Nasopharyngeal Cancer Follow-up

Updated: Nov 17, 2016
  • 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

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  • 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. [30]

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Complications

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  • Late toxicity of radiotherapy may include xerostomia, hypothyroidism, fibrosis of the neck with complete loss of range of motion, trismus, dental abnormalities, and hypoplasia of irradiated muscular and bony structures. Because of the high doses of radiotherapy used in this disease, these late toxicities can be significant, especially in younger children.

  • Endocrinopathies and growth retardation can occur secondary to radiotherapy to the pituitary gland. Panhypopituitarism can occur in some instances.

  • Sensorineural hearing loss may occur with the use of cisplatin and radiotherapy. [31]

  • Renal toxicity can occur in patients receiving cisplatin.

  • Caries and poor dental hygiene are associated complications. Osteonecrosis of the mandible is a rare complication of radiotherapy and is often avoided with proper dental care.

  • Second malignancy may occur in a child who has received previous radiotherapy. This risk is small but continues throughout life.

  • With proper radiotherapy techniques, the chance for development of radiation myelitis should be less than 1%.

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Prognosis

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  • The results of clinical trials that include both radiation therapy and chemotherapy generally report long-term survival rates of 50-80% overall. [15, 32, 33]

  • In a study by Serin et al, the 5-year overall survival rate was 42% with radiotherapy alone and 58% with chemoradiation. [34]

  • Rodriguez-Galindo et al reported a 4-year event-free and overall survival rate of 77% and 75%, respectively, in a Phase II Pediatric Oncology Group clinical trial using radiation alone for patients with T1-T2N0M0 disease and radiation with neoadjuvant chemotherapy for all others. [20] Most were treated with 4 cycles of chemotherapy consisting of methotrexate, cisplatin, 5-fluorouracil, and leucovorin prior to radiotherapy.

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Patient Education

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  • Patients and parents should be educated regarding the importance of follow-up after completion of all therapy. A detailed discussion of the risks of chemotherapy, especially the risk of febrile neutropenia, is necessary. Families should also be well informed of the issues of late effects.

  • For excellent patient education resources, visit eMedicineHealth's Cancer Center. Also, see eMedicineHealth's patient education article Cancer of the Mouth and Throat.

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