Guidelines for Complications of Cancer Treatment Vol VIII Part B

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and follow-up after treatment for nausea and vomitingsymptoms. In addition, patients with cancer and small bowelobstruction were examined as a special subset of patients whopresent with nausea and vomiting. The standards presentedhere for preventing and managing nausea and vomiting incancer care should be incorporated into care pathways andshould become the expectation rather than the exception.2. American Society of Clinical OncologyGuideline for Antiemetics in Oncology: Update2006Mark G.K, Paul J.H, Mark R.S, et al. J Clin Oncol2006; 24:2932-47.PURPOSE: To update the 1999 American Society of ClinicalOncology guideline for antiemetics in oncology.UPDATEMETHODOLOGY: The Update Committee completed areview and analysis of data published from 1998 thru February2006. The literature review focused on published randomizedcontrolled trials, and systematic reviews and meta-analyses ofpublished phase II and phase III randomized controlled trials.RECOMMENDATIONS: The three-drug combination of a5-hydroxytryptamine-3 (5-HT 3) serotonin receptor antagonist,dexamethasone, and aprepitant is recommended beforechemotherapy of high emetic risk. For persons receivingchemotherapy of high emetic risk, there is no group of patientsfor whom agents of lower therapeutic index are appropriatefirst-choice antiemetics. These agents should be reserved forpatients intolerant of or refractory to 5-HT 3serotonin receptorantagonists, neurokinin-1 receptor antagonists, anddexamethasone. The three-drug combination of a 5-HT 3receptor serotonin antagonist, dexamethasone, and aprepitantis recommended for patients receiving an anthracycline andcyclophosphamide. For patients receiving other chemotherapyof moderate emetic risk, the Update Committee continues torecommend the two-drug combination of a 5-HT 3receptor401
serotonin antagonist and dexamethasone. In all patientsreceiving cisplatin and all other agents of high emetic risk, thetwo-drug combination of dexamethasone and aprepitant isrecommended for the prevention of delayed emesis. TheUpdate Committee no longer recommends the combinationof a 5-HT 3serotonin receptor antagonist and dexamethasonefor the prevention of delayed emesis after chemotherapeuticagents of high emetic risk. CONCLUSION: The UpdateCommittee recommends that clinicians administer antiemeticswhile considering patients’ emetic risk categories and othercharacteristics.3. The oral neurokinin-1 antagonist aprepitant forthe prevention of chemotherapy-induced nauseaand vomiting: a multinational, randomized,double-blind, placebo-controlled trial inpatients receiving high-dose cisplatin—theAprepitant Protocol 052 Study GroupHesketh PJ, Grunberg SM, Gralla RJ, et al. J ClinOncol. 2003; 21:4112-9Purpose: In early clinical trials with patients receiving highlyemetogenic chemotherapy, the neurokinin antagonistaprepitant significantly enhanced the efficacy of a standardantiemetic regimen consisting of a type-three 5-hydroxytryptamine antagonist and a corticosteroid. Thismulticenter, randomized, double-blind, placebo-controlledphase III study was performed to establish definitively thesuperiority of the aprepitant regimen versus standard therapyin the prevention of chemotherapy-induced nausea andvomiting (CINV). PATIENTS AND METHODS: Patientsreceiving cisplatin > or = 70 mg/m2 for the first time weregiven either standard therapy (ondansetron and dexamethasoneon day 1; dexamethasone on days 2 to 4) or an aprepitantregimen (aprepitant plus ondansetron and dexamethasone on402
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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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adiation-related solid SMNs will in
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0.71, p
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5.65%) within 45 years after a CNS
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adiation damage though supporting v
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without calcification. Inflammation
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patients treated using the original
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incidence of valvular thickening at
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12. Hancock S, Hoppe R. Long-term c
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syndrome and bronchiolitis oblitera
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Darby SC, McGale P, Taylor CW, Peto
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undertaken, based on individual pat
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Pathophysiological Aspects:The func
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Symptoms: Symptoms related to pulmo
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Prevention of Pneumonitis and Lung
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genotyping analysis of single nucle
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Registry of Patients. We computed I
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eceived elective nodal irradiation
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Int J Radiat Oncol Biol Phys. 1995
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worsening during the treatment shou
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Differential Diagnosis: This sign i
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Dose Incidence Comments Author>30 G
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PET scan findings have been describ
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3. Pallis CA, Louis S, Morgan RL.:
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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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Page 364 and 365: Suggested Reading:A) Neuropsycholog
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Page 374 and 375: OBJECTIVE: To assess cerebrovascula
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Page 382 and 383: Febrile NeutropeniaNeutropenia is w
Page 384 and 385: Approach to initial antibiotic use
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Page 388 and 389: DocumentedinfectionsSuggesteddurati
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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
Page 402 and 403: Chemotherapy Induced Nausea andVomi
Page 404 and 405: Level I Level II Level III Level IV
Page 406 and 407: Types & doses of AntiemeticsDrug &
Page 408 and 409: supported by a meta-analysis, which
Page 412 and 413: day 1; aprepitant and dexamethasone
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Page 416 and 417: Late Effects in Childhood CancerSur
Page 418 and 419: to increase their awareness about l
Page 420 and 421: Contd...Score2BStatement of consens
Page 422 and 423: 6 Kurkure PA, Achrekar S, Uparkar U
Page 424 and 425: nonirradiated group did not differ
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Page 428 and 429: Our ACT model has 3 basic facets; p
Page 430 and 431: The relative risk of developing TLS
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Page 442 and 443: Table 4 Patient Stratification by R
Page 444 and 445: Table 6 Management of Electrolyte A
Page 446 and 447: of TLS and improve the management o
Page 448 and 449: 4. Efficacy and safety of rasburica
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Page 452 and 453: Though there are many chemotherapeu
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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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