Abstract
We thank Dr. Marcy et al. [1] for his interest in our paperentitled ‘‘Subclavian vein versus arm vein for totallyimplantable central venous port for patients with head andneckcancer:aretrospectivecomparativeanalysis[2]’’andweappreciate this opportunity to make a comment on his letter.In our study, we compared two different routes of venousaccess, the subclavian and arm veins, for patients with headandneckcancer(HNC).Incidenceofpostproceduraladverseevents wassignificantlyhigherinthearmportgroup (8.5 %)than in the subclavian port group (22.6 %) [2]. Phlebitis wasthe most frequently encountered events in our study and it isseen only in patients with an arm port (9.5 %). Kuriakoseetal.[3]observedasignificantdifference betweentherateofvenous thrombosis in the brachial approach (11.8 %) andthat in the subclavicular approach (5.2 %). Becausemechanical stress on the catheter may lead to phlebitis orupper extremity thrombosis, the length of catheter, the ratioof dimensions of the implanted catheter and the target vein,and venous stasis are included in the potential causativefactors. Allen et al. [4] demonstrated that phlebitis occurredless often in basilic vein approach than in cephalic veinapproach. Itis thelimitationofourstudy,because we didnotanalyze these factors.The systemic chemotherapy for HNC consisting ofdocetaxel, cisplatinum, and 5-fluorouracil is commonlyperformed [5], and the central venous ports will be indi-cated in HNC patients more frequently in the future. Cri-teria for port selection in HNC patients may become animportant guide to treat such patients. Although ourexperiences are still limited, we all agree with the selectioncriteria described in the letter [1]. We believe that we willfind the most reasonable approach based on the author’sproposal with further experience.
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