Society for Oncology Massage
Uncommon Interest, Training, Compassion

Radiation Fibrosis

Cancer Patients Who Have Had Lymphatic Irradiation
Are at Perpetually Increased Risk of Lymphedema
 

Radiation induces fibrosis in all soft tissues.  Oncology massage therapists often remind their clients to discuss this with their physicians since both massage and medical literature indicate that anyone who has had radiation therapy is at permanently increased risk of lymphedema. 

Irradiated tissue may deteriorate indefinitely.  Radiation induces fibrosis, scarring and adhesions in lymph nodes, lymphatics and blood vessels. Circulation is impaired.  Waste products stagnate.  Nutrients and oxygen are not brought in.  The fibrosis increases.  It can be a vicious, downward spiral.

 

"There might be a lifelong risk of developing late complications, of which patients and clinicians should be aware." (1)

"Radiation-induced fibrosis (RIF) represents one of the most common long-term adverse effects of curative radiotherapy." (2)

"After radiation treatment, a number of cells containing major changes can have a long survival and disappear very slowly, becoming a chronic focus of immunological system stimulation. This stimulation can produce ... late radiation-related adverse effects of varying severity."  (3)

"With >10,000,000 cancer survivors in the U.S. alone, the late effects of cancer treatment are a significant public health issue. ... Much work has been done that has led to an improvement in our understanding of the molecular mechanisms underlying the development of normal tissue injury after [radiation] therapy. In many cases, these injuries are characterized at the histologic level by loss of parenchymal cells, excessive fibrosis, and tissue atrophy." (4)

Of particular note is this graph, taken from O'Sullivan and Levin (2):

Cumulative 10-year incidence of grade 2 or 3 fibrosis following head/neck radiation.

An example of how to interpret this chart:   At five  years after radiation, 40% of previously undissected patients have developed grade 2 or 3 fibrosis, as have 70% of dissected patients.

                                         Years after the initiation of radiation.
 

Therapist/Client Takeaway Patients continue to develop clinically significant radiation induced fibrosis for 10 years and beyond.  Fibrotic nodes, lymphatics and blood vessels all contribute to lymphedema.  When receiving massage, patient/clients can reduce the risk of precipitating lymphedema by seeing massage therapists who are trained to make the necessary adjustments for a lymphatic system damaged by radiation.

 

Citations

1.  Radiother Oncol. 2001 Dec;61(3):233-46.
Quantification of late complications after radiation therapy.
Jung H, Beck-Bornholdt HP, Svoboda V, Alberti W, Herrmann T.
Institute of Biophysics and Radiobiology, University of Hamburg, Hamburg, Germany.

2.  Semin Radiat Oncol. 2003 Jul;13(3):274-89.
Late radiation-related fibrosis: pathogenesis, manifestations, and current management.
O'Sullivan B, Levin W.
Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada.

3.  Breast Cancer Res. 2005;7(5):R690-8. Epub 2005 Jul 1.
Early and late skin reactions to radiotherapy for breast cancer and their correlation with radiation-induced DNA damage in lymphocytes.
López E, Guerrero R, et al
Servicio de Oncología Radioterápica, Hospital Universitario Virgen de las Nieves, Granada, Spain.

4.  Oncologist. 2010;15(4):350-9.
Targeting the TGF-beta1 pathway to prevent normal tissue injury after cancer therapy.
Anscher MS.
Department of Radiation Oncology, Virginia Commonwealth University, Richmond, Virginia, USA.

 

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