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Recommendations for head and neck surgical oncology practice in a setting of acute severe resource constraint during the COVID-19 pandemic: an international consensus
The speed and scale of the global COVID-19 pandemic has resulted in unprecedented pressures on health services worldwide, requiring new methods of service delivery during the health crisis. In the setting of severe resource constraint and high risk of infection to patients and clinicians, there is an urgent need to identify consensus statements on head and neck surgical oncology practice. We completed a modified Delphi consensus process of three rounds with 40 international experts in head and neck cancer surgical, radiation, and medical oncology, representing 35 international professional societies and national clinical trial groups. Endorsed by 39 societies and professional bodies, these consensus practice recommendations aim to decrease inconsistency of practice, reduce uncertainty in care, and provide reassurance for clinicians worldwide for head and neck surgical oncology in the context of the COVID-19 pandemic and in the setting of acute severe resource constraint and high risk of infection to patients and staff.
Journal Article
CONTAINMENT OF A NEW ADMINISTRATION SYSTEM FOR HAZARDOUS DRUGS
Clinicians are regularly exposed to hazardous drugs (HDs). Existing protective equipment may be more effective during drug preparation than administration. USP 800 now requires the use of Closed System Transfer Devices (CSTDs) during HD administration. A new closed administration system for minimizing exposure of healthcare professionals to HDs was recently marketed. The objective was to evaluate the efficacy of the ChemfortTM CADM system in preventing HD release during administration. Containment was assessed upon the first and final (10th) connection cycle at both beginning and end of shelf-life (four different test groups). The principles of the NIOSH 2015 containment performance draft protocol! were followed: isopropanol (IPA) is the drug surrogate; acceptance criterion is <1.0 ppm IPA vapor concentration inside a closed chamber. Three tasks were developed to mimic administration and subsequent disconnection of three different combinations of CADM components. The Bag Adaptor Ghemfort™ Port is the required partner of each of the other three CADM components: Closed Adaptor Spike Port (task 1); Closed Y-inline Set (task 2); and Closed Secondary IV Set (task 3). In each task, a 500 ml IV bag containing 70% IPA was connected in series with the tested components and placed inside a closed chamber, which was sealed and connected to a Fourier-transform infrared spectroscopy gas analyzer in a closed circuit. Inside the chamber, administration was simulated, and IPA levels were monitored during the task and for at least 30 minutes afterwards. Each task was repeated four times per test group. The relevant result for each repetition was the highest increase in IPA vapor concentration reached over the course of the task, relative to the average background levels before commencement of that task. IPA concentrations observed for all components in all test groups were well below the acceptance criterion of 1.0 ppm. CSTDs are well-adopted in pharmacy, but less during administration. USP 800 requires use of CSTDs for administration. A new closed administration system was evaluated according to a NIOSH methodology. Results show that CADM prevents the escape of hazardous aerosols and vapors and that new administration systems could potentially raise the safety standard for clinicians to that already adopted in pharmacies.
Journal Article
Incidence of PEG-Asparaginase-Induced Pancreatitis in Children During Acute Lymphoblastic Leukemia Treatment: A Multicenter Study
Acute lymphoblastic leukemia (ALL) is the most common pediatric cancer globally. PEG-asparaginase (PEG-ASPA), a cornerstone of ALL treatment, significantly improves outcomes but is associated with serious toxicities, including acute pancreatitis (AP). This study evaluates the incidence and associated risk factors of PEG-ASPA-induced AP among pediatric ALL patients in Saudi Arabia.
This multicenter retrospective cohort study included pediatric ALL patients treated with PEG-ASPA between January 2019 and October 2023 at three tertiary Saudi centers. Data included demographics, risk stratification, PEG-ASPA doses, and toxicity. AP was defined per CTCAE v5.0 criteria. A multivariate logistic regression model was used to evaluate risk factors.
Of 322 pediatric patients, 5% (n=16) developed AP. Events were more frequent in children >10 years old (44%) and during consolidation (38%) and interim maintenance 2 (38%) phases. Multivariate analysis showed that age >10 years (OR=3.65), high-risk protocols (OR=2.07), and >5 PEG-ASPA doses (OR=1.58) were associated with increased AP risk. Most cases were grade 2 or 3 and resolved with supportive care.
The incidence of PEG-ASPA-induced AP among pediatric ALL patients in Saudi Arabia is consistent with international data. Higher age, intensive protocols, and cumulative dosing may increase risk. Routine monitoring of pancreatic enzymes and triglycerides prior to PEG-ASPA administration is recommended to enhance early detection and reduce the risk of severe toxicity.
Journal Article
A Rare Presentation of Prostate Cancer: Psoas Muscle Metastasis Without Bone Involvement
Prostate cancer is one of the most common cancers worldwide. We present a unique case of metastatic prostate cancer manifesting initially with a psoas muscle mass causing abdominal and hip pain. Computed tomography (CT) imaging revealed a large mass within the left psoas muscle with prominent pelvic and retroperitoneal lymphadenopathy, initially concerning for rhabdomyosarcoma. However, a biopsy of the psoas mass confirmed metastatic prostate adenocarcinoma. Interestingly, a nuclear whole-body bone scan and spinal MRI were negative for bone involvement or other metastases. The patient was treated with anti-androgen therapy along with abiraterone and docetaxel and had a positive serologic and radiologic response. He was also offered radiation as per the phase III Prostate Cancer Consortium in Europe-1 (PEACE-1) trial. This case underscores the importance of recognizing atypical metastatic sites, such as skeletal muscle, in prostate cancer, as they can complicate initial diagnosis and delay management. Understanding the mechanisms of rare metastatic patterns and the diagnostic approaches required is crucial for improving outcomes in prostate cancer patients.
Journal Article