Late toxicities management

Patients who receive palliative radiation therapy generally have limited life expectancy. However, patients now live longer with incurable cancer, and palliative radiation therapy applies more aggressive dose regimens. Practitioners of palliative radiation oncology need to consider potential toxicity and how to manage these toxicities. This chapter focuses on two more common late toxicity of radiation therapy, skin and spinal cord toxicity. The common themes between these areas reflect general commonality in managing late radiation effects. Conservative management, local debridement, and physical therapy approaches should be employed when possible. Multimodality treatment is often necessary for challenging cases. Inflammatory changes are generally managed with steroids, which are the most common and efficacious treatment. Vascular modulation with pentoxifylline, vitamin E, bevacizumab, and hyperbaric oxygen may work in concert with steroids. Stem cell therapies may be promising in the future. Current options often do not completely reverse effects of late changes. Further work is necessary to develop improved prophylaxis and treatment options.