Simple fabrication technique of personalized endocavitary brachytherapy applicator for maxillary alveolar cancer.

Purpose: We report on methods and outcomes of post-operative endocavitary brachytherapy after prior irradiation and salvage surgery in a patient with maxillary alveolar squamous cell carcinoma (SCC). Material and methods: A 67-year-old male with right maxillary alveolar SCC was referred for brachytherapy after prior definitive chemoradiotherapy and salvage posterior maxillectomy. A personalized endocavitary applicator was fabricated using dental impression plastic tray, vinyl polysiloxane paste, and four flexible catheters to deliver fourteen 3.5 Gy high-dose-rate fractions. High-risk and intermediate-risk clinical target volumes were treated to 3.7 Gy (D90) and 2.4 Gy (D98), with mandibular dose limited to 2.3 Gy (D2cc) per fraction. These corresponded to total 2 Gy equivalent doses (EQD2) of 72.8 Gy, 40.5 Gy, and 34 Gy, respectively. Results: The patient developed grade 2 mucositis and was disease-free for six months. He had biopsy-confirmed local recurrence at 8 months. He refused further treatment and expired within a month. Conclusions: This simple approach to a personalized endocavitary applicator is feasible and allows for lower costs and less treatment delays, while ensuring patient comfort and convenience.

Applicability of the National Comprehensive Cancer Network/Multinational Association of Supportive Care in Cancer Guidelines for Prevention and Management of Chemotherapy-Induced Nausea and Vomiting in Southeast Asia: A Consensus Statement.

A meeting of regional experts was convened in Manila, Philippines, to develop a resource-stratified chemotherapy-induced nausea and vomiting (CINV) management guideline. In patients treated with highly emetogenic chemotherapy in general clinical settings, triple therapy with a serotonin (5-hydroxytryptamine-3 [5-HT3]) antagonist (preferably palonosetron), dexamethasone, and aprepitant is recommended for acute CINV prevention. In resource-restricted settings, triple therapy is still recommended, although a 5-HT3 antagonist other than palonosetron may be used. In both general and resource-restricted settings, dual therapy with dexamethasone (days 2 to 4) and aprepitant (days 2 to 3) is recommended to prevent delayed CINV. In patients treated with moderately emetogenic chemotherapy, dual therapy with a 5-HT3 antagonist, preferably palonosetron, and dexamethasone is recommended for acute CINV prevention in general settings; any 5-HT3 antagonist can be combined with dexamethasone in resource-restricted environments. In general settings, for the prevention of delayed CINV associated with moderately emetogenic chemotherapy, corticosteroid monotherapy on days 2 and 3 is recommended. If aprepitant is used on day 1, it should be continued on days 2 and 3. Prevention of delayed CINV with corticosteroids is preferred in resource-restricted settings. The expert panel also developed CINV management guidelines for anthracycline plus cyclophosphamide combination schedules, multiday cisplatin, and chemotherapy with low or minimal emetogenic potential, and its recommendations are detailed in this review. Overall, these regional guidelines provide definitive guidance for CINV management in general and resource-restricted settings. These consensus recommendations are anticipated to contribute to collaborative efforts to improve CINV management in Southeast Asia.

Povidone-iodine for the management of oral mucositis during cancer therapy.

Oral mucositis (OM) is a common and often dose-limiting side effect of cancer therapy. Povidone iodine (PVP-I) formulations have been shown to decrease the incidence and severity of OM, but the relevance of these findings remains unclear. The objective of the present study was to review evidence for the use of PVP-I for OM management. An algorithm identified relevant articles published online, and a panel of experts with experience in the management of OM reviewed the findings. Six studies fulfilled the criteria for full review. Two studies provided evidence of moderate quality. Two of the studies with negative findings were confounded by the use of PVP-I concentrations that are too low to be efficacious. The remaining two studies were found to have design flaws. There exists reasonable evidence to support a recommendation for the use of PVP-I in the management of cancer therapy-related OM.

Patient Management with Eribulin in Metastatic Breast Cancer: A Clinical Practice Guide.

Eribulin, an antimicrotubule chemotherapeutic agent, is approved for the treatment of pretreated metastatic breast cancer (mBC) based on the positive outcomes of phase II and phase III clinical trials, which enrolled mainly Western patients. Eribulin has recently been approved in an increasing number of Asian countries; however, there is limited clinical experience in using the drug in certain countries. Therefore, we established an Asian working group to provide practical guidance for eribulin use based on our clinical experience. This paper summarizes the key clinical trials, and the management recommendations for the reported adverse events (AEs) of eribulin in mBC treatment, with an emphasis on those that are relevant to Asian patients, followed by further elaboration of our eribulin clinical experience. It is anticipated that this clinical practice guide will improve the management of AEs resulting from eribulin treatment, which will ensure that patients receive the maximum treatment benefit.

Safety Analysis of Adjuvant Chemotherapy with Docetaxel Administered with or without Anthracyclines to Early Stage Breast Cancer Patients: Combined Results from the Asia- Pacific Breast Initiatives I and II.

