The side effects depend on what part of the body treated. Since sarcomas are not very sensitive to radiation, high doses must be used (usually over 6000cGy) which can cause more short term side effects (local skin burn) and more long term problems (scar tissue or fibrosis, which causes tightness in the extremity and may limit mobility and increase the risk of swelling or edema.)

Short term: use skin care creams and treat as any radiation dermatitis

Long term: promote physical therapy and try to avoid any additional trauma or injury since the high doses of radiation will make wound healing more difficult.

The side effects consent from from the RTOG sarcoma (RTOG 95-14) trial  and RTOG 0030 below are  typical:

RISKS AND DISCOMFORTS

The risks associated with this treatment will be those associated with the cancer and the treatments given. The treatments used in this program may cause all, some, or most of the side effects listed below.

Radiation Therapy

The risks and discomforts associated with radiation can be divided into early reactions (those happening during or shortly after radiation) and late reactions (those happening well after the completion of radiation). In general, most radiation reactions (other than fatigue) are limited to the site being treated. For example, if my leg is being treated, I will not feel nauseated from radiation treatment. My doctor will specifically identify those risks connected with the location of my tumor.

Early reactions may consist of the following:

1) Skin reactions. This may be mild (slight redness) to severe (painful skin blistering). Skin reactions may become most noticeable during chemotherapy courses. If the head and neck area is being treated, the lining of the mouth and throat may become sore and red, causing difficulty swallowing. These reactions will subside with time.

2) Fatigue (tiredness). Many patients undergoing radiation complain of feeling tired.

3) Reduction in blood counts. Radiation can temporarily lower red blood cell, white cell and platelet counts, possibly resulting in bleeding or infection.

4) If the abdominal wall is being treated, I may develop diarrhea.

5) Wound healing delay after surgery may result.

Late reactions may include:

1) Skin reactions. Skin in the treated volume may appear tanned and may stay this way for a number of years after radiation.

2) Fibrosis (hardening of the tissues): Tissues in the treated area may feel hard and woody. If this occurs, it is likely to be permanent.

3) Pain in a limb. This symptom may occur one to several years after completion of treatment and may last for many years.

4) Swelling. This may occur in the first year after treatment. In many patients this will resolve. Some patients will have persistent swelling and will need to use elastic stockings. If severe, I may require the use of a pump that pushes swelling out of the extremity. Some patients will notice temporary swelling after strenuous activity.

5) Fracture. Radiation can make bones more susceptible to fracture.

6) Bruising. Irradiated skin, especially over the shin and elbow, may heal more slowly if injured or bruised.

7) If the abdominal wall is being treated, injury to the bowel is an uncommon but potentially serious side effect.

8) If the back area is being treated, injury to the spinal cord is a very rare but potentially serious complication.

9) Risk of cancer. Radiation can cause tumors in the irradiated tissues. Fortunately, this is rare (1 in 2,000) in adults but can occur many years after treatment.

10) Damage to other organs. If heart, lung, liver or stomach are in the field of treatment these organs could be damaged.

RTOG Consent Form (RTOG 0330)

Radiation Therapy (RT)

The risks and discomforts associated with radiation can be divided into early reactions (those happening during or shortly after radiation) and late reactions (those happening well after the completion of radiation). Sometimes after radiation, the skin in the treated area may turn red, blister, and/or peel while you are receiving chemotherapy or just after you have chemotherapy. In general, most radiation reactions (other than fatigue) are limited to the site being treated. For example, if your leg is being treated, you will not feel nauseated from radiation treatment. Your doctor will specifically identify those risks connected with the location of your tumor.

Early RT reactions:

Very Likely

• Mild (slight redness) to severe (painful skin blistering) skin reactions; may become most noticeable during chemotherapy. The combination of radiation and doxorubicin may result in more severe side effects, especially in skin reactions such as scar tissue.

• Tiredness

• Reduction in blood counts, possibly resulting in bleeding or infection

• Diarrhea (if abdominal wall is treated)

• Wound healing delay after surgery

Late RT Reactions:

Very Likely

• Skin in the treated area may appear tanned and may stay this way for a number of years after radiation.

• Tissues in the treated area may feel hard and woody: If this occurs, it is likely to be permanent.

• Pain in a treated limb: This symptom may occur one to several years after completion of treatment and may last for many years.

• Swelling: This may occur in the first year after treatment. In many patients this will go away. Some patients will have persistent swelling and will need to use elastic stockings. If severe, you may require the use of a pump that pushes swelling out of the extremity. Some patients will notice temporary swelling after strenuous activity.

• Bones more susceptible to fracture.

• Irradiated skin, especially over the shin and elbow, may heal more slowly if injured or bruised.

Less Likely, but Serious

• Injury to the bowel (if abdominal wall is treated)

• If heart, lung, liver, or stomach are in the field of treatment, these organs could be damaged.

Rare

• Injury to the spinal cord (if the back area is treated)

• Radiation can cause tumors in the irradiated tissues. This is rare (1 in 2,000) in adults but can occur many years after treatment.