Long-Term Infusional Systems: Complications in Cancer Patients

Long-term central vein catheters have found clinical application in different fields of medicine and particularly in oncology. In fact, the continuous infusion of some drugs has become the standard treatment in a wide variety of cancers, but central vein catheters are not without risks. The authors report their experience with central vein catheters. From January 1, 1998, to December 31, 1999, 98 central vein catheters were placed in neoplastic patients. Seventy-seven (78.6%) Groshong and 16 (16.3%) Port-a-cath catheters were used. The central vein catheters were placed under local anesthesia. Before placement of the central vein catheters, the patients were checked by chest X-ray and neck ultrasonography. The procedure was performed under fluoroscopic control. The central vein catheters were flushed periodically with normal saline solution and sodium heparin. Sterile transparent adhesive dressings were used to occlude the operative site. The median follow-up of patients was 9 catheter months (range, 1-24 months). There were a few early and late clinically evident complications. The early complications were dislodgement in 5 cases (5.1%). The late complications were: fibrin sleeve in 1 case (1.1%), thrombosis in 2 cases (2.1%) and skin infection in 4 cases (4.1%). The low prevalence of major complications related to implants and management of these supports an increased use in oncology.

Sorption of arsenate and dichromate on polymerin, Fe(OH)x-polymerin complex and ferrihydrite

Dihydrogenarsenate [H(2)AsO(4)(-), As(V)] or dichromate [Cr(2)O(7)(2-), Cr(VI)] at pH=4.0 showed to be sorbed on a Fe(OH)(x)-polymerin complex and ferrihydrite to a greater extent than on polymerin, the organic polymeric fraction of olive oil mill wastewater (OMW). In particular, the maximum amount (x(m)) of arsenate sorbed on Fe(OH)(x)-polymerin complex was similar to that on ferrihydrite (880.26 and 743.02 mmol kg(-1), respectively), and was much greater than that sorbed on polymerin (384.25 mmol kg(-1)). The sorption of dichromate was to a comparable extent on Fe(OH)(x)-polymerin complex and ferrihydrite (205.90 and 254.88 mmol kg(-1), respectively). Cr(III), a less toxic chromium form, mainly, and Cr(V) were indeed the effective forms sorbed on polymerin (200 mmol kg(-1)), as a consequence of the redox reaction of the strongly toxic Cr(VI) with the CH(2)OH groups of the polysaccharide moiety of this bio-sorbent, according to the data deriving from XPS and DRIFT analyses. The potential exploitation of the selected sorbents for the removal of As(V) or Cr(VI) from aqueous effluents is briefly discussed.

Protracted infusion of 5 fluorouracil and toxicity during CMF administration in adjuvant setting of breast cancer

19618

Background: Protracted infusion of 5FU(PI) increases response rates and reduces toxicity when compared to bolus administration (BA): the mechanism of action of this drug appears to depend on the dose and the schedule of administration. In some trials 5FU was given as a BA: 30% incidence of severe mucositis or diarrhea was observed. These side effect decreased to less than 15% in trials in which 5FU was infused over 30 minutes and even less when the same dose of 5FU was given over 1 hour or over 2 hours. The CMF i.v. schedule with BA of all three drugs in the adjuvant setting of breast cancer has been shown to be associated with frequent gastrointestinal and mielo-toxicity. PI of 5FU in the CMF schedule can reduce toxicity and improve the quality of life. Methods and Results: From July 2003 to October 2006, 95 patients with breast cancer, mean age 56 years (range 40–75) were treated with adjuvant CMF (1, 8 every 28 days) with 5FU PI (1 hour). Toxicity and compliance were compared to those of 75 patients treated in our institution with CMF-5FU BA (10 min). Toxicity was coded by NCI-CTC. We observed that the patients treated with CMF-5FU PI compared to 5FU BA showed G2–3 nausea: 31.5% vs 46%, G2–3 emesis: 26.3% vs 34.6%, G2 diarrhea: 0% vs 2.6%,asthenia: 18.9% vs 33.3%, G2 neutropenia: 21.0% vs 30.6%, G3 neutropenia: 18.9% vs 20.0% ,G4 neutropenia: 9.4% vs 12%,G3–4 mucositis: 12.6% vs 18.6% and hand -foot syndrome 1.0% vs 0%. Compliance in CMF with 5FU PI compared to CMF with 5FU BA was: 6 cycles administered in 92.6% vs 88.0%, day 8 omitted in 11.5% vs 13.3%, dose reduction in 15.7% vs 17.3%. Conclusions: In our experience, 5 FU PI reduces the gastrointestinal toxicity, particularly nausea and emesis compared to BA.We suggest that less toxicity treatment schedule improves the quality of life and is mandatory mainly in frail and elderly patients.

No significant financial relationships to disclose.

The role of reduced glutathione on oxaliplatin-induced neuropathy in colorectal cancer patients

19539

Background: Peripheral sensory neuropathy is a common side-effect of oxaliplatin based chemotherapy. The neuropathy is cumulative and dose-related. Symptoms include sensory ataxia and dysesthesia of the limbs, mouth, throat and larynx, and may be exacerbated by exposure to cold. Studies suggest that Glutathione (GSH) is neuroprotective against oxaliplatin-induced neuropathy. Methods: From Jan. 2004, 83 consecutive colorectal cancer patients (pts) elegibile to oxaliplatin-based regimen were treated with GSH 1500 mg/mq over a 15-minute infusion period before oxaliplatin. Treatment-related toxicity was evaluated based on National Cancer Institute (NCI) Criteria. Results: After four cycles of chemotherapy, 5 pts (6%) experienced G1 neurotoxicity. After eight cycles, 2 pts (2.4%) experienced G2 sensory neuropathy (duration < 7 days) and 8 (9.6%) pts G1. After 12 cycles, G3 sensory neuropathy was observed in 2 pts (2.4%), G2 in 8 (9.6%) and G1 in 11 pts (13%). Neither G4 sensory neuropathy was registered nor treatment interruption was required. Conclusions: These findings suggest that use of GSH may protect from oxaliplatin-induced neuropathy. In fact, in our series, only 2 (2.4%) pts experienced severe paresthesia interfering with daily activities and none hade permanent sensory loss. However, only a well designed randomised controlled study will definitely prove the protective effect of GSH on oxaliplatin induced neurotoxicity.

No significant financial relationships to disclose.

Growth disturbances following fractures of the femur and tibia in children

We reviewed 160 diaphyseal and metaphyseal fractures of the femur and tibia in children treated between 1964 and 1980 at the Orthopaedic and Traumatological Clinic of the University of Rome. The initial documentation was complete in these cases and 96 presented for clinical and radiographic long-term follow-up. The analysis of this material showed that lengthening of the affected limb had occurred in 46% of cases. The amount of such lengthening, however, was only from 0.5 to 1.5 cm and never exceeded 2 cms. It was most frequent in children between the ages of 3 to 8 years with fractures of the tibia, particularly in the upper third of the bone.