Effectiveness of topically applied chamomile in the treatment of oral mucositis: a literature review

Oral mucositis (OM) is one of the main adverse events observed during the treatment of neoplasms, especially in relation to head and neck (H&N) cancer. Complications, initially non-infectious of OM, can significantly compromise the chosen therapy, extend the hospitalization period and decrease the quality of life of patients with H&N cancer. Therefore, the present work presents a narrative review that gathers, presents and discusses studies on the relationship between the topical application of chamomile-based pharmaceutical products and the treatment of oral mucositis, with an emphasis on its effectiveness. A literature search was conducted in August 2021 using PubMed, Scielo and LILACS. From literature search was identified 869 papers, of which 06 were selected to answer the guiding question of this study. Finally, it could be seen that chamomile has great potential to help manage OM, as well as other oral complications, especially in cases of patients undergoing H&N cancer treatments using radiotherapy. Furthermore, formulations containing chamomile have been shown to be effective in slowing the progression of OM grades. However, it is necessary to evaluate in each formulation, the possible impacts of each pharmaceutical adjuvant, as well as the adverse events capable of increasing pharmacotherapeutic adherence.

430 Evaluation of A Prioritisation Policy for HPB Resections in the COVID-19 Era

Aim The COVID19 pandemic has caused oncological services worldwide to face unprecedented challenges resulting in treatment disruptions for cancer patients requiring surgery. Hepatopancreatico-biliary cancers are characterised by a low resectability rate and rapid progression. This study aims to assess the effectiveness of a prioritisation policy for this cohort of patients during the initial COVID19 outbreak. Method The prioritisation policy and triage system are described in detail. Patients undergoing surgery between April-July 2020 (COVID period) were compared to a control group from the preceding year. Statistical analysis was carried out to evaluate timeliness of treatment, peri-operative characteristics and short-outcomes. Results Patient selection was restructured to prioritise patients with performance status of < 2 with presence of cancer complications, borderline resectable- or biologically aggressive disease. Where feasible, neoadjuvant therapy was advocated. An elective safe corridor pathway was established to reduce the risk of COVID19 infection. During the COVID19 and pre-COVID19 period, 94 and 115 patients underwent surgery, respectively. No patients contracted COVID19 post-operatively. There were less patients with ASA≥3 during the COVID19 period vs. pre-COVID19 (12.8% vs. 34.2%; p < 0.001). Median time between referral and surgery was greater during the COVID19 compared to the pre-COVID19 period, at 64 days vs. 49 days, respectively (p = 0.023). Despite this difference no NHS waiting list breaches occurred. Incidence of postoperative complications were comparable between groups. Conclusions The outlined prioritisation policy for oncological hepatopancreatico-biliary resections was effective in providing safe surgery during the COVID-19 outbreak. Whether the observed delay in treatment will affect long-term outcomes remains to be seen

Focal Therapy for Prostate Cancer: Complications and Their Treatment

Focal therapy is a modern alternative to selectively treat a specific part of the prostate harboring clinically significant disease while preserving the rest of the gland. The aim of this therapeutic approach is to retain the oncological benefit of active treatment and to minimize the side-effects of common radical treatments. The oncological effectiveness of focal therapy is yet to be proven in long-term robust trials. In contrast, the toxicity profile is well-established in randomized controlled trials and multiple robust prospective cohort studies. This narrative review summarizes the relevant evidence on complications and their management after focal therapy. When compared to whole gland treatments, focal therapy provides a substantial benefit in terms of adverse events reduction and preservation of genito-urinary function. The most common complications occur in the peri-operative period. Urinary tract infection and acute urinary retention can occur in up to 17% of patients, while dysuria and haematuria are more common. Urinary incontinence following focal therapy is very rare (0–5%), and the vast majority of patients recover in few weeks. Erectile dysfunction can occur after focal therapy in 0–46%: the baseline function and the ablation template are the most important factors predicting post-operative erectile dysfunction. Focal therapy in the salvage setting after external beam radiotherapy has a significantly higher rate of complications. Up to one man in 10 will present a severe complication.

