hygiene . Oral cavity . nutritional status. hydration.
chemotherapy. Diet. frequency of bowel movements . bleeding • Character. hemorrhoids. HIV status. change in bowel habits • Assessment for erythema. medications. ulceration. sexual practices.Assessment: Early Detection of Infection • Rectal mucosa • Pt hx.
pruritis.genitilia lesions. hematuria. ulcerations. urgency. vaginal/penile discharge) Exam . bladder -toxic chemotherapy. symptom of GU infection (dysurina. odor • • . discharge Characteristics of urine .color. turbidity. urinary frequency. HIV status.Assessment: Early Detection of Infection • Genitourinary System • Pt Hx. Benign prostatic hypertrophy.
focal neurological signs.Assessment: Early Detection of Infection • Central Nervous System • Subtle changes in neurologic function can signify either the onset of an infection or progression of a malignancy. • Headache. personality changes. nuchal rigidity. fever. seizures . meningismus. altered mental status.
– Vital signs including temperature for fever. – Prophylactic pulmonary hygiene measures especially for B cell deficiencies – Monitor CBC with differential – Meticulously clean sources where bacteria live – No fresh cut flowers or live plants in room – Encourage regular personal hygiene (include oral care) – Protect from other persons with infections – Assign only healthy HCP to care for patient – Avoid injections .Nursing Management: Interventions • Goal of interventions is to prevent or minimize infections.
000/mm3 Effect of nitrosoureas.POTENTIAL FOR BLEEDING s Platelet count < 100. some antibiotics (mitomycin C) Patient teaching s s s s s s s avoid aspirin prevent constipation D/C use of razors .000/mm3 Risk for bleeding high if < 25.
75% BMT patients sDirect effect (cytotoxic) or indirect (related to myelosuppression) sDose-related. pre-existing oral disease.ORAL TOXICITY sPain. local irritants. myelosuppression . Alteration in Nutrition s2-3 X more often in hematologic malignancies. common with antimetabolites & some antibiotics sRisk factors: elderly. poor oral hygiene.
resolves day 21-28 s S&S: dry mucosa. day 7-14. bleeding s Interventions: s s s s pre-chemo dental evaluation oral hygiene nutrition analgesics . taste alterations. cont.ORAL TOXICITY. s Begins at nadir. pain. burning sensation. inflammation & ulceration.
sucralfate suspension s Culture of lesions Soft toothbrush & unwaxed floss if platelet ct ok and no lesions s s .ORAL HYGIENE s After each meal and at HS at least Lubrication of lips. saliva substitutes s s Salt and soda or Normal saline Topical anesthetics ac & prn – s viscous lidocaine.
Nausea and Vomiting sExperienced by over 50% of all patients receiving chemotherapy QOL most feared side effect worsens throughout the treatment can lead to non-compliance sDecreased q q q sPhysiological q q q dehydration fluid and electrolyte imbalance esophageal tears .
Influencing Factors sAge sPrevious sSex sCourse sHistory sHistory emetic control number of motion sickness heavy alcohol use .
Chemotherapy Factors sEmetic sEmetic sDose sCombination sType potential pattern of administration .
Pattern of Occurrence sAcute within 1-2 hours q resolves in 24 hours q sDelayed q begins or continues after 24 hours sAnticipatory present prior to a course of chemo q operant conditioning q difficult to treat q often persists after chemo d/c'd q .
e.g. sSerotonin inhibitor + Steroid sAnticholinergic + Anxiolytic s .Pharmacologic Therapy Based on emetic pathway(s) s Consider emetogenic potential of chemo agents used s Pre-med essential s “Around-the Clock” dosing s Consider delayed N&V s Combination antiemetic therapy.
Non .Drug Therapies sProgressive sGuided muscle relaxation imagery sHypnosis sTiming s of treatment sAcupuncture .
antibiotics. 5-FU.Enteritis sCells of small intestine most vulnerable sAntimetabolites (ARAC. AGVH disease. dactinomycin) s5-FU & leukovorin most toxic sSymptoms due to cellular necrosis or. MTX) & antibiotics (doxorubicin. less likely to infection or antibiotic-associated colitis sRisk factors: XRT to abd/pelvis. dietary changes sCan progress to denudement of GI lining .
opiates – s s . resolving 3-4 wks Interventions: low fat.Enteritis. antisecretory agents. s S & S: diarrhea. bloody stools Day 7-14. low residue. gluten & lactose-free diets – culture for clostridium difficile toxin – antidiarrheal drugs once infection R/O q anticholinergics. antispasmodics. anal irritation. rectal urgency. abd cramping. con't.
