Breast cancer in octogenarian women: clinical characteristics and outcome.

PURPOSE: Breast cancer incidence increases in the elderly but data on treatment and outcomes of elderly patients is limited. We assessed the clinicopathological features and outcomes of our patients with breast cancer aged ≥80 years in comparison with their younger postmenopausal counterparts. METHODS: The records of 83 patients diagnosed with breast cancer after the age of 80 (group 1) between 2003 and 2011 in 4 different centers were retrospectively evaluated and the clinicopathological features and outcomes were assessed in comparison with a control group (group 2) of 249 patients aged between 60-70 years. RESULTS: Median ages at diagnosis were 82 years (range 80-95) and 64 years (range 60-70) for group 1 and group 2, respectively. The incidence of invasive cancers other than ductal or lobular type was higher in group 1 than in group 2 (20 vs 8%; p=0.0177rpar;. More patients in group 1 had Charlson Comorbidty scores ≥1 than those in group 2 (49 vs 36%; p=0.011). Patients in group 1 had more conservative operations and less axillary node dissections (ALND) and they received chemotherapy, trastuzumab or radiotherapy less frequently compared to their younger counterparts in group 2. Median follow up period was 36 months (range 1-178) in group 1 and 24 months (range 12-217) in group 2. Five-year disease free survival (DFS) was 53.7 and 75.9) (p=0.005), 5-year overall survival (OS) was 61.9% and 80.47percnt; in group 1 and group 2 (p=0.001), respectively. Advanced stage (stage IV vs stage I, II, III, p=0.051) and cerbB2 positivity (p<0.001) were found to be associated with shorter DFS in patients ≥80 years of age. CONCLUSION: Although the majority of patients were undertreated in our study according to the current guidelines, mortality rates were quite low. Different biology of the disease in the elderly might explain this difference.

Acute infusion reactions to chemotherapeutic drugs: a single institute experience.

PURPOSE: Treating cancer often involves the use of chemotherapeutic agents. Due to the growing incidence of cancer worldwide and the expanding number of treatment options, it is important to understand the risks of adverse events associated with these treatments. In this study, we monitored the occurrence of acute infusion reactions in an outpatient chemotherapy center from April 2011 to April 2012. METHODS: For patients who developed infusion reactions, the causative drug, the dose and number of treatments received, the onset time of the reaction, the duration of the reaction, blood pressure, pulse, level of oxygen saturation during the reaction, and other symptoms were recorded. The severity of reactions was determined in accordance with NCI toxicity criteria. A reaction was considered as grade 1-2 (mild-moderate) if the patient experienced flushing, rash, fever, tremor, dyspnea, rigor, and mild hypotension. Symptoms such as severe hypotension, bronchospasm, cardiac dysfunction and anaphylaxis, requiring therapeutