Guidelines for Complications of Cancer Treatment Vol VIII Part B

partial symptomatic resolution (P = 0.003). They concludedthat delivery of HBOT therapy within 6 months of hematuriaonset results in a greater therapeutic response rate.Severe injuries not amenable to the above managementstrategies may require construction of continent urinaryreservoirs from small or large intestine. Vesico-vaginal fistulasmay be repaired using a variety of surgical approaches. Theprinciples of repair include meticulous surgical technique,excision of the fistula site, multilayer closure, use of wellvascularizedtissue, when possible, and interposition ofomentum, muscle, peritoneum or fat.Skin and Subcutaneous Tissues:As mentioned earlier skin is an early reacting tissue by virtueof rapidly dividing epithelial cells and subcutaneous fibrofattytissue the late reacting tissues. So radiation induced acutetoxicities are commonly seen in skin ranging from erythema,dry desquamation (peeling), moist desquamation andulceration. Local hygiene, quality of radiation (cobalt / linac),skin folds and area of skin surface radiated. All these factorsare also applicable to development of subcutaneous fibrosis(mild, woody to stony hard). The skin toxicities can bemanaged conservatively by superficial cleaning, applyingsmoothening ointments like aloederm, steroids and barrierhydrocolloid dressings or 1% GV paint. Chronic non healingulcerations are best treated with grafts. Severe symptomaticwoody / stony fibrosis may also require surgical interventionand reconstruction.Hematological toxicitiesIn adults, a major portion of hematopoietic tissue lies in skull,sternum, ribs, vertebrae and pelvic bones (35-40%). In pelvicradiation therapy, a large amount of marrow gets irradiatedwhich can be measured in the peripheral blood by levels of273