Assessment of the management of carcinomatous meningitis from breast cancer globally: a study by the Breast International Group Brain Metastasis Task Force.

BACKGROUND: Carcinomatous meningitis (CM) is a severe complication of breast cancer. The Breast International Group (BIG) carried out a survey to describe the approach to CM internationally. PATIENTS AND METHODS: A questionnaire on the management of CM was developed by the Brain Metastases Task Force of BIG and distributed to its groups, requesting one answer per group site. RESULTS: A total of 241 sites responded, 119 from Europe, 9 from North America, 39 from Central/South America, 58 from Asia, and 16 in Australia/New Zealand, with 24.5% being general hospitals with oncology units, 44.4% university hospitals, 22.4% oncology centers, and 8.7% private hospitals. About 56.0% of sites reported seeing <5 cases annually with 60.6% reporting no increase in the number of cases of CM recently. Nearly 63.1% of sites investigate for CM when a patient has symptoms or radiological evidence, while 33.2% investigate only for symptoms. For diagnosis, 71.8% of sites required a positive cerebrospinal fluid cytology, while magnetic resonance imaging findings were sufficient in 23.7% of sites. Roughly 97.1% of sites treat CM and 51.9% also refer patients to palliative care. Intrathecal therapy is used in 41.9% of sites, mainly with methotrexate (74.3%). As many as 20 centers have a national registry for patients with breast cancer with central nervous system metastases and of those 5 have one for CM. Most (90.9%) centers would be interested in participating in a registry as well as in studies for CM, the latter preferably (62.1%) breast cancer subtype specific. CONCLUSIONS: This is the first study to map out the approach to CM from breast cancer globally. Although guidelines with level 1 evidence are lacking, there is a high degree of homogeneity in the approach to CM globally and great interest for conducting studies in this area.

Complete closure of cancer-related anovaginal and anoperineal fistulas in locally advanced anal canal carcinomas by upfront intra-arterial chemotherapy followed by combined radiochemotherapy: report of two cases.

PURPOSE: Cancer-related fistulas are a major problem in locally advanced anal canal carcinoma, because conservative radiochemotherapy may not be recommended in this setting. Therefore, it is usually recommended to proceed to an abdominoperineal resection with definitive colostomy in the presence of such lesions. METHODS: Because chemotherapy can lead to closure of cancer-related fistulas and local intra-arterial chemotherapy is effective in locally advanced anal canal cancer, we treated two anal canal carcinoma patients presenting with cancer-related fistulas with upfront intra-arterial chemotherapy followed by radiochemotherapy, leading to complete closure of fistulas. RESULTS: Both patients are free of colostomy and in complete remission after more than four years of follow-up. CONCLUSIONS: This conservative approach combining local intra-arterial chemotherapy and standard radiochemotherapy is feasible and should be considered in the management of such locally advanced anal canal carcinoma.

[Multi-systemic toxicity of colchicine and renal failure: apropos of a case]. / Toxicité multisystémique de la colchicine et insuffisance rénale: à propos d'un cas.

The use of colchicine can produce various side effects, but multiorgan toxicity is rare. We report the first Swiss case of multiorgan toxicity involving typical neuromuscular lesions. Muscular biopsy is a valuable tool in confirming the diagnosis. Renal insufficiency and hepatobiliary diseases are predisposing factors for such complications. Colchicine pharmacology in the case of renal insufficiency is discussed.