La. Admin. Code tit. 48 § I-2337

Current through Register Vol. 50, No. 11, November 20, 2024

Section I-2337 - Radiation Therapy (Radiation Oncology)

A. Head and Neck

1. Early Reactions

a. reduced and sticky saliva, loss of taste and appetite, altered sense of smell, nausea;

b. sore throat, difficulty swallowing, weight loss, fatigue;

c. skin changes; redness, irritation, scaliness, blistering or ulceration, color change, thickening, hair loss;

d. hoarseness, cough, loss of voice and swelling of airway;

e. blockage and crusting of nasal passages;

f. inflammation of ear canal, feeling of "stopped-up" ear, hearing loss, dizziness;

g. dry and irritable eye(s), if the eyes or tear glands are in the radiation beam;

h. depression of blood count leading to increased risk of infection and/or bleeding;

i. these reactions are likely to be intensified by chemotherapy before, during or after radiation therapy.

2. Late Reaction(s)

a. dry mouth and altered, or loss sense of, taste;

b. tooth decay and gum changes;

c. bone damage, especially in jaws;

d. stiffness and limitation of jaw movement;

e. changes in skin texture and/or coloration, permanent hair loss, scarring of skin, poor healing of surgical wounds, and death of normal tissue;

f. swelling of tissues, particularly under the chin;

g. throat damage causing hoarseness, pain, or difficulty breathing or swallowing;

h. eye damage causing dry eye(s), cataract, loss of vision, or loss of eye(s), if the eye is in the radiation beam;

i. ear damage causing dryness of ear canal, fluid collection in middle ear, hearing loss;

j. brain, spinal cord, or nerve damage causing alteration of thinking ability;

k. pituitary or thyroid gland damage requiring long-term hormone replacement therapy;

l. in children, there may be additional late reactions as follows:

i. disturbances of bone and tissue growth;

ii. abnormal development of facial bones;

iii. brain damage causing a loss of intellectual ability, learning capacity, and reduced intelligence quotient (I.Q.);

iv. second cancers developing in the irradiated area.

B. Central Nervous System

1. Early Reactions

a. skin and scalp reaction with redness, irritation, scaliness, blistering, ulceration, change in color, thickening, hair loss;

b. nausea, vomiting, headaches;

c. fatigue, drowsiness;

d. altered sense of taste or smell;

e. inflammation of ear canal, feeling of "stopped-up" ear, hearing loss, dizziness;

f. depression of blood count leading to increased risk of infection and/or bleeding;

g. these reactions are likely to be intensified by chemotherapy before, during or after radiation therapy.

2. Late Reactions

a. permanent hair loss of variable degrees, altered regrowth, texture, and color of hair;

b. persistent drowsiness and tiredness.

c. brain damage causing a loss of some degree of thinking ability, memory or personality changes, loss of sensation or balance, seizures, hemorrhage, or steroid dependency due to brain swelling, rarely, severe damage may produce paralysis or death;

d. scarring of skin;

e. spinal cord or nerve damage causing paralysis, loss of strength, feeling, or coordination in any part of the body;

f. damage to eye(s) or optic nerve(s) causing loss of vision;

g. ear damage causing dryness of ear canal, fluid collection in middle ear, hearing loss;

h. pituitary gland damage requiring long-term hormone replacement therapy;

i. in children, there may be additional late reactions as follows:

i. disturbances of bone and tissue growth;

ii. bone damage to spine, causing stunting of growth, curvature, and/or reduction in height;

iii. abnormal bone growth in the face or pelvis;

iv. brain damage causing a loss of intellectual ability, learning capacity, and reduced intelligence quotient (I.Q.);

v. second cancers developing in the irradiated area.

C. Thorax

1. Early Reactions

a. skin changes: redness, irritation, scaliness, ulceration, change in color, thickening; hair loss on the chest;

b. inflammation of esophagus causing pain on swallowing, heartburn, or sense of obstruction;

c. loss of appetite, nausea, vomiting, weight loss, and weakness;

d. inflammation of the lung with pain, fever, and cough;

e. inflammation of the heart sac with chest pain and possible decreased heart function;

f. bleeding or creation of a fistula resulting from tumor destruction;

g. depression of blood count leading to increased risk of infection and/or bleeding;

h. intermittent electric shock-like feelings in the lower spine or legs on bending the neck;

i. these reactions are likely to be intensified by chemotherapy before, during or after radiation therapy.

2. Late Reactions

a. changes in skin texture and/or coloration, permanent hair loss and scarring of skin;

b. lung scarring or shrinkage causing shortness of breath;

c. narrowing of esophagus causing swallowing problems;

d. constriction of heart sac which may require surgical correction;

e. damage to heart muscle or arteries leading to heart failure or heart attack;

f. fracture of ribs;

g. nerve damage causing pain, loss of strength or feeling in arms;

h. spinal cord damage causing paralysis, loss of strength or feeling in arms and legs and/or loss of control of bladder and rectum;

i. liver damage;

j. loss of thyroid function;

k. in children, there may be additional late reactions as follows:

i. disturbances of bone and tissue growth;

ii. bone damage to spine, causing stunting of growth, curvature, and/or reduction in height;

iii. underdevelopment or absence of development of female breast;

iv. second cancers developing in the irradiated area.

