Screening for infectious foci in breast cancer patients prior to high-dose chemotherapy and stem cell transplantation.
Cancer patients treated with high-dose chemotherapy (HDC) followed by peripheral stem cell transplantation are at risk for infections during neutropenia. Our standard policy was to screen for potential infectious foci prior to HDC. Screening for infectious foci consisted of chest and sinus roentgenograms and a visit to the ear-nose-throat surgeon (ENT surgeon) and the dentist. The purpose of this study was to evaluate this approach. Between 1993 and 2000, 73 breast cancer patients received HDC.


RESULTS
All chest roentgenograms were normal. ENT screening yielded in three (symptomatic) patients a potential infectious focus. In 32 patients (44%) a potential dental infectious focus was diagnosed and treated. During neutropenia after HDC clinical infections occurred in 15 patients (21%). In only 5 patients (7%) the infection focus was probably the upper respiratory tract.


CONCLUSIONS
Potential ENT infectious foci were infrequent and all were symptomatic. Potential dental infectious foci were seen quite often; whether they would have had clinical impact if left untreated remains speculative.
Nieboer
P
P
Department of Medical Oncology, University Hospital Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands.
Roodenburg
J L
JL
van der Laan
B F
BF
de Vries
E G
EG
Mulder
N H
NH
van der Graaf
W T
WT
D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D016470:Bacteremia / Q000209:etiology / Q000382:microbiology / Q000517:prevention & control; D001943:Breast Neoplasms / Q000188:drug therapy / Q000382:microbiology* / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000009:adverse effects; D004305:Dose-Response Relationship, Drug; D015251:Epirubicin / Q000008:administration & dosage / Q000009:adverse effects; D005472:Fluorouracil / Q000008:administration & dosage / Q000009:adverse effects; D005767:Gastrointestinal Diseases / Q000000981:diagnostic imaging / Q000382:microbiology; D006801:Humans; D008875:Middle Aged; D009059:Mouth Diseases / Q000382:microbiology; D009503:Neutropenia / Q000139:chemically induced / Q000382:microbiology; D011859:Radiography; D012141:Respiratory Tract Infections / Q000000981:diagnostic imaging / Q000382:microbiology; D013203:Staphylococcal Infections / Q000209:etiology / Q000517:prevention & control; D033581:Stem Cell Transplantation; D013290:Streptococcal Infections / Q000209:etiology / Q000517:prevention & control
D015251:Epirubicin; D003520:Cyclophosphamide; D005472:Fluorouracil