Guidelines for Complications of Cancer Treatment Vol VIII Part B

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oSource control ASAP after successful initialresuscitation (1C) S (exception: infected pancreaticnecrosis) (2B) WSource control measureo Maximum efficacyo Minimal physiologic upset (1D) So Remove intravascular access devices if potentiallyinfected (1C) S2004 EHaemodynamic support and adjunctive therapy Fluid therapyo Fluid-resuscitate using crystalloidsor colloids (1B) So Target CVP > 8 mm Hg (12 mmHg if MV) (1C) So Use fluid challenge Till associated with hemodynamicimprovement (1D) So Fluid challenge 1 L Crystalloids or 300–500 mL colloids over30 mins. (1D) SReduce rate when cardiac filling pressuresincrease without concurrent hemodynamicimprovement (1D) S2004 EVasopressorso Maintain MAP > 65 mm Hg (1C) So Use NE & Dopa as initial vasopressors (1C) S79
o Epinepphrine, phenylephrine and vasopressin NOTinitial vasopressors (2C). Wo Vasopressin 0.03 units/min may be added to NE. 2004 E & DVasopressorso Epinephrine first alternative agent when poorresponse to NE or Dopa (2B). Wo Do not use low-dose dopamine <strong>for</strong> renal protection(1A) So In pts needing vasopressors, insert an arterialcatheter ASAP (1D) S2004 B & EInotropic therapyo Use dobutamine in patients with myocardialdysfunction (1C) So DO NOT increase cardiac index to supranormallevels (1B) So Aim <strong>for</strong> adequate O 2delivery 2004 E & ASteroidso IV hydrocortisoneo hypotension refractory to fluids & vasopressors(2C) Wo ACTH stimulation test not recommended (2B) Wo Hydrocortisone preferred to dexamethasone (2B)Wo Fludrocortisone optional if hydrocortisone used(2C) W80
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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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Page 39 and 40: monitored for the development of po
Page 41 and 42: modality, and tumor stage distribut
Page 43 and 44: 26. Pain and other symptoms during
Page 45 and 46: 28. Coping, catastrophizing and chr
Page 47 and 48: surgical technique at the time of m
Page 49 and 50: 0.001), 0.315 cm +/- 1.27 at the an
Page 51 and 52: or heat and superficial incision is
Page 53 and 54: RecommendationsA. Preparation of th
Page 55 and 56: 3. Mangram AJ, Horan TC, Pearson ML
Page 57 and 58: Mild hypothermia increases blood lo
Page 59 and 60: Perioperative Normothermia to Reduc
Page 61 and 62: Priorities: Restoration of circulat
Page 63 and 64: than 1.5 times control values but f
Page 65 and 66: outcomes that may result from the u
Page 67 and 68: Preoperative Preparation of the Pat
Page 69 and 70: patients, or other patients who may
Page 71 and 72: Obstruction can occur at the level
Page 74 and 75: c. Administer face mask preoxygenat
Page 76 and 77: 5. The use of exhaled carbon dioxid
Page 78 and 79: disorder) may occur after an episod
Page 80 and 81: undergoing general anesthesia, eith
Page 82 and 83: anesthesia awareness occurred in ea
Page 84 and 85: The current guidelines are actually
Page 86 and 87: o S - Strong Recommendation -Commit
Page 90 and 91: oooWean steroids once vasopressors
Page 92 and 93: Mechanical ventilation of sepsis-in
Page 94 and 95: o CVVH offers easier management inh
Page 96 and 97: critically ill patient that are con
Page 98 and 99: Rivers E, Nguyen B, Havstad S, et a
Page 100 and 101: in survival of 7.6%. By the second
Page 102 and 103: parameters (gastric mucosal Pco2, s
Page 104 and 105: syndrome. We therefore conducted a
Page 106 and 107: Complications After Limb SalvageSur
Page 108 and 109: local tumor and to preserve as much
Page 110 and 111: femoral head to the center of the k
Page 112 and 113: 4. Griffin AM, Parsons JA, Davis AM
Page 114 and 115: 20. Roberts P, Chan D, Grimer RJ, e
Page 116 and 117: An infection can have disastrous co
Page 118 and 119: and facilitating reimplantation sur
Page 120 and 121: features of a two-stage revision is
Page 122 and 123: patients had an amputation. Two oth
Page 124 and 125: its main role is confined to ruling
Page 126 and 127: 2. Capanna R, Morris HG, Campanacci
Page 128 and 129: 21. Wilson MG, Kelley K, Thornhill
Page 130 and 131: 39. Love C, Marwin SE, Tomas MB, Kr
Page 132 and 133: 5. A systematic review of 25 RCT’
Page 134 and 135: (cefazolin or cefuroxime) or penici
Page 136 and 137: 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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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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