Guidelines for Complications of Cancer Treatment Vol VIII Part B

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Conclusion:Incidence of SMN is increasing with improved cancer survival,better awareness, and closer surveillance and rigorous followup.Contrary to popular belief all SMN cannot be attributed toradiation therapy, rather aetiology of SMN is a complexinteraction of various host and treatment related factors. Stillthe risk of malignancy development following irradiation islow and should be weighed against the risks of death andcarcinogenicity from other factors, toxicity of chemotherapy,morbidity and mortality of surgery, and existing alternativesto radiotherapy in the treatment of cancer patients. Potentialcarcinogenicity should not be regarded as a contraindicationto the use of radiotherapy. With the increasing incidence ofSMN, there is a need for population-based registries todocument, analyse, and interpret the data pertaining to theseSMN. Risk of SMN is not equal among all cancer patients.There is need to develop methods to identify patients at highrisk of SMN based on molecular and genetic factors. Thesehigh-risk subgroups should be counselled about the risk ofSMN, regarding life-style modification (eg. smoking cessation,high-fibre & low-fat diet, regular physical exercise etc.) andclose long-term follow up. The options of early and frequentscreening and chemoprevention strategies also need to beevaluated appropriately.References:1. Ries LAG, Harkins D, Krapcho M, et al., (eds). 2006.SEER Cancer Statistics Review, 1975-2003. Bethesda,MD, National Cancer Institute. Available at http://seer.cancer.gov/csr/1975_2003/, based on November2005 SEER data submission, posted to the SEERwebsite, 20062. Curtis RE, Freedman DM, Ron E, et al. NewMalignancies Among Cancer Survivors: SEER Cancer289
Registries, 1973-2000. National Cancer Institute, NIHPubl. No. 05-5302. Bethesda, MD, 20063. Travis LB, Rabkin CS, Brown LM, et al. CancerSurvivorship - genetic susceptibility and second primarycancers: research strategies and recommendations. J NatlCancer Inst 2006;98:15-254. Murray EM, Werner D, Greeff EA, et al. Postradiationsarcomas: 20 cases and a literature review. Int J RadiatOncol Biol Phys 1999;45:951-65. Cahan WG, Woodward HQ, Higinbotham NL, et al.Sarcoma arising in irradiated bone: a report of elevencases. Cancer 1948;1:3-296. Lorimore SA, Coates PJ, Wright EG, et al: Radiationinducedgenomic instability and bystander effects: Interrelatednon-targeted effects of exposure to ionizingradiation. Oncogene 2003;22:7058-697. Hall E, Wuu C: Radiation Induced Second Cancers: Theimpact of 3D-CRT and IMRT. Int J Radiat Oncol BiolPhys 2003;56(1):83-88. Constine L, Tarbell N, Hudson M, et al: Subsequentmalignancies in children treated for Hodgkin’s Disease:Association with gender and radiation dose. Int J RadiatOncol Biol Phys 2008;72(1):24-339. Ng AK, Bernardo MV, Weller E, et al: Secondmalignancy after Hodgkin disease treated with radiationtherapy with or without chemotherapy: long-term risksand risk factors. Blood 2002;100(6):1989-9610. Rusthoven K, Chen C, Raben D, et al: Use of externalBeam radiotherapy is associated with reduced incidenceof second primary head and neck cancer: A SEERdatabase analysis. Int J Radiat Oncol Biol Phys2008;71(1):192-8290
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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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along with its variations, and a me
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anatomy as related to surgery of th
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Risk factorsCentral compartment (Le
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Goal - To raise serum calcium level
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Pharyngocutaneous Fistula (PC Fistu
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Based on our institutional practice
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fistula: The Memorial University ex
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Risk factors (LOE-5)Patient factors
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oCircumferencial excision and inser
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y trauma or tumor, exposing the und
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Arytenoid cartilage is reported to
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Filntisis, G.A., et al. “Laryngea
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As high as 52% patients are detecte
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ManagementPostural exercisesDisorde
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References1) Objective assessment o
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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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Page 260 and 261: Complications Associated with use o
Page 262 and 263: Following is the example of hematol
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Page 270: Section — IIIRadiotherapyContribu
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Page 281 and 282: Acute symptoms usually subside seve
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Page 289 and 290: ate expected in the standard popula
Page 292 and 293: adjusting for competing causes of d
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Page 316 and 317: 12. Hancock S, Hoppe R. Long-term c
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Page 320 and 321: Darby SC, McGale P, Taylor CW, Peto
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Page 324 and 325: Pathophysiological Aspects:The func
Page 326 and 327: Symptoms: Symptoms related to pulmo
Page 328 and 329: Prevention of Pneumonitis and Lung
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Page 340 and 341: Differential Diagnosis: This sign i
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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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