Third Course Of Chemotherapy Research Articles

Effect of prehydration solution on hearing threshold after chemotherapy in patients with head and neck cancers: a retrospective study.

The study aimed to evaluate the effect of prehydration solution on hearing thresholds after cisplatin chemotherapy. In this retrospective cohort study, we reviewed the data of patients who underwent ≥3 courses of cisplatin-based chemotherapy for locally advanced head and neck cancers at a tertiary referral center (n=64). The dextrose solution (DW) group (n=26) received 2 L of normal saline and 1 L of 5% dextrose. The Hartmann solution (HS) group (n=38) received 2 L of normal saline and 1 L of HS. Hearing data were measured 1 day before starting the first course of chemotherapy, and again 20 days after the first, second, and third courses of chemotherapy. The severity of hearing loss was evaluated using the Common Terminology Criteria for Adverse Events (CTCAE). Thresholds at all frequencies after chemotherapy were greater in the DW group than in the HS group. The increase in thresholds in 1 to 4 kHz after the third course of chemotherapy was greater in the DW group than in the HS group. CTCAE grades after the second and third courses of chemotherapy were greater in the DW group than in the HS group. Logistic regression showed that the odds ratio for CTCAE grade 3 or 4 after the third course of chemotherapy in the DW group was 4.84 on univariate analysis. Prehydration using a solution with salt was associated with a decrease in change in hearing thresholds after cisplatin chemotherapy in patients with head and neck cancers.

Evaluation of the Concentration of Selected Elements in Patients with Cancer of the Reproductive Organs with Respect to Treatment Stage-Preliminary Study.

(1) Background: The aim of this study was to assess the concentrations of selected elements in female patients with cancer of the reproductive organs, taking into account the stage of treatment. (2) Methods: The study sample consisted of 51 patients with advanced endometrial cancer and ovarian cancer, undergoing chemotherapy. The median age of the studied patients with endometrial cancer was 66.0 years (IQR: from 60.75 to 70.25), and with ovarian cancer―60.0 years (IQR: from 49.0 to 64.0). Each of the qualified women, after consent to participate in the study, had her blood drawn several times (before surgery, the first course of chemotherapy, the third course of chemotherapy, and the sixth course of chemotherapy) in order to determine serum levels of macro- and micronutrients (Na, Mg, Ca, Zn, P, Cu, Fe, Cd, Ni, and Sr). (3) Results: In the study group of patients with cancer of the reproductive tract, the concentrations of iron (<0.001), magnesium (0.038), sodium (0.014), and nickel (0.037) varied significantly over the course of the study. The analysis showed that the interaction between the stage of chemotherapy and the type of cancer had an effect on the concentrations of magnesium and cadmium (p < 0.05). (4) Conclusions: In the studied group of patients with ovarian and endometrial cancer, the applied chemotherapy significantly changed the concentrations of Fe, Na, and Ni, regardless of the type of tumor. Changes in Mg and Cd concentrations resulted from the interaction between the stage of chemotherapy and the type of cancer. The results of serum concentrations of selected elements in women with cancer of the reproductive organs may help understand the physiological changes resulting from the applied chemotherapy.

Liposomal Amphotericin B Induced Acute Reactions

Three formulations of amphotericin B are available: liposomal, lipid complex and conventional. The liposomal amphotericin B is more preferred agent than other formulations because of its tolerability, safety and potent antifungal activity. However, the liposomal amphotericin B can cause infusion-related reactions. In this case report, we aimed to report a patient who developed infusion-related reactions during the treatment with the liposomal amphotericin B but eventually tolerated the prolonged infusion. In this case report, we present a patient who developed an infusion-related reaction during The liposomal amphotericin B treatment. A 26-year-old male patient with acute promyelocytic leukemia was hospitalized for the third course of chemotherapy. Due to the invasive fungal infection history in previous hospitalizations, the liposomal amphotericin B 400 mg (IV, 5 mg/kg) once daily was initiated as secondary antifungal prophylaxis. Swelling in infusion site and chest pain were reported within 10 minutes of the liposomal amphotericin B administration, and the infusion rate was slowed down to 400 mg/6 hours from 400 mg/2 hours. All these reactions disappeared with prolonged infusion time. The patient received a total of 7 liposomal amphotericin B doses subsequently without any reaction during the chemotherapy cycle. In our experience, the liposomal amphotericin B-induced infusion-related reactions can be resolved by prolonging the infusion time.

