Radiation Therapy to the Mantle Field
You will be receiving 4 to 5 weeks of radiation treatment to the mantle field. This booklet will tell what you need to do to take care for yourself during and after your treatment. It will tell you what to expect and what side effects might occur.
The word mantle comes from Old English, French, and Latin languages. It means a cloak or loose covering about the shoulders. Mantle field radiation treatment focuses on lymph nodes in the neck (cervical), armpit (axillary), collarbone (clavicular), and breast bone (mediastinal) areas.
How Radiation Treatment is Given
Mantle field radiation treatment is given over four to five weeks. One treatment (fraction) is given every day, Monday through Friday. Each treatment takes about 90 seconds. During the treatment, you will be alone in the treatment room. We can hear and see you via a camera and intercom system. If you need anything during the treatment, simply call out. The therapist will stop the treatment to help you.
Positioning for Your Treatment
Each day, right before your treatment, you will be asked to get into position on a treatment table. The radiation therapists will help you get into the correct position. Some patients are put into “molds”. These molds are made during the treatment planning period.
Tiny dots or marks may also have been put on your skin. These marks relate to your treatment field. They look like tiny freckles and will not be easy to see. Oil based skin markers or a dye may be used to make these marks.
If these marks fade, they will be remarked. After your radiation treatment is finished, you can allow the marks to fade. You can also gently remove them using soap and water or baby oil. These marks may rub off on your clothes. If this happens, spray the stains with hair spray or Spray'N'Wash® before you wash your clothes.
Radiation Skin Reaction
Most radiation goes through the skin into body tissues. Even so, the skin in treatment sites can become reddened and irritated. It can also become dry and itchy. Sometimes, the skin will peel and become moist. This happens most often in skin folds and curves. The radiation therapists will tell you which sites to watch.
Watch your skin closely and report any changes you notice. Use the skin care products as directed. As your skin reaction develops, we will also watch it closely. We may tell you to change the way you care for your skin. Some skin reactions can be painful. Tylenol® or ibuprofen is usually helpful. If you need something stronger or help with skin care, let us know.
If you have questions or concerns after your treatments end, call the Radiation Oncology (open 8–5) at (608) 263-8500 and ask to speak to a nurse. If the clinic is closed, your call will be transferred to the answering service. Give the operator your name and phone number with the area code. The doctor will call you back.
Skin Care during Treatment
In order to protect your skin during treatment, you should follow the guidelines listed below. You will need to follow these guidelines during your treatment and afterwards, until your skin has fully healed.
1. You may bathe or shower as usual using lukewarm water. If you need soap, use one that is meant for dry or sensitive skin. Rinse skin well and gently pat it completely dry. Do not rub the skin in treatment fields.
2. AVOID heat--heating pads, very hot water in the bath or shower, and hot water bottles.
3. AVOID cold. Do not allow the skin to become chilled from exposure to ice or very cold water or air.
4. AVOID sunlight or sunlamps on the skin in the treatment site. When you are outside, keep the area covered with clothing. If clothing does not completely cover the area, use a sunscreen with SPF of 20 or higher.
5. AVOID rubbing or using friction on the skin exposed to treatment. Do not rub or scrub the treated area. Wear comfortable, loose, cotton based clothing that will allow good air flow. Avoid clothing made of nylon or synthetics because they hold moisture next to the skin. Clothes that bind can cause further irritation to the radiated skin.
6. AVOID the use of tape on skin in the treated area.
7. In most cases, nothing should be applied to the treated skin unless approved of by your doctor or nurse. This includes bath oils, perfumes, talcum powders, and lotions. If a skin reaction is expected, we will suggest a skin moisturizer. Use it each day as instructed.
Remember: Your skin needs to be clean and dry before each treatment. Lotions and creams should be applied 2 – 4 times per day to help your skin feel better. You should not apply lotions or creams in the 1-2 hour period before your treatment. If your treatment is later in the day, you may apply a skin care product if it will be fully absorbed by the time your treatment is given.
Care of Skin After Treatment
1. Although rare, late effects may occur. These late effects may occur months to years after the end of treatment. Treated skin may continue to be dry. It may also darken in color, or become firm and tough. It may help to apply skin moisturizer or Vitamin E oil.
2. The skin in treatment areas may always be extra sensitive to sunlight. When outdoors, use a sunscreen of SPF 20 or higher. This is because the skin in treatment fields is at higher risk for a certain type of skin cancer.
Dry or Sore Throat
Sometimes a dry or sore throat occurs with treatment. This may begin by the third week. There are a number of things that you can do to feel less discomfort.
- Use a vaporizer in your main living area or in your bedroom at night when you sleep.
