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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

WHAT ARE THE MOST SERIOUS ADVERSE EVENTS DURING AND AFTER RADIATION THERAPY?

Bhadrasain Vikram, MD

glioblastoma stupp nejm 352 987 96 2005
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 neck bonner nejm 354 567 78 2006
HEAD & NECKBonner, NEJM 354:567-78, 2006.
  • >Grade 3 toxicity:
    • Mucosal 56%
    • Dysphagia 26%
    • Dermatitis 23%
    • Weight loss 11%
small cell lung ld turrisi nejm 340 265 71 1999
SMALL CELL LUNG - LDTurrisi, NEJM 340:265-71, 1999.
  • >Grade 3 non-heme toxicity:
    • Esophagitis in 32%
    • Infection
    • Fever
    • Vomiting
    • Pulmonary effects
    • Weight loss
esophagus minsky jco 20 1167 74 2002
ESOPHAGUSMinsky, JCO 20:1167-74, 2002.
  • >Grade 3 acute toxicity in 71%.
  • >Grade 3 late toxicity in 37%.
    • Esophageal strictures, perforations, bleeding.
breast post lumpectomy fyles nejm 351 963 970 2004
BREAST: POST-LUMPECTOMYFyles, NEJM 351:963-970, 2004.
  • >Grade 3 toxicity:
    • Fatigue 1%
    • Skin erythema 1%
breast post mastectomy ragaz jnci 97 116 1126 2005
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 op regine jama 299 1019 1026 2008
PANCREAS: POST-OPRegine, JAMA 299:1019-1026, 2008.
  • >Grade 3 non-heme toxicity in 58%. Most common:
    • Diarrhea
    • Stomatitis
    • Nausea & Vomiting
prostate low risk lawton ijrobp 67 39 47 2007
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 risk bolla lancet 360 103 108 2002
PROSTATE: HIGH-RISKBolla, Lancet 360:103-108, 2002.
  • >Grade 3 toxicity:
    • Erectile dysfunction 68%
    • GI/GU toxicity 3.7%
cervix morris nejm 340 1137 1143 1999
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
rectum sauer nejm 351 1731 1740 2004
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
anal ajani jama 299 1914 1921 2008
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
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.