Guidelines for Complications of Cancer Treatment Vol VIII Part B

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MucositisMucositis is an inflammatory response of mucosal epithelialcells to the cytotoxic effects of radiation and chemotherapyPathogenesisPhase I: Vascular phase – release of free radicals, resulting inincreased vascular permeabilityPhase II: Epithelial phase: Impaired cell division, reductionin the epithelial turn over, erythemaPhase III: Ulcerative phase: microbial colonization of mucosalsurfacePhase IV: Healing phase: hematopoietic recoveryClinical effects Frequent treatment breaks: leading to inferior localcontrol rates. Pain. Malnutrition. Local and systemic infection. Need for feeding tube placement. Hospitalization.177
Deterioration in the Quality of life.Increased mortality.Incidence of oral mucositisConventional RT: 80%RT+ Chemotherapy: 90%RT Altered fractionation: 100%Grade III-IV mucositisConventional fractionation: 25-45%R Taltered fractionation : 52%Weight loss due to mucositis: 3-6.7kgTiming of mucositis Conventional: begins at 1-2 weeks, ulcerative mucositisdevelops after 30 Gy. Accelerated: peaks within 3 weeks. Interstitial implant: begins 7-10 days, peaks after 2weeks. Limited to the field of radiation and resolves 3-6 weeksafter completion of radiotherapy.Risk factorsPatient relatedYoung age (rapid epithelial mitotic rate) and very old.Poor nutritional status.Poor oro-dental hygiene during therapy (ill fittingdentures, periodontal disease, caries).Comorbidities affecting distribution or excretion ofchemotherapeutic drugs (renal, hepatic etc).Neutrophil count before treatment.178
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Guidelines forComplications ofCance
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Dedicated toAll our patients atThe
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Section IIHead & Neck 151Complicati
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PrefaceTreatment of cancer by vario
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Section — IGeneralContributorsDr.
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6. Complications after breast recon
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promises to reduce this risk of ser
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preceded by increased sensory hyper
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had significant lymphoedema. The fa
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2. Smoking as a risk factor for wou
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4. Preoperative core needle biopsy
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eduction mammoplasty, and axillary-
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postoperative wound infection follo
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ablative surgical treatment for car
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postoperative seroma formation usin
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dressing consisted of a circumferen
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mastectomies with axillary node cle
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mastectomy for breast cancer. Early
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monitored for the development of po
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modality, and tumor stage distribut
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26. Pain and other symptoms during
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28. Coping, catastrophizing and chr
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surgical technique at the time of m
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0.001), 0.315 cm +/- 1.27 at the an
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or heat and superficial incision is
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RecommendationsA. Preparation of th
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3. Mangram AJ, Horan TC, Pearson ML
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Mild hypothermia increases blood lo
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Perioperative Normothermia to Reduc
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Priorities: Restoration of circulat
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than 1.5 times control values but f
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outcomes that may result from the u
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Preoperative Preparation of the Pat
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patients, or other patients who may
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Obstruction can occur at the level
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c. Administer face mask preoxygenat
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5. The use of exhaled carbon dioxid
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disorder) may occur after an episod
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undergoing general anesthesia, eith
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anesthesia awareness occurred in ea
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The current guidelines are actually
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o S - Strong Recommendation -Commit
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oSource control ASAP after successf
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oooWean steroids once vasopressors
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Mechanical ventilation of sepsis-in
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o CVVH offers easier management inh
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critically ill patient that are con
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Rivers E, Nguyen B, Havstad S, et a
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in survival of 7.6%. By the second
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parameters (gastric mucosal Pco2, s
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syndrome. We therefore conducted a
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Complications After Limb SalvageSur
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local tumor and to preserve as much
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femoral head to the center of the k
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4. Griffin AM, Parsons JA, Davis AM
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20. Roberts P, Chan D, Grimer RJ, e
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An infection can have disastrous co
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and facilitating reimplantation sur
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features of a two-stage revision is
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patients had an amputation. Two oth
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its main role is confined to ruling
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2. Capanna R, Morris HG, Campanacci
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21. Wilson MG, Kelley K, Thornhill
