Radiation therapy provides an important role in the management of HGG. Nursing care provided by the radiation oncology nurse begins at the initial consult visit and continues into the early post-radiation phase. Patients and families must be educated regarding treatment schedules and expected effects and side effects. Options available to patients include conventional regional radiation, whole brain radiation, stereotactic radiosurgery such as gamma knife or photon beam, brachytherapy, and hyperthermia (31). It is often difficult to assess if symptoms are being caused by the radiation therapy itself, tumor growth, or other concurrent therapies. Acute symptoms occur within the first few weeks to months and are usually self-limiting. These include nausea but rarely vomiting, anorexia, impaired taste, fatigue, increased seizures, increased neurologic deficits, skin changes, hair loss, and impaired wound healing. Some patients whose radiation fields lie near the ear can experience hearing loss, ear pain, discomfort, and in some cases otitis media. Being prepared for hair loss can make the experience easier and allow patients to prepare by finding a wig, hairpiece, cutting their hair, or buying scarves, turbans, hats, or other head coverings. Patients may desire a wig for the alopecia and a prescription can be written for a cranial prosthesis, which is usually reimbursed by most insurance companies. Increased symptoms may require a temporary increase in the steroid dose. Delayed effects such as memory impairment, hypopituitarism, and radiation necrosis can often be progressive over time and are usually managed by the neuro-oncology nurse.
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