BACKGROUND: The Asia-Pacific Breast Initiatives (APBI) I and II registries were established to collect safety data for patients with early stage breast cancer receiving adjuvant docetaxel-based regimens in the Asia-Pacific region. MATERIALS AND METHODS: Data from the two registries were combined to perform a safety analysis. Participants in the registry were women with early stage operable breast cancer with an intermediate or high risk of recurrence. These women received adjuvant chemotherapy that included docetaxel between 2006 and 2011. Adverse events (AEs) were recorded and analyzed. RESULTS: Data were collected from 3,224 patients from 13 countries. The mean dose intensity of docetaxel was 24.1, 22.7, 25.1 mg/m2/week among patients receiving docetaxel-based monotherapy, combination therapy and sequential therapy, respectively. Granulocyte colony-stimulating factor (G-CSF) was given with docetaxel to 41.8% of women and 20.6% of women receiving prophylactic antibiotics. Adverse events were reported in 86% of patients (anthracycline-containing regimens vs. non-anthracycline regimens; 87% vs. 80%). The most common adverse events were alopecia, nausea, neutropenia, vomiting, and myalgia. Adverse events NCI CTCAE ≥Grade 3 were reported in 45.4% of patients. Serious adverse events were reported in 13% of patients, of which 2.5% led to study discontinuation. Forty-six deaths (1.4%) were reported, with no significant difference between regimens. CONCLUSIONS: The safety parameters of adjuvant docetaxel therapy used to treat sequential Asian women were comparable to those reported in clinical trials evaluating the role of adjuvant docetaxel. No unusual adverse events linked to Asia-Pacific region patients were observed.

Docetaxel-based adjuvant therapy for breast cancer patients in Asia-Pacific region: Results from 5 years follow-up on Asia-Pacific Breast Initiative-I.

AIM: To acquire patient characteristics, safety, relapse and survival outcomes of early-stage breast cancer patients receiving docetaxel (Taxotere(R))-based regimen in adjuvant setting from the Asia-Pacific region. METHODS: This was an open-label, international, longitudinal, multicenter, observational, prospective cohort of consecutive early breast cancer (EBC) patients with a high risk of recurrence being treated with various docetaxel-containing anthracycline and non-anthracycline adjuvant regimens during 2006-2013. RESULTS: In this study, 1542 patients were enrolled. Anthracycline-containing regimens were administered in 92% of patients, while 8% of patients received non-anthracycline-containing docetaxel-based regimens. The mean dose intensity of docetaxel was 25.8, 22.4 and 25.4 mg/m(2) /week among patients receiving docetaxel-based monotherapy, combination and sequential therapy, respectively. Adverse events were reported in 94.9% of patients (anthracycline vs non-anthracycline regimen; 95.1% vs 93.5%). Serious adverse events were reported in 12.6% of patients (12.4% vs 14.6%). Grade 4 neutropenia was reported in 25.2% of patients (24.7% vs 30.9%) and febrile neutropenia in 1.9% of patients (2% vs 0.8%). Only 7% of patients had a relapse or a second primary malignancy. At 5-year follow-up, there were 127 (8.3%) deaths (8.4% vs 6.5%). CONCLUSION: The Asia-Pacific Breast Initiative-I registry highlights the important patient and treatment characteristics of EBC patients treated with adjuvant docetaxel chemotherapy from the Asia-Pacific region that will help physicians to understand the impact of different docetaxel treatments on the clinical outcomes in this population.

Efficacy and acceptability of a mifepristone-misoprostol combined regimen for early induced abortion among women in Mexico City.

OBJECTIVE: To evaluate the experience of women receiving mifepristone-misoprostol for early induced abortion in public sector facilities in the Federal District of Mexico City. METHODS: An open-label prospective study was conducted with 1000 pregnant women who sought induced abortion with a pregnancy of up to 63days of gestation, as measured from the date of their last menstrual period. The study was conducted in three public sector healthcare facilities: two secondary level hospitals and one primary care clinic. Women ingested 200mg mifepristone on day 1, followed by 800µg buccal misoprostol 24hours later, and they returned for follow-up on day 8. The primary outcome was complete abortion without recourse to surgical intervention. RESULTS: A total of 971 women received mifepristone-misoprostol and were included in the analysis for efficacy of treatment. The overall efficacy of the combined medical abortion regimen studied was 97.3% (n=945); the success rate did not vary significantly by gestational age (95.9%-100%; P=0.449). Most women (n=922, 95.0%) had a successful induced abortion with only one dose of misoprostol. CONCLUSION: The combined mifepristone and buccal misoprostol regimen was found to be highly effective and acceptable among Mexican women. www.ClinicalTrials.gov: NCT00386282.

Present status and perspectives of colorectal cancer in Asia: Colorectal Cancer Working Group report in 30th Asia-Pacific Cancer Conference.

