Guidelines for Complications of Cancer Treatment Vol VIII Part B

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incidence of valvular thickening at 10 years after irradiationwas 8% and rose to 45% at 20 years with grade 3 changes in4.1%. Patients who had echocardiograms 1-6 years after abaseline echocardiogram, 8% of patients with normal heartvalves at initial study developed valvular thickening and 37%of those with abnormal valves showed progression of valvularabnormality.Future Directions:Currently available evidence suggests a strong relationshipbetween “Volume of Normal Tissue Irradiated”, “TotalRadiation Dose”, “Fraction Size of Radiation Dose”,“Interaction with Chemotherapeutic Agents”, and “AssociatedCo morbidities” as major factors influencing the developmentand severity of Cardiopulmonary complications associatedwith thoracic irradiation as in Lung cancer, Breast Cancer,Hodgkin’s disease etc. Advanced radiation therapytechnologies like, Intensity Modulated Radiation Therapy(IMRT), Image Guided Radiation Therapy (IGRT), HelicalTomotherapy etc. which primarily aim at reducing the dose tonormal tissues while delivering the intended dose to the targetvolume would help reduce the radiation related adverse effectssignificantly. Optimal dose intensity and sequencing of varioustreatment modalities (Radiotherapy, Chemotherapy, &Surgery) would further reduce the incidence of acute and lateadverse effects of treatment.References:1. Veinot JP, Edwards WD. Pathology of radiation-inducedheart disease: A surgical and autopsy study of 27 cases.Hum Pathol; 27:766–773. (1996)2. Fajardo LF, Stewart JR. Pathogenesis of radiationinducedmyocardial fibrosis. Lab Invest; 29:244–257.(1973)305
3. Mittal S, Berko B, Bavaria J, et al. Radiation-inducedcardiovascular dysfunction. Am J Cardiol; 78:114–115.(1996)4. Arsenian MA. Cardiovascular sequelae of therapeuticthoracic radiation. Prog Cardiovasc Dis; 33:299–312.(1991)5. Van Rijswijk R, Verbeek J, Haanen C, et al. Majorcomplications and causes of death in patients treated forHodgkin’s disease. J Clin Oncol; 5:1624-1633. (1987)6. Cosset J-M, Henry-Amar M, Meerwaldt J. Long termtoxicity of early stage of Hodgkin’s disease therapy: TheEORTC experience. Ann Oncol; 2(suppl 2):77-82.(1991)7. Vaughan Hudson B, Vaughan Hudson G, Linch D, et al.Late mortality in young British National LymphomaInvestigation Patients cured of Hodgkin’s disease. AnnOncol; 5:567-566. (1994)8. Mauch P, Kalish L, Marcus K, et al. Long term survivalin Hodgkin’s disease: Relative impact of mortality,Second tumors, infection and cardiovascular disease.Cancer J Sci Am; 1:33-42. (1995)9. Hancock S, Tucker M, Hoppe RT Factors affecting latemortality from heart disease after treatment of Hodgkin’sdisease. JAMA; 270(16):1949-1955. (1993)10. Boivin, J.F., Hutchinson, G.B., Lubin, J.H. and Mauch,P. Coronary artery disease mortality in patients treatedfor Hodgkin’s disease. Cancer; 69: 1241–1247. (1992)11. Constine L, Schwartz R, savage D, et al. Cardiacfunction, perfusion and morbidity in irradiated long termsurvivors of Hodgkin’s disease. Int. J. Radiat. Oncol.Biol. Phys; 39:897-906. (1997)306
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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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EMG studies on scapulo-humeral and
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Chyle Fistula after Neck Dissection
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Rationale:LCTs, which constitute 70
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CSF Leak after Craniofacial Resecti
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to the muscle to recreate the orbit
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Conservative treatmentIt is logical
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Complications Associated with use o
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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 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
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
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Page 306 and 307: 5.65%) within 45 years after a CNS
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Page 310 and 311: without calcification. Inflammation
Page 312 and 313: patients treated using the original
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
Page 322 and 323: undertaken, based on individual pat
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 336 and 337: Int J Radiat Oncol Biol Phys. 1995
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Page 340 and 341: Differential Diagnosis: This sign i
Page 342 and 343: Dose Incidence Comments Author>30 G
Page 344 and 345: PET scan findings have been describ
Page 346 and 347: 3. Pallis CA, Louis S, Morgan RL.:
Page 348 and 349: 24. Abbatucci JS, Delozier T, Quint
Page 350 and 351: and summarized into specific recomm
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Page 354 and 355: Complications are mainly described
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Page 360 and 361: development after brain tumor thera
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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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