Nasopharyngeal Cancer Follow-up

Updated: Nov 15, 2021
  • Author: Arnold C Paulino, MD; Chief Editor: Cameron K Tebbi, MD  more...
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Follow-up

Further Outpatient Care

Radiation therapy is often administered on an outpatient basis. Follow-up is necessary after all radiation and chemotherapy has been administered.

Patients are evaluated every 3 months during the first year and every 6 months during the second and third years after treatment. Thereafter, follow-up is necessary every year.

Physical examination and a detailed history should be performed with each visit.

Imaging of the head and neck (CT or MRI), CT of the chest, and bone scan/positron emission tomography (PET) (if positive at distant metastatic sites at diagnosis) are usually performed every 3 months for the first year and then every 6 months for the next 2 years after therapy is completed to assess response.

A dental examination prior to radiotherapy and on a routine basis after therapy is recommended because of the possibility of caries and poor dental hygiene. Osteonecrosis of the mandible is a rare complication of radiotherapy and is often avoided with proper dental care.

As many children develop endocrine abnormalities after treatment, screening testing for hypothyroidism, growth hormone deficiency, and adrenal axis disorders should occur on a frequent basis after the completion of therapy.

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Further Inpatient Care

Certain types of chemotherapy will need to be administered on an inpatient basis.

Patients who develop febrile neutropenia need to be admitted for intravenous antibiotics. The antibiotic regimen usually consists of an antipseudomonal cephalosporin, with or without an aminoglycoside (especially in the context of renal dysfunction seen in patients receiving platinum-based chemotherapy) and/or an antistaphylococcal coverage.

Severe cases of malnutrition and dehydration may require inpatient management with support from a pediatric nutritionist.

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Inpatient & Outpatient Medications

Routine medications are not often administered and depend on treatment-related symptomatology.

Pneumocystis jiroveci pneumonia (also known as PCP) prophylaxis is recommended once chemotherapy starts and until 3 months after therapy is completed.

Annual influenza vaccination (inactivated or killed vaccine, also know as the "flu shot") is recommended for every pediatric patient.

Amifostine (Ethyol) may be used in the management of patients with nasopharyngeal cancer. This drug has been found to reduce xerostomia resulting from radiotherapy and nephrotoxicity resulting from cisplatin chemotherapy.

Pentoxifylline has been used for treatment of radiation-induced fibrosis. [35]

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