Childhood cancer survivors can be at risk for developing the following head, eyes, ears, nose & throat late effects:
- Craniofacial Abnormalities
- Cataracts
- Eye Problems
- Ototoxicity
- Chronic Sinusitis
- Dental Abnormalities
- Xerostomia
- Osteoradionecrosis
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If your patient does not have a Survivor Health Plan (SHP), please refer him/her to the appropriate survivor clinic.
Important factors in determining risk for HEENT late effects:
- Age of patient at time of treatment
- Total dose of radiation
- Radiation in combination with chemotherapy
- Time since treatment
- Tumor in the Central Nervous System
- Underlying medical condition
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Chemotherapy
Table 1
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Craniofacial Abnormalities
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Cataracts
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Eye Problems*
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Ototoxicity*
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Chronic Sinusitis
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Dental Abnormalities*
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Xerostomia
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Osteo-radionecrosis
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All Chemotherapy
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X
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Alkylating Agents
Busulfan
Carmustine
BCNU
Chlorambucil
Cyclophosphamide
Cytoxan
Ifosphamide
Lomustine
CCNU
Mechlorethamine
Melphalan
Procarbazine
Thiotepa
Dacarbazine
DTIC
Temozolomide
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X
(Busulfan Only)
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Heavy Metals
Carboplatin
Cisplatin
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X
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Antimetabolites
Cytarabine
Ara-C
Mercaptopurine
6MP
Thioguanine
6TG
Methotrexate
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Anthracycline antibiotics
Daunorubicin
Doxorubicin
Adriamycin
Epirubicin
Idarubicin
Mitoxantrone
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Chemotherapy
Table 2
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Craniofacial Abnormalities
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Cataracts
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Eye Problems*
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Ototoxicity*
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Chronic Sinusitis
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Dental Abnormalities*
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Xerostomia
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Osteo-radionecrosis
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Anti-tumor antibiotics
Bleomycin
Dactinomycin
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Corticosteroids
Dexamethasone
Decadron
Prednisone
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X
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Enzymes
Asparaginase
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Plant alkaloids
Vincristine
Vinblastine
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Epipodophyllotoxins
Etoposide
VP16
Teniposide
VM26
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Radiation
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Craniofacial Abnormalities
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Cataracts
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Eye Problems*
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Ototoxicity*
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Chronic Sinusitis
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Dental Abnormalities*
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Xerostomia
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Osteo- radionecrosis
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All Radiation
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TBI
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X
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X
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Head/Brain
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X
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X
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> 30 Gy
Include TBI
in total dose
calculation
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> 30 Gy
Include TBI
in total dose
calculation
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X
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X
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X
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> 40 Gy
Include TBI
in total dose
calculation
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Neck
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X
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X
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> 40 Gy
Include TBI
in total dose
calculation
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Thorax
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Abdomen
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Pelvis
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Extremity
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Surgery/Other
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Craniofacial Abnormalities
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Cataracts
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Eye Problems*
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Ototoxicity*
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Chronic Sinusitis
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Dental Abnormalities*
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Xerostomia
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Osteo-radionecrosis
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Enucleation
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X
(impaired
cosmesis/
poor fit/
orbital
hypoplasia)
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Neurosurgery
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X
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Radioiodine Therapy
(I-131 Thyroid ablation)
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X
(lacrimal duct
atrophy)
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Hematopoietic
Stem Cell Transplant
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Craniofacial Abnormalities
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Cataracts
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Eye Problems*
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Ototoxicity*
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Chronic Sinusitis
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Dental Abnormalities*
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Xerostomia
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Osteo-radionecrosis
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Hematopoietic
Stem Cell Transplant
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Hematopoietic Stem Cell Transplant
with ANY history of chronic Graft vs. Host Disease (GVHD)
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X
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X
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X
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