Dynamic Assessment of Measurable Residual Disease in Favorable-Risk Acute Myeloid Leukemia in First Remission, Treatment, and Outcomes

Purpose:We aimed to investigate outcomes of different post-remission treatment (PRT) choices based on dynamic measurable residual disease (MRD) in favorable-risk AML (FR-AML).Methods: Four hundred and three younger patients with FR-AML in first complete remission (CR1) were enrolled in this registry-based cohort study, including 173 who received chemotherapy (CMT), 92 autologous stem cell transplantation (auto-SCT), and 138 allogeneic SCT (allo-SCT). Subgroup analyses were performed based on dynamic MRD after the first, second, and third courses of chemotherapy. The primary endpoint was the 5-year overall survival (OS).Results: For patients with negative MRD after 1 course of chemotherapy, comparable OS was observed among the CMT, auto-SCT and allo-SCT groups (p=.284). But CMT had better graft-versus-host-disease-free, relapse-free survival (GRFS) than allo-SCT (p=.027). For patients with negative MRD after 2 courses of chemotherapy, comparable OS was also observed among the three groups (p=.967). However, CMT and auto-SCT had better GRFS than allo-SCT (p=.045; p=.020, respectively). For patients with negative MRD after 3 courses of chemotherapy, allo-SCT had better disease-free-survival than CMT (p=.011). However, OS was comparable among the three groups (p=.177). For patients with persistently positive MRD after 3 courses of chemotherapy or recurrent MRD, allo-SCT had better OS than CMT and auto-SCT (p=.012; p=.046, respectively).Conclusions: Dynamic MRD might improve therapy stratification and optimize PRT selection for FR-AML in CR1. CMT might be preferable for patients with negative MRD within 3 cycles of chemotherapy while allo-SCT for patients with persistently positive MRD after 3 cycles of chemotherapy and recurrent MRD. DisclosuresNo relevant conflicts of interest to declare.

Association Between Measurable Residual Disease in Patients With Intermediate-Risk Acute Myeloid Leukemia and First Remission, Treatment, and Outcomes

Measurable residual disease (MRD) is widely used as a therapy-stratification factor for acute myeloid leukemia (AML), but the association of dynamic MRD with postremission treatment (PRT) in patients with intermediate-risk AML (IR-AML) has not been well investigated. To investigate PRT choices based on dynamic MRD in patients with IR-AML. This cohort study examined 549 younger patients with de novo IR-AML in the South China Hematology Alliance database during the period from January 1, 2012, to June 30, 2016, including 154 who received chemotherapy, 116 who received an autologous stem cell transplant (auto-SCT), and 279 who received an allogeneic SCT (allo-SCT). Subgroup analyses were performed according to dynamic MRD after the first, second, and third courses of chemotherapy. The end point of the last follow-up was August 31, 2020. Statistical analysis was performed from December 1, 2019, to September 30, 2020. Receipt of chemotherapy, auto-SCT, or allo-SCT. The primary end points were 5-year cumulative incidence of relapse and leukemia-free survival. Subgroup analyses were performed for 549 participants (314 male participants [57.2%]; median age, 37 years [range, 14-60 years]) according to the dynamics of MRD after 1, 2, or 3 courses of chemotherapy. Comparable cumulative incidences of relapse, leukemia-free survival, and overall survival were observed among participants who had no MRD after 1, 2, or 3 courses of chemotherapy. Participants who underwent chemotherapy and those who underwent auto-SCT had better graft-vs-host disease-free, relapse-free survival (GRFS) than those who underwent allo-SCT (chemotherapy: hazard ratio [HR], 0.35 [95% CI, 0.14-0.90]; P = .03; auto-SCT: HR, 0.07 [95% CI, 0.01-0.58]; P = .01). Among participants with MRD after 1 course of chemotherapy but no MRD after 2 or 3 courses, those who underwent auto-SCT and allo-SCT showed lower cumulative incidence of relapse (auto-SCT: HR, 0.25 [95% CI, 0.08-0.78]; P = .01; allo-SCT: HR, 0.08 [95% CI, 0.02-0.24]; P < .001), better leukemia-free survival (auto-SCT: HR, 0.26 [95% CI, 0.10-0.64]; P = .004; allo-SCT: HR, 0.21 [95% CI, 0.09-0.46]; P < .001), and overall survival (auto-SCT: HR, 0.22 [95% CI, 0.08-0.64]; P = .005; allo-SCT: HR, 0.25 [95% CI, 0.11-0.59]; P = .001) vs chemotherapy. In addition, auto-SCT showed better GRFS than allo-SCT (HR, 0.45 [95% CI, 0.21-0.98]; P = .04) in this group. Among participants with MRD after 1 or 2 courses of chemotherapy but no MRD after 3 courses, allo-SCT had superior cumulative incidence of relapse (HR, 0.10 [95% CI, 0.06-0.94]; P = .04) and leukemia-free survival (HR, 0.18 [95% CI, 0.05-0.68]; P = .01) compared with chemotherapy, but no advantageous cumulative incidence of relapse (HR, 0.15 [95% CI, 0.02-1.42]; P = .10) and leukemia-free survival (HR, 0.23 [95% CI, 0.05-1.08]; P = .06) compared with auto-SCT. Among participants with MRD after 3 courses of chemotherapy, allo-SCT had superior cumulative incidences of relapse, leukemia-free survival, and overall survival compared with chemotherapy (relapse: HR, 0.16 [95% CI, 0.08-0.33]; P < .001; leukemia-free survival: HR, 0.19 [95% CI, 0.10-0.35]; P < .001; overall survival: HR, 0.29 [95% CI, 0.15-0.55]; P < .001) and auto-SCT (relapse: HR, 0.25 [95% CI, 0.12-0.53]; P < .001; leukemia-free survival: HR, 0.35 [95% CI, 0.18-0.73]; P = .004; overall survival: HR, 0.54 [95% CI, 0.26-0.94]; P = .04). Among participants with recurrent MRD, allo-SCT was also associated with advantageous cumulative incidence of relapse, leukemia-free survival, and overall survival compared with chemotherapy (relapse: HR, 0.12 [95% CI, 0.04-0.33]; P < .001; leukemia-free survival: HR, 0.24 [95% CI, 0.10-0.56]; P = .001; overall survival: HR, 0.31 [95% CI, 0.13-0.75]; P = .01) and auto-SCT (relapse: HR, 0.28 [95% CI, 0.09-0.81]; P = .02; leukemia-free survival: HR, 0.30 [95% CI, 0.12-0.76]; P = .01; overall survival: HR, 0.26 [95% CI, 0.10-0.70]; P = .007). This study suggests that clinical decisions based on dynamic MRD might be associated with improved therapy stratification and optimized PRT for patients with IR-AML. Prospective multicenter trials are needed to further validate these findings.

