![]() RT may cause neuropathy due to nerve injury, although it may take several years for symptoms to appear. This condition rarely progresses to a true transverse myelitis which is associated with Brown-Séquard syndrome. ![]() The patient notes an electric shock-like sensation mostly felt with neck bending (flexion). RT to the neck can affect the spinal cord, resulting in a self-limited transverse myelitis, known as “Lhermitte’s sign”. These can include serious problems such as memory loss, stroke-like symptoms, and brain function. These include difficulties to organize one’s thoughts, find the right word, or balance a checkbook: (1) problems in multitasking, (2) processing information slower, (3) behavioral and emotional changes, such as irrational behavior, mood swings, inappropriate anger or crying, and socially inappropriate behavior, and (4) severe confusion. Cognitive problems can manifest in the following symptoms or behavioral changes: (1) trouble concentrating, focusing, or paying attention, (2) mental fog or disorientation, (3) difficulty with spatial orientation, (4) memory loss or difficulty remembering things, especially names, dates, or phone numbers, (5) problems with understanding, (6) difficulties with judgment and reasoning, and (7) impaired ability to calculate and organize, and impaired language skills. Other causes for cognitive problems are pain, side effects of medications, emotional state, and other medical problems. Many patients who received RT to the head and neck and/or chemotherapy experience attention, thinking, or short-term memory problems. Use of a humidification especially in the bedroom can provide relief. Dietary change from dry, tough food to easier to swallow moist, softer ones can improve nutritional status and quality of life. ![]() Acupuncture has been found helpful in reducing pain and dry mouth. Preliminary data suggest that hyperbaric oxygen (HBO) can provides benefit for patients with xerostomia who have some residual salivary gland function. Treatment include salivary stimulants (sialagogues), such as pilocarpine, amifostine, and cevimeline. Low-level laser treatment of the salivary glands can intensify cell metabolism and its application on salivary glands could improve salivation. The use of saliva substitutes or artificial saliva (containing hyetellose, hyprolose, or carmellose), stimulation of saliva production from intact salivary glandular tissues by taste/mastication, pharmacological avoiding smoking and all products that contain caffeine or alcohol, using a bedside humidifier at night, and raising the head of the bed can be helpful. Keywords: Radiation, Side effects of radiation, Fibrosis, Head and neck cancer, Lymphedema, Mucositis This review presents these side effects and their management. These side effects present difficult challenges to the patients and their caregivers and require life-long strategies to alleviate their deleterious effect on basic life functions and on the quality of life. Patients who undergo radiotherapy for nasopharyngeal carcinoma tend to suffer from chronic sinusitis. Late side effects include: permanent loss of saliva osteoradionecrosis radiation recall myositis, pharyngoesophageal stenosis dental caries oral cavity necrosis fibrosis impaired wound healing skin changes and skin cancer lymphedema hypothyroidism, hyperparathyroidism, lightheadedness, dizziness and headaches secondary cancer and eye, ear, neurological and neck structures damage. The likelihood and severity of complications depends on a number of factors, including the total dose of radiation delivered, over what time it was delivered and what parts of the head and neck received radiation. Patients undergoing radiation therapy for head and neck cancer (HNC) experience significant early and long-term side effects.
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