Table 6.

Management strategies for adverse events requiring special attention

Adverse event	Grade 3–4 (%) [24, 30]	Recommendations
Neutropenia	22.2%–42.5%	Hematopoietic functions in baseline were evaluated before treatment for every patient Prophylactic use of filgrastim (G-CSF) or sargramostim (GM-CSF) is recommended In addition to bone marrow suppression, splenomegaly and hypersplenism should be focused on, and local treatment of the spleen if necessary Dose adjustment of chemotherapeutic drugs is required for grade 4 neutropenia Occurrence of febrile neutropenia requires dose adjustment and therapeutic antibiotics for infections
Diarrhea	2%–6%	Early-onset diarrhea usually occurs on the day of medication, mainly accompanied by cramping abdominal pain, tearing, sweating, increased saliva, hypotension, dizziness, and blurred vision. In severe cases, atropine 0.25 mg can be injected subcutaneously, along with intravenous rehydration therapy Delayed diarrhea: dose-limiting toxicity, which usually appears after 24 h of medication, with an incidence of 80%–90%, of which 39% are severe. The median time of occurrence was 5 days after medication, lasting for an average of 4 days, and severe cases can be fatal. Loperamide (Imodium) can be administered orally: the first dose is 4 mg and then 2 mg every 2 h. Continue to use the medication for 12 h after the last watery defecation and generally do not exceed 48 h. If diarrhea persists for >48 h, seek medical attention immediately Dose adjustment of chemotherapeutic drugs is required for grade 3–4 diarrhea
Fatigue	3.8%–11.2%	Evaluate the patient’s nutritional status before treatment and intervene Add nutritional support during treatment Strengthen health survey
Intestinal obstruction	2.9%–4.8%	Evaluate the size of the primary tumor and the risk of obstruction before treatment, and use laxatives if necessary to keep the bowel open Pay attention to the use of antiemetic drugs during treatment. Long-acting 5-HT antagonists are not recommended for patients at a high risk of obstruction Deal with difficulties in defecation in time Strengthen dietary guidance If intestinal obstruction occurs during treatment and conservative medical treatment is ineffective, preventive stoma surgery could be considered
Intestinal perforation	2.2%	Evaluate the size of the primary tumor and the risk of perforation before treatment, and keep the bowel open Once perforation occurs during treatment, immediately evaluate the operation and provide the best supportive treatment