Guidelines for Complications of Cancer Treatment Vol VIII Part B

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Contd...Score2BStatement of consensusThere is non-uniform consensus of the panel that(1) There is lower-level evidence linking the lateeffect with therapeutic exposure and (2) thescreening recommendation is appropriate based oncollective clinical experience of panel members.3 There is major disagreement that therecommendation is appropriate.The COG Guidelines emphasize the need for a thorough history& physical examination as the primary assessment for cancerrelated late effects during periodic screening. Recommendation& frequency of investigations are based on the score; thusreducing the burden of unnecessary investigations. Details onsystem wise late effects, possible causative agents,recommended evaluation & frequency of monitoring for lateeffects can be accessed on the COG website(www.survivorshipguidelines.org).However, stringent COG guidelines are difficult to adopt indeveloping countries like India due to logistic and financialconstraints. To ensure compliance on ongoing basis, a morepractical follow up strategy is suggested by the Scottishguidelines 14 for long-term follow-up of childhood cancersurvivors based on the intensity of therapy received. 15 Thethree levels of follow up recommended are summarized intable below. To optimize the follow-up of long-term survivorseach centre should adopt its own policy keeping in mind thebasic guiding principles of existing international standards andstrategies.411
Level Treatment Method of Frequency Examplefollow upA - surgery alone postal or 1-2 yrs - Wilms st1/2telephone- LCH- low risk (single systemchemotherapydisease)B - chemotherapy Nurse or 1-2 yrs majority of- low dose primary patientscranial care-led (e.g. All inirradiation less (with firstthan or equal appropriate remission)to 24 Gy trainingprotocols)C - radiotherapy medically annual - brain tumorsexcept low supervised - post BMTdose cranial long term - stage 4 ptsirradiation follow up (any tumor- mega therapy clinic type)References1. SEER Cancer Statistics Review, 1975-2004. Vol. basedon November 2006 SEER data submission, posted tothe SEER web site, 2007. National Cancer Institute:Bethesda, MD Ries, L.A.G., et al., eds 2007.2. Pui CH, Cheng C, Leung W, et al.Extended follow-upof long-term survivors of childhood acute lymphoblasticleukemia.N Engl J Med. 2003;349:640-93. Hudson MM, Mertens AC, Yasui Y, et al. Health statusof adult long-term survivors of childhood cancer: a reportfrom the Childhood Cancer Survivor Study. Jama.2003;290:1583-92.4. Oeffinger KC, Mertens AC, Sklar CA, et al. Chronichealth conditions in adult survivors of childhood cancer.N Engl J Med. 2006;355:1572-82.5. Hudson MM, Hester A, Sweeney T, et al. A model ofcare for childhood cancer survivors that facilitatesresearch. J Pediatr Oncol Nurs. 2004;21:170-4412
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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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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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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 &
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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 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
Page 454 and 455: corticosteroids with variable respo
Page 456 and 457: Nephrotoxicity ofChemotherapeutic D
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Page 460 and 461: Table 2 Chemotherapeutics Requiring
Page 462 and 463: against ifosfamide nephrotoxicity.
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Page 466 and 467: 7. Obesity - Probably due to over d
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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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