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39. Love C, Marwin SE, Tomas MB, Kr
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5. A systematic review of 25 RCT’
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(cefazolin or cefuroxime) or penici
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Page 138 and 139: such as concomitant use of prophyla
Page 140 and 141: Surgical techniqueAdherence to meti
Page 142 and 143: 2. Another small prospective random
Page 144 and 145: Antibiotic prophylaxis for dental a
Page 146 and 147: Antimicrobial Prophylaxis in Orthop
Page 148 and 149: 35. Tai CC, Nirvani AA, Holmes A, e
Page 150 and 151: 53. Parker MJ, Roberts C. Closed su
Page 152 and 153: Vessel Related Issues in Sarcoma:Ev
Page 154 and 155: sequences may be of value. They cau
Page 156 and 157: an excellent alternative to amputat
Page 158: 5. Hünerbein M, Hohenberger P, Str
Page 162 and 163: Oral IncompetenceOral competence is
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Page 166 and 167: 16. R. Song, Y. Gao, Y. Song, Y. Yu
Page 168 and 169: The incidence is usually lower afte
Page 170 and 171: Late fibrotic phase: Attempted tiss
Page 172 and 173: Ref: A Lyons, N Ghazali/ British J
Page 174 and 175: 17. Store G, Boysen M. Mandibular o
Page 176 and 177: amino acids, proteins and traces of
Page 178 and 179: RTOG, EORTC and CTCAE, version 3 fo
Page 180 and 181: difference in the disease related p
Page 182 and 183: References1. Bourhis J, Rosine D. R
Page 184 and 185: with head and neck cancer. N Engl J
Page 188 and 189: Type of cancer: high risk for mucos
Page 190 and 191: Oral care protocol1. Brush all toot
Page 192 and 193: 3. El-Sayed S, Nabid A, ShelleyW, e
Page 194 and 195: 1) Recipient site problems- The maj
Page 196 and 197: estoration of vascular flow to tiss
Page 198 and 199: General Complications- Deep vein th
Page 200 and 201: Nerve Injuries(Recurrent and Superi
Page 202 and 203: paramedian position, it will result
Page 204 and 205: along with its variations, and a me
Page 206 and 207: anatomy as related to surgery of th
Page 208 and 209: Risk factorsCentral compartment (Le
Page 210 and 211: Goal - To raise serum calcium level
Page 212 and 213: Pharyngocutaneous Fistula (PC Fistu
Page 214 and 215: Based on our institutional practice
Page 216 and 217: fistula: The Memorial University ex
Page 218 and 219: Risk factors (LOE-5)Patient factors
Page 220 and 221: oCircumferencial excision and inser
Page 222 and 223: y trauma or tumor, exposing the und
Page 224 and 225: Arytenoid cartilage is reported to
Page 226 and 227: Filntisis, G.A., et al. “Laryngea
Page 228 and 229: As high as 52% patients are detecte
Page 230 and 231: ManagementPostural exercisesDisorde
Page 232 and 233: References1) Objective assessment o
Page 234 and 235: Diagnosis Average time to hypothyro
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Management of Facial Nerve InjuryIn
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2. Interposition or cable graft (to
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Prevention of corneal exposure Tars
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flushing) and localized sweating (g
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Other options :1. Intracutaneous in
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Shoulder Dysfunction or PainfulShou
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EMG studies on scapulo-humeral and
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Chyle Fistula after Neck Dissection
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Rationale:LCTs, which constitute 70
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CSF Leak after Craniofacial Resecti
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to the muscle to recreate the orbit
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Conservative treatmentIt is logical
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Complications Associated with use o
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Following is the example of hematol
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ooooooo direct interaction with the
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ooooointravenously over 15 minutes
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in most of the patients. The common
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Section — IIIRadiotherapyContribu
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nodes are involved or suspected to
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function. In general, with conventi
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like ultrasonography, CT scan, endo
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catheter passed through the anus in
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Acute symptoms usually subside seve
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granulocytopenia, thrombocytopenia
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adiation therapy), IMRT (intensity-
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patients who have received radical
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ate expected in the standard popula
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adjusting for competing causes of d
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therapy (3D-CRT) and intensity modu
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attributed to use of cisplatin base
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Conclusion:Incidence of SMN is incr
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11. Travis LB, Fossa SD, Schonfeld
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adiation-related solid SMNs will in
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0.71, p
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5.65%) within 45 years after a CNS
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adiation damage though supporting v
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without calcification. Inflammation
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patients treated using the original
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incidence of valvular thickening at
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12. Hancock S, Hoppe R. Long-term c
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syndrome and bronchiolitis oblitera
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Darby SC, McGale P, Taylor CW, Peto
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undertaken, based on individual pat
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Pathophysiological Aspects:The func
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Symptoms: Symptoms related to pulmo
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Prevention of Pneumonitis and Lung
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genotyping analysis of single nucle
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Registry of Patients. We computed I
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eceived elective nodal irradiation
