Chua Gail Wan Ying, Vig Prachi Simran
Division of Radiation Oncology National Cancer Centre Singapore Singapore Singapore.
Yong Loo Lin School of Medicine National University of Singapore Singapore Singapore.
Paediatr Neonatal Pain. 2023 Feb 2;5(1):1-9. doi: 10.1002/pne2.12094. eCollection 2023 Mar.
Radiotherapy is an important aspect of oncological treatment in several childhood cancers. However, radiotherapy is known to have numerous side effects, including detrimental effects on growth, neurocognitive impairment, and the development of secondary malignancies. One less studied long-term side effect of pediatric radiotherapy treatment is chronic pain. While the short-term toxicities of radiotherapy resolve over a few weeks to months, the chronic pain caused by radiotherapy-induced tissue damage can significantly affect children's quality of life. As long-term childhood cancer survivors age into adulthood, they are typically followed up by a wide variety of doctors, not all of whom may be familiar with radiotherapy-induced chronic pain and its management. The aim of this review is to discuss the various common manifestations of radiotherapy-related pain in children, as well as ways to identify and manage these. Common radiotherapy-related side effects leading to chronic pain symptoms include radiation fibrosis, enteritis, dermatitis, lymphedema, neuropathic pain, and effects on bone development. The pathophysiology, evaluation and management of these are briefly summarized in this review. This is followed by an overview of radiotherapy techniques that allow greater sparing of normal tissue, minimizing future painful side effects. Finally, the assessment of pain in children is described, as well as strategies for management, and red flag symptoms that should prompt urgent specialist referral. In conclusion, a good understanding of the long-term side effects of radiotherapy treatment in children is essential for the various medical professionals that follow-up the child in the years after treatment. For young children, the evaluation of pain is in itself a challenge, and effects on growth, development, and learning are crucial. For older children, social and psychological factors become increasingly important. As radiation therapy techniques continue to advance, the spectrum and incidence of chronic pain syndromes may change over time.
放射治疗是多种儿童癌症肿瘤治疗的重要方面。然而，众所周知，放射治疗有许多副作用，包括对生长的不利影响、神经认知障碍以及继发性恶性肿瘤的发生。儿科放射治疗较少被研究的一种长期副作用是慢性疼痛。虽然放射治疗的短期毒性在几周至几个月内会消退，但由放射治疗引起的组织损伤导致的慢性疼痛会显著影响儿童的生活质量。随着儿童癌症长期幸存者步入成年，他们通常会接受各种各样医生的随访，并非所有医生都熟悉放射治疗引起的慢性疼痛及其管理。本综述的目的是讨论儿童放射治疗相关疼痛的各种常见表现，以及识别和管理这些疼痛的方法。导致慢性疼痛症状的常见放射治疗相关副作用包括放射性纤维化、肠炎、皮炎、淋巴水肿、神经性疼痛以及对骨骼发育的影响。本综述简要总结了这些副作用的病理生理学、评估和管理方法。接下来概述了能更好地保护正常组织、将未来疼痛副作用降至最低的放射治疗技术。最后，描述了儿童疼痛的评估、管理策略以及应促使紧急转诊至专科医生的警示症状。总之，对于在治疗后数年对儿童进行随访的各类医学专业人员来说，充分了解儿童放射治疗的长期副作用至关重要。对于幼儿而言，疼痛评估本身就是一项挑战，且对生长、发育和学习的影响至关重要。对于大龄儿童，社会和心理因素变得越来越重要。随着放射治疗技术不断进步，慢性疼痛综合征的范围和发生率可能会随时间而变化。
