Complications In Oncology Patients Research Articles

Role of Tumor Microenvironment in the Risk of Thromboembolic Complications in Ovarian Cancer

Introduction. Incidence of ovarian cancer remains high in the overall prevalence of oncological pathology. Adjuvant chemotherapy refers to its treatment options. Patients with oncological pathology are faced with a high risk of thrombosis and thromboembolism, with up to 30% lethal outcome within a month of its development. A number of cancer cells are known to induce platelet aggregation, contributing to thrombosis and metastasis as a result of this interaction. Accordingly, the paper is aimed at presenting a clinical case for demonstrating the role of P-selectin expression in the complications in a patient with ovarian cancer. Materials and methods. The present paper evaluates platelet activation marker in a patient undergoing chemotherapy courses after cytoreductive surgery. Following the case conference and in accordance with the clinical recommendations of the Russian Oncology Association (AOR) and Russian Society of Clinical Oncology (RUSSCO), cytoreduction (CC-0), radical hysterectomy, transverse colectomy, left hemicolectomy with rectum resection were performed. The interventions included ascendostomy, pelvic, lateral right-sided and left-sided peritonectomy, pelvic lymphoadenectomy, total omentectomy, Renape-French HIPEC (hyperthermic intraperitoneal chemotherapy), abdominal and pelvic drainage. Expression of P-selectin on the platelet surface was measured as a marker of platelet activation. Results and discussion. At the time of admission, the patient had high CD62 expression activity compared to healthy volunteers (CD62 ADP- — 11.2%, CD62 ADP — 24.7% vs CD62 ADP- — 1.3%, CD62 ADP — 17.2%). During the complex treatment of ovarian cancer, the platelet activation increased (CD62 ADP- — 21.8 %, CD62 ADP+ — 30.1 %). At discharge, CD62 expression values reached the conditional norm, presumably indicating thrombosis development. Conclusion. Tumor microenvironment influences the hemostasis system. Detailed study into this issue obtains a high potential for the prevention of primary and secondary thromboembolic complications in oncologic patients.

Association between risk of malnutrition defined by patient-generated subjective global assessment and adverse outcomes in patients with cancer: a systematic review and meta-analysis.

To assess the association between the risk of malnutrition, as estimated by the Patient-Generated Subjective Global Assessment (PG-SGA) numerical scores, and adverse outcomes in oncology patients. Systematic review and meta-analysis. A comprehensive search was conducted in PubMed, Web of Science, Embase, CKNI, VIP, Sinomed and Wanfang databases. Studies that examined the association between the risk of malnutrition, as estimated by the PG-SGA numerical scores, and overall survival (OS) or postoperative complications in oncology patients were included. Patients were classified as low risk (PG-SGA ≤ 3), medium risk (PG-SGA 4-8) and high risk of malnutrition (PG-SGA > 8). Nineteen studies reporting on twenty articles (n 9286 patients). The prevalence of medium and high risk of malnutrition ranged from 16·0 % to 71·6 %. A meta-analysis showed that cancer patients with medium and high risk of malnutrition had a poorer OS (adjusted hazard ratios (HR) 1·98; 95 % CI 1·77, 2·21) compared with those with a low risk of malnutrition. Stratified analysis revealed that the pooled HR was 1·55 (95 % CI 1·17, 2·06) for medium risk of malnutrition and 2·65 (95 % CI 1·90, 3·70) for high risk of malnutrition. Additionally, the pooled adjusted OR for postoperative complications was 4·65 (95 % CI 1·61, 13·44) for patients at medium and high risk of malnutrition. The presence of medium and high risk of malnutrition, as estimated by the PG-SGA numerical scores, is significantly linked to poorer OS and an increased risk of postoperative complications in oncology patients.

Radiation Recall Pneumonitis: Imaging Appearance and Differential Considerations.