The Effect of Lung Cancer and Chemotherapy on Sleep Quality and Quality of Life

Objective: Lung cancer affects the quality of sleep and life depending on both local and systemic impacts. Chemotherapy that is frequently used in the treatment of lung cancer can affect quality of sleep and life due to disease response, side effects of chemotherapy, systemic effects due to chemotherapeutic agents and complications of immunosuppression. The sleep and life quality levels of patients with locally advanced and metastatic stage lung cancer and the effect of chemotherapy on sleep and quality of life in this patient group were investigated in this study. Method: The Pittsburg Sleep Quality Index and the EORTC QLQ-C30 Cancer Patients’ Quality of Life Scale were applied to the patients who received chemotherapy alone with diagnosis of locally advanced and metastatic stage lung cancer at the time of diagnosis and after the third course of chemotherapy to evaluate sleep quality and quality of life. The mean age of the patients was 61.85 (± 6.80) and 89.8% of them were male. 69.5% of all patients had poor sleep quality at the time of diagnosis. Physical function was found to be affected the most in terms of functional parameters. The symptoms that most affected the quality of life were fatigue and dyspnea. Results: A significant correlation was observed between sleep quality and quality of life at the time of diagnosis in patients with lung cancer, but no significant change was found in sleep quality in the early period after chemotherapy. There was a statistically weak worsening in social functions and nausea symptom after chemotherapy and a statistically significant worsening in the malaise symptom when the quality of life scores were evaluated. Other quality of life parameters were generally similar to those before treatment. Conclusion: In conclusion, while chemotherapy does not make a significant change in the sleep quality of patients in the early period in patients with lung cancer, it may negatively affect the quality of life.

Elevated Microparticles, Thrombin-antithrombin and VEGF Levels in Colorectal Cancer Patients Undergoing Chemotherapy

Hypercoagulable state and neoangiogenesis are common phenomena associated with malignancy. Cancer patients have increased levels of circulating endothelium-derived microparticles (EMPs), which have been hypothesized to be involved in numerous pathophysiological processes. Hemostasis and angiogenesis are also activated in colorectal cancer (CRC) patients. The study aimed to investigate potential influence of chemotherapy on EMPs, thrombin anti-thrombin complex (TAT) and vascular endothelial growth factor (VEGF) levels in CRC patients undergoing chemotherapy. The study group consisted of 18 CRC patients: 8 stage III colon cancer (CC) and 10 stage IV rectal cancer (RC) patients. EMPs, TAT and VEGF levels were assessed before chemotherapy and after the third course. Results were compared with 10 healthy subjects. EMP concentration was measured by flow cytometry, while TAT and VEGF concentrations were assayed employing ELISA. Compared to the control group, CC and RC patients had significantly higher levels of tissue factor (TF)-bearing and non-TF-bearing EMPs before and after three courses of chemotherapy. VEGF concentrations in CRC patients were higher than in the control groups and increased following chemotherapy. TAT levels were elevated in CRC patients before chemotherapy compared to healthy subjects and significantly increased after the third course of chemotherapy. No significant correlation was found either between EMP and TAT levels, or between EMP concentrations and VEGF levels in the study group. CRC patients have increased EMPs, and TAT as well as VEGF levels tend to increase during chemotherapy.

