Guidelines for Complications of Cancer Treatment Vol VIII Part B

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Int J Radiat Oncol Biol Phys. 1995 Mar30;31(5):1187-203.Injury to the lung from cancer therapy: clinical syndromes,measurable endpoints, and potential scoring systems.McDonald S, Rubin P, Phillips TL, Marks LB.Department of Radiation Oncology, University of RochesterCancer Center, NY, USA.Toxicity of the respiratory system is a common side effect andcomplication of anticancer therapy that can result in significantmorbidity. The range of respiratory compromise can extendfrom acute lethal events to degrees of chronic pulmonarydecompensation, manifesting years after the initial cancertherapy. This review examines the anatomic-histologicbackground of the lung and the normal functional anatomicunit. The pathophysiology of radiation and chemotherapyinduced lung injury is discussed as well as the associatedclinical syndromes. Radiation tolerance doses and volumesare assessed in addition to chemotherapy tolerance and riskfactors and radiation-chemotherapy interactions. There are avariety of measurable endpoints for detection and screening.Because of the wide range of available quantitative tests, itwould seem that the measurement of impaired lung functionis possible. The development of staging systems for acute andlate toxicity is discussed and a new staging system for LateEffects in Normal Tissues (LENT) is proposed.327
Radiation MyelopathyIntroduction:Spinal Cord is a very eloquent part of CNS. The densely packedtracts, the complex neuronal networks and the vascular supplymake it a very sensitive structure to not only surgicalinterventions but to Radiation Therapy. All the more, it spansa long course in the body and thus is an important dose limitingorgan in the treatment of tumors of head and neck, lung,mediastinum, Hodgkin’s disease and the primary andmetastatic tumors of the cord itself.Etiopathogenesis:The knowledge about pathogenesis is evolving with fewautopsy studies and numerous animal studies. The cellsinvolved are almost all the cells seen in spinal cord, i.e.Oligodendrocytes, Microglia, Vascular endothelial cells andNeurons. Ionizing radiations lead to early and late orchestraof events involving altered gene expressions and cytokinemediated auto- and paracrine effects, vasculopathies, loss ofoligodendrocyte precursor cell population and microgliosis. 1There is not much evidence of acute radiation injury to thespinal cord during therapeutic radiation and any neurodefecit328
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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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ooooooo direct interaction with the
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ooooointravenously over 15 minutes
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in most of the patients. The common
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Section — IIIRadiotherapyContribu
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nodes are involved or suspected to
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function. In general, with conventi
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like ultrasonography, CT scan, endo
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catheter passed through the anus in
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Acute symptoms usually subside seve
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granulocytopenia, thrombocytopenia
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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
Page 300 and 301: 11. Travis LB, Fossa SD, Schonfeld
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Page 304 and 305: 0.71, p
Page 306 and 307: 5.65%) within 45 years after a CNS
Page 308 and 309: adiation damage though supporting v
Page 310 and 311: without calcification. Inflammation
Page 312 and 313: patients treated using the original
Page 314 and 315: incidence of valvular thickening at
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 332 and 333: Registry of Patients. We computed I
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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
Page 352 and 353: adequate. With the increasing use o
Page 354 and 355: Complications are mainly described
Page 356 and 357: IQ decline is associated with sever
Page 358 and 359: activity’ of a person, essentiall
Page 360 and 361: development after brain tumor thera
Page 362 and 363: Highest relative risk of second can
Page 364 and 365: Suggested Reading:A) Neuropsycholog
Page 366 and 367: aseline. Male sex, longer symptomat
Page 368 and 369: number of patients. Cognition was p
Page 370 and 371: 16 years, the corresponding value w
Page 372 and 373: 15 of 20 (75%) subjects, endocrine
Page 374 and 375: OBJECTIVE: To assess cerebrovascula
Page 376 and 377: hypometabolism. Of the 17 patients
Page 378: 10-20 months, with an average of 18
Page 382 and 383: Febrile NeutropeniaNeutropenia is w
Page 384 and 385: 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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