Australian Doctor 20th June 2025 | Page 37

HOW TO TREAT 37 of the lateral wall. Nick is treated with palliative radiotherapy. Figures 10A and 10B demonstrate his CT scans before and after treatment.
ausdoc. com. au 20 JUNE 2025

HOW TO TREAT 37 of the lateral wall. Nick is treated with palliative radiotherapy. Figures 10A and 10B demonstrate his CT scans before and after treatment.

Case study three
Astrid, a 75-year-old female, presents with dysphagia and a left-sided neck fullness on a background of coeliac disease. A biopsy of the left side of her neck demonstrates a squamous cell carcinoma. FDG PET reports a large intensely avid locally invasive proximal oesophageal tumour involving the left hemithyroid( see figure 11A). Her case is discussed at an MDT meeting, and definitive chemoradiotherapy is recommended. Figure 11B is her FDG PET scan after treatment.
Table 1. Possible local effects of radiation therapy Location / target Side effect Treatment Skin
Erythema may occur, peaking shortly after completion of treatment
Brain and scalp Hair loss in the treated area may be transient or permanent, dependent on the dose delivered during treatment
Head and neck
Importantly, this differs from chemotherapy-related alopecia, where all hair is lost, rather than hair in only a certain area
Mucosal ulceration can occur acutely, particularly when treating cancers involving the head or neck
In severe cases, creams or dressings may be used. Generally, only conservative management is required
This can be managed with mouth washes and analgesia
A dry mouth may be transient or permanent and can be managed with artificial saliva sprays and washes
Dental care is of particular importance as a dry mouth can lead to accelerated dental decay
Any vomiting centres Nausea or vomiting Managed with antiemetics as needed
Case study four
Susan, a 65-year-old female presents
Breast cancer
Lymphoedema may occur in the arm following treatment for breast cancer but may also affect other sites
The risk of lymphoedema is estimated prior to treatment of lymphatics
with PR bleeding, on a background of prior melanoma excision, hypertension, dyslipidaemia and eczema. Colonoscopy demonstrates a large non-obstructive mass in the distal rectum up to the dentate line.
Biopsy demonstrates a moderately differentiated adenocarcinoma. MRI pelvis reports a 7.1cm tumour, 3.6cm from the anal verge( see figure 12A). The tumour involves the circumferential margin and there is a 0.3cm extension into perirectal fat. A CT of the chest, abdomen and pelvis does not demonstrate any metastatic dis-
The rectum directly or from an incidental dose received by the rectum during prostate radiotherapy
Pelvic area
Pelvic area
Change in bowel habits may result following treatment
This may occur transiently shortly following radiotherapy or may be a permanent change
Irritation of the bladder may occur from pelvic treatments and can manifest with symptoms similar to a urinary tract infection
Urinary incontinence as a late effect is rare, with incidence increasing following surgery
Fertility issues are particularly important with younger patients and gonad sensitivity to radiation
Even a small, scattered dose of radiation to the pelvis may affect fertility
Management may include antimotility agents or review by dietitian for dietary modification
Bladder irritation can be managed with medication or with ablation of neovascularisation in the long term, if there is evidence of bleeding from radiation cystitis
Urinary incontinence is largely managed with pelvic floor exercises or operative intervention by a urologist
ease. An FDG PET scan reports uptake in the primary lesion, but no uptake elsewhere. Susan is managed with
Impotence in men is an important consideration when treating prostate cancer with radiotherapy
Figure 10. Single metastasis in the right lung treated with palliative radiotherapy( 8Gy / 1f) to prevent haemoptysis.
Figure 11. A cT4N0M0 squamous cell carcinoma of the oesophagus treated with definitive chemoradiotherapy( 50Gy / 25f).
A
FDG PET scan before treatment.
A
CT scan before treatment.
B
FDG PET scan after treatment.
Figure 12. A cT3bN1M0 low rectal adenocarcinoma treated with neoadjuvant chemoradiotherapy( 50Gy / 25f) before planned resection.
B
CT scan after treatment.
A MRI scan before treatment.
B MRI scan after treatment.