D. Breast

1. Early Reactions

a. skin changes: redness (sunburn-like), irritation, scaliness, blistering, ulceration, coloration, thickening; hair loss;

b. breast changes, including swelling, tightness, tenderness or pain;

c. inflammation of the esophagus causing pain on swallowing, heartburn, or sense of obstruction;

d. lung inflammation with cough;

e. inflammation of heart sac with chest pain and possible decreased heart functions;

2. Late Reactions

a. changes in skin texture and/or coloration, permanent hair loss and scarring of skin;

b. breast changes, including thickening, firmness, tenderness, shrinkage, or edema (swelling);

c. swelling of arm;

d. stiffness and discomfort in shoulder joint;

e. rib damage causing pain or fracture;

f. nerve damage causing pain, loss of strength or feeling in arm;

g. damage to heart muscle or heart sac leading to heart failure;

h. permanent scarring of the lung producing shortness of breath, cough, or susceptibility to infection;

i. loss of thyroid functions;

j. if there is a cancer recurrence, mastectomy may be required.

E. Abdomen

1. Early Reactions

a. skin changes: redness, irritation, scaliness, ulceration, change in color, thickening; hair loss;

b. loss of appetite, nausea, vomiting;

c. weight loss, weakness, fatigue;

d. inflammation of stomach causing indigestion, heartburn, and ulcers;

e. inflammation of bowel causing cramping and diarrhea;

f. depression of blood count leading to increased risk of infections and/or bleeding;

g. these reactions are likely to be intensified by chemotherapy before, during, and/or after radiation therapy.

2. Late Reactions

a. changes in skin texture and/or coloration, permanent hair loss and scarring of skin;

b. stomach damage causing persistent indigestion, pain, and bleeding;

c. bowel damage causing narrowing or adhesions of bowel with obstruction, ulceration or bleeding which may require surgical correction, chronic diarrhea, or poor absorption of food elements;

d. kidney damage leading to kidney failure and/or high blood pressure;

e. liver damage leading to liver failure;

f. spinal cord or nerve damage causing paralysis, loss of strength or feeling in legs and/or loss of control of bladder and/or rectum;

g. these reactions are likely to be intensified by chemotherapy in a patient who is receiving, has received, or will receive radiation therapy:

F. Female Pelvis

1. Early Reactions

a. inflammation of bowel causing cramping, diarrhea, nausea, vomiting, and/or decreased appetite;

b. inflammation of rectum and anus causing pain, spasm, discharge, bleeding;

c. bladder inflammation causing burning, frequency, spasm, pain, bleeding;

d. skin changes: redness, irritation, scaliness, blistering or ulceration, coloration, thickening; hair loss;

e. disturbance of menstrual cycle;

f. vaginal discharge, pain, irritation, bleeding;

g. depression of blood count leading to increased risk of infection and/or bleeding;

h. these reactions are likely to be intensified by chemotherapy before, during or after radiation therapy.

2. Late Reactions

a. bowel damage causing narrowing or adhesions of the bowel with obstruction, ulceration, bleeding, chronic diarrhea, or poor absorption of food elements and may require surgical correction or colostomy;

b. bladder damage with loss of capacity, frequency of urination, blood in urine, recurrent urinary infections, pain, or spasm which may require urinary diversion and/or removal of bladder;

c. changes in skin texture and/or coloration, permanent hair loss, scarring of skin;

d. bone damage leading to fractures;

e. ovarian damage causing infertility, sterility, premature menopause, or genetic damage to future offspring;

f. vaginal damage leading to dryness, shrinkage, pain, bleeding, or sexual dysfunction;

g. swelling of the genitals or legs;

h. nerve damage causing pain, loss of strength or feeling in legs, and/or loss of control of bladder or rectum;

i. fistula between the bladder and/or bowel and/or vagina;

j. pelvic fibrosis producing obstruction of bowel or ureters;

k. in children, there may be additional late reactions as follows:

i. disturbances of bone and tissue growth;

ii. bone damage to pelvis and hips causing stunting of bone growth and/or abnormal development;

iii. second cancers developing in the irradiated area.

G. Male Pelvis

1. Early Reactions

a. inflammation of bowel causing cramping, diarrhea, nausea, vomiting, and/or decreased appetite;

b. inflammation of rectum and anus causing pain, spasm, discharge, bleeding;

c. bladder inflammation causing burning, frequency, spasm, pain and/or bleeding;

d. skin changes: redness, irritation, scaliness, blistering or ulceration, coloration, thickening; hair loss.

e. depression of blood count leading to increased risk of infection and/or bleeding;

f. these reactions are likely to be intensified by chemotherapy before, during or after radiation therapy.