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Int J Radiat Oncol Biol Phys. 1995
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worsening during the treatment shou
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Differential Diagnosis: This sign i
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Dose Incidence Comments Author>30 G
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PET scan findings have been describ
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3. Pallis CA, Louis S, Morgan RL.:
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24. Abbatucci JS, Delozier T, Quint
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and summarized into specific recomm
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adequate. With the increasing use o
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Complications are mainly described
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IQ decline is associated with sever
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activity’ of a person, essentiall
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development after brain tumor thera
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Highest relative risk of second can
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Suggested Reading:A) Neuropsycholog
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aseline. Male sex, longer symptomat
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number of patients. Cognition was p
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16 years, the corresponding value w
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15 of 20 (75%) subjects, endocrine
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OBJECTIVE: To assess cerebrovascula
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hypometabolism. Of the 17 patients
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10-20 months, with an average of 18
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Febrile NeutropeniaNeutropenia is w
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Approach to initial antibiotic use
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Known colonization with Penicillin/
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DocumentedinfectionsSuggesteddurati
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Zygomycosis and other mold infectio
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Overall risk Examples Febrile neutr
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Broad spectrum DOSE Spectrum Commen
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Role of G-CSF-Primary Prophylaxis:R
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Chemotherapy Induced Nausea andVomi
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Level I Level II Level III Level IV
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Types & doses of AntiemeticsDrug &
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supported by a meta-analysis, which
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and follow-up after treatment for n
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day 1; aprepitant and dexamethasone
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2-3: APR 80 mg every day) or a cont
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Late Effects in Childhood CancerSur
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to increase their awareness about l
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Contd...Score2BStatement of consens
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6 Kurkure PA, Achrekar S, Uparkar U
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nonirradiated group did not differ
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Gaslini Children’s Research Hospi
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Our ACT model has 3 basic facets; p
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The relative risk of developing TLS
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the excretion of uric acid and phos
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hyperuricemia (> 7.5 mg/dL), treatm
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hydration, and the administration o
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which the different drugs are admin
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Table 2. Cairo-Bishop clinical Tumo
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Table 4 Patient Stratification by R
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Table 6 Management of Electrolyte A
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of TLS and improve the management o
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4. Efficacy and safety of rasburica
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Pulmonary Toxicity of Antineoplasti
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Though there are many chemotherapeu
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corticosteroids with variable respo
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Nephrotoxicity ofChemotherapeutic D
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associated with use of carbopltin c
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Table 2 Chemotherapeutics Requiring
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against ifosfamide nephrotoxicity.
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The incidence of mucositis involvin
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7. Obesity - Probably due to over d
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conditioning treatment and for 3 da
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References and Recommended Readings
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metabolism for activity, cyclophosp
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delays excretion and eventually res
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Combination Chemotherapy:Combinatio
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Vincristine: No dose reduction if b
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19. Slichenmyer WJ, Rowinsky EK, Gr
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AlopeciaCommon drugs causing alopec
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dependent, occurring from 8 days to
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Cancer Induced Anemia (CIA)Introduc
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system. There is an upregulation of
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time may represent increasing anemi
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(rHuEPO) whiles the other received
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Table 3. Improvements in Hemoglobin
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2. Groopman JE, Itri LM. Chemothera
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epoetin alfa versus oral iron or no
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NOTES
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Guidelines for Complications of Cancer Treatment Vol VIII Part B

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