Radiation recall pneumonitis is an inflammatory reaction of previously radiated lung parenchyma triggered by systemic pharmacological agents (such as chemotherapy and immunotherapy) or vaccination. Patients present with non-specific symptoms such as cough, shortness of breath, or hypoxia soon after the initiation of medication or vaccination. Careful assessment of the patient's history, including the thoracic radiation treatment plan and timing of the initiation of the triggering agent, in conjunction with CT findings, contribute to the diagnosis. Once a diagnosis is established, treatment includes cessation of the causative medication and/or initiation of steroid therapy. Differentiating this relatively rare entity from other common post-therapeutic complications in oncology patients, such as recurrent malignancy, infection, or medication-induced pneumonitis, is essential for guiding downstream clinical management.

Two cases of port catheter migration to the right ventricle: is it a rare complication in oncological patients?

Two cases of port catheter migration to the right ventricle: is it a rare complication in oncological patients?

Low-level laser therapy in the supportive treatment of dermatologic adverse events in oncology

Supportive treatment plays an important role in oncology nowadays. The main aims of oncologic supportive treatment are management of cancer symptoms and adverse events of cancer treatment.
 In terms of dermatologic adverse events the most important types of reaction are oral mucositis during radiation therapy, chemotherapy and during hematopoetic stem cell transplantation, palmoplantar syndrome during chemotherapy, palmoplantar skin reaction, acneiform paronychia and pyogenic granulomas during targeted therapy, immune-related dermatologic adverse events during immunotherapy.
 During recent years, special attention has been paid to low level laser therapy for the prophylaxis and management of cancer therapy dermatologic adverse events. The effects of low level laser therapy may have a beneficial effect on many conditions that play important roles in the pathogenesis of radiation and chemotherapy-induced complications in oncologic patients. Therapeutic effects of low level laser therapy are attributed to the stimulation of adaptive processes and to the increase of nonspecific resistance. The latter develop due to the close interaction of the immune, humoral and nervous systems. When choosing a method for the supportive treatment of cancer therapy adverse events, it is extremely important to establish safety in terms of the tumor process and absence of negative effects on cancer treatment.
 Effects of low level laser therapy on the proliferative and invasive activity of an existing malignancy remains a matter of debate due to conflicting results from in vitro studies.
 At the same time, according to the results of numerous clinical studies, the use of this method is assumed to be safe for cancer patients.

State-of-the-Art Imaging Techniques in Metastatic Spinal Cord Compression.

Simple SummaryMetastatic Spinal Cord Compression (MSCC) is a feared complication in oncology patients due to its potential for severe pain, permanent neurological disability and mechanical instability of the spine. This narrative review, conducted by keyword searches in PubMed and Google Scholar databases, aims to describe the important role of imaging in MSCC diagnosis and treatment. Diagnosis is typically achieved via Magnetic Resonance Imaging (MRI), although Computed Tomography (CT) Myelogram and conventional CT imaging can be performed in certain clinical situations. Metal artifact reduction techniques for MRI and CT are continually being researched to facilitate imaging in MSCC patients with spinal implants. Imaging also has an important role in pre-treatment planning, in-room image-guidance, and post-treatment follow-up for MSCC patients treated with stereotactic body radiotherapy. Recent advances in deep learning tools for image analysis can reduce the time to MSCC diagnosis, enabling earlier treatment for superior functional outcomes.Metastatic Spinal Cord Compression (MSCC) is a debilitating complication in oncology patients. This narrative review discusses the strengths and limitations of various imaging modalities in diagnosing MSCC, the role of imaging in stereotactic body radiotherapy (SBRT) for MSCC treatment, and recent advances in deep learning (DL) tools for MSCC diagnosis. PubMed and Google Scholar databases were searched using targeted keywords. Studies were reviewed in consensus among the co-authors for their suitability before inclusion. MRI is the gold standard of imaging to diagnose MSCC with reported sensitivity and specificity of 93% and 97% respectively. CT Myelogram appears to have comparable sensitivity and specificity to contrast-enhanced MRI. Conventional CT has a lower diagnostic accuracy than MRI in MSCC diagnosis, but is helpful in emergent situations with limited access to MRI. Metal artifact reduction techniques for MRI and CT are continually being researched for patients with spinal implants. Imaging is crucial for SBRT treatment planning and three-dimensional positional verification of the treatment isocentre prior to SBRT delivery. Structural and functional MRI may be helpful in post-treatment surveillance. DL tools may improve detection of vertebral metastasis and reduce time to MSCC diagnosis. This enables earlier institution of definitive therapy for better outcomes.

