2026 UT MDACC Resident Planning Clinic: Case-based Panel on Late Effects in Radiotherapy

Delivered in-person at FCT3.5001, 1400 Pressler Blvd, Houston, TX, 77030, 2026-10-29T0800. Précis — “Late Head and Neck Toxicity: A Case-Based Panel” (Hutcheson, Moreno, Koutroumpakis)The panel uses a single longitudinal case to walk through the full spectrum of late radiation effects after head and neck radiotherapy. The index patient is a 22-year-old man diagnosed in 2014 with a massive WHO type 3 undifferentiated nasopharyngeal carcinoma (T4N2M0) invading the sphenoid, clivus, cavernous and carotid spaces, treated with induction TPF followed by concurrent chemotherapy and 70 Gy/35 fractions of IMPT. His twelve-year course then unfolds as a series of toxicities, each anchoring a didactic/Q&A panel segment.Swallowing (Hutcheson): Early MBS shows only mild dysphagia, but by 2018–2020 persistent pharyngeal edema progresses to flash aspiration, silent penetration and bilaterally weakened pharyngeal contraction. The panel frames radiation-associated dysphagia (RAD) as an evolving injury—mucositis → edema → fibrosis → denervation—introduces DIGEST grading, and distinguishes acute, chronic, and late-onset phenotypes, noting that dysphagia-optimized IMRT evidence (DARS) does not address very delayed onset. Age-stratified NTCP data show older patients tolerate less constrictor dose.Osteoradionecrosis (Moreno): A left mandibular ORN presentation introduces the ClinRad staging system (minor bone spicules; Grades 0–3) with serial radiographic examples, plus practical dental management: avoiding extraction in high-dose fields in favor of endodontics and decoronation.Lower cranial neuropathy: Delayed CN IX/X/XII palsy occurs in ~5–12% of OPC survivors with median latency 5–8 years, is dose/volume dependent (SPC dose), and drives late PEG, tracheostomy and pneumonia (ORs 20–30).Cardiovascular (Koutroumpakis): Carotid stenosis prevalence is ~26% after neck RT; the case shows progressive stenosis despite statin therapy complicated by nonadherence. New 2026 data (Triantafyllou et al., Adv Radiat Oncol) show afferent baroreflex failure in ~20% of OPC survivors, nearly three-fold more common with LCNP, arguing that new neuropathy should trigger autonomic evaluation.By 2026 the patient carries ORN, trismus, late-RAD, carotid disease and baroreflex failure, xerostomia, cranial neuropathies, endocrinopathies and neck fibrosis—illustrating why multidisciplinary survivorship care is essential.