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Serious Adverse Events During and After Radiation Therapy

This article examines the most serious adverse events experienced by patients during and after radiation therapy for various common cancers. The impact of advanced technologies on these events is also discussed.

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Serious Adverse Events During and After Radiation Therapy

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  1. WHAT ARE THE MOST SERIOUS ADVERSE EVENTS DURING AND AFTER RADIATION THERAPY? Bhadrasain Vikram, MD

  2. 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

  3. HEAD & NECKBonner, NEJM 354:567-78, 2006. • >Grade 3 toxicity: • Mucosal 56% • Dysphagia 26% • Dermatitis 23% • Weight loss 11%

  4. SMALL CELL LUNG - LDTurrisi, NEJM 340:265-71, 1999. • >Grade 3 non-heme toxicity: • Esophagitis in 32% • Infection • Fever • Vomiting • Pulmonary effects • Weight loss

  5. ESOPHAGUSMinsky, JCO 20:1167-74, 2002. • >Grade 3 acute toxicity in 71%. • >Grade 3 late toxicity in 37%. • Esophageal strictures, perforations, bleeding.

  6. BREAST: POST-LUMPECTOMYFyles, NEJM 351:963-970, 2004. • >Grade 3 toxicity: • Fatigue 1% • Skin erythema 1%

  7. BREAST: POST-MASTECTOMYRagaz, JNCI 97:116-1126, 2005. • >Grade 3 late toxicity @ 20 years: • Cardiac 1% • Arm edema 6% • Symptomatic pneumonitis 0.6%

  8. PANCREAS: POST-OPRegine, JAMA 299:1019-1026, 2008. • >Grade 3 non-heme toxicity in 58%. Most common: • Diarrhea • Stomatitis • Nausea & Vomiting

  9. 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%

  10. PROSTATE: HIGH-RISKBolla, Lancet 360:103-108, 2002. • >Grade 3 toxicity: • Erectile dysfunction 68% • GI/GU toxicity 3.7%

  11. 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

  12. 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

  13. 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

  14. 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.

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