Massive Retroperitoneal and Subcutaneous Emphysema after Transanal Excision of Rectal Cancer

Transanal excision (TAE) is considered a safe, alternative approach for patients with early stage of rectal cancer. Complications associated with TAE are rare, such as bleeding, perforation, incontinence, and rectal stricture. Subcutaneous emphysema is early complication of laparoscopic surgery, common during upper gastrointestinal and gynecological surgery. We report a case of retroperitoneal and subcutaneous emphysema emerging after TAE of rectal tumor. The patient presented with changed bowel habits. Colonoscopy with pathology reports, ultrasound, and magnetic resonance imaging showed an adenocarcinoma in the rectum at a 5 cm from the anus and did not reveal signs of invasive growth, pathologic lymph nodes, or systemic metastases. After surgery patient complained about abdominal pain and severe subcutaneous emphysema. Computed tomography showed retroperitoneal emphysema with no signs of rectal wall defect. He received antibiotics and was kept hospitalized with a solid diet and the retroperitoneal air disappeared on the thoracic X-ray. Patients who remain clinically stable or steadily improving without signs if peritonitis can be managed conservatively. Only in case of ineffectiveness of conservative therapy, undergo surgery.

Radical cystectomy in bladder cancer: complications, prognosis, history of the method

The article is a review of domestic and foreign literature sources covering the development of complications and long-term prognoses during radical cystectomy, as well as the history of the development of the method. The gold standard for the treatment of muscle invasive bladder cancer (MIBC) is radical cystectomy with bilateral pelvic lymph node dissection. The high incidence of intra- and postoperative complications, as well as a large number of repeat visits (up to 25 %) in the first 30 days after open radical cystectomy necessitates a search and implementation of new methods of surgical treatment, one of which is robotic-assisted radical cystectomy (RARC). The robotic method reduces the need for intra- and postoperative blood transfusion, but does not significantly improve the patient’s quality of life compared to open surgery. The main disadvantage of the RARС is the long operation time. Urinary drainage is a necessary component of radical cystectomy. The most modern methods of derivation are «dry» stoma placement and orthotopic bladder surgery with urination along the native urethra. However, the choice of urinary drainage must be made based on a number of factors, including the patient’s comorbidities, surgical feasibility, postoperative care capacity, and patient preference.

Cohort-based association study of germline genetic variants with acute and chronic health complications of childhood cancer and its treatment: Genetic risks for childhood cancer complications Switzerland (GECCOS) study protocol

BackgroundChildhood cancer and its treatment may lead to many acute and chronic health complications. Related impairment in quality of life, excess in deaths, and accumulated health care costs are relevant. There is a wide inter-individual variability in the type and severity of health complications. Genetic variations are suggested to contribute to individual susceptibility. So far, only few genetic variants have been used to risk-stratify treatment and follow-up care. This study platform aims to identify germline genetic variants associated with acute and late complications of childhood cancer.MethodsThe Genetic Risks for Childhood Cancer Complications Switzerland (GECCOS) study is a nationwide cohort study. It includes patients and survivors who were diagnosed with childhood cancers or Langerhans cell histiocytosis before age 21 years, were registered in the Swiss Childhood Cancer Registry (SCCR) since 1976 and have consented to the Pediatric Biobank for Research in Hematology and Oncology (BaHOP), Geneva, host of the Germline DNA Biobank Switzerland for Childhood Cancer and Blood Disorders (BISKIDS). BISKIDS is a national biobank for the collection of germline DNA in childhood cancer patients and survivors.GECCOS uses demographic and clinical data from the SCCR and the associated Swiss Childhood Cancer Survivor Study (SCCSS), which contains health-related data of survivors. Phenotypic data consist of objective measurements, health conditions diagnosed by physicians, second primary neoplasms, self-reported and health-related information from participants. Germline genetic samples and sequencing data have been collected in BISKIDS. We will perform gene panel sequencing, whole-exome sequencing, or whole-genome sequencing depending on the research questions. We will perform association analyses to identify genetic variants associated with specified health conditions. We will use clustering and machine-learning techniques and assess multiple health conditions in different models.DiscussionGECCOS will serve as an overarching platform to enable genotype-phenotype association analyses on complications associated with childhood cancer and its treatments. Knowledge of germline genetic variants associated with childhood cancer-associated health conditions will help to further individualize cancer treatment and follow-up care, potentially resulting in improved efficacy and reduced side effects, for personalized cancer care.Trial registrationClinicaltrials.gov: NCT04702321