Myocardial contractility dysfunction in patients with chronic lymphocytic leukemia receiving chemotherapy and their treatment with enalapril

Aim. To assess eft ventricular (LV) contractility dysfunction in patients with chronic lymphocytic leukemia (CLL) receiving chemotherapy with fludarabine, cyclophosphamide, and rituximab (FCR), and to determine the enalapril.effectiveness for their treatment.Material and methods. The study included 49 patients with newly diagnosed Binet stage B CLL in combination with class I-II stable angina, stage 1-2 hypertension and LV ejection fraction (EF) &gt;50%. All subjects did not take angiotensin converting enzyme inhibitors (ACE inhibitors), had no clinical signs of heart failure (HF), and all had indications for FCR combination use before study start. Patients underwent two-dimensional echocardiography initially, before starting chemotherapy (period V1) and after three (84±5 days) (V2) and six (168±7 days) (V3) courses of chemo therapy (enalapril) was added to the treatment regimen in the experimental group.Results. After the third course of chemotherapy, a relative percentage decrease in global longitudinal strain (GLS) was noted in the experimental and control groups — by 16,16±0,80 and 16,2±0,79, respectively (p=0,764). These changes are considered a cardiotoxicity predictor. At the same time, LVEF values remained within the normal range: 63,4% [65; 68] in the experimental group and 63,9% [61,6; 67] in the control group (p=0,960). After the sixth course, LVEF values significantly differed (p=0,002): in the control group, five patients (21%) had cardiotoxicity; in experimental group, there were no patients with cardiotoxicity.Conclusion. A clinically significant decrease in GLS is a marker of subclinical LV contractile dysfunction and is a cardiotoxicity predictor in CLL patients receiving chemotherapy with FCR. The timely addition of enalapril to the treatment regimen can prevent cardiotoxicity in such patients. The need for early assessment of GLS during FCR courses for the detection and prevention of cardiotoxicity has been proved.

Guillain-Barre syndrome associated with Hodgkin’s lymphoma: A case report

Introduction Guillain-Barre syndrome or acute inflammatory demyelinating polyneuropathy has been described in association with different malignant lymphomas, particularly with Hodgkin’s lymphoma. Guillain-Barre syndrome causes muscle weakness and paresthesias which interferes in treatment and can affects the prognosis of patients with underlying lymphoma. We report here a case of Guillain-Barre syndrome in a patient with Hodgkin's lymphoma. Case presentation A 27-year-old man with a diagnosis of stage IIIA relapsed refractory Hodgkin’s lymphoma presented with asymmetrical flaccid arefelxic paraparesis, one month after the end of the third course of chemotherapy. He had been treated 3 years previously for Hodgkin's lymphoma. The clinical course and neurological examination were consistent with Guillain-Barre syndrome. Cerebrospinal fluid studies revealed markedly elevated protein. Nerve conduction studies demonstrated demyelinating motor polyneuropathy with conduction block. Magnetic resonance imaging did not show evidence of metastasis or spinal cord compression. Following intravenous immunoglobulin administration, the neurological symptoms were significantly reduced after one month and subsequently treated with chemotherapy for his lymphoma. Conclusion This case report highlights the importance of considering GBS in the background of Hodgkin’s lymphoma. Guillain-Barre syndrome can make the treatment of patients with lymphoma more difficult and can interfere with delivering full-dose conventional chemotherapy. However, the patient will require follow-up examinations.

Capecitabine induced fingerprint changes.

Fingerprinting is recognized as an easily accessible means of personal identification; however, fingerprints can be damaged after administration of some chemotherapy agents that result in hand and foot syndrome (HFS). Fingerprint loss may also be due to reasons unrelated to HFS. This study evaluated the incidence of fingerprint changes in patients treated with capecitabine-containing chemotherapy regimens and its relations to various grades of HFS. Seventy-one patients who received chemotherapy with or without capecitabine as part of their regimen were enrolled in the study. Fingerprints were collected once before the initiation of chemotherapy and once after the third course of chemotherapy. The fingerprints were examined by the Iranian Society of Forensic Physicians, for probable changes in the post-chemotherapy states. Thirty-seven patients were enrolled in the capecitabine group and 34 in a comparison group. Fingerprint changes were observed in 25 (67.6%) of the 37 patients in the capecitabine group and none in the comparison group. There was no correlation between the occurrence or severity of HFS and fingerprint changes (P=0.880).In capecitabine group, the total dose and course numbers of capecitabine were not significant in patients with and without fingerprint changes. Based on our findings, we recommend notifying patients who are considered for capecitabine therapy about the risk of fingerprint changes before the initiation of treatment, as this may have legal implications.

