Internal Medicine

0521779407-09 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:12

Head and Neck Cancer 661

➣donor site issues in reconstruction usually mild and transient

(e.g. rehabilatation following fibula free flap; shoulder physical

therapy following pectoralis major myocutaneous flap)

➣wound healing: infection, fitula, delay in post-operative RT

➣medical: aspiration & pneumonia, MI, numbness, scars generally

esthetically acceptable, DVT/embolus, etc

follow-up

During Radiation

■Regularly assess potential side effects of radiotherapy and chemo-

therapy: low WBC, low RBC, low platelelets, mucositis

Perioperative

■Monitor for infection, wound healing issues, and medical complica-

tions

■associated with surgery

Long-Term Routine Follow-Up

■Essential because of risk for second tumors and for management of

side effects and complications of treatment, as well as coordination

of other medical problems.

■Clinical exam

➣monthly 1st year, every other month in year 2, every 3rd month

year 3,

➣every 4th month year 4, every 6 months thereafter

■Radiologic exam

➣Baseline post-treatment MRI 2 months after completion of all Rx

➣Annual CXR (if no PET)

➣Consider annual PET as cancer surveillance, especially in

younger

➣patients under 60 and those without usual risk factors

■Laboratory tests

➣TSH every 6 months for 3 yrs (30% incidence of hypothyroidism

in irradiated necks)

➣AST/ALT annually (if no PET)

complications and prognosis

Complications

■Radiation

➣dysphagia (see side effects) may be permanent, incidence

depends in part on extent of pharyngeal tumor