Kras mutation as a risk factor for venous thromboembolism in patients with metastatic pancreatic cancer.

e16267 Background: Venous thromboembolism (VTE) is a common complication in oncology patients. It has been reported that VTE increases morbidity and mortality in these patients. It’s prevalence in metastatic pancreatic cancer (mPC) ranges around 4-7.5% Preclinic studies suggest that the mutation of the KRAS oncogene (KRASm) is associated with a higher risk of VTE among patients with colorectal cancer. KRASm appears to increase the expression of tissue factor, a physiological trigger of coagulation that is found on the surface of tumor cells. This association has not been studied in mPC, where this mutation can be found in 90% of the cases. Our aim is to determine the prevalence and risk factors associated with VTE taking into consideration the status of KRAS. Methods: We conducted a retrospective study within a cohort of patients with mPC that had a determination of the KRAS status. These patients were treated at Medical Oncology between January 2017 and December 2020. We performed a descriptive and survival analysis of our sample. We also studied the prevalence of VTE among the. Results: Our study cohort was 88 patients (pts), 63 (61, 2%) men and 40 (38, 8%) women. The median age was 63 years (32-84). 19 pts (18, 4%) were KRAS wild type (KRASwt), 69 pts (67%) KRASm. There was no statistically significant difference in gender, age, performance status, comorbidities, primary tumor/metastases location, disease control rate and toxicity between KRASwt and KRASm. Median serum levels of Ca 19.9 were higher in KRASm (39.847 U/ml vs 2026 U/ml). At the time of diagnosis, 78 pts (88, 6%) were metastatic and 10 pts (11, 4%) were localized/locally-advanced. Most of metastatic pts (62/78) were KRASm (p = 0, 015). Most common histology (86, 4%) was adenocarcinoma. This histology was more frequent in KRASm, 61, 8% (p = 0, 02). At time of analysis, 72 pts (69, 9%) were dead, most of them (54, 4%) were KRASm (p = 0, 001). 31 pts developed VTE: 4 were KRASwt and 27 KRASm. The prevalence of VTE was 36, 3%. It was greater in KRASm (39, 1%) than in KRASwt (26, 3%). There were 7 cases of rethrombosis instead of anticoagulant treatment (1 KRASwt and 6 KRASm). KRASwt seems to be a protective factor in the development of VTE (OR 0, 55; CI 95% 0, 18-1, 71). The most common entity were VTE of splenoportomensenteric axis (16 pts), followed by pulmonary embolism, EP, (7 pts), deep venous thrombosis, DVT, (4 pts) EP + DVP (3 pts), thrombosis associated with central venous catheter (3 pts) and other locations (2 pts). There were no differences in VTE location between KRASwt and KRASm. The median overall survival (OS) was 12, 82 months (CI 95%: 7, 87-17, 78). It was higher in KRASwt (26 months; CI 95%: 12, 21-40, 48) than in KRASm (9, 8 months; CI 95%: 6, 07-13, 65). This difference was statistically significant (p = 0, 001). Conclusions: In our cohort, the prevalence of VTE is higher than de prevalence described in the literature and was greater in KRASm population. OS was significantly larger in KRASwt.

Undiagnosed Malignancy and Therapeutic Complications in Oncology Patients.

