Follow-up/Toxicity Flashcards
What is the approximate long-term PEG tube dependency rate after CRT for OPC?
The long-term PEG tube dependency rate after CRT can be as high as 15%–20%, which is reduced with efforts on sparing swallowing structures (pharyngeal constrictors, larynx) with swallowing exercises and the use of PEG on demand.
What are some typical RT dose constraints for the parotid glands?
Typical RT dose constraints for the parotid glands are (a) mean dose to either parotid <26 Gy or (b) at least 50% of either parotid gland <30 Gy.
What is the typical RT dose constraint for the inner ears?
The mean dose to the inner ears should be ≤35 Gy.
Appx what % of pts receiving cisplatin-based chemo will experience hearing loss as a result of ototoxicity?
∼30% of pts will experience hearing loss.
What were the xerostomia rates for OPC pts treated with IMRT in RTOG 00–22?
Xerostomia rates in RTOG 00–22 (Eisbruch A et al., IJROBP 2010) were 55% at 6 mos, 25% at 1 yr, and 16% at 2 yrs. Salivary output did not recover over time.
What was the observed rate of osteoradionecrosis with accelerated hypofractionated IMRT in RTOG 00–22?
The observed rate of osteoradionecrosis was 6% in RTOG 00–22 (Eisbruch A et al., IJROBP 2010), which is higher than expected for IMRT (potentially b/c of the accelerated hypofractionated approach). Other toxicities were acceptable (grade 2+ for mucosa [24%], salivary [67%], esophagus [19%]).
What oral care do all pts need to be instructed on?
Fluoride trays. Consult a dental oncologist before any dental procedures.
What is the follow-up paradigm for OPC pts?
OPC follow-up paradigm: H&P + pharyngolaryngoscopy (q1–3 mos for yr 1, q2–6 mos for yr 2, q4–8 mos for yrs 3–5, q12 mos if >5 yrs), imaging (for signs/Sx), annual TSH, speech/hearing/dental evaluation, and smoking cessation.
