Chapter 21 - Rads, Systemic Tx H/N CA Flashcards
Benefit of adding chemo to radiation
Most common H/N chemo
Chemo potentiates effects of RT
Cisplatin- most common chemo for H/N chemorads
When to use postop chemorads
ECS, pos marg
Definitive H/N Rads doses
66-70 Gy definitive gross
Usually once/day 6-7 wk, 1.8-2.25 Gy per day
High risk elective neck- 60
Low risk- 54
Postop- 66
How radiation kills cells
ROS
Strand breaks
Who cannot be Tx with RT
Coll Vasc Dz
Hypersensitivity (Atax Telang)
Prego esp 1-2 tri
Xeroderma, Li Fraumeni INC risk secondary cancers
When to consider induction chemo
Hypo/Nasopharynx (can decrease risk of distant Mets, improved organ preservation)
Consider if delay in definitive chemorads and patient has upper airway obstruction/dental abscess
AE of Cisplatin
Hearing loss, renal failure, peripheral neuropathy, electrolytes, GI
AE of carboplatin
Electrolyte abnormalities, myelosuppression
AE of 5-FU
Mucositis, hand-foot syndrome, photosensitivity, maculopapular rash
AE of Paclitaxel
P neuro, arthralgia, myalgia
AE of Docetaxel
P neuro, edema, asthenia
Cetuximab AE
acneiform rash, dermatitis, hypomagnesemia, neutropenia
Which early stage H/N tumors should be treated with RT? Which should still get surgery?
RT (if T1-2, N0-1): tongue, tonsil, larynx, hypopharynx, can be considered RT candidates. Nasopharynx uses RT regardless of stage
No RT: salivary glands, FOM. Use surgery regardless of how early stage it is
When to add concurrent chemo to radiation for initial Tx of H/N cancers
T3-4, N2-3
When to offer adjuvant RT/chemo
margin positive, T3-4, multiple/bulky positive nodes, ECS, PNI, LVI, nodal disease in IV/V, oral cavity depth of invasion >2mm or close margins, recurrent dz treated with salvage surgery
When to add concurrent chemo to RT after surgical resection?
positive margins, extracapsular spread/extension
When to add adjuvant RT for salivary tumors
close/pos marg, pT3-4, intermediate/high grade, adenoid cystic, bone invvasion, PNI, PVI, node positive
When to start adjuvant RT
4-6 weeks after (need healing, but H/N cancers repopulate quickly)
Complete both surgery and ratiation within 13 weeks
When to use Rads for skin cancer
Huge tumor - morbid surgery
cosmetic
nonsurgical candidates
When to use adjuvant RT +/- chemo for skin cancer
PNI, pos margin, parotid invasion, ear primary with depth invasion >2mm, Clark’s level IV+, poor diff
When to radiate nodes for skin cancer
> 3 + nodes, ECS, >4cm, deep invasion, invade underlying structures, cancer of ear esp preauricular
Timing of AE of H/N radiation
Acute: Weeks 2-3, resolve 4-6 weeks after completion
AE of H/N Rads
Fatigue Skin rxn Mucositis Xerostomia Hoarse, otitis media, dry eyes, conjunctivitis, keratitis, sinonasal congestion, epistaxis
How to treat Rads AE fatigue, skin rxn, xerostoma
Fatigue: exercise, antidepressant
Skin: Moisturizer (non-perfumed), humectant
Xerostomia: water/baking soda/salt/peroxide rinse, biotin, pilocarpine, amifostene (prophy), hygiene
How to treat mucositis/dysphagia/odynophagia
diet, manuka honey, lidocaine, benadryl, antacids, NSAIDs, narcotics, sucralfate, steroids, hydration/nutrition
Long term RT complications
xerostomia, skin, hypothyroid, ORN, bone exposure, laryngeal edema, esophageal stenosis, vision/hearing, trismus, secondary cancers
Stereotactic Body Radiotherapy
Good for re-irradiation
Delivery high dose to areas of relapse, spare normal tissues
