Chemo Secrets From a Breast Cancer Survivor

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The 2 most common chemotherapy agents used for sinonasal malignancies are cisplatin and 5-fluo-rouracil. Systemic cisplatin toxicity most commonly includes nausea and vomiting, renal failure, myelo-suppression—with repeated treatment cycles, alopecia, and ototoxicity and neurotoxicity as a cumulative effect. 5-Fluorouracil may cause myelosuppression, mucositis, gastritis and diarrhea.68

The impressive results achieved with aggressive chemoradiotherapy regimens for advanced disease are associated with an increased toxicity. Harrison's regimen of cisplatin (+/-mitomycin) and concomi-

Figure 11-14. Intraoperative photograph of a left total maxillec-tomy defect with resection of the orbital floor but preservation of the orbital contents.

tant hyperfractionated radiation therapy followed by additional cisplatin and vinblastine caused significant mucositis in all 52 patients during the radiation phase. Of the 27 patients treated with both cisplatin and mitomycin, 2 (7.4%) died from sepsis resulting in the removal of mitomycin from the protocol. Treatment breaks were required in 38 percent of the patients, and only 44 percent of patients were able to tolerate two cycles of the post-radiation adjuvant treatment. There were severe acute complications in 34 percent of patients, including severe mucositis, granulocytopenia and sepsis, lung toxicity, blindness, frontal lobe necrosis, and osteoradionecrosis.44 The selective intra-arterial administation of high dose chemotherapy may lead to different complications. Lee's series of 24 patients treated with intra-arterial cisplatin and bleomycin through the internal maxillary artery followed by 5-fluo-rouracil had 2 deaths: the first 2 days after infusion following a generalized seizure, and the second 6 days after infusion without apparent cause. One additional patient suffered a cerebrovascular accident.37 Robbins has noted that the administration of sodium thiosulfate following intra-arterial cisplatin decreases systemic toxicity by forming a

Figure 11-15. Reconstruction of the orbital floor, with a split rib graft, in the same patient shown in Figure 11-14.

nontoxic product and permitting higher regional doses of cisplatin to be delivered to the tumor site.38,39 The added morbidity of selective arterial cannulation with the still unclear effects of highdose regional chemotherapy must be weighed together when considering the use of selective intra-arterial chemotherapy.

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