Radiation Fibrosis Syndrome: the Evergreen Menace of Radiation Therapy

Abstract

Fibrosis is a descriptive appellation referring to the obliteration of normal tissue components replaced by matrix and disorganized and varied collagen fibrils that result in the loss of organ function and frequent tissue contraction leading to death or significant deterioration in the quality of life. Radiation fibrosis syndrome (RFS) is a progressive fibrotic tissue sclerosis with various clinical symptoms in the irradiation field. It is usually a late complication of radiation therapy and may occur weeks or even years after treatment. It may affect the musculoskeletal, soft tissue, neural tissue, and cardiopulmonary systems. RFS is a serious and lifelong disorder that, nevertheless, may often be prevented when identified and rehabilitated early. Genetic factors likely play a significant role in the development of chronic fibrotic response to radiation injury that persists even after the initial insult is no longer present. Management of this syndrome is a complex process comprising medication, education, rehabilitation, and physical and occupational therapy. A bibliographical search was carried out in PubMed using the following keywords: "radiation fibrosis," "radiation fibrosis syndrome," and "radiation-induced fibrosis." We also reviewed the most relevant and recent series on the current management of RFS, and the reviewed data are discussed in this article. This review discusses the pathophysiology, evaluation, and treatment of neuromuscular, musculoskeletal, and functional disorders as late effects of radiation treatment.

Keywords: Ionizing radiation; radiation fibrosis syndrome; radiotherapy.

Figure 1

Skin darkening and scarring in a case of carcinoma breast post radiation therapy

Figure 2

Radiation dermatitis in a case of H and N carcinoma during radiation therapy

Figure 3

Mucositis and ulceration in a case of H and N carcinoma post radiation therapy

Figure 4

Skin induration post radiation therapy

Figure 5

Osteoradionecrosis of left upper alveolus post radiation therapy

Figure 6

Soft tissue oedema post radiation therapy in a case of carcinoma urethra

Figure 7

Lymphedema as a sequelae to radiation therapy in an operated case of carcinoma breast

Figure 8

Progressive fibrosis and thickening of the skin post radiation therapy as delayed sequelae

Figure 9

Progressive fibrosis, ischemia and adherence to underlying subcutaneous and fibro-fatty tissues seen in a case of carcinoma cervix post external beam radiation therapy

Figure 10

Torticolis as a delayed sequence of radiation therapy in a H and N carcinoma