| (H) In children, depression of blood count leading
to increased risk of infection and/or bleeding is more common.
(2) Late reactions.
(A) Changes in skin texture and/or coloration, permanent
hair loss, scarring of skin.
(B) Stomach damage causing persistent indigestion,
pain, and bleeding.
(C) Bowel damage causing narrowing or adhesions of
bowel with obstruction, ulceration, or bleeding which may require
surgical correction, chronic diarrhea, or poor absorption of food
elements.
(D) Kidney damage leading to kidney failure and/or
high blood pressure.
(E) Liver damage leading to liver failure.
(F) Spinal cord or nerve damage causing loss of strength
or feeling in legs and/or loss of control of bladder and/or rectum.
(G) In children, there may be additional late reactions.
(i) Disturbances of bone and tissue growth.
(ii) Bone damage to spine causing stunting of growth,
curvature and/or reduction in height.
(iii) Bone damage to pelvis causing stunting of bone
growth and/or abnormal development.
(iv) Second cancers developing in the irradiated area.
(g) Female pelvis.
(1) Early reactions.
(A) Inflammation of bowel causing cramping and diarrhea.
(B) Inflammation of rectum and anus causing pain, spasm,
discharge, bleeding.
(C) Bladder inflammation causing burning, frequency,
spasm, pain, bleeding.
(D) Skin changes: redness, irritation, scaliness, blistering
or ulceration, coloration, thickening, hair loss.
(E) Disturbance of menstrual cycle.
(F) Vaginal discharge, pain, irritation, bleeding.
(G) Depression of blood count leading to increased
risk of infection and/or bleeding.
(H) In children, these reactions are likely to be intensified
by chemotherapy before, during, or after radiation therapy.
(I) In children, depression of blood count leading
to increased risk of infection and/or bleeding is more common.
(2) Late reactions.
(A) Bowel damage causing narrowing or adhesions of
the bowel with obstruction, ulceration, bleeding, chronic diarrhea,
or poor absorption of food elements and may require surgical correction
or colostomy.
(B) Bladder damage with loss of capacity, frequency
of urination, blood in urine, recurrent urinary infections, pain,
or spasm which may require urinary diversion and/or removal of bladder.
(C) Changes in skin texture and/or coloration, permanent
hair loss, scarring of skin.
(D) Bone damage leading to fractures.
(E) Ovarian damage causing infertility, sterility,
or premature menopause.
(F) Vaginal damage leading to dryness, shrinkage, pain,
bleeding, or sexual dysfunction.
(G) Swelling of the genitalia or legs.
(H) Nerve damage causing pain, loss of strength or
feeling in legs, and/or loss of control of bladder or rectum.
(I) Fistula between the bladder and/or bowel and/or
vagina.
(J) In children, there may be additional late reactions.
(i) Disturbances of bone and tissue growth.
(ii) Bone damage to pelvis and hips causing stunting
of bone growth and/or abnormal development.
(iii) Second cancers developing in the irradiated area.
(h) Male pelvis.
(1) Early reactions.
(A) Inflammation of bowel causing cramping and diarrhea.
(B) Inflammation of rectum and anus causing pain, spasm,
discharge, bleeding.
(C) Bladder inflammation causing burning, frequency,
spasm, pain, and/or bleeding.
(D) Skin changes: redness, irritation, scaliness, blistering
or ulceration, coloration, thickening, hair loss.
(E) Depression of blood count leading to increased
risk of infection and/or bleeding.
(F) In children, these reactions are likely to be intensified
by chemotherapy before, during or after radiation therapy.
(G) In children, depression of blood count leading
to increased risk of infection and/or bleeding is more common.
(2) Late reactions.
(A) Bowel damage causing narrowing or adhesions of
the bowel with obstruction, ulceration, bleeding, chronic diarrhea,
or poor absorption of food elements and may require surgical correction
or colostomy.
(B) Bladder damage with loss of capacity, frequency
of urination, blood in urine, recurrent urinary infections, pain,
or spasm which may require urinary diversion and/or removal of bladder.
(C) Changes in skin texture and/or coloration, permanent
hair loss, scarring of skin.
(D) Bone damage leading to fractures.
(E) Testicular damage causing reduced sperm counts,
infertility, sterility, or risk of birth defects.
(F) Impotence (loss of erection) or sexual dysfunction.
(G) Swelling of the genitalia or legs.
(H) Nerve damage causing pain, loss of strength or
feeling in legs, and/or loss of control of bladder or rectum.
(I) Fistula between the bowel and other organs.
(J) In children, there may be additional late reactions.
(i) Disturbances of bone and tissue growth.
(ii) Bone damage to pelvis and hips causing stunting
of bone growth and/or abnormal development.
(iii) Second cancers developing in the irradiated area.
(i) Skin.
(1) Early reactions.
(A) Redness, irritation, or soreness.
(B) Scaliness, ulceration, crusting, oozing, discharge.
(C) Hair loss.
(D) These reactions are likely to be intensified by
chemotherapy.
(2) Late reactions.
(A) Changes in skin texture causing scaly or shiny
smooth skin, thickening with contracture, puckering, scarring of skin.
(B) Changes in skin color.
(C) Prominent dilated small blood vessels.
(D) Permanent hair loss.
(E) Chronic or recurrent ulcerations.
(F) Damage to adjacent tissues including underlying
bone or cartilage.
(G) In children, second cancers may develop in the
irradiated area.
(j) Extremities.
(1) Early reactions.
(A) Skin changes: redness, irritation, scaliness, ulceration,
coloration, thickening, hair loss.
(B) Inflammation of soft tissues causing tenderness,
swelling, and interference with movement.
(C) Inflammation of joints causing pain, swelling and
limitation of joint motion.
(D) In children, these reactions are likely to be intensified
by chemotherapy before, during or after radiation therapy.
(E) In children, depression of blood count leading
to increased risk of infection and/or bleeding is more common.
(2) Late reactions.
(A) Changes in skin reaction and/or coloration, permanent
hair loss and scarring of the skin.
(B) Scarring or shrinkage of soft tissues and muscle
causing loss of flexibility and movement, swelling of the limb.
(C) Nerve damage causing loss of strength, feeling
or coordination.
(D) Bone damage causing fracture.
(E) Joint damage causing permanent stiffness, pains
and arthritis.
(F) Swelling of limb below the area treated.
(G) In children, there may be additional late reactions.
(i) Disturbances of bone and tissue growth.
(ii) Bone damage to limbs causing stunting of bone
growth and/or abnormal development.
(iii) Second cancers developing in the irradiated area.
(k) Total body irradiation.
(1) Early reactions.
(A) Loss of appetite, nausea, vomiting.
(B) Diarrhea.
(C) Reduced and sticky saliva, swelling of the salivary
gland(s), loss of taste.
(D) Hair loss.
(E) Sore mouth and throat, difficulty swallowing.
(F) Permanent destruction of bone marrow leading to
infection, bleeding, and possible death.
(G) Inflammation of the lung with fever, dry cough
and difficulty breathing with possible fatal lung failure.
(H) Damage to liver with possible fatal liver failure.
(I) In children, these reactions are likely to be intensified
by chemotherapy before, during or after radiation therapy.
(J) In children, depression of blood count leading
to increased risk of infection and/or bleeding is more common.
(2) Late reactions.
(A) Lung scarring causing shortness of breath, infection,
and fatal lung failure.
(B) Cataract formation in the eyes, possible loss of
vision.
(C) Testicular damage in males causing sterility.
(D) Ovarian damage in females causing premature menopause
and sterility.
(E) Increased risk of second cancer.
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