Radiation therapy is used as an adjunct treatment for cancer to kill off any remaining cancer cells in the surrounding tissues which are often called “micrometastases.” Radiation therapy is not appropriate for all cancer patients, but for those who do have treatment plans which include radiation, the short and long-term effects can be difficult to tolerate. Today, I want to share more about one long-term effect of radiation therapy called radiation fibrosis.
What is Radiation Fibrosis?
Radiation fibrosis (RF) refers to tissue changes which occur locally after someone goes through radiation therapy. Tissues which are most often affected are the skin, subcutaneous tissues (fat, muscle, bone), organs such as the lungs or heart, or the gastrointestinal/genitourinary tracts depending on the part of the body that is irradiated. Ions from radiation beams cause DNA damage and localized inflammation around the tumor site as well as in the surrounding normal tissues. The degree of damage often depends on each individual’s sensitivity to the radiation itself as well as the dose given and area of tissue treated.
Who is at Risk for Radiation Fibrosis?
Anyone who undergoes radiation therapy as part of their cancer treatments is at risk for RF. Some factors that increase susceptibility of developing RF include:
- Those who also have concurrent chemotherapy or surgery
- Those with pre-existing connective tissue disorders (scleroderma, lupus, or Marfan’s syndrome)
- Those with a genetic mutation in the ataxia-telangiectasia (ATM) gene which assists to repair damaged DNA
How does Radiation Fibrosis Present?
RF onset can be immediate, early delayed (0-3 months after treatment), or late delayed (>3 months after treatment), however most find that symptoms begin to show up 3-4 months after treatment ends. Symptoms usually come on gradually and they are, unfortunately, not reversible.
Some of the symptoms include:
- Thickening of the skin
- Muscle tightness or atrophy
- Limited joint mobility
- Mucosal fibrosis (mouth, throat, GI tract, genitourinary tracts)
What Treatments are Available for Radiation Fibrosis?
Physical therapy is proven to increase range of motion lasting up to six months post-treatment (and probably longer if the person continues their exercises)! PT’s can use manual therapy or prescribe specific exercises to mobilize the skin and myofascial tissues, increase range of motion in affected joints, improve strength, and manage lymphedema (if they are a lymphedema specialist – if not, then they should refer you to someone who is a certified lymphedema specialist).
For reproductive/colorectal cancers in particular, seeing a pelvic floor physical therapist may be indicated to ensure independence with toileting (especially bowel movements) or to assist with sexual concerns like pelvic pain or tightness.
Other potentially-beneficial treatments may include hyperbaric oxygen therapy, pentoxyfilline (a drug that helps to improve blood flow to the tissues) with or without the addition of vitamine E (a powerful antioxidant), and botox injections – but the research is still pending on the true benefits of these treatments!
If you or someone you know is going through radiation therapy, let them know about RF & send them to a physical therapist to help with any mobility concerns they may have!
- Radiation-induced fibrosis: mechanisms and implications for therapy (Straub, et al. 2015)
- Supervised physical therapy in women treated with radiotherapy for breast cancer (Braz da Silva Leal, et al. 2016)
- Radiation Fibrosis Syndrome: Neuromuscular and Musculoskeletal Complications in Cancer Survivors (Stubblefield, et al. 2011)