Long-term outcomes of alternating chemoradiotherapy in patients with advanced nasopharyngeal cancer: a single-centre experience over the last decade.

We assessed the long-term outcomes of alternating chemoradiotherapy (ACRT) using 5-fluorouracil and cisplatin (FP) in 25 patients with stage II or advanced nasopharyngeal cancer treated at our institution between April 1999 and April 2010. Median follow-up duration was 87 months (range 2-189). According to the 2009 TNM classification (UICC), six patients were in stage II, nine in stage III, and 10 in stage IV. Treatment completion, response and five-year survival rates were retrospectively assessed. ACRT was performed with a first course of chemotherapy administered followed by the initial round of radiotherapy (36 Gy). Then, a second course of chemotherapy with additional radiotherapy (20-30 Gy) was administered, followed by a final third course of chemotherapy. For chemotherapy, 5-fluorouracil (5-FU, 800 mg/m2/24 h) was intravenously administered for five days, and cisplatin (CDDP, 50 mg/m2/24 h) was administered on the last two days. Treatment completion rate was 96% (24 of 25 cases), and the response rate was 100% (CR: 24 cases and PR: 1 case). Additionally, the five-year overall survival rate was 89.3%. We have demonstrated that ACRT is an effective regimen to treat nasopharyngeal cancer, revealing higher treatment completion, response, and five-year overall survival rates compared with other combinatorial radiotherapy and chemotherapy treatment regimens.

Myocardial Ischemia during Combined Chemotherapy with Etoposide and Cisplatin for Non-Small Cell Lung Cancer

Cardiovascular ischemia has been recognized as a serious but uncommon complication of chemotherapy. We report a case of myocardial ischemia during combined chemotherapy with cisplatin and etoposide for non-small cell lung cancer. A 58-year-old man with non-small cell lung cancer and previous history of coronary artery disease suffered chest pain with ECG changes during the third course of chemotherapy with cisplatin and etoposide. Chemotherapy should be used cautiously in patients with coronary risk factors.

Early detection of the cardiotoxicity induced by chemotherapy drug through two-dimensional speckle tracking echocardiography combined with high-sensitive cardiac troponin T

Objective: To investigate the clinical value of two-dimensional speckle tracking echocardiography(2D-STE) combined with high-sensitive cardiac troponin T (hs-cTnT) in early detection of the cardiotoxicity induced by chemotherapy drug. Methods: Seventy-five non-Hodgkin's lymphoma patients who received the CHOP regimen were recruited in this study. Conventional echocardiography and 2D-STE were performed on these patients before chemotherapy, the second day after the third course of chemotherapy (during chemotherapy) and the second day after the last course of chemotherapy (after chemotherapy). The parameters included left ventricular ejection fraction (LVEF), global longitudinal strain (LS), global circumferential strain (CS) and global radial strain (RS). The serum hs-cTNT levels were tested simultaneously. Results: Three cycles of CHOP were completed in 30 patients and 6-8 cycles of CHOP were completed in 45 patients. The LVEF of 75 patients before, during and after chemotherapy was (63.8±2.6)%, (63.8±2.8)% and (64.0±3.3)%, respectively, without significant difference (P=0.91). However, the LS of 75 patients before, during and after chemotherapy was (-18.5±1.7)%, (-16.5±1.9)% and (-16.0±1.6)%, respectively. The CS was (-20.9±2.9)%, (-19.3±3.5)% and (-19.2±3.2)%, respectively. The RS was (39.2±6.4)%, (35.3±5.2)% and (35.0±6.2)%, respectively. The hs-cTnT was (0.001 0±0.002 0)ng/ml, (0.006 3±0.008 9)ng/ml and (0.007 3±0.003 8)ng/ml, respectively. The LS, CS and RS were significantly decreased while hs-cTnT was significantly increased during chemotherapy when compared to those before chemotherapy (all of P<0.01). Alternatively, the LS, CS, RS and hs-cTnT after chemotherapy were marginally different from those during chemotherapy (all of P>0.05). Moreover, T(LS-SD), T(CS-SD) and T(RS-SD) showed no significant difference before, during and after chemotherapy (all of P>0.05). The reduction of LS was positively associated with the enhancement of hs-cTnT after chemotherapy (r=0.60, P<0.01). Conclusion: 2D-STE combined with hs-cTnT can effectively and precisely detect the occult cardiotoxicity induced by anthracycline.

