2021_Book_TextbookOfPatientSafetyAndClin

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A. Marcolongo et al.
Toxicities
monitoring
Patient
evaluation
Decision to
+/- RT
Treatment
monitoring
Dose and
Volumes
Prescription
Treatment
delivery
or replanning
Equipment and software
commissioning
and Quality Assurance
Positioning and
Immobilization
Patient setup
RT simulation
imaging
Treatment plan
approve
Delineation of
Target Volumes
Planning
Delineation of
Organs at Risk
Fig. 18.1 Radiotherapy process of care from the first evaluation to follow-up. (Modified from WHO World Alliance
for Patient Safety Radiotherapy Safety Expert Consensus Group)
it is often difficult to evaluate the direct effect of
radiotherapy on depression as well as several
other symptoms [29].
Specific symptoms relating to the irradiation
of specific regions involve several organs. Here,
we summarize only the main ones.
Acute and late effects of RT on the central nervous
system are common and represent a significant
source of morbidity. In particular, patients
with tumor-related neurocognitive dysfunction
may exhibit exacerbated deficits after RT [30].
Dermatitis caused by radiation is a common
adverse effect of radiotherapy, often complicating
treatment of breast, prostate, perineum, and
head and neck cancers. It is, however, difficult to
evaluate the real burden of the phenomenon as
clinical practice in this field is biased by unreliable
and contradictory evidence [31]. Early reactions
include skin rash, and dry and humid
exfoliation, while delayed events include
pigmentation changes, telangiectasias, hair loss,
atrophy, and ulcerations.
With regard to vascular diseases due to radiotherapy,
patients who received left-sided radiotherapy
as compared with those receiving
right-sided radiotherapy experienced increased
risks of developing coronary heart disease (RR
1,29) and cardiac death (RR 1,22). Radiotherapy