Guidelines for Complications of Cancer Treatment Vol VIII Part B

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CSF Leak after Craniofacial ResectionsCerebrospinal fluid (CSF) leak is the most important postoperativecomplication following surgeries of the skull base(both anterior and lateral skull base). It can be life-threateningand lead to various other CNS complications like meningitis,cerebritis , epidural and brain abscess, increasing overallmorbidity and mortality.IncidenceEarlier series reported very high CSF leak rates of upto 71%.However improvements in techniques of skull basereconstruction have seen a reduction in these figures. Recentseries of malignant lesions of anterior skull base report anoverall complication rate of 39% and CSF leak rate of 2%.Radiographic features that predict CSF leak include.1) Dural and brain involvement.2) cribriform plate involvement3) proximity to eustachian tube.245
PreventionThe main principle to prevent CSF leakage after skull baseresection is to create an anatomical and functional seal betweenintracranial and extracranial contents bya) water-tight dural closure either primarily or by use of afree patch graftsa. pericranial patchb. fascia latac. synthetic grafts are best avoided unless absolutelynecessary.b) Use of vascularised pericranial graft to reinforce the duralclosure, if required.The vascularized pericranial flap is the workhorse foranterior skull base reconstruction. It derives its supplyfrom the supraorbital and supratrochlear arteries. Theflap is passed below and beyond the dural suture lineand fixed to the dura or the bone of the skull base. If theorbital roofs are intact, then the pericranial flap may besufficient to support the brain without bonyreconstruction. Autologous or synthetic tissue glue maybe used to reinforce the closure and promote a watertightseal.In some cases with a large postoperative cavity, the deadspace has to be occluded to prevent infection and toprovide support to the overlying brain. This may be donebyi) local Temporalis muscle flap: medial transpositionof temporalis muscle is an effective way ofconstructing anterolateral skull base defects. Careshould be taken to preserve its attachment to thecoronoid process to preserve its blood supply. Itmay be used with a part of cortical bone attached246
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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
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Oral IncompetenceOral competence is
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flap is insensate and has no motor
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16. R. Song, Y. Gao, Y. Song, Y. Yu
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The incidence is usually lower afte
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Late fibrotic phase: Attempted tiss
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Ref: A Lyons, N Ghazali/ British J
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17. Store G, Boysen M. Mandibular o
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amino acids, proteins and traces of
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RTOG, EORTC and CTCAE, version 3 fo
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difference in the disease related p
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References1. Bourhis J, Rosine D. R
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with head and neck cancer. N Engl J
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MucositisMucositis is an inflammato
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Type of cancer: high risk for mucos
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Oral care protocol1. Brush all toot
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3. El-Sayed S, Nabid A, ShelleyW, e
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1) Recipient site problems- The maj
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estoration of vascular flow to tiss
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General Complications- Deep vein th
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Nerve Injuries(Recurrent and Superi
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paramedian position, it will result
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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
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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
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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
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Page 258 and 259: Conservative treatmentIt is logical
Page 260 and 261: Complications Associated with use o
Page 262 and 263: Following is the example of hematol
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Page 268 and 269: in most of the patients. The common
Page 270: Section — IIIRadiotherapyContribu
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Page 275 and 276: function. In general, with conventi
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Page 279 and 280: catheter passed through the anus in
Page 281 and 282: Acute symptoms usually subside seve
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Page 287 and 288: patients who have received radical
Page 289 and 290: ate expected in the standard popula
Page 292 and 293: adjusting for competing causes of d
Page 294 and 295: therapy (3D-CRT) and intensity modu
Page 296 and 297: attributed to use of cisplatin base
Page 298 and 299: Conclusion:Incidence of SMN is incr
Page 300 and 301: 11. Travis LB, Fossa SD, Schonfeld
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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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