Guidelines for Complications of Cancer Treatment Vol VIII Part B

Complications are mainly described according to the radiationportals (e.g focal conformal RT, CSI and WBRT) or grade ofthe tumour (high and low grade). Grade and site of disease,age of presentation, radiation energy used (cobalt / Linearaccelerator) and also intensity of treatment regimen (fractionschedule, total RT dose) have an important role in thedevelopment of acute and late complications. Acute toxicitiesare defined as complications occurring within 2 months aftercomplications of treatment. Late complications usually occurafter 2-3 years, however may be observed even many yearsafter completion of treatment. The incidence and prevalenceof toxicity also varies with the duration of follow up (e.gneuropsychological and neuroendocrine impairment has shownto increase with longer follow up). Few complications likeradiation induced CVA and radiation necrosis(pesudoprogression) have been described only in recentliteratures.In last few years there is a paradigm shift from earlier usedlarger conventional portals to current practice of imaging basedplanning and multiple smaller conformal portals. Irradiatednormal tissue and thus complication profile of treatment haschanged in last few decades. The toxicity evaluation tools havealso evolved in recent years. Thus, it is imperative to interpretthe complication rate and severity with respect to the followup data, treatment schedules, toxicity evaluation tools usedand also patient demographic profile.Evidences of CNS complications afterradiation therapyNeuropsychological functionNeurological function assessment is traditionally being doneby clinical examination, Karnofsky performance status (KPS)and neurological performance status (NPS). These are simpletests, require minimum expertise and are used to detect any345