Malignant complications

Antisense Oligonucleotides. Table 2 Viral disorders with malignant complications as potential targets for ribozyme gene therapies... 

Virus Malignant complication Target gene for ribozymes Ribozyme-induced change of function... 

Buscarini E, Buscarini L (2004) Radiofrequency thermal ablation with expandable needle of focal liver malignancies complication report. Eur Radiol 14 31-37... 

Buscarini E, Buscarini L (2004) Radiofrequency thermal ablation with expandable needle of focal liver malignancies complication report. Eur Radiol 14 31-37 Curley SA, Marra P, Beaty K, et al (2004) Early and late complications after radiofrequency ablation of malignant liver tumors in 608 patients. Ann Surg 239 450-458 de Baere T, Elias D, Dromain C, et al (2000) Radiofrequency ablation of 100 hepatic metastases with a mean followup of more than 1 year. AJR Am J Roentgenol 175 1619-1625... 

Chronic infections with hepatitis B or C virus (HBV, HCV), CMV, EBV or human papillomavirus (HPV) are seen in 10% of renal transplant recipients. These infections can affect the graft (CMV) or other organs (liver for HBV and HCV), or contribute to the development of a malignant complication (EBV, HPV). In addition, carriers of M. tuberculosis before engraft-... 

A common cause of PTH-dependent hypercalcemia results from benign, or occasionally malignant, enlargement of one or more parathyroid glands, a condition known as primary hyperparathyroidism (PHPT). Although many patients with PHPT present in an asymptomatic state that does not require medical intervention, some are afflicted with excess bone loss, kidney stones, or other complications. If patients are... 

Colorectal cancer is a well-established complication of ulcerative colitis (Lennard-Jones era/., 1990 Ekbom et al., 1990). It has been shown that inflammation enhances the formation of colonic tumours in experimental animals given known carcint ens (Chester etal., 1986) and it is tempting to speculate that the longterm inflammatory response is respronsible for the increased risk of malignancy in ulcerative colitis. However, there is very little direct evidence to support this. It has also been postulated that free radicals may play a part in the development of sporadic cancers (Babbs,... 

Some comatose patients are unconscious for less than 2 hours, do not show signs of severe toxicity, and have few complications. In other patients, coma lasts from 2 to 24 hours, and symptoms are more marked. Patients with severe toxicity, including status epi -lepticus and malignant hyperthermia, may remain in coma for 1 day to 3 weeks. These patients often have respiratory or metabolic acidosis. Comatose patients are susceptible to aspiration pneumonia and rhabdomyolysis. Head injury and intracerebral bleeding should be considered as the cause of the comatose state. 

Radiologic and/or endoscopic procedures are usually required to objectively document the presence of ulcers. Barium studies have a high sensitivity and are considered first-line tests to radiographically document an ulcer. However, the cost and complexity of all of these tests has led to the promotion of an early empiric treatment strategy for patients at low risk for PUD-related sequelae (e.g., malignancy). An empiric treatment strategy is appropriate for patients less than 50 years of age who have mild or intermittent epigastric symptoms and no evidence of PUD-related systemic symptoms or complications. 

Subtotal thyroidectomy is indicated in patients with very large goiters and thyroid malignancies and those who do not respond or cannot tolerate other therapies. Patients must be euthyroid prior to surgery, and patients often are administered iodide preoperatively to reduce gland vascularity. The overall surgical complication rate is 2.7%. Postoperative hypothyroidism occurs in 10% of patients who undergo subtotal thyroidectomy. 

Allogeneic hematopoietic stem cell transplantation (HSCT) is the only potential cure for SCD. The best candidates are children with SCD who are younger than 16 years of age with severe complications who have an identical H LA-matched donor, usually a sibling. The transplant-related mortality rate is between 5% and 10%, and graft rejection is approximately 10%. Other risks include secondary malignancies, development of seizures or intracranial bleeding, and infection in the immediate posttransplant period.6,25,32,33... 

With increased success in pediatric clinical trials, the overall survival rate for pediatric cancers has increased significantly over the last 35 years. For certain disease states, the overall survival rate for specific pediatric malignancies is now up to 80%. Unfortunately, the consequences of success are that approximately two-thirds of childhood cancer survivors have at least one chronic or late-occurring complication of treatment. Long-term follow-up of survivors treated decades ago also has revealed very late sequelae.24... 

Brain metastasis is the most common neurologic complication seen in patients with cancer. Approximately 170,000 patients develop brain metastases in the United States each year.20 Many malignancies are frequently associated with brain metastases (Table 96-7). While melanoma is the tumor type most likely to metastasize to the brain, brain metastases owing to lung and breast cancers are seen more often because they are among the most common cancers. In addition, brain metastasis may be diagnosed at the same time as the primary malignancy in around 20% of cases.22 Around 80% of brain metastases occur in the cerebral hemispheres, 15% in the cerebellum, and 5% in the brain stem. 

Various malignancies can also induce an anaemic state. This is often associated with decreased serum EPO levels, although iron deficiency, blood loss or tumour infiltration of the bone marrow can be complicating factors. In addition, chemotherapeutic agents administered to this patient group often adversely affect stem cell populations, thus rendering the anaemia even more severe. 

In acute uric acid nephropathy, acute renal failure occurs as a result of blockage of urine flow secondary to massive precipitation of uric acid crystals in the collecting ducts and ureters. This syndrome is a well-recognized complication in patients with myeloproliferative or lymphopro-liferative disorders and results from massive malignant cell turnover, particularly after initiation of chemotherapy. Chronic urate nephropathy is caused by the long-term deposition of urate crystals in the renal parenchyma. 

Allogeneic hematopoietic stem cell transplantation is the only therapy that is curative. The best candidates are younger than 16 years of age, have severe complications, and have human leukocyte antigen-matched donors. Risks must be carefully considered and include mortality, graft rejection, and secondary malignancies. 

Long-term complications of radiotherapy, chemotherapy, and chemora-diotherapy include gonadal dysfunction, secondary malignancies, and cardiac disease. Patients treated for HL are at increased risk of developing leukemia, GI tumors, lung cancer, and breast cancer. 

Carcinogenesis An increased incidence of malignancy is a recognized complication of immunosuppression in recipients of organ transplants. 

This chapter will review trials of chemoradiation in cervical cancer, including the recent trials that established the value of this approach, and will discuss several questions that remain to be resolved regarding this treatment, including the ideal dose and schedule, and the effect of chemoradiation on compliance and complications. The last section of this chapter will briefly discuss the use of chemoradiation in the treatment of other gynecologic malignancies. 

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