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Electronic Letters to:

reviews:
S. Vescia, A. K. Baumgärtner, V. R. Jacobs, M. Kiechle-Bahat, A. Rody, S. Loibl, and N. Harbeck
Management of venous port systems in oncology: a review of current evidence
Ann Oncol 2008; 19: 9-15 [Abstract] [Full text] [PDF]
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[Read eLetter] Management of venous port systems in oncology: - practical aspect
Igor Olejnik, Boguslaw Bucki and Barbara Krolak-Olejnik   (16 July 2008)

Management of venous port systems in oncology: - practical aspect 16 July 2008
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Igor Olejnik,
Pediatrician hematologist/oncologist
Unit of Oncology&Hematology, Center of Pedaitrics &Oncology, Truchan 7 St., 41-500 Chorzów, PL,
Boguslaw Bucki and Barbara Krolak-Olejnik

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Re: Management of venous port systems in oncology: - practical aspect

During the past 25 years, enormous progress was obtained in the diagnosis and treatment of childhood cancer. Nowadays, therapy is more individualized, risk-oriented. Such developments have resulted in improved long-term event-free survival, which in childhood acute lymphoblastic leukemia already exceeds 80% (1). Intensive treatment would require recurrent, frequently daily, peripheral venipunctures associated with significant distress for childhood and adolescent cancer patients. To improve comfort of treatment, totally implantable venous access systems have been introduced enabling frequent blood-sampling and long-term chemotherapy (2-3). In our daily practice we experience the same problem mentioned in the study where the port system is flushable but no aspiration of blood is possible due to a small thrombus occluding the catheter tip. In our institutions, we have administered alteptase (rtPA) . Guidelines for its local use are given in ALL IC-BFM 2002 protocol (4). Guidelines are based on the studies of Monagle et al. and Timoney et al. (5, 6). This modality has been validated for efficacy and safety at MSKCC. To make it cost effective the content of the original vial was divided into aliquots q 2.5 ml with 1 mg/ml of the drug, which were frozen at - 20˚ C for up to 30 days and thawed ad hoc. The technique proved effective in clearing occluded central venous access devices.

References

1.Pui CH, Evans WE. Treatment of acute lymphoblastic leukemia. N Engl J Med 2006;354:166-178.

2.Winick NJ, Carroll WL, Hunger SP. Childhood leukemia--new advances and challenges. N Engl J Med 2004;351:601-603.

3.Bow EJ, Kilpatrick MG, Clinch JJ. Totally implantable venous access ports systems for patients receiving chemotherapy for solid tissue malignancies: A randomized controlled clinical trial examining the safety, efficacy, costs, and impact on quality of life. J Clin Oncol 1999;17:1267- 1273

4.Fronkova E, Mejstrikova E, Avigad S, et al. Minimal residual disease (MRD) analysis in the non-MRD-based ALL IC-BFM 2002 protocol for childhood ALL: is it possible to avoid MRD testing? Leukemia. 2008 May;22(5):989-97.

5.Monagle P, Michelson AP, Bovill E, Andrew M. Antithrombotic therapy in children. Chest 2001; 119: 344 – 370 S;

6.Timoney JP, Malkin MG, Leone DM et al. Safe and cost effective use of alteplase for clearance of occluded central venous access devices. J Clin Oncol 2002; 20: 1918 - 1922;

Conflict of Interest:

None declared