The acute toxicities of chemotherapy

[Paediatric oncology in Hungary]

The significance of paediatric oncology is increasing due to its increasing incidence and its leading role among the causes of mortality in children. The epidemiology, prophylaxis and therapy of paediatric malignancies in Hungary are discussed surveying the results and the most important tasks in the future.

Reações tegumentares adversas relacionadas aos agentes antineoplásicos: parte II

Os eventos e reações envolvendo quimioterapia são frequentes na prática oncológica. Agentes quimioterápicos são uma modalidade de tratamento amplamente utilizada. Efeitos colaterais podem variar de frequência e também ser confundidos com outras manifestações tegumentares do tratamento oncológico. Este artigo objetiva expor as informações sobre reações cutâneas à quimioterapia, em especial, aqueles para os quais o dermatologista é requisitado a emitir parecer e a comentar sobre a segurança e a viabilidade da readministração de uma droga específica. Os autores descrevem os aspectos associados a esses eventos, fazendo uma análise detalhada de cada um deles.

Persistent left superior vena cava: a reason for pseudodisplacement of a port catheter

Port catheters have been increasingly used in recent years. Using one case as an example, we demonstrate how an anatomic variation can easily become a pitfall when inserting a central venous catheter, port catheter, pacemaker or Swan-Ganz catheter. We report a case of persistent left superior vena cava, the most common variation in the thoracic venous system. Since these procedures are increasingly being performed, surgeons, anesthesiologists and radiologists should be aware of the possible anatomic variations.

Mucocutaneous reactions to chemotherapy

Chemotherapeutic agents are a widely used treatment modality. Side effects range from common to unusual and may be confused with other cutaneous sequelae of oncologic treatment. The goal of this communication is to elaborate on previous descriptions of the cutaneous manifestations of chemotherapeutic treatment and to discuss more recent findings.

LEARNING OBJECTIVE

At the conclusion of this learning activity, participants should be able to generate a differential diagnosis of possible etiologies for varying patterns of cutaneous involvement in patients receiving chemotherapy and identify the various cutaneous side effects of chemotherapeutic treatment. In addition, they should be able to distinguish life-threatening side effects that require immediate management from more benign manifestations of chemotherapeutic treatment.

Principles of treatment of pediatric solid tumors

Great strides have been made in the treatment of pediatric solid tumors over the last three decades. A multimodality approach involving a combination of surgery, radiation therapy, and chemotherapy is now used in the treatment of these diseases. This article reviews the principles that guide the use of these modalities and the multidisciplinary approach used to integrate them into a coordinated treatment plan. The role of each modality in the control of local and systemic disease is described. Radiation treatment planning, dose fractionation, and toxicity are also discussed.

Drug targeting in cancer chemotherapy: a clinical perspective

Drug targeting is a phenomenon which maneuvers the distribution of drug in the body in such a manner that the major fraction of the drug interacts exclusively with the target tissue at a cellular or subcellular level. Numerous strategies have been developed to accomplish this goal; some of them have been tried clinically for improving cancer chemotherapy. This review updates the current status of research in the area of targeted drug delivery, with particular emphasis on its application in the clinical management of carcinomas.

Pharmacologic considerations in the treatment of acute lymphoblastic leukemia

Great strides have been made in the chemotherapy of childhood ALL over the past three decades. Principles and concepts learned from early successes in treating this disease subsequently have been applied to the treatment of other pediatric cancers and adult malignancies. Because of the prominent role of chemotherapy in the treatment of ALL, a clear understanding of the clinical pharmacology of the antileukemic drugs is essential. This article reviews issues relating to the clinical pharmacology of the anticancer drugs that are commonly used in the treatment of acute lymphoblastic leukemia.

Prevention of cytotoxic drug induced skin ulcers with dimethyl sulfoxide (DMSO) and alpha-tocopherole

Accidental subcutaneous extravasation of several antineoplastic agents may provoke skin ulcerations for which there has been no simple and effective treatment. Since January 1983 we have treated all patients in our institution sustaining extravasation by a cytotoxic drug with a combination of DMSO and alpha-Tocopherole. During the first 48 hr after extravasation a mixture of 10% alpha-Tocopherole acetate and 90% DMSO was topically applied. The bandage was changed every 12 hr. So far eight patients with extravasation of an anthracycline or Mitomycin were treated on this protocol. No skin ulceration, functional or neurovascular impairment occurred in any of these patients. The only toxic effect observed by this treatment was a minor skin irritation. The combination of DMSO and alpha-Tocopherole seems to prevent skin ulceration induced by anthracyclines and Mitomycin.

Treatment methods for extravasations of chemotherapeutic agents: a comparative study

A rat model was used to compare early surgical intervention with injectable and topical antidotes with regard to their effectiveness in preventing cutaneous ulcers that were caused by intradermal injections of vesicant chemotherapeutic agents. The (animals) rats received bilateral flank injections of doxorubicin, vincristine, actinomycin D, mitomycin C, or carmustine (BCNU) in concentrations that were comparable to concentrations used for human patients; after the injections they underwent debridement at various intervals or received immediate applications of selected antidotes. Many "antidotes" which were frequently used, were not effective in limiting the size of the ulcer and in producing rapid healing of ulcers that were caused by experimental vesicant extravasations. Early surgical debridement was the most effective method of decreasing vesicant ulcer size and facilitating rapid ulcer healing of all the interventions tested.