Radiation Fibrosis

If you receive radiation treatment for your head and neck cancer, you are at risk of developing radiation fibrosis. Radiation targets cancer cells, but it also affects healthy cells and tissue in and around the field of treatment by causing increased production of a protein called fibrin. Over time, fibrin accumulates and may eventually cause tissue damage. This damage can occur in any kind of tissue that is exposed to radiation, including the bone, skin, connective tissue, muscles, nerves, and blood vessels of the jaws, face, neck, and throat. Such damage may result in shortening of tissues like tendons and ligaments, muscle atrophy or contraction, brittle bones, nerve damage, or lymphedema. Taken together, the symptoms of this tissue damage is called Radiation Fibrosis Syndrome (RFS).


Symptoms

The symptoms of RFS can develop weeks to years following treatment. Once symptoms begin, they may progressively worsen over time. Patients and survivors suffering from RFS may experience:

  • Trismus, difficulty or inability to open the mouth, resulting from radiation to the muscles and connective tissues of the jaws.
  • Cervical dystonia, or tightness, pain and/or spasms of the neck, resulting from radiation to the neck.
  • Lymphedema, or swelling, in the head and neck.
  • Dysphagia, difficulty with swallowing or an inability to swallow, resulting from radiation to the muscles of the throat.
  • Difficulty with speaking.

RFS Occurrence in Head and Neck Cancer

The symptoms of RFS that you’re most likely to experience depend on the parts of your head and neck that are targeted by radiation therapy, the dosage of radiation you receive, and whether your radiation was combined with chemotherapy or surgery.

  • 25% of patients whose treatment exposes the muscles of the jaw to radiation will develop trismus that is severe enough to impact normal function.
  • 10% of patients whose treatment exposes the soft tissues of the neck to radiation will develop fibrosis that results in pain, discomfort, and decreased mobility.
  • Less than 10% of patients will experience lymphedema that results in significant functional impairment or deformity.
  • 15% of patients whose treatment exposes the throat muscles to radiation will develop dysphagia. The severity of swallowing impairment depends on the dose of radiation, the specific location that is targeted, and whether the patient also received chemotherapy.

How to Manage

Treatment for RFS most often will involve physical therapy, occupational therapy, and speech and swallowing therapy. Sometimes, surgery may be an option.

  • Trismus may be improved through the use of commercially available oral appliances.
  • Cervical dystonia, neck pain, and tightness may require physical therapy to increase range of motion and decrease pain. In some cases, medications to treat nerve pain may be helpful.
  • Lymphedema may require manual lymphatic drainage or compression bandages.
  • Dysphagia treatment typically requires referral to a speech language pathologist who is experienced working with head and neck cancer patients and dysphagia rehabilitation programs.

Management of RFS symptoms is most effective when implemented early. If you notice any changes in your ability to open your mouth; begin to experience pain in the jaw, throat or neck; notice stiffness or decreased range of motion in your neck; muscle spasms, persistent pain, or swelling in your face or neck; or experience changes in your ability to speak or swallow, speak with your medical team about interventions that may help.


References
  • “Radiation Fibrosis.” American Head & Neck Society, 13 Sept. 2018, www.ahns.info/survivorship_intro/radiation-fibrosis/.
  • “Radiation Fibrosis Syndrome.” OncoLink, www.oncolink.org/cancers/head-and-neck/side-effect-management-support-resources/radiation-fibrosis-syndrome.

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Becoming a patient with a serious illness after practicing medicine for over 40 years allowed me to understand the hardship and difficulties that patients face in ways I could not have done before.Itzhak Brook, M.D. Msc.
Physician and Professor of Pediatrics, Georgetown University School of Medicine and Throat Cancer Survivor


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