In some post-irradiation studies, radiation damage is present in 90% or more of 10 year survivors. 
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Since late radiation effects themselves can be lethal, but undertreating cancer also has its risks, prevention of unwanted radiation damage is important.

UV radiation damage to membranes, proteins, DNA and other cellular targets is predominantly related to oxidative processes. Vitamin E and possibly other antioxidants partly protect cells from radiation damage.

<b>Infection existing in tissues that are irradiated create worse long term effects, including bone necrosis, central nervous system necrosis, and persistent infection.</b> "All patients who developed chronic persistent infection during or shortly after the radiation therapy, increased local tissue sensitivity to late radiation damage. As a result, severe bone, cerebellar and brainstem necrosis was observed at doses that are normally considered safe. We therefore strongly recommend that any infection in a proposed irradiated area should be treated aggressively, with surgical debridement if necessary, before radiotherapy is administered, or that infection developing during or after irradiation is treated promptly." 

<b>Close observation over function of large nerve trunks and plexuses while the patients are receiving radiation to the area is necessary. Early diagnosis and treatment of radiation plexitis and neuritis is essential for adequate recovery of limb function.</b> Diagnosis of radiation damage to the peripheral nervous system should rest on clinical electrophysiological findings defining the degree of the nerve fiber injury.  Hyperbaric oxygen therapy has been useful in restoring nerve function.
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Saline breast implants might be used to displace organs away from the radiation field when treating malignant tumors of the trunk, thereby minimizing the radiation dose to uninvolved organs. In patients with pelvic tumors the bowel can be fixed to the upper abdomen by use of Polyglycolic acid mesh (Devon) to minimize radiation associated small bowel injury. There is no severe disturbance of bowel motility, and after 3 to 4 months the small bowel will again descend into the pelvis.

Techniques that concentrate radiation in small areas, like IORT, and implantation radiation, can prevent large areas of healthy tissue from becoming inadvertently damaged. Intraoperative radiotherapy (IORT), with radiation applied directly to the tumor or tumor bed with the abdomen open is a useful process. Stomach and intestines can be easily excluded from the radiation field to avoid late radiation damage.

The use of a radiation protectant such as amifostine prior to irradiation might prevent normal tissue damage, while not preventing tumor lysis.  For further details, see the section on amifostine in the Chemotherapy web page on this site.
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