![]() And then in terms of the high blood pressure, there’s a lot interest in that, and, frankly, people are so concerned about it that they wouldn’t use the drug. The 5-FU can cause diarrhea and mouth sores and also a rash on the hands and feet, so that’s something we certainly check for. And so, you really have to be careful you’re not causing falls and having people stumble or have other problems. Now, if somebody has a preexisting neuropathy, it can be a problem with balance because proprioceptionthat sense of where your joints are when you’re not actually looking at them-can be affected. Even when walking across a cold linoleum floor, for instance, people can get a little uncomfortable feeling. So, we just warn them about that so they’re just aware of it, basically.Īnd then, finally, over time in a cumulative fashion, it gets a little bit worse with each dose. The other thing I also warn them about is what I and many people call first bite syndrome, which is that the first bite in the morning can be quite uncomfortable in the jaw if they bite something hard. Many patients will have that last for a few hours. The first is that if they touch a cold object, like eat ice cream or drink a cold drink or pick up an ice cube, it creates a very uncomfortable feeling in the fingertips or on their throats, and that’s because of that cold sensitivity. The key thing that I warn patients about is cold sensitivity, which is from the neuropathythe nerve damage from oxaliplatin-and that manifests itself in a couple different ways. And you’ll have other patients who just sail through and really have no problem. You’ll have patients who will have a horrible allergic reaction the first day, and you’re basically never able to use that regimen again. Obviously, it depends patient to patient, and oftentimes we try to see that patient back after the first week to get a sense of how they’re going to do. The toxicities of FOLFOX and bevacizumab are usually fairly mild. And, of course, this patient has a left-sided tumor, so in this case, we would not use liver-directed therapy. In an unplanned subgroup analysis, they did show that right-sided tumors seemed to have more benefit, but that really isn’t enough to affect our treatment recommendations. What they found was that although it improved what’s called hepatic progression-free survival-meaning the disease didn’t get worse in the liver for a bit longer-unfortunately, it had no effect on overall survival. In those studies, patients with advanced unresectable colorectal cancer with liver predominant disease-meaning most of the bulk of the tumor was in the liver-are randomized to either have embolization with radio spheres or not. All rights reserved.Wells Messersmith, MD:The issue of liver-directed therapy is a complex question that has been settled recentlynot completely, but a lot of helpful information came from the SIRFLOX and FOXFIRE trials. Present results further support the role of sympathetic chain in the development of FBS.Ĭervical sympathetic trunk Deep lobe of parotid gland External carotid artery First bite syndrome Parapharyngeal space.Ĭopyright © 2016 Elsevier Ireland Ltd. Among the patients in whom ECA was preserved, FBS developed in 43% of the patients in whom sympathetic chain was sacrificed and in 4% of the patients in whom sympathetic chain was preserved. FBS developed in 57% of patients undergoing external carotid artery (ECA) ligation and in 12.5% of patients in whom ECA was preserved (p=0.0008). FBS was most common in the patients who had tumor arising from deep lobe of parotid gland in comparison with other sites (50% vs 18%, p=0.017). Partial resolution of FBS symptoms occurred in 69% and complete resolution in 12%, whereas 15% had no change. Retrospective review of 53 patients undergoing surgery of the upper neck between 20.įBS developed in 16 patients (30%). The aim of this study is to highlight the etiology of this potentially debilitating chronic pain syndrome. First bite syndrome is the development of pain in the ipsilateral parotid region after the first few bites of food and can be seen after surgery of the upper cervical region.
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