- Avoid smoking and chewing tobacco.
- Drink plenty of liquids – 8 to 10 glasses each day.
- Suck hard candies, mints, or medicated lozenges.
- Avoid alcohol, hot foods, acidic foods and juices (orange, lemon, lime, or grapefruit), and spicy foods.
- Your doctor may prescribe a numbing spray or a liquid, if needed.
Problems with Swallowing
Trouble swallowing is a side effect of radiation to the chest when the esophagus is part of the treatment field. The range and type of discomfort vary from person to person. You may notice burning or fullness, or have a lump in your throat when you swallow. Swallowing may become difficult about two weeks into the treatment. The problem may go on for two to four weeks after your treatments finish. The tips below may help.
- Relax, eat slowly, and chew your food well so it can be digested easily. Eat small meals (4 to 6 per day).
- Drink 8 to 12 glasses of liquid each day.
- Cool, soft foods help to soothe the esophagus.
- Antacids sometimes help to coat and protect the esophagus. Ask your doctor before you begin using an antacid.
- Sometimes, a pain medicine is needed. If you have pain that prevents eating or swallowing, talk with your doctor.
Foods to Choose
Foods to Avoid
Milk products, milkshakes, eggnog; pear, apple, prune, grape or cranapple juice; water-diluted citrus juices; Kool-Aid®; Carnation Instant Breakfast® or other nutritional supplements.
Alcohol; full-strength citrus juices; carbonated beverages; very hot or very cold drinks.
Milk toast; soft cooked or poached eggs; diced, moist meats; hot cereals cooked with milk.
Dry cereals; dry toast; granola.
Mainand Side Dishes
Tender, moist, cooked meats – grind or blend meats with gravies and sauces, if needed; moist casseroles; rice or noodles with gravy or sauce; macaroni and cheese; mashed potatoes; baby food; creamed soups; soft, cooked vegetables; moist baked beans.
Highly seasoned or spicy dishes; chewy, dry, tough meat or poultry; fried foods; undercooked vegetables
Slices of cheese or cheese spread; sliced bananas; cooked fruit; graham crackers soaked in milk; peanut butter on soft bread.
Dry crackers; nuts; potato chips; raw fruit or vegetables; hard bread; rough textured foods; spicy dips.
Pudding; ice cream; gelatin; custard; tapioca; yogurt; fudgesicles; popsicles
Any crumbly, dry, chewy dessert.
Liquid or powdered food supplements add protein and calories to your diet. These supplements can be found in grocery, drug, and health food stores. Some brand names include: Carnation Instant Breakfast®, Boost®, Ensure®, Sustacal®, Osmolyte®, and Skandi-Shake®. Persons with diabetes may use Glucerna® or Choice® products. GNC (a health food store) also carries a supplement called Gainer’s Fuel® by Twinlab. Many stores carry generic brands of these supplements. Canned liquid supplements are easy to use. Just pop the can and drink. Powders can be mixed into fluids or foods.
Radiation to the abdomen can cause nausea and vomiting. Some patients reduce their intake or stop eating entirely to avoid these symptoms. This is not recommended. Your body needs food to heal and rebuild normal tissue damaged by radiation. Food also provides energy and strength to help you complete your treatments. Tell your doctor or nurse if you have nausea or vomiting. Often, these symptoms can be controlled.
Some of the tips listed below may be helpful.
1. Eat small amounts of salty foods such as crackers or pretzels.
2. Drink small amounts of clear, cold drinks such as 7-up®, ginger ale, and caffeine-free cola. Avoid drinking large amounts, as they can cause gas.
3. Try cold foods such as Popsicles®, gelatin desserts, yogurt, cottage cheese, cheese, deviled eggs, and cold meats.
4. Relax, eat slowly and chew your food well. Eat small meals (4-6 per day). This will also reduce a tense stomach.
5. Avoid eating 1-2 hours before and after treatment.
Feeling tired (fatigue) during radiation treatment is a common side effect. The severity of fatigue varies from person to person. Fatigue does not mean that your tumor is getting worse. Some people feel no fatigue and are able to keep up with their normal routines. Others feel the need to take an extra nap each day. Still others change their routines, working only part time, for example. Some people don’t do anything that requires a large amount of energy. Fatigue can begin right away, or it can occur after 1 – 2 weeks of treatment. It can go on for several weeks to months after treatment has ended. Rarely, it can last for up to a year.
Low blood counts may also cause you to feel tired. Your bone marrow makes blood cells. If a lot of bone is in your radiation field, your production of blood cells may be slowed down for a time. This is a short term side effect. Your doctor may order a blood test from time to time to check your blood cell counts.
Here are a few tips that may help with feeling tired.