Despite technologic and medical advancements, autopsies are essential to uncover clinically unsuspected diagnoses, to advance our understanding of disease processes, and to help reduce medical errors. To investigate the percentage of malignancy clinically diagnosed and undiagnosed in a series of hospital autopsies. Secondarily, to explore the therapeutic complications directly contributing to death in cancer patients. A 10-year retrospective study (2008-2018). All nonforensic autopsies performed at the University of Vermont Medical Center during this period were reviewed by 2 pathologists, and data, including antemortem diagnoses of malignancy, and autopsy findings, including therapeutic complications, were collected. A total of 246 cases documented a diagnosis of malignancy. In 34.5% (85 of 246) of cases a tissue diagnosis of malignancy was first documented following postmortem examination. In 41.2% (35 of 85) of cases there was clinical antemortem suspicion of malignancy, whereas in 58.8% (50 of 85) clinically unsuspected malignancy was first diagnosed after postmortem examination. In 16.0% (8 of 50) of cases the undiagnosed malignancy was the primary cause of death. The overall rate of therapeutic complication related to the treatment of oncologic disease in patients that resulted in death was 21.7% (35 of 161). Our study shows the percentage of clinically unsuspected malignancies revealed by postmortem examination to be 5% (50 of 1003) of all autopsy cases. In 16% (8 of 50) of cases, the cause of death was due to the clinically undiagnosed malignancy, and hence not to an incidental finding. Despite advances in medical therapy in the management of oncologic disease, in up to 21.7% (35 of 161) of cases therapeutic complications directly contributed to death.

Use of Viscoelastography in Malignancy-Associated Coagulopathy and Thrombosis: A Review.

The relationship between malignancy and coagulopathy is one that is well documented yet incompletely understood. Clinicians have attempted to quantify the hypercoagulable state produced in various malignancies using common coagulation tests such as prothrombin time, activated partial thromboplastin time, and platelet count; however, due to these tests' focus on individual aspects of coagulation during one specific time point, they have failed to provide clinicians the complete picture of malignancy-associated coagulopathy (MAC). Viscoelastic tests (VETs), such as thromboelastography (TEG) and rotational thromboelastometry (ROTEM), are whole blood analyses that have the advantage of providing information related to the cumulative effects of plasma clotting factors, platelets, leukocytes, and red cells during all stages of the coagulation and fibrinolytic processes. VETs have gained popularity in the care of trauma patients to objectively measure trauma-induced coagulopathy (TIC), but the utility of VETs remains yet unrealized in many other medical specialties. The authors discuss the similarities and differences between TIC and MAC, and propose a mechanism for the hypercoagulable state of MAC that revolves around the thrombomodulin-thrombin complex as it switches between activating the protein C anticoagulation pathway or the thrombin activatable fibrinolysis inhibitor coagulation pathway. Additionally, they review the current literature on the use of TEG and ROTEM in patients with various malignancies. Although limited research is currently available, early results demonstrate the utility of both TEG and ROTEM in the prediction of hypercoagulable states and thromboembolic complications in oncologic patients.

MON-603 Racial Distribution of Endocrine Complications in Oncology Patients Treated with Immune Checkpoint Inhibitors

Background: Immune-related adverse events (irAEs) have been frequently described with the growing use of immune checkpoint inhibitors (ICI) in cancer treatment. While many autoimmune diseases are known to be more prevalent in certain racial groups, it is unknown if there are racial disparities in the rate of irAEs. Clinical trials reporting irAEs thus far have not explored their distribution in underrepresented minorities. It is important to study irAEs in racially diverse populations to better understand which patients are more likely to be impacted. Hypothesis: We sought to describe the demographics of a diverse cohort of patients treated with ICIs, as well as the racial distribution of irAEs. We hypothesized that there would be a significant difference among self-reported races experiencing ICI-related endocrine diseases. Methods: IRB approval was obtained to identify 411 oncology patients who were treated with ICIs between January 2011 and April 2017 from an EMR-based data repository. We collected data on age, gender, BMI, comorbidities, and median follow up time, which were further stratified according to self-identified race (White, Black, Hispanic, Asian, Other/Unknown). Endocrine adverse events were recorded according to race and were defined as events that were ≥ Grade 2 according to the Common Terminology Criteria for Adverse Events. We used the Fisher exact test for categorical variables and the Kruskal-Wallis test for continuous variables in the comparative analyses. Results: Of 411 patients treated with ICIs, 53.3% were White, 10.2% were Black, 10.5% were Hispanic, 7.5% were Asian, and 18.5% were Other/Unknown. The mean age was 65.3 years (67.8 in Whites, 63.7 in Blacks, 62.2 in Hispanics, 60.5 in Asians, 62.8 in Other/Unknown; p=0.0012). 38.4% were Female and 61.6% were Male. Mean BMI was 25.9 kg/m2. 10.9% of all patients had pre-existing autoimmune disease (White: 11.0%, Black: 9.5%, Hispanic: 11.6%, Asian: 0, Other/Unknown: 15.8%; p=0.164). 7.3% of all patients had pre-existing thyroid disease (White: 6.9%, Black: 7.1%, Hispanic: 7.0%, Asian: 0, Other/Unknown: 11.8%; p=0.311). Mean follow up period was 8.7 months. 54 (13.1%) patients experienced any endocrine adverse effect without a statistically significant difference among racial groups (White: 16.0%, Black: 16.7%, Hispanic: 11.6%, Asian: 6.5%, Other/Unknown: 6.6%; p=0.189). 14.8% developed hypophysitis, 70.4% developed thyroid disease, 13.0% developed adrenal insufficiency, and 1.9% developed diabetes. Conclusions: Self-reported race was not associated with the development of ICI-related endocrinopathies in a diverse group of oncology patients. Further studies are needed to continue to characterize the populations experiencing immune-related endocrine complications in ICI therapy.