2-3 wks after first cycle. reversible 4-6 wks s Patient preparation for loss s Avoid sun. methotrexate.Alopecia Varies according to chemo agent (partial vs. comes out by handfuls over 1-2 day period. vincristine. cold. s Hair/scalp care s ** No ice caps s . anthracyclines. cytoxan s Not confined to the scalp s Hair loss often total. total).
less if prior XRT liposomal preparations s Weeks or months post-chemo Irreversible.Cardiotoxicity s Cardiomyopathy: direct damage to myocyte Anthracyclines – – – s incidence of 2 -3 % cumulative doses of 550/m2. 60% mortality s .
s Taxol: bradycardia most common – Ventricular tachycardia – conduction blocks – s Interventions: baseline EKG.Cardiotoxcicity. echo – endomyocardial biopsies – continuous infusion of agent – early recognition of S & S – . con't.
Mitomycin C: capillary leak. edema .Pulmonary Toxicity s Irreversible and progressive Interstitial pneumonitis Pulmonary fibrosis Higher in elderly. busulfan. previous XRT Agents: – – s s s s Bleomycin: 10% with > 450 units. pulm. BCNU ARAC.
basilar fine rales s s s . mild fever. pre-existing lung disease.Pulmonary Toxicity. con't. elderly Clinical onset slow (months) S & S: dry cough. exertional dyspnea. s Occurs from a few months to 10 years postchemo Risk factors: previous XRT.
areflexia. foot drop vincristine. seizures. coma methotrexate: encephalopathy cisplatinum: ototoxicity HD ARAC (>2gm/m2): cerebellar + peripheral . taxoids dose-related.Neuro Toxicity s Peripheral Neuropathies – – – myalgias. distal sensory loss. usually reversible s CNS (can be irreversible) – – – – ifosfamide: blurred vision. CN & motor dysfunctions. motor weakness. incontinence. cisplatinum.
suprapubic pain Cytoxan (up to 10%) & less often. bladder fibrosis & contraction. microcapillary irritation & ulceration & S: usually painless hematuria.ifosfamide with ifosfamide from Mesna sS s Agents: s Protection s Long-term cystitis.GU TOXICITY s Hemorrhagic cystitis: chemo by-products bind to bladder mucosa. rarely requires cystectomy .
cont. s Usually occurs days to wks post-chemo Not necessarily dose-related Interventions: aggressive hydration & diuresis – frequent voiding – bladder irrigation via 3-way Foley – cystoscopy to cauterize bleeders – vasopressins to decrease clotting – intravescicular administration of agents – s s .GU TOXICITY.
decreasing dose s Drying of skin with most agents Most dramatic is erythema. puritis & peeling (with cytokines) s . hyperpigmentation. and peeling of soles and palms (hand/foot syndrome) – abates with interruption of drug.Skin Toxicity s Erythema.
Overwhelming experience Not relieved by rest Causative factors in absence of anemia unknown; most often with cytokines Quality of life Interventions:
Age & dose related Alkylating agents most toxic Men:
damage to spermatocytes, azoospermia,
oligospermia, abnormal motility abnormal semen volume
destruction of ovarian follicles
Gondal Toxicities, con't.
S & S (general): fatigue, anxiety, loss of libido, altered body image S & S (males): impotence S & S (females): hot flashes, irregular menses or amennorhea, dysparunia Interventions:
sperm banking OCPs to protect ovarian follicle
with poorer prognosis than usual Highest incidence following Hodgkin's disease s s s s .Second Cancers s Chemo is carcinogenic Related to alkylating agents Leukemias and non-Hodgkins lymphomas.
Bone Marrow Transplant • Autologous • Allogenic • Matched unrelated donor .
Bone Marrow Transplant Allogenic Matched unrelated donor Graft versus host disease skin liver gut .