OBJECTIVE: To reveal the present status and future directions of colorectal cancer in Asia. METHODS: The Working Group consisted of oncologists from six Asian countries (Japan, Korea, Hong Kong, China, Taiwan, Singapore and Philippines) discussed colorectal cancer in the 30th Asia-Pacific Cancer Conference and made a consensus report. RESULTS: The incidence of colorectal cancer has been increasing rapidly in recent decades, and mortality has also increased except in Japan and Singapore. Colorectal screening with fecal occult blood tests is a national policy in Taiwan, Japan and Korea. Total colonoscopy is the most common examination for diagnosing colorectal cancers and neoplasms. However, there are differences in the macroscopic classification used. Laparoscopic surgery for colon cancer is extensively used, although the indication varies. Adequate lymph node harvesting of more than 12 nodes is performed in most countries. Neoadjuvant chemoradiation therapy is not routinely done for T2 or T3 rectal cancer. Total mesorectal excision is the standard surgery for rectal cancer. Survival rate data are unavailable for many countries and should be compiled in all. The differences in the health-care delivery systems affect the treatment choices for unresectable colorectal cancer. Infusional 5-FU plus leucovorin plus oxaliplatin (FOLFOX) is the most popular first-line regimen. Cetuximab is mainly used as a second- or third-line regimen with reference to k-ras mutation. Oxaliplatin-based adjuvant chemotherapy is commonly used for stage III disease, whereas the clinical practice for stage II disease varies. CONCLUSIONS: Further clinical cooperation is needed to optimize the management of colorectal cancer in Asia.

Multicenter, randomized trial of ramosetron plus dexamethasone versus ramosetron alone in controlling cisplatin-induced emesis.

GOALS: To establish whether the combination of a corticosteroid (dexamethasone) and the newer serotonin-3 (5-HT(3)) receptor antagonist ramosetron is superior to ramosetron alone in controlling cisplatin-induced emesis. PATIENTS AND METHODS: A total of 283 patients aged 18-75 years with confirmed malignant disease who were scheduled to receive cisplatin > or =50 mg/m(2) with or without other antineoplastic agents were randomized to intravenous treatment with either ramosetron 300 microg plus dexamethasone 20 mg ( n=149) or ramosetron 300 microg alone ( n=134) given 30 min prior to cisplatin infusion. If vomiting occurred in the following 24 h, patients in both groups received an intravenous rescue dose of ramosetron 300 microg. Subsequently, on days 2 and 3, treatment was continued orally with either ramosetron 100 microg once daily plus dexamethasone 8 mg twice daily, or ramosetron 100 microg once daily. MAIN RESULTS: During the first 24 h after cisplatin infusion, significantly more patients receiving combination therapy had a complete response (no nausea or vomiting or requirement for rescue therapy) than those receiving ramosetron alone (68% vs 54%, respectively; P=0.034), and significantly fewer patients needed a rescue dose of ramosetron (22% vs 34%, respectively; P=0.032). In addition, the percentages of patients with no nausea and no vomiting were significantly greater in the ramosetron plus dexamethasone group than in the ramosetron-alone group at both 24 h and 72 h after cisplatin administration. CONCLUSIONS: The antiemetic efficacy of ramosetron in cancer patients receiving highly emetogenic cisplatin chemotherapy is significantly enhanced by its use in combination with dexamethasone.

Hígado graso agudo del embarazo: informe de un caso y revisión de la literatura / Acute fatty liver of pregnancy: a case report and literature review

El hígado graso agudo del embarazo (HGAE) es una entidad rara, potencialmente fatal que afecta a mujeres en el último trimestre del embarazo. Se caracteriza por un período prodrómico de síntomas seguido por ictericia, falla hepática y trastornos de coagulación e infiltración grasa del hígado, demostrada por biopsia hepática. Su incidencia es de uno en cada mil nacimientos, con mayor frecuencia en mujeres con embarazos gemelares. Se informa del caso de una paciente de 29 años de edad, primigesta, con embarazo gemelar de 33 a 34 semanas, con tensión arterial de 140/90 mmHg, plaquetas 160,000/dL, TP 25.6 seg, TPT 64.7 seg, glucosa 52 mg/dL, creatinina 2.1 mg/dL, ácido úrico 11.9 mg/dL, DHL 1063 U/I, TGP 220 U/I, FA 1172 U/I, bilirrubina total 8.4 md/dL, proteinuria 30 mg/dL. Se efectuó cesárea, previa corrección de pruebas de coagulación. Se obtuvo gemelo I masculino con peso de 2,070 g, Apgar 8-9, gemelo Il femenino con peso de 2,050 g, óbito. La biopsia hepática confirmó el diagnóstico. La causa del HGAE es desconocida. La frecuencia en embarazos gemelares se ha incrementado. Aproximadamente la mitad de los casos presentan hipertensión y proteinuria. Están elevadas las transaminasas, fosfatasa y bilirrubinas. Hay hipoglucemia. El tiempo de protrombina está alargado. El diagnóstico diferencial entre preeclampsia y HGAE no es crucial porque el manejo obstétrico es el mismo. El tratamiento principal es el "nacimiento temprano" (interrupción del embarazo) y las medidas de sostén. El obstetra debe tener un alto índice de sospecha para esta enfermedad hepática.