Survivorship: Late Effects After Radiation for Sarcoma (Extremity)

Side Effects After Cancer Treatment

There are different types of side effects you may have during or after cancer treatment.

• Short-term: side effects that happen while you are on treatment and end shortly after treatment. Example: mouth sores that heal within a few weeks after treatment is finished.
• Long-term: side effects that happen while you are on treatment and last for months to years. Some of these side effects will not go away. Example: neuropathy.
• Late effects: side effects that happen months to years after you have finished treatment. Example: scar tissue forming and causing health issues.

This article focuses on the late effects of radiation treatment for sarcoma of an extremity.

Late effects can be health issues or psychological, emotional, and practical challenges.

Late Effects After Radiation for Sarcoma (of an extremity)

Side effects from radiation treatment affect the area of the body in the treatment field. The treatment field includes the cancer and in some cases nearby healthy tissue. How radiation is given has changed over the years, leading to a lower risk of late effects. Talk with your radiation oncologist to find out which areas were in your treatment field.

Late effects of radiation treatment for sarcoma (of an extremity) include:

Damage to the Bones

Radiation can cause small cracks (fractures) in the bones that are in the treatment field. Try to avoid falls or accidents. If you do get hurt, ask your provider if you need an x-ray to check for bone damage.

Nerve Damage

Survivors who got radiation to the chest or underarm area can have damage to their brachial plexus nerve. This is caused by scar tissue in the area pressing on the nerves or stopping the blood supply to the nearby muscles.

• Radiation injury to the nerves and muscles is called radiation-induced neuropathy or radiation fibrosis. It develops in the years after treatment and slowly worsens over time.
• Symptoms can include pain, loss of strength, decreased feeling (sensation), loss of coordination, or loss of movement or function of the muscle. The area affected will depend on the area that was in the radiation field.
• If you have any of these issues, tell your provider. Some of these things can be caused by other health issues, so your provider will need to figure out the cause.
• If radiation fibrosis is the cause, it may help to see a cancer rehabilitation physician or physiatrist, and physical or occupational therapists. These specialists can help you manage your symptoms with therapy, medications, and assistive devices.

Lymphedema Risk

If you did not have an amputation, you may be at risk for lymphedema. Damage to the lymph nodes through surgery or radiation can lead to lymphedema. Lymphedema is swelling that can happen in the genital area, belly, buttocks, legs or feet. It can cause pain, be disfiguring (cause changes to appearance), make activity difficult, and increase the risk of infection in the area.

• Talk to your provider if you are having any new swelling. You should see a Certified Lymphedema Therapist (CLS) at the first sign of swelling to try to keep the lymphedema from worsening.
• Any area that has lymphedema or that is at risk for lymphedema is also at high risk for infection. If you have any signs of infection, call your care team right away or go to the emergency room. These signs include a sudden increase in swelling, an increase in pain, redness, the area being warm to the touch, or fever.

Skin Changes

Radiation can lead to changes in the skin that don’t go away.

• You may find new scars or changes in the color or texture of your skin. Radiation can also change the color and texture of your hair or can cause hair loss that never grows back in the treated area.
• The soft tissue and muscles under the skin can cause scarring and/or shrinkage, which can lead to a loss of flexibility and movement or chronic swelling in the area treated.
• You may get chronic or recurring ulcers of the skin in the area treated. Blood vessels of the skin may become dilated (larger) and more visible, but this is not harmful.
• If the skin feels tight or sore, you can put vitamin E on the skin.
• Use fragrance and dye-free soaps and moisturizers in the area if your skin is sensitive after radiation.

After radiation, the skin in the treated area is more sensitive to sunlight. This sensitivity will last for your lifetime. Practice sun safety, use plenty of sunscreen, wear a wide-brimmed hat, and keep skin in the treated area covered with clothing. Try to not be out in the sun between the hours of 10 am-4 pm when it is the strongest.

If you notice any new or worsening skin issues, you should call your provider.

Managing Late Effects

Tell your care team about any new or worsening symptoms. Some side effects need care from healthcare providers who specialize in working with cancer survivors. There are Interdisciplinary survivorship clinics at many cancer centers. If there is not a survivorship clinic near you, talk with your oncology care team about support for managing your late effects.

After treatment, talk with your oncology team about getting a survivorship care plan, which can help you in your transition to survivorship and learn about life after cancer. You can build your own survivorship care plan using the  OncoLife Survivorship Care Plan.