Serial comprehensive geriatric assessment in elderly head and neck cancer patients undergoing curative radiotherapy identifies evolution of multidimensional health problems and is indicative of quality of life.

Head and neck (H&N) cancer is mainly a cancer of the elderly; however, the implementation of comprehensive geriatric assessment (CGA) to quantify functional age in these patients has not yet been studied. We evaluated the diagnostic performance of screening tools [Vulnerable Elders Survey-13 (VES-13), G8 and the Combined Screening Tool 'VES-13 + (17-G8)' or CST], the feasibility of serial CGA, and correlations with health-related quality of life evolution [HRQOL; European Organisation for Research and Treatment of Cancer Quality of Life Questionnaires (EORTC QLQ)-C30 and -HN35] during therapy in hundred patients, aged ≥65 years, with primary H&N cancer undergoing curative radio(chemo)therapy. Respectively 36.8%, 69.0%, 62.1% and 71.3% were defined vulnerable according to VES-13, G8, CST and CGA at week 0, mostly due to presence of severe grade co-morbidities, difficulties in community functioning and nutritional problems. At week 4, significantly more patients were identified vulnerable due to nutritional, functional and emotional deterioration. The CST did not achieve the predefined proportion necessary for validation. Vulnerable patients reported lower function and higher symptom HRQOL scores as compared with fit patients. A comparable deterioration in HRQOL was observed in both groups through therapy. In conclusion, G8 remains the screening tool of choice. Serial CGA identifies the evolution of multidimensional health problems and HRQOL conditions during therapy with potential to guide individualised supportive care.

Dermatological side effects of current and upcoming targeted therapies in oncology.

Targeted therapies are gaining field in oncology practice. Some of them are already well established, others are upcoming. They target cancer cells more selectively, therefore causing less collateral damage. Dermatologic side effects are common and sometimes class specific. The skin toxicity profile of EGFR inhibitors, MEK en Raf inhibitors, mTOR inhibitors, VEGF targeting molecules, multikinase inhibitors, the HER2 monoclonal antibody trastuzumab and the CTLA-4 monoclonal antibodies are discussed. When possible, a pathogenic mechanism and treatment options are described.

A 41-year-old man with breast cancer and dyspnoea: an exceptional complication in an uncommon disease.

A case of advanced breast cancer in a young male, who developed progressive dyspnoea a few months after treatment with chemotherapy is described. The clinical and radiological picture, supported by lung function testing, finally revealed the tentative diagnosis of bronchiolitis obliterans, most probably due to cyclophosphamide, one of the drugs used in the cytotoxic therapy. Two distinct clinical patterns of pulmonary toxicity associated with cyclophosphamide are reviewed: the acute pneumonitis that occurs early in the course of treatment; and the chronic, progressive, fibrotic process, of which bronchiolitis obliterans is an uncommon presentation. Cyclophosphamide pulmonary toxicity is primarily a clinical diagnosis and the typical features are discussed. Early-onset pneumonitis due to cyclophosphamide is a reversible process with a good prognosis. On the other hand, late-onset pneumonitis or lung fibrosis is essentially irreversible and follows a chronically progressive course over months to years. It almost inevitably leads to terminal respiratory failure.