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HEENT QuickFact

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

 

 

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

Chemotherapy

Table 1

 

Craniofacial Abnormalities

 

 Cataracts

 

Eye    Problems*   

 

 Ototoxicity*

 

Chronic Sinusitis

Dental Abnormalities*

Xerostomia

  Osteo-radionecrosis 

 

All Chemotherapy           

 

 

 

 

 

X

 

 

Alkylating Agents

Busulfan

Carmustine

   BCNU

Chlorambucil

Cyclophosphamide

  

Cytoxan

Ifosphamide

Lomustine

   CCNU

Mechlorethamine

Melphalan

Procarbazine

Thiotepa

 

Dacarbazine

    DTIC

Temozolomide

 

X

(Busulfan Only)

 

 

 

 

 

 

 

Heavy Metals

Carboplatin

Cisplatin

 

 

 

 

X

 

 

 

 

Antimetabolites

Cytarabine

   Ara-C

Mercaptopurine

   6MP

Thioguanine

   6TG

Methotrexate

 

 

 

 

 

 

 

 

 

 

Anthracycline antibiotics

Daunorubicin

Doxorubicin

   Adriamycin

Epirubicin

Idarubicin

Mitoxantrone

 

 

 

 

 

 

 

 

 

Chemotherapy

Table 2                     

 

Craniofacial Abnormalities

 

 Cataracts      

 

Eye    Problems*   

 

 Ototoxicity*

Chronic Sinusitis

Dental Abnormalities*

Xerostomia

  Osteo-radionecrosis 

 

Anti-tumor antibiotics        

Bleomycin

Dactinomycin

 

 

 

 

 

 

 

 

 

Corticosteroids

Dexamethasone

   Decadron

Prednisone

 

 

X

 

 

 

 

 

 

 

Enzymes

Asparaginase

 

 

 

 

 

 

 

 

 

Plant alkaloids

Vincristine

Vinblastine

 

 

 

 

 

 

 

 

 

Epipodophyllotoxins

Etoposide

   VP16

Teniposide

   VM26

 

 

 

 

 

 

 

 

 

 

Radiation                  

Craniofacial Abnormalities

 

 Cataracts            

 

 Eye    Problems*   

 

 Ototoxicity*

 

Chronic Sinusitis

Dental Abnormalities*

Xerostomia

       Osteo-  radionecrosis  

 

All Radiation                      

 

 

 

 

 

 

 

 

TBI

 

X

 

 

 

X

 

 

 

Head/Brain

X

X

> 30 Gy

 

Include TBI

in total dose

 calculation

> 30 Gy

 

Include TBI

in total dose

 calculation

X

X

X

> 40 Gy

 

Include TBI

in total dose

calculation

Neck

 

 

 

 

 

X

X

> 40 Gy

 

Include TBI

in total dose

calculation

Thorax

 

 

 

 

 

 

 

 

Abdomen

 

 

 

 

 

 

 

 

Pelvis

 

 

 

 

 

 

 

 

Extremity

 

 

 

 

 

 

 

 

 

 

Surgery/Other             

                    

Craniofacial Abnormalities

 

 Cataracts      

 

 Eye    Problems*  

 

 Ototoxicity*

 

Chronic Sinusitis

Dental Abnormalities*

Xerostomia

  Osteo-radionecrosis 

 

Enucleation

 

 

 

 

 

 

 

X

(impaired

cosmesis/

poor fit/

orbital

hypoplasia)

 

 

 

 

 

 

Neurosurgery

 

 

X

 

 

 

 

 

 

Radioiodine Therapy

(I-131 Thyroid ablation)

 

 

X

(lacrimal duct

atrophy)

 

 

 

 

 

 

Hematopoietic

Stem Cell Transplant     

Craniofacial Abnormalities

 Cataracts        

 

 Eye    Problems*

 

 Ototoxicity*

 

Chronic Sinusitis

Dental Abnormalities*

Xerostomia

  Osteo-radionecrosis 

 

Hematopoietic

Stem Cell Transplant

 

 

 

 

 

 

 

 

Hematopoietic Stem Cell Transplant with ANY history of chronic Graft vs. Host Disease (GVHD)

 

 

X

 

 

X

X

 

*For further information about the types of eye problems, ototoxicity and dental abnormalities, and for recommendations on how to screen for all potential late effects, please refer toThe Children’s Oncology Group Long-Term Follow-Up Guidelines.


Health Links – Teaching Handouts from The Children’s Oncology Group

 

Eye Health

Cataracts

Dental Health

Osteoradionecrosis

Hearing Loss


Visit  www.survivorshipguidelines.org   to find many of the Health Links translated into other languages. 

 

Reference:

Children’s Oncology Group Long-Term Follow-Up Guidelines for Survivors of Childhood, Adolescent, and Young Adult Cancers, and related Health Links Version 4.0. October, 2013. www.survivorshipguidelines.org/ .

 

Source: Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta
Last Updated: 1/30/2015 4:09:57 PM
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