Currently, localized pulpalgia is listed as a rare manifestation of chemotherapy treatments in patients with malignant tumors. The neuropathy originated from neurotoxicity of anticancer drugs is usually described as a diffuse jaw pain or numbness in orofacial structures. This article reports localized tooth pain as a possible outcome of administrating high dosage chemotherapy drugs particularly in the last cycles of application.

Hair loss is a transient but often psychologically devastating consequence of cancer chemotherapy. A wide range of chemotherapy agents can affect the growing cells of the hair follicle. The frequency and severity of alopecia varies depending upon the specific chemotherapy agent or combination regimen administered the dosage of drugs, and the treatment schedule. The majority of chemotherapy-induced alopecia is reversible once therapy is discontinued, with the possible exception of the epidermal growth factor receptor (EGFR) inhibitors.All patients who will receive chemotherapy that may result in alopecia should be informed of the likely side effect of hair loss. Options such as head wraps, hats, or wigs should be discussed in advance so that the patient can be more physically and emotionally prepared.Although scalp protection through cooling or tourniquet has been reported to minimize delivery of chemotherapeutic agents to the scalp thereby potentially decreasing the risk of hair loss, case reports of cutaneous metastases or spread in these settings prevent general recommendation for their use. Because chemotherapy-associated hair loss is transient and completely reversible after cessation of therapy, adequate counseling and psychological support before and during therapy should take precedence over the use of such devices.Currently there are no available pharmacologic interventions that have been shown to decrease the risk of chemotherapy-induced alopecia. Although minoxidil has not shown efficacy in preventing chemotherapy induced alopecia, the use of minoxidil during the period of regrowth may help to minimize hair follicle miniaturization in patients at risk for androgenetic alopecia.

Background: Limited data exists to support the benefit from second-linechemotherapy in patients with metastatic urothelial carcinoma. Factors that predictsurvival following progression after first-line platinum-based regimens in patientstreated outside clinical trials are not clear. This study intends to evaluate differentprognostic factors and the impact of second-line chemotherapy on survival. Methods: We retrospectively reviewed patients with metastatic urothelial carcinomawho experienced disease progression following first-line platinum-based regimens formetastases. These patients received treatment and follow up visits at a single institution. The effect of demographic, disease characteristics, and second-line therapy on overallsurvival was examined through univariate and multivariate cox-regression analyses. Results: There were 64 patients included. A total of 27 (42%) patients did not receivesecond-line chemotherapy because of poor Eastern Cooperative Oncology Groupperformance status, 20 (31%) received combination chemotherapy (platinum-based in17), and 17 (27%) received a single agent chemotherapy. The median overall survivalfrom the date of documented progression after first-line therapy was 5. 0 months. Inmultivariate analysis, a correlation existed between poor overall survival and performancestatus of ≥ 1 (HR: 5. 74, 95% CI: 1. 4-45. 57, P=0. 036), no second-line chemotherapy(HR: 2. 72, 95% CI: 1. 39-5. 31, P=0. 003), and ≥ 2 metastatic sites (HR: 5. 19, 95% CI: 1. 74-15. 44, P<0. 001). Conclusion: A significant proportion of patients with metastatic urothelial carcinomawere not eligible for second-line chemotherapy because of poor performance status. Use of second-line chemotherapy, Eastern Cooperative Oncology Group performancestatus, and number of metastatic sites were important determinants of survival.

Bladder cancer is among most common cancers especially in men. After radical cystectomy for locally advanced bladder cancer, there is a significant rate of recurrence, most commonly as distant metastasis. For this reason, systemic chemotherapy has been explored in both Neoadjuvant and adjuvant settings. Some advantages of Neoadjuvant chemotherapy over an adjuvant design include: 1) better tolerance of chemotherapy prior cystectomy. 2) Allowing for individual assessment of in vivo tamor response and 3)downstaging that allows for better resectability and bladder conservation. Multiple studies have shown that complete pathologic Response (PT0) to preoperative chemotherapy is a powerful surrogate of long term disease free survival in locally advanced bladder cancer. On the basis of a more recent metaanalysis with cisplatin based combination chemotherapy complete pathologic response (PT0) up to 38.1% and absolute survival benefit of 6.5% were observed that is similar to that seen for perioperative chemotherapy for other malignancies notably breast and colorectal cancer, Recently some biologic biomarkers are able to predict tumor response to chemotherapy thus with identifying Nonresponders Protects them from toxicities of chemotherapy and preclude delaying potentially curative local therapies. Some of these including expression profiles of predictive genes in cDNA microarray, P53 and angiogenesis factor VEGF expression and lymph vascular invasion (LVI) on pathology specimen.With newer generation chemotherapy agents and molecular targeted therapies Such as ani- EGFR agents and trastuzumab improvement in pathologic complete response and thus overall out come may be seen that will be a primary goal for bladder cancer patients.