Age-adjusted charlson comorbidity index and 30-day morbidity in pelvic surgeries.

Introduction:Charlson comorbidity index (CCI) is a validated tool enabling clinicians for prediction of adverse events posttherapy. In this study, we planned to estimate the predictive value of age-adjusted CCI (ACCI) in assessing the perioperative complication in oncological patients undergoing major pelvic surgeries.Methods:This was a single arm, prospective, observational study, in which adult patients with pelvic malignancies undergoing pelvic surgeries were selected. The relationship between the ACCI and Grade 3–5 adverse events were tested using Fisher's test.Results:The rate of Grade 3–5 adverse event rate was 16.7% (11 patients, n = 66). Among the whole cohort, 11 patients (16.7%) had high score on ACCI. The rate of Grade 3–5 adverse events was higher in the cohort of patients with high ACCI score (45.5% vs. 10.9%, P = 0.014). The sensitivity, specificity and negative and positive predictive values were 45.5%, 89.1%, 89.1%, and 45.5%, respectively.Conclusion:ACCI can predict for postsurgical adverse events. It has a high negative predictive value for nonoccurrence of adverse events.

Diagnosis, Treatment, and Outcome of Arterioureteral Fistula: The Urologist's Perspective

Arterioureteral fistula (AUF) is a rare but potentially life-threatening disease that primarily arises as a long-term complication in oncological patients who have permanent ureteral stenting. The incidence is rising. The objective of this study was to outline the risk factors for management and outcome of AUF in a large individual case series. Twenty-six AUF cases in 24 patients from six German tertiary referral centers occurring between 2008 and 2016 were identified retrospectively and entered into a dedicated database by using patient notes and out-patient visits. Of 24 patients, 23 had a history of abdominopelvic surgery for oncological disease, 21/24 had undergone radiotherapy, and 23/24 had long-term ureteral stenting. All cases presented with visible hematuria, 11/26 at the time of a stent exchange. Blood transfusions were required in 92.3%, and intravenous inotropes were needed in 46.2%. Of 26 patients, 11 had flank pain. CT angiogram was positive in 35.7%. Angiography and endovascular fistula repair was performed in 88.5%, and the rest received open surgical repair. Mortality was 7.7%. Endovascular treatment was technically successful in 91.3%, and open surgery was successful in 3/4 cases. Recurrent AUF developed in 3/24 patients. Stent-related complications occurred in 15%. Vascular complications were common. Long-term survival was limited due to progression of the underlying malignant disease. AUF results in major hemorrhage and warrants time-efficient diagnosis and treatment. Awareness is key. When AUF is considered, interventional angiography should promptly be performed. Fistula detection can be improved by guidewire manipulation. Pre-interventional CT angiogram may be omitted due to low sensitivity. Endovascular repair with stenting and/or coiling is effective and safe.

Dental Management of Oral Complications in Oncology Patients

Dental Management of Oral Complications in Oncology Patients

Abstract No. 552 - Risk factors for chest port complications in oncologic patients

Abstract No. 552 - Risk factors for chest port complications in oncologic patients

The disorders of hemostasis system and thrombotic complications in oncologic patients having liver operation.