1. Listen to your body and rest when you need to. A short nap during the day or sleeping a little longer may help.
2. Make time for activities you enjoy. Take a walk in the fresh air, visit with a friend, or pursue a hobby during the times that you feel most energetic. Do things that help you feel good.
3. Stop smoking and do not drink alcohol to excess. Do something healthy for yourself. If you need help with this, talk with your doctor or nurse. There are ways we can help.
4. If you work you may want to keep working. Some people are able to maintain a full time job. Others find it helpful to work fewer hours. Many employers understand and will agree to part time work. We can schedule your treatment times to fit in with your work schedule.
5. Plan regular active exercise – daily walks, riding an exercise bike, or any mild exercise. Go at your own pace. Never exercise to the point of fatigue. A good rule of thumb is that you should feel less tired after the exercise than you did before the exercise.
6. Take advantage of emotional outlets. Pent-up emotions can add to fatigue. Talk with family or friends. Having a good cry or laugh can be helpful.
7. Eat well. Keep foods around that need little effort to prepare – cheese, yogurt, or slices of meat. When you feel well, prepare and freeze meals to eat later when you are tired. Extra calories and protein are needed to maintain energy while getting treatments. They also help repair normal skin cells damaged by your treatment. Speak with a clinic nurse if you have problems eating.
8. Drink lots of fluid – 8 to 12 glasses per day. The water will help to flush some of the by-products of your cancer fighting treatment out of your body.
9. If you need help with your basic daily needs, ask your nurse or the social worker to help you contact your local resources. You may be able to receive help with meals, housekeeping, personal care, transportation, support groups, and respite care.
10. Accept offers of help from family and friends. If friends ask if they can help, accept it! If they ask you to call if you “need anything,” they may need specific ideas from you. Often people want to help but don’t know what things you need the most help doing. Things like mowing the lawn, baking a casserole or watching the kids, can help both you and your friends to feel good.
11. Visits from family and friends can be pleasant, but also tiring. You do not need to be the perfect host or hostess. Let family and friends fix dinner, and get the drinks and snacks for you!
12. Some people may have pain from cancer or other causes. Pain can be very tiring. Your doctor and nurse can work with you to achieve good pain control. Let them know about any discomfort you have during treatment.
About 3 weeks into the course of your treatment, the hair on the nape of your neck will begin to fall out. During the next week or so most or all of the hair in that area will fall out. It will begin to grow back within 3 months, and you should have all of it back within 6 months.
As a result of the radiation treatment, you can expect a short-term decrease in the number of white blood cells (the cells that fight infection). A weekly blood test will be done to check your blood counts. If you develop a fever tell your doctor or nurse. Avoid being around people with contagious diseases such as colds, flu, strep throat, measles, chicken pox, etc.
Possible Late Effects of Mantle Field Radiation Treatment
The most common long-term side effect of mantle field treatment is a change in the way the thyroid gland works. During your follow-up visits, a simple blood test will be done to check for thyroid problems before they have any effect on your body. If any problems are found, you may be referred to an endocrine doctor who will most likely advise you to take a thyroid pill daily.
Ten to fifteen percent of the patients treated with radiation to the mantle field have a tingling that extends down their arm and legs when they flex their neck. This sensation is known as Lhermitts Syndrome. It has no medical significance and resolves on its own.
Herpes zoster (shingles) can occur within one to two years after you have finished your mantle field treatment. If you should develop this chicken pox-like rash, call your doctor or nurse right away. The outbreak is most often limited to one area. It can be controlled with oral medicine.
Radiation pneumonitis, an inflammation of the irradiated areas in the lungs, is detected in less than five percent of the patients. It can occur one to three months after radiation is over. The symptoms are a mild cough, a low fever, and a mild shortness of breath. Pneumonitis can be treated with steroids.
A diagnosis of cancer brings concerns other than the need to manage the acute side effects of treatment. Often, it affects many other areas of your life. Patients feel its impact on their emotions, marriage, family, jobs, finances, thoughts and feelings about the future, and many other important areas of life. The nurses and social workers can help you cope with these issues. They can suggest support services and resources. Feel free to speak them at any time.
Cancer Resource Services
Cancer Connect is a service of the UW Comprehensive Cancer Center. The staff can answer your questions about local treatments. Cancer Connect has knowledge of community resources and support services. The number is (608) 262-5223.
Cancer Information Service is a phone service of the National Cancer Institute. It is a resource for local cancer care as well as cancer care around the country. The toll free number is 1-800-4-CANCER (1-800-422-6237).
The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Any duplication or distribution of the information contained herein is strictly prohibited.
Last Updated: 08/18/2011
Copyright © 08/18/2011 University of Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#5216
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