Follow-up/Toxicity Flashcards
How does the toxicity of CI 5-FU differ from that of bolus administration?
Bolus administration of 5-FU confers greater hematologic toxicity, whereas CI confers greater GI toxicity (mucositis, diarrhea). (Smalley SR et al., JCO 2006)
What was a major late complication of neoadj RT in the Swedish Rectal Cancer trial?
SBO was more likely in the neoadj RT arm in the Swedish Rectal Cancer trial (RR 2.5) (Birgisson H et al., Br J Surg 2008), and may be a limitation of a short course regimen (5 Gy × 5).
What 3 toxicities were worse with neoadj RT in the Swedish Rectal Cancer trial?
Median bowel movement frequency (20 movements/wk vs. 10 movements/wk, SS), fecal incontinence (62% vs. 27%, SS), and impaired social life (30% vs. 10%, SS) were worse in the neoadj RT arm when c/w Sg alone in the Swedish Rectal Cancer trial.
What does the post-Tx surveillance include for colorectal cancer?
Post-Tx rectal cancer surveillance: H&P q3–6 mos for 2 yrs (then q6 mos for 5 yrs) and CEA on same schedule for St. II/III pts. CT C/A/P is performed q6–12 mos for 5 yrs and colonoscopy at 1 yr, or within 3–6 mos if not done before treatment due to obstructing lesion.
Which retrospective study found comparable Tx results/toxicity with RT in rectal cancer pts with IBD?
A Mt. Sinai study by Green S et al. found comparable Tx results/toxicity with RT in rectal cancer pts with IBD. (IJROBP 1999)
How long after conventional RT can side effects develop, and what are some common side effects of RT?
Signs and Sx can occur as early as 6–18 mos following RT. Frequent Sx include diarrhea (bloody), colicky abdominal pain, and n/v. Less common are SBO, fistulas, bowel perforation, and severe bleeding. Bowel malabsorption may occur with weight loss. Damage to the ileum can impair resorption of vitamin B12 and bile acid with steatorrhea as a consequence (Guckenberger M et al., Int J Colorectal Dis 2006). Consider pelvic physical therapy including vaginal dilator use to mitigate GI, GU, sexual, and musculoskeletal side effects.
