Hello, after my wife's 26th radiation treatment ten days ago, her treatment was put on hold because of burns to her neck. The 26th treatment was the first time they removed the "bowlus" around the neck, my understanding is the bowlus pulls the radiation effect closer to the surface of the skin. That day her skin still just mostly looked a deep red with maybe a little bit of oozing and a bit of "alligator skin" look. When the RO saw her after treatment, she immediately said that we would need to put a hold on further treatment to give the neck time to heal. We started out just using Aquafor, a hydrocort cream and a benedryl gel but within two days her skin had pretty well broken down with bleeding, oozing and almost like her scar were trying to open up including her trache stoma. For the last week we have been using silver sulfadiazine on the worst area and Aquafor on the area around it. Today they gave us a morphine cream that could be applied to the top of the other creams to help with pain. Couple of questions, have may others experienced this skin breakdown, used these creams and how long did it take to heal? Has anyone experienced nausea from a morphine cream? She had a very difficult time catching her breath after throwing up to the point where we were almost headed to the ER and the Oncologist on-call suggested she go in to get looked over and get a chest x-ray. I didn't ask at the time but about the only reason I could think of that she would need a chest x-ray would be if something maybe got down her lungs when throwing up?

Anyway just looking for others experiences.

Thanks,

Tom, I used the aquafor cream and I think that may have been what broke my neck out in blisters. I'm not for sure however I have only had 16 radiation treatments and 4 chemo and I have been doing fine until they gave me that for reddened dry skin on my neck. I hope your wife gets better real soon and you both are in my thoughts. Angel

Tom - my husband had terrible burns to his neck the last week of radiation. He's two and a half weeks out of treatment and is finally almost healed. The trick is Silvadene. Smear a thin (but not stingy) layer on the entire area (not just the visibly burned parts) several times a day (washing in between each application). Leave it uncovered if possible.

I hope your doctor prescribed the 400 gram jar for you. We were given these silly 25 gram tubes at first so I wasn't using enough in order to conserve it. Get the jar! I swear, it works like magic.

Thanks for the input, they had given us 100 grams (2 - 50 gm jars) and so far I have used just about one of them. I have only been using it on the "open" areas three times a day. We have gone back and forth on taking it off between applications because of all the bleeding so sometimes I would just apply more over the top and to the areas where it had slid around. It does look better today, yesterday I would have said the area was about 3"x8" and today is a little more irregular shaped but the main area probably 1.5"x6".

I know when we first just used the Aquafor, I wondered if that was just making it worse but think that was just the lingering effects of the radiation.

Was curious about this "bowlus" thing, my wife said that it was a plastic thing that they would tape on her neck between her neck and the mask. I assume this is a standard thing to help direct the radiation but just sounds kind of strange. Did they use something similar on your husband or Angel are they using something like that on you?

Tim didn't have anything like that. A "bolus" effect is when the radiation is intensified due to there being cream or lotion on the area (I'm sure your doc told her not to put anything on the area for a few hours prior to treatment, right?). Could that be the "bolus" the doctor meant?

You should definitely wash between applications and wash your hands before applying. Not doing so can result in infection. Tim uses cetaphil. It's very gentle. And use your hands only. Don't use a washcloth or scrub or anything.

Is she on a fentanyl patch for the pain? Tim was all the way up to 150 mcg and is now tapering down, currently at 100 mcg.

Her radiation is in the morning so always showers and doesn't put any lotions or creams on until after treatment. Whatever they were using must produce that bolus effect and they just call it a bolus. I believe they said the were using it to make the radiation more effective closer to the surface of the skin so it may have worked essentially like putting a cream on.

She is on the fentanyl patch but just 25mg and still using Oxycodone. She was going to go up to 50mg but also started taking fluconazole for thrush which can react with the fentanyl and make the effect of the fentanyl more intense.

She has been using a surgical scrub to clean the area. I know at first she was using a washcloth and having trouble because the silver sulfadiazine would want to stick. Another patient at the clinic told us that he found it easier on his neck when the person applying it used a vinyl glove, so have always been washing and using gloves.

Thanks for the tips.

I am not familiar with a "Bolus". You might want to have her RO explain what it is actually doing.

I thought most (if not all) IMRT systems used a built-in multi-leaf collimator for beam shaping and modulation intensity variation by blocking beamlets.

"In radiation therapy, Bolus is a tissue equivalent substance placed on the patients skin in order to achieve the required dose distribution to the target site and surrounding healthy tissues."

http://en.wikipedia.org/wiki/Bolus_(radiation_therapy)

http://www.civco.com/oncology/miscellaneous/bolus/skinless/

Google is your friend...

TomT, They haven't used any kind of Bolus or anything on my neck or anywhere else other that I wear a mask that was made for me, made of mesh that bolts my head to the table so I won't move it and they tie my hands to ropes that are attached to a piece of wood under my feet so I am in the same position each treatment. But they don't put anything else on me. Angel