Cannonball Opacities in the Emergency Department: A Case of Recurrent Malignant Schwannoma in a Long-Term Survivor

SESSION TITLE: Genetic and Developmental Disorders SESSION TYPE: Affiliate Case Report Poster PRESENTED ON: Tuesday, October 31, 2017 at 01:30 PM - 02:30 PM INTRODUCTION: Malignant peripheral nerve sheath tumours (MPNSTs), or malignant schwannomas, are extremely uncommon soft-tissue sarcomas of neural origin. They behave aggressively, are rapidly progressive and typically portend a poor prognosis. CASE PRESENTATION: A 50-year-old lady with neurofibromatosis type 1 (NF-1), smoker (19 pack-year history), presented to the emergency department (ED) due to difficulty breathing at rest with progressive worsening over the previous few weeks. The patient had recently (two weeks earlier) received her third course of chemotherapy (CYVADIC protocol: cyclophosphamide, vincristine, doxorubicin, and dacarbazine) for recurrence of MPNST. Urgent chest X-ray in the ED revealed cannonball opacities in both lungs, predominantly in the bases. These radiological changes were consistent with pulmonary metastases from the MPNST, but mimicked those seen in primary metastatic lung cancer. The patient was in the terminal stage of disease and succumbed a week later. DISCUSSION: Von Recklinghausen disease, or NF-1, is among the most common genetic disorders.1 About half of the cases of MPNSTs occur in the context of NF-1.2 This is a unique case of NF-1 and recurrence of MPNST in a long-term survivor. Approximately 17 years earlier, the patient had undergone tumour reduction and adjuvant radiotherapy for MPNST of the left forearm. Seven months prior to this ED presentation, recurrence of MPNST in the same forearm required repeat surgical reduction. Three months later, her left arm was amputated at the middle of the humeral shaft due to disease relapse and chemotherapy was subsequently initiated. CONCLUSIONS: This report serves to: 1) raise awareness about this exceptionally rare pathology, 2) illuminate the achievement of long-term survival in a NF-1 patient and her dramatic ED presentation due to lung metastases and 3) highlight the importance of maintaining regular follow-up visits to ensure timely intervention for recurrent and potentially metastatic disease. Reference #1: Farid M, Demicco EG, Garcia R, Ahn L, Merola PR, Cioffi A, Maki RG. Malignant peripheral nerve sheath tumors. Oncologist 2014 Feb;19(2):193-201. doi: 10.1634/theoncologist.2013-0328. Reference #2: Ducatman BS, Scheithauer BW, Piepgras DG, Reiman HM, Ilstrup DM. Malignant peripheral nerve sheath tumors. A clinicopathologic study of 120 cases. Cancer 1986;57: 2006-21. DISCLOSURE: The following authors have nothing to disclose: Katherina Sreter, Gorana Mirosevic No Product/Research Disclosure Information

Changes in ischemia-modified albumin in myocardial toxicity induced by anthracycline and docetaxel chemotherapy.

This study aims to evaluate differences in myocardial toxicity induced by different chemotherapy regimens. Patients were divided into 2 groups: epirubicin (EPI) combined with cyclophosphamide (EC) group and docetaxel combined with cyclophosphamide (TC) group. Changes in electrocardiograph (ECG) and ischemia-modified albumin (IMA) were determined pre- and 1, 3, and 6 courses of postchemotherapy. After the first course of chemotherapy, there was no significant difference in ECG and abnormal IMA incidence rates between the TC groups and EC groups (P > .05). After the third course and at the end of the sixth course, ECG and abnormal IMA incidence rates in the EC group were significantly higher than in the TC group (P < .05). Besides, IMA values significantly increased with the increase in chemotherapy courses in the EC group; and the value of the postsixth course was significantly higher than in the pre- and postfirst and -third courses of chemotherapy. IMA value in the postsixth course in the TC group was significantly higher than that in the pre- and postfirst and -third courses of chemotherapy. In addition, IMA values at the postfirst and -third courses of chemotherapy in the EC group were significantly higher than in the TC group. Both EC and TC chemotherapy regimens were harmful to the myocardium, and the incidence rate of myocardial damage increased with the increase of cumulative dose. Besides, the degree of myocardial damage in EC group was significantly higher than in the TC group.

Role of clinical oncology pharmacist in determination of pharmaceutical care needs in patients with colorectal cancer

ObjectiveTo determine and evaluate the pharmaceutical care needs and quality of life of patients with colorectal cancer.Methods36 Patients with colorectal cancer eligible for chemotherapy after surgery were included in the...

