Guidelines for Complications of Cancer Treatment Vol VIII Part B

creatinine in males, 0.85 X (140-age) X body weight /72 X serum creatinine in case of females) is an importantpre-requisite in selecting patients for cisplatin basedconcurrent chemoradiation and neoadjuvantchemotherapy. Patients with calculated creatinineclearance < 50 mL/min should not be taken for thesetreatments.o Most of the patients with head neck cancer arenutritionally compromised due to poor oral intake andare prone for treatment related toxicities. Insertion offeeding tubes before commencement of treatment maybe helpful in such patients.- (LOE-3)o To prevent the myelosuppression use of prophylactic G-CSF is recommended with regimens which have morethan 20% incidence of febrile neutropenia (taxanes basedtriplets). Patients who have had grade 3 / 4 leucopenia,neutropenia or febrile neutropenia can be given G-CSFduring next cycle. –(LOE-1)o There is no role of amifostine in the prevention ofchemotherapy-induced thrombocytopenia. 12 - (LOE-2)o Prevention of chemotherapy induced nausea andvomiting in head neck cancer patients requires the useof aprepitant, 5-HT3 receptor antagonist anddexamethasone prior to administration of chemotherapyand dexamethasone and aprepitant for 3 days afterchemotherapy. 10,13 – (LOE-1)o To avoid the nephrotoxicity associated with cisplatin,hydration with normal saline 2-3 hours before and 4-6after the administration plays an important role. Itprevents the hydrolysis of cisplatin in the tubules andreduces its time of contact with tubular epithelium. –(LOE-3)o Amifostine may have a role in preventing the cisplatininduced nephrotoxicity. Amifostine is given256