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Chemotherapie und Strahlentherapie: Hauptnebenwirkungen und Management-Prinzipien

Both modalities target rapidly dividing cells, causing on‑target toxicity in normal tissues. Understanding common side effects enables proactive management.

Chemotherapy: Systemic Toxicities

Organ System	Key Effects	Monitoring/Mitigation
Hematologic	Neutropenia, anemia, thrombocytopenia	CBC q cycle; G‑CSF for febrile neutropenia risk
GI	Nausea/vomiting (acute/delayed), mucositis, diarrhea	5‑HT3/NK1/dexamethasone prophylaxis; oral care
Dermatologic	Alopecia, hand‑foot syndrome, rash, nail changes	Scalp cooling (alopecia); urea creams (HFS)
Renal	Tubular toxicity (cisplatin), hemorrhagic cystitis (cyclophosphamide)	Hydration, mesna, dose adjustment
Hepatic	Sinusoidal obstruction, steatohepatitis	LFTs monitoring
Cardiac	Anthracycline cardiomyopathy, 5‑FU ischemia	Echo/MUGA baseline/serial; dexrazoxane
Pulmonary	Bleomycin pneumonitis/fibrosis	PFTs; avoid high O₂
Neurologic	Peripheral neuropathy (platinums, taxanes, vinca)	Dose reduction; duloxetine for CIPN
Reproductive	Gonadal failure, infertility	Fertility preservation counseling pre‑treatment
Secondary malignancy	AML/MDS (alkylators, topo II inhibitors), solid tumors	Long‑term survivorship screening

Radiation Therapy: Local/Regional Toxicities

Site	Acute	Late
Skin	Erythema, desquamation	Fibrosis, telangiectasia, pigment change
Mucosa	Mucositis, dysphagia, proctitis	Stricture, fistula, atrophy
Organ‑specific	Pneumonitis (lung), cystitis (bladder), enteritis (bowel)	Fibrosis, secondary cancer, vascular injury
Systemic	Fatigue (universal)	—

Shared Principles

Pre‑treatment baseline assessment (organ function, fertility, psychosocial).
Multidisciplinary supportive care (palliative, nutrition, rehab, psycho‑oncology).
Survivorship care plans documenting exposures and surveillance schedules.

Individual risk varies by regimen, dose, volume, age, comorbidities, and genetics. Oncology teams tailor prophylaxis and surveillance accordingly.

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