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WHAT ARE THE MOST SERIOUS ADVERSE EVENTS DURING AND AFTER RADIATION THERAPY?. Bhadrasain Vikram, MD. GLIOBLASTOMA Stupp, NEJM 352:987-96, 2005. > Grade 3 non-heme toxicity in 31%. Most common: Fatigue & other constitutional symptoms Rashes & other skin effects Infection Effects on vision
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WHAT ARE THE MOST SERIOUS ADVERSE EVENTS DURING AND AFTER RADIATION THERAPY? Bhadrasain Vikram, MD
GLIOBLASTOMAStupp, NEJM 352:987-96, 2005. • >Grade 3 non-heme toxicity in 31%. Most common: • Fatigue & other constitutional symptoms • Rashes & other skin effects • Infection • Effects on vision • Nausea & Vomiting
HEAD & NECKBonner, NEJM 354:567-78, 2006. • >Grade 3 toxicity: • Mucosal 56% • Dysphagia 26% • Dermatitis 23% • Weight loss 11%
SMALL CELL LUNG - LDTurrisi, NEJM 340:265-71, 1999. • >Grade 3 non-heme toxicity: • Esophagitis in 32% • Infection • Fever • Vomiting • Pulmonary effects • Weight loss
ESOPHAGUSMinsky, JCO 20:1167-74, 2002. • >Grade 3 acute toxicity in 71%. • >Grade 3 late toxicity in 37%. • Esophageal strictures, perforations, bleeding.
BREAST: POST-LUMPECTOMYFyles, NEJM 351:963-970, 2004. • >Grade 3 toxicity: • Fatigue 1% • Skin erythema 1%
BREAST: POST-MASTECTOMYRagaz, JNCI 97:116-1126, 2005. • >Grade 3 late toxicity @ 20 years: • Cardiac 1% • Arm edema 6% • Symptomatic pneumonitis 0.6%
PANCREAS: POST-OPRegine, JAMA 299:1019-1026, 2008. • >Grade 3 non-heme toxicity in 58%. Most common: • Diarrhea • Stomatitis • Nausea & Vomiting
PROSTATE: LOW-RISKLawton, IJROBP 67:39-47, 2007. • >Grade 3 acute toxicity: • GU bleeding/toxicity 8% • >Grade 3 late toxicity: • Erectile dysfunction 9% • GU obstruction/retention 2%
PROSTATE: HIGH-RISKBolla, Lancet 360:103-108, 2002. • >Grade 3 toxicity: • Erectile dysfunction 68% • GI/GU toxicity 3.7%
CERVIXMorris, NEJM 340:1137-1143, 1999. • >Grade 3 acute non-heme toxicity in 11%. Most common: • Nausea & vomiting • Diarrhea • >Grade 3 late toxicity in 12%. Most common: • Bowel & Urinary toxicity
RECTUMSauer, NEJM 351:1731-1740, 2004. • >Grade 3 non-heme acute toxicity in 27%. Most common: • Diarrhea • Dermatitis • >Grade 3 late toxicity in 14%. Most common: • Diarrhea • Bowel obstruction/strictures • Bladder problems
ANALAjani, JAMA 299:1914-1921, 2008. • >Grade 3 non-heme acute toxicity in 74%. Most common: • Skin toxicity • Bowel toxicity • >Grade 3 late toxicity in 11%. Most common: • Bowel toxicity • Skin & Subcutaneous
SUMMARY • Serious adverse events frequently occur during and after radiation therapy in many common cancers. • The impact of advanced technologies (IMRT, Protons, etc.) in that regard has until now been quite modest.