The surgical interventions in patients with malignant tumors of liver cause a development of various forms of syndrome of disseminated intravascular coagulation (DIC) with significant increasing of concentration of markers of intravascular blood coagulation against the background of dramatic decreasing of activity of factors of prothrombin complex, level of natural anti-coagulants and components of fibrinolytic system. The thrombosis of veins of various localization developed in 12 patients with subacute form of DIC. The application of low-molecular heparin in combination with concentrate of anti-thrombin III and freshly frozen plasma decreases intensity of intra-vascular blood coagulation and results in reduction of factors of coagulation and is an efficient and adequate method of treatment of thrombosis and thromboembolism of pulmonary artery in oncologic patients. The significant increasing of level of D-dimer, von Willebrand factor against the background of dramatic decreasing of prothrombin activity, content of antithrombin III and level of plasminogen are hemostasiologic factors of development of severe liver insufficiency. The corresponding timely diagnostic and correction permits to ameliorate results of surgical treatment of patients with malignant tumors of liver.

A prospective study of an inpatient febrile neutropenia clinical practice guideline in oncology patients.

114 Background: Febrile neutropenia (FN) is a common complication in oncology patients and is associated with significant morbidity and mortality if untreated. Because of this, it is regarded as a medical emergency. FN treatment guidelines universally recommend the prompt initiation ( < 60 minutes) of intravenous antibiotic therapy. We hypothesized that a quality initiative project creating a new FN clinical practice guideline (CPG) would reduce the time to antibiotic administration (TTA) for inpatient oncology patients with FN. Methods: This prospective study compared patients diagnosed with an initial episode of FN (4/2015-8/2015) with historical controls (4/2013-8/2013) on an inpatient oncology floor at a tertiary care academic hospital. Interventions included the development of an institutional CPG which standardized the definition of FN, implementation of a new clinical workflow, creation of education sessions for LIP’s and RN’s, and creation of an electronic FN order set. The primary outcome was TTA, with target goal being < 60 minutes from the onset of fever. Secondary outcomes included time to antibiotic order, need for ICU care, and 30-day mortality. P-values were calculated using a chi-square test. Results: In total, 31 consecutive FN episodes were observed over the 5-month study period. The median TTA decreased from 112 minutes in 2013 to 37.5 minutes in 2015 (p < 0.001). 30/31 (97%) patients in the 2015 group had their antibiotics ordered within 60 minutes vs 14/22 (64%) in 2013 (p = 0.002). 26/31 (84%) patients in the 2015 group had antibiotics administered within 60 minutes vs 4/22 (18%) in 2013 (p < 0.001). There was no significant difference in need for ICU care (16% in 2015 vs 9% in 2013, p = NS) or 30-day mortality (6% in 2015 vs 5% in 2013, p = NS). Conclusions: The inpatient FN CPG is a significant quality improvement initiative that has shown significant improvements in TTA. We were able to demonstrate value by a significant decrease in median TTA compared to historical controls with a significantly increased percentage of patients having both antibiotics ordered and administered within 60 minutes. In our cohort of patients, no significant differences were noted in rates of ICU care or 30-day mortality.

The identification and sensitivity to antibiotics of clostridia, including Clostridia difficile isolated under infectious complications in oncologic patients.

The 76 strains of Clostridium related to 14 species including 28 strains of C.difficile, were isolated from 74 samples of biological material taken out of oncologic patients. The species identification of strains was implemented by MALDI-TOF mass spectrometry using technique of direct application without extraction. The 74 strains (97.4%) were identified up to specie with reliability evaluation 2.0-2.5. Among C.non-difficile the most frequently were separated C.perfringens (42%), group of C.clostridioforme (24%). The sensitivity of separated strains to anti-microbial preparations was established with E-tests technique. The different species of Clostridia had different sensitivity to antibiotics. The strains C.perfringens are sensitive to all testing antibiotics whereas species related to group C.clostridioforme are resistant to fluoroquinolones (100%)б penicillin (67%). The resistance to fluoroquinolones was observed in C.scindens, C.ramosum, C.symbiosum. The strains C.scindens, C.tertium are resistant to penicillin. Among C.difficile, 93% of strains were resistant to penicillin, 57% - to imipenem and 100% - to fluoroquinolones.

