Guidelines for Complications of Cancer Treatment Vol VIII Part B

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adequate. With the increasing use of 3-D treatment planningand dose delivery, this issue, particularly volumetricinformation, will become even more critical. As a part of theNCI contract N01 CM-47316, a task force, chaired by theprimary author, was formed and an extensive literature searchwas carried out to address this issue. In this issue, in thismanuscript we present the updated information on toleranceof normal tissues of concern in the protocols of this contract,based on available data, with a special emphasis on partialvolume effects. Due to a lack of precise and comprehensivedata base, opinions and experience of the clinicians from fouruniversities involved in the contract have also beencontributory. Obviously, this is not and cannot be acomprehensive work, which is beyond the scope of thiscontract.343
Radiation Induced Central NervousSystem ComplicationsIntroductionRadiation therapy (RT) is an important component of treatmentof cancer. However, RT may cause acute and late complicationsas a side effect in a proportion of patient. RT inducedcomplications to the central nervous system (CNS) may occurafter treatment of primary brain tumour, metastatic braintumour, prophylactic cranial RT (ALL, lymphoma, small celllung cancer) and also after treatment of head and neck cancer(temporal lobe necrosis, radiation myelitis).CNS complications after RT are dependent upon several patientand treatment related factors. Toxicity profile of focal RT isentirely different from cranio-spinal (CSI) or whole brain RT(WBRT). Important late toxicities after RT in brain tumourare mainly neuropsychological, neurological function andneuroendocrine impairment, and also radiation induced secondmalignancy. Apart from these above complications otherrelatively less described ones are cardiovascular accident(CVA), radiation induced necrosis, growth / sexual functionimpairment, radiation induced optic neuropathy (RION),radiation myelitis and skin toxicities (e.g permanent hair loss).344
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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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adiation therapy), IMRT (intensity-
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patients who have received radical
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ate expected in the standard popula
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adjusting for competing causes of d
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therapy (3D-CRT) and intensity modu
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attributed to use of cisplatin base
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Conclusion:Incidence of SMN is incr
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11. Travis LB, Fossa SD, Schonfeld
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Page 310 and 311: without calcification. Inflammation
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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 324 and 325: Pathophysiological Aspects:The func
Page 326 and 327: Symptoms: Symptoms related to pulmo
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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
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Page 348 and 349: 24. Abbatucci JS, Delozier T, Quint
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Page 354 and 355: Complications are mainly described
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Page 364 and 365: Suggested Reading:A) Neuropsycholog
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Page 368 and 369: number of patients. Cognition was p
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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
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Page 382 and 383: Febrile NeutropeniaNeutropenia is w
Page 384 and 385: Approach to initial antibiotic use
Page 386 and 387: Known colonization with Penicillin/
Page 388 and 389: DocumentedinfectionsSuggesteddurati
Page 390 and 391: Zygomycosis and other mold infectio
Page 392 and 393: Overall risk Examples Febrile neutr
Page 394 and 395: Broad spectrum DOSE Spectrum Commen
Page 400 and 401: 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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