Clinical analysis of renal dysfunction in 59 patients with gynecological malignant tumor during chemotherapy

Objective: To analysis the patients with gynecological malignant tumor and gynecologic malignant tumor complicated with kidney diseases appeared renal dysfunction during chemotherapy, and protect the residual renal function. Methods: A retrospective analysis of 59 patients with gynecological malignant tumor with abnormal renal function during chemotherapy in Peking University People's Hospital from May 2000 to April 2016. According to whether or not complicated with kidney diseases and renal dysfunction before chemotherapy, all cases were divided into two groups. Group A was the patients without kidney diseases and with normal renal function before chemotherapy (n=35), while group B with kidney disease before chemotherapy (n=24), included 10 cases of normal renal function and 14 cases of abnormal renal function. Results: (1) During chemotherapy there were respectively 24 cases(69%) occurred mild renal dysfunction, 3 cases(9%) of moderate renal dysfunction, 1 case(3%) of severe renal dysfunction, 6 cases (17%) of renal failure, 1 case(3%) of reversible renal dysfunction in group A. While, among 10 cases of normal renal function patients in group B, there were 7 cases(7/10) occurred mild renal dysfunction, 1 case (1/10) of moderate renal dysfunction, 1 case(1/10) of severe renal dysfunction, 1 case(1/10) of renal failure. Among 14 cases with abnormal renal function in group B, there were respectively 1 patient(1/14) who renal dysfunction was from mild to renal failure, 9 cases(9/14) of stable renal function and 4 cases(4/14) of severe renal dysfunction became improved after chemotherapy. (2) Renal dysfunction occurred and the number of chemotherapy course: 45 patients with normal renal function (including 35 cases in group A, 10 cases with normal renal function in group B), there were 11 cases(24%) occurred renal dysfunction after intraperitoneal chemotherapy, 20 cases(44%) occurred in the 1-3 courses of treatment, 10 cases(22%) occurred in the 4- 8 courses, while 4 cases(9%) appeared after 8 courses. Among 14 patients with abnormal renal function before chemotherapy in group B, there were respectively 1 patient(1/14) with renal dysfunction was from mild to renal failure occurred at the third courses of chemotherapy, 9 cases(1/14) of stable renal function, 4 cases(4/14) of severe renal dysfunction became improved from the 1-3 course of chemotherapy. (3) The regimen adjustment of chemotherapy before and after the occurrence of renal dysfunction: 45 patients with normal renal function, the platinum-based chemotherapy regimen were used before the occurrence of renal dysfunction. After renal dysfunction occurred, all the patients were received chemoprotective agent amifostine. Among 44 cases with cisplatin-based chemotherapy, 24 cases of them were replaced with carboplatin or oxaliplatin, 4 cases of them just treated with paclitaxel, 2 cases performed chemotherapy and dialysis sequneced, 7 cases adjusted dosage, while the other cases did not any special treatment because of mild renal dysfunction. Finally, there were 37 cases successfully completed the chemotherapy, while 7 cases could not completed chemotherapy, because renal dysfunction was aggravated or renal failure. The 5 year survival rate of 37 cases was 64.9%, 7 cases that did not completed chemotherapy was 14.3%. Fourteen cases with renal dysfunction in group B, 4 cases of them with mild received cisplatin-based chemotherapy, 6 cases used paclitaxel combined carboplatin regimen, including 2 cases with chemotherapy and dialysis sequenced, 3 cases adjusted dosage paclitaxel, 1 case performed modify FOLFOX regimens chemotherapy (tegafur+oxaliplatin+calcium folinate). All 14 patients were successfully completed chemotherapy. The 5 year survival rate was 57.1%. Conclusions: Chemotherapy drugs, especially for platinum-based regimens could induce acute renal insufficiency, even aggravated or lead to renal failure in patients with gynecological cancer. Therefore, we should pay attention to the prevention and treatment of renal dysfunction in patients with gynecological malignant tumor during chemotherapy, adjustment the chemotherapy regimen in patients with renal dysfunction.

The trend of chemotherapy-induced peripheral neurotoxicity in ovarian cancer survivors and its impacts on daily life during and one year after treatment.

