Guidelines for Complications of Cancer Treatment Vol VIII Part B

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Pharyngocutaneous Fistula (PC Fistula)PC fistula is the commonest complication followinglaryngectomy. The incidence varies widely from 7-50%in various studies.Fistulae generally occur in the immediate postoperativeperiod, anytime between 5-15 days. However,occurrence of late fistulae especially during or afteradjuvant therapy is also known.Signs and symptoms Erythema and edema of the skin flaps and suture lines Elevated and turbid drain output Frank salivary leak from the suture line. Cough due to aspiration if the fistula is trickling into thestoma Constitutional symptoms like fever, malaise may precedethe onset of fistula.Diagnosis Is usually clinical (see above) Estimation of drain amylase or a conray swallow can beused as confirmatory tests, though they are rarelyrequired203
Risk factors Poor nutritional status and a low serum albumin.Pre/postoperative hemoglobin levelCo-morbid conditions such as diabetesPrevious chemoradiotherapyPyriform sinus cancers requiring partial pharyngectomyor laryngeal cancers requiring an extended laryngectomywhere part of the pharyngeal mucosa is excisedPrevention Surgical technique is of utmost importance General principle is to perform a tension free andvascularised anastomosis When indicated, use of pedicled or microvascular flapsto augment inadequate mucosa and achieve a tensionfree anastomosis There is no proven impact of the type closure (T vsVerical vs Horizontal), type of suture material used(vicryl vs catgut), pattern of closure (continuous vsinterrupted), initiation of feeding (late vs early) andpreoperative tracheostomy on PC fistula. In individuals with high risk factors, a levator scapulaemuscle rotation or a pectoralis major myofascial flapmay be used to cover the exposed carotid arteries toprevent a carotid blowout.Management Majority of fistulae respond well to conservativemanagement. There is no consensus on duration of observationfollowing a PC fistula.204
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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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should be based on the isolates fro
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such as concomitant use of prophyla
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Surgical techniqueAdherence to meti
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2. Another small prospective random
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Antibiotic prophylaxis for dental a
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Antimicrobial Prophylaxis in Orthop
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35. Tai CC, Nirvani AA, Holmes A, e
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53. Parker MJ, Roberts C. Closed su
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Vessel Related Issues in Sarcoma:Ev
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sequences may be of value. They cau
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an excellent alternative to amputat
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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 186 and 187: MucositisMucositis is an inflammato
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 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
Page 236 and 237: Management of Facial Nerve InjuryIn
Page 238 and 239: 2. Interposition or cable graft (to
Page 240 and 241: Prevention of corneal exposure Tars
Page 242 and 243: flushing) and localized sweating (g
Page 244 and 245: Other options :1. Intracutaneous in
Page 246 and 247: Shoulder Dysfunction or PainfulShou
Page 248 and 249: EMG studies on scapulo-humeral and
Page 250 and 251: Chyle Fistula after Neck Dissection
Page 252 and 253: Rationale:LCTs, which constitute 70
Page 254 and 255: CSF Leak after Craniofacial Resecti
Page 256 and 257: to the muscle to recreate the orbit
Page 258 and 259: Conservative treatmentIt is logical
Page 260 and 261: 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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