2. Late Reactions

a. bowel damage causing narrowing or adhesions of the bowel with obstruction, ulceration, bleeding, chronic diarrhea, or poor absorption of food elements and may require surgical correction or colostomy;

b. bladder damage with loss of capacity, frequency of urination, blood in urine, recurrent urinary infections, pain, or spasm which may require urinary diversion and/or removal of bladder;

c. changes in skin texture and/or coloration, permanent hair loss, scarring of skin;

d. bone damage leading to fractures;

e. testicular damage causing reduced sperm counts, infertility, sterility, or risk of birth defects;

f. impotence (loss of erection) or sexual dysfunction;

g. swelling of the genitalia or legs;

h. nerve damage causing pain, loss of strength or feeling in legs, and/or loss of control of bladder or rectum;

i. fistula between the bowel and other organs;

j. pelvic fibrosis producing obstruction of bowel or ureters;

k. in children, there may be additional late reactions as follows:

i. disturbances of bone and tissue growth;

ii. bone damage to pelvis and hips causing stunting of bone growth and/or abnormal development;

iii. second cancers developing in the irradiated area.

H. Skin

1. Early Reactions

a. redness, irritation, or soreness;

b. scaliness, ulceration, crusting, oozing, discharge;

c. hair loss;

d. these reactions are likely to be intensified by chemotherapy.

2. Late Reaction(s)

a. changes in skin texture causing scaly or shiny smooth skin, thickening, with contracture, puckering, scarring of skin;

b. changes in skin color or overall appearance;

c. prominently dilated small blood vessels;

d. loss of sweating in treated area;

e. permanent hair loss;

f. chronic or recurrent ulcerations, severe damage may require skin grafting or plastic surgery;

g. damage to adjacent tissues, including underlying bone or cartilage;

h. possible injury may occur from trauma, sun, or frostbite unless the treated area is forever protected;

i. in children, second cancers may develop in the irradiated area.

I. Extremities

1. Early Reactions

a. skin changes: redness, irritation, scaliness, ulceration, coloration, thickening; hair loss;

b. inflammation of soft tissues causing tenderness, swelling, and interference with movement;

c. inflammation of joints causing pain, swelling and limitation of joint motion;

d. these reactions are likely to be intensified by chemotherapy before, during or after radiation therapy;

e. depression of blood counts leading to increased risk of infection and/or bleeding.

2. Late Reactions

a. changes in skin reaction and/or coloration, permanent hair loss, and scarring of the skin;

b. scarring or shrinkage of soft tissues and muscle causing loss of flexibility and movement, swelling of the limb;

c. nerve damage causing loss of strength, feeling, or coordination;

d. bone damage causing fracture;

e. joint damage causing permanent stiffness, pain, and arthritis;

f. swelling of limb below the area treated;

g. in children, there may be additional late reactions as follows:

i. disturbances of bone and tissue growth;

ii. bone damage to limbs causing stunting of bone growth and/or abnormal development;

iii. second cancers developing in the irradiated area.

J. Total Body Irradiation

1. Early Reactions

a. loss of appetite, nausea, vomiting;

b. diarrhea;

c. reduced and sticky saliva, swelling of the salivary gland(s), loss of taste;

d. hair loss;

e. sore mouth and throat, difficulty swallowing;

f. permanent destruction of bone marrow leading to infection, bleeding, and possible fatal lung failure;

g. inflammation of the lung with fever, dry cough and difficulty breathing with possible fatal lung failure;

h. damage to liver with possible fatal liver failure;

i. depression of blood counts leading to increased risk of infection and/or bleeding;

j. these reactions are likely to be intensified by chemotherapy before, during or after radiation therapy.

2. Late Reactions

a. lung scarring causing shortness of breath, infection, and fatal lung failure;

b. cataract formation in the eyes, possible loss of vision;

c. testicular damage in males causing sterility;

d. ovarian damage in females causing premature menopause and sterility;

e. increased risk of second cancer;

f. decreased ability to give further chemotherapy or other cancer treatment.

K. Endobronchial Radiation

1. Early Reactions

a. a mild sore throat;

b. some difficulty in swallowing;

c. bleeding;

d. infection or pneumonia.

2. Late Reactions

a. damage to spinal cord possibly producing paralysis;

b. lung scarring;

c. hemorrhage (possibly fatal);

d. inflammation of heart sac;

e. fistula (opening between bronchial tree and lung and/or esophagus);

f. pneumothorax (collapse of lung);

g. abscess formation;

h. death.

La. Admin. Code tit. 48, § I-2337

Promulgated by the Department of Health and Hospitals, Louisiana Medical Disclosure Panel, LR 18:1391 (December 1992), repromulgated LR 19:1581 (December 1993), amended by the Department of Health and Hospitals, Office of Public Health, Medical Disclosure Panel, LR 23:75 (January 1997).

AUTHORITY NOTE: Promulgated in accordance with R.S. 40:1299, 40E et seq.