To explore the trend of progression and regression of peripheral neuropathy (PN) induced by combination of carboplatin and paclitaxel, and the impacts on daily activities. PN was evaluated by nurse-based interview and patient-reported measures in their diary. The severity of PN scaled by National Cancer Institute Common Toxicity Criteria (NCI-CTC) before each cycle of chemotherapy and at three, six, and 12 months after drug withdrawal and coded as Grade I - V. The authors enrolled 106 eligible patients with ovarian cancer who underwent six cycles of combined chemotherapy of carboplatin plus paclitaxel. No patients showed Grade IV and V of PN and it was gradually aggravated following the dose accumulation. About 29.3% of the patients presented no PN, 64.2% Grade I, and 6.6% Grade II after the third course of chemotherapy, but increased to 36.8% of Grade I, 25.5% of Grade II, and 34.9% of Grade III after the sixth course of chemotherapy. At one-year follow-up, the rate of PN still existed with the rate of 88.5%, 57.3%, and 38.7% at three, six, and 12 months after drug withdrawal. Thirty-one patients encountered accidents, such as sharp injury (14.2%), fall (9.4%), burn (3.8%), and cold injury (1.9%). A significant proportion of patients with epithelial ovarian cancer treated with carboplatin plus paclitaxel suffer long term neuropathy and it affects patient's daily activities. Specialized care is necessary to provide not only during treatment, but also months to years after drugs withdrawal.

Tai Chi Exercise for Cancer-Related Fatigue in Patients With Lung Cancer Undergoing Chemotherapy: A Randomized Controlled Trial

ContextTai Chi is a traditional Chinese health-promoting exercise. It has been shown to enhance mental health and improve psychological condition. ObjectivesWe aimed to assess the effectiveness of Tai Chi exercise for cancer-related fatigue in patients with lung cancer undergoing chemotherapy. MethodsWe conducted a randomized trial of Tai Chi exercise as compared with low-impact exercise as a control intervention. Exercises were practiced every other day, a one-hour session for 12 weeks for each of the study groups. The primary end point was a change in total score of the Multidimensional Fatigue Symptom Inventory–Short Form (MFSI-SF). Secondary end points were changes in five subscale scores of the MFSI-SF. All assessments were repeated at three time points, T0: before first course of chemotherapy; T1: before third course of chemotherapy; and T2: at the end of the fourth course of chemotherapy. ResultsBetween January 2012 and December 2014, 96 patients were enrolled in this trial. At six and 12 weeks, the Tai Chi group had a lower MFSI-SF total score compared with the control group (59.5 ± 11.3 vs. 66.8 ± 11.9, P < 0.05; 53.3 ± 11.8 vs. 59.3 ± 12.2, P < 0.05). At six weeks, the Tai Chi group had lower MFSI-SF general subscale scores (18.1 ± 4.6 vs. 20.4 ± 4.5, P < 0.05) and physical subscale scores (17.5 ± 4.4 vs. 19.1 ± 4.5, P < 0.05), and higher MFSI-SF vigor subscale scores (14.5 ± 3.3 vs. 11.6 ± 3.4, P < 0.05), compared with the control group. But no significant differences were found in emotional subscale (20.2 ± 3.6 vs. 20.0 ± 3.5, P > 0.05) and mental subscale (18.2 ± 4.0 vs. 18.9 ± 3.9, P > 0.05) scores between the Tai Chi group and the control group. At 12 weeks, the MFSI-SF subscale scores showed the same trends as at six weeks. ConclusionTai Chi is an effective intervention for managing cancer-related fatigue in patients with lung cancer undergoing chemotherapy, especially for decreasing general fatigue and physical fatigue, and increasing vigor.

Dynamic contrast-enhanced perfusion area detector CT for non-small cell lung cancer patients: Influence of mathematical models on early prediction capabilities for treatment response and recurrence after chemoradiotherapy

PurposeTo determine the capability and influence of the mathematical method on dynamic contrast-enhanced (CE-) perfusion area detector CT (ADCT) for early prediction of treatment response as well as progression free and overall survival (PFS and OS) of non-small cell lung cancer (NSCLC) patients treated with chemoradiotherapy. Materials and methodsSixty-six consecutive stage III NSCLC patients underwent dynamic CE-perfusion ADCT examinations, chemoradiotherapy and follow-up examinations. Response Evaluation Criteria in Solid Tumors (RECIST) criteria were used to divide all patients into responders and non-responders. Differences in each of the indices for all targeted lesions between measurements obtained 2 weeks prior to the first and the third course of chemotherapy were determined for all patients. ROC analyses were employed to determine the capability of perfusion indices as markers for distinguishing RECIST responders from non-responders. To evaluate their capability for early prediction of therapeutic effect, OS of perfusion index-based responders and non-responders were compared by using the Kaplan–Meier method followed by log-rank test. ResultsArea under the curve (Az) for total perfusion by means of the dual-input maximum slope method was significantly larger than that of pulmonary arterial perfusion using the same method (p=0.007) and of perfusion with the single-input maximum slope method (p=0.007). Mean OS demonstrated significantly difference between responder- and non-responder groups for total perfusion (p=0.02). ConclusionMathematical models have significant influence on assessment for early prediction of treatment response, disease progression and overall survival using dynamic CE-perfusion ADCT for NSCLC patients treated with chemoradiotherapy.