Cardiac sudden death as a result of acute coronary artery thrombosis during chemotherapy for testicular carcinoma

Perioperative mortality of head and neck cancers

Background

Head and neck cancers are aggressive cancers, most clinical studies focused on the prognosis of patients with head and neck cancer. However, perioperative mortality was rarely mentioned.

Methods

A retrospective analysis was performed using all head and neck cancer patients admitting in the Department of Oral and Maxillofacial Surgery of the Second Xiangya Hospital, Central South University from January 2010 to December 2019. The analysis of overall survival and progression-free survival were performed using the Kaplan–Meier method, and cross tabulation with chi-squared testing was applied to analyze the difference in parameters between groups.

Results

From January 2010 to December 2019, a total of 6576 patients with head and neck cancers were admitted to our department and 7 died in the hospital, all of whom were middle-aged and elderly patients including 6 males and 1 female. The perioperative mortality rate (POMR) was about 1‰. The causes of death included acute heart failure, rupture of large blood vessels in the neck, hypoxic ischemic encephalopathy due to asphyxia, respiratory failure and cardiopulmonary arrest.

Conclusion

Preoperative radiotherapy, previous chemotherapy, hypertension, diabetes, advanced clinical stage and postoperative infection are risk factors for perioperative mortality of head and neck cancer.

Vascular Toxicities of Cancer Therapies: The Old and the New--An Evolving Avenue

Since the late 1990s, there has been a steady decline in cancer-related mortality, in part related to the introduction of so-called targeted therapies. Intended to interfere with a specific molecular pathway, these therapies have, paradoxically, led to a number of effects off their intended cancer tissue or molecular targets. The latest examples are tyrosine kinase inhibitors targeting the Philadelphia Chromosome mutation product, which have been associated with progressive atherosclerosis and acute vascular events. In addition, agents designed to interfere with the vascular growth factor signaling pathway have vascular side effects ranging from hypertension to arterial events and cardiomyocyte toxicity. Interestingly, the risk of cardiotoxicity with drugs such as trastuzumab is predicted by preexisting cardiovascular risk factors and disease, posing the question of a vascular component to the pathophysiology. The effect on the coronary circulation has been the leading explanation for the cardiotoxicity of 5-fluorouracil and may be the underlying the mechanism of presentation of apical ballooning syndrome with various chemotherapeutic agents. Classical chemotherapeutic agents such as cisplatin, often used in combination with bleomycin and vinca alkaloids, can lead to vascular events including acute coronary thrombosis and may be associated with an increased long-term cardiovascular risk. This review is intended to provide an update on the evolving spectrum of vascular toxicities with cancer therapeutics, particularly as they pertain to clinical practice, and to the conceptualization of cardiovascular diseases, as well. Vascular toxicity with cancer therapy: the old and the new, an evolving avenue.

SCAI Expert consensus statement: Evaluation, management, and special considerations of cardio-oncology patients in the cardiac catheterization laboratory (endorsed by the cardiological society of india, and sociedad Latino Americana de Cardiologıa intervencionista)

In the United States alone, there are currently approximately 14.5 million cancer survivors, and this number is expected to increase to 20 million by 2020. Cancer therapies can cause significant injury to the vasculature, resulting in angina, acute coronary syndromes (ACS), stroke, critical limb ischemia, arrhythmias, and heart failure, independently from the direct myocardial or pericardial damage from the malignancy itself. Consequently, the need for invasive evaluation and management in the cardiac catheterization laboratory (CCL) for such patients has been increasing. In recognition of the need for a document on special considerations for cancer patients in the CCL, the Society for Cardiovascular Angiography and Interventions (SCAI) commissioned a consensus group to provide recommendations based on the published medical literature and on the expertise of operators with accumulated experience in the cardiac catheterization of cancer patients.

The Clinical Evaluation of Tegafur Gimeracil Oteracil Combined with THP and DDP for Second-Line Treatment of Advanced Cardiac Carcinoma

The aim of this study is to explore the clinical effect of tegafur gimeracil oteracil combined with pirarubicin hydrochloride (THP) and diamminedichloroplatinum (DDP) for second-line treatment of advanced cardiac carcinoma, and find the most effective method to improve its survival rate and decrease the adverse reactions. 70 patients with advanced cardiac carcinoma admitted during February 2010-March 2014 were selected and divided into two groups with 35 cases in each group. All patients were treated with THP and DDP, and tegafur gimeracil oteracil was added to the observation group. The differences of effective rate, life quality, and adverse reactions after treatment in observational group were observed. The result of total curative effect indicated that the occurrence rate of complete remission + partial remission (CR + PR) in the control group was 28.57 %, the total effective rate was 51.43 %, the occurrence rate of CR + PR in the observational group was 34.29 %, and the total effective rate was 57.15 %; there was no statistical difference between the two groups (P > 0.05). The result of KPS scoring indicated that the improvement rate in the control group was 28.57 %, the total effective rate was 62.86 %, the improvement rate in the observational group was 42.86 %, and the total effective rate was 80 %; there was statistical difference between two groups (P < 0.05); the occurrence rates of adverse reactions including leukocyte decrease, thrombocytopenia, anemia, nausea and vomiting, constipation, peripheral neurovirulence, hepatotoxicity, and renal toxicity were statistically different (P < 0.05). Tegafur gimeracil oteracil combined with THP and DDP in treating advanced cardiac carcinoma can improve the life quality and decrease the adverse reactions.