Clinical experience using a tensor fascia lata flap in oncology patients

The tensor fascia lata (TFL) flap is used to reconstruct various anatomical structures in different regions of the body. We herein describe the use of TFL flaps for a variety of indications, and discuss the results of such procedures with respect to postoperative complications in oncology patients. We reviewed 15 oncology patients who were treated with TFL flaps. The lesions were located in the groin in five patients, the lower abdomen in five, and the buttocks, ischium, shoulder, thigh and upper abdomen in one patient each. Abdominal wall reconstruction was performed in nine patients. Three patients underwent resection of femoral vessels and the tumor in the groin, followed by a vascular graft implant. In these patients, the combined flaps were transferred to reconstruct the defects. Nine patients developed complications. No total flap loss occurred in any patient. Postoperative complications, such as necrosis in the distal part of the flap (33%) and ventral hernias (11%) were seen, but these percentages were comparable to those seen in previous reports. Our review shows that the TFL flap is useful to reconstruct the defects in various anatomical sites in oncology patients.

The posterior thigh flap revisited: clinical use in oncology patients

The posterior thigh flap is a reliable flap owing to the dependability of the inferior gluteal artery. Its utility for the reconstruction of sacral, perineal, ischial, pelvic, trochanteric and vulvar defects is well established. We herein describe the use of the flap for a variety of indications, and discuss the results with respect to postoperative complications in oncology patients. We reviewed nine oncology patients who were treated with pedicled posterior thigh flaps. We assessed the use of this treatment by recording the site of the defect, the type of flap used, and the presence or absence of previous surgical procedures, radiation therapy and postoperative complications. Defects after resection of soft tissue sarcomas were the most common condition (n = 4), followed by skin cancers (n = 2), gastrointestinal cancers (n = 2) and radiation osteomyelitis (n = 1). Six patients (66 %) developed complications; three (33 %) were major and three (33 %) were minor. There was one case of total necrosis of the flap and two cases of partial necrosis. In oncology patients, the posterior thigh flap is an excellent choice for the reconstruction of sacral, ischial, pelvic or buttock defects, since it does not cause any donor site morbidity.

Abnormal cardiomarkers in leukemia patients treated with allogeneic hematopoietic stem cell transplantation

Clinical cardiac complications in oncologic patients may develop from subclinical myocardial damage. Biomarkers N-terminal pro brain natriuretic peptide (NT-proBNP) and troponin T (cTnT) have been hypothesized to reflect preclinical cardiotoxicity earlier than echocardiography. The aim of this study was to assess prospectively the serial values of these cardiomarkers in leukemia patients treated with allogeneic hematopoietic stem cell transplantation (HSCT). Twenty-one patients who were treated with allogeneic HSCT for acute leukemia at mean age of 32.8 years (range: 19-58) were studied. The conditioning regimen included high-dose cyclophosphamide in combination with total body irradiation (TBI) or busulphan. All patients were treated with anthracyclines earlier (median cumulative dose 250 mg/m, range: 150-580). Cardiomarkers were measured before the preparative regimen (PR) and on days 1, 14 and 30 after HSCT. Their cardiac systolic function was assessed before PR, and 1-2 months after HSCT by echocardiography. The differences in NT-proBNP before PR and after HSCT were statistically significant (p<0.001). The values of cTnT before and after HSCT were also significantly different (p=0.005). Persistent abnormalities (30 days after HSCT) of NT-proBNP levels were found in 19/21 patients (90.5 %) and of cTnT levels in 10/21 patients (47.6 %). The median cTnT concentrations were higher in patients treated with TBI than in patients without TBI (p=0.013). The median NT-proBNP values were higher in patients pretreated with higher cumulative doses of anthracyclines (>250 mg/m vs ≤250 mg/m) Cardiac symptoms developed in 3/21 (14.3 %) patients (Tab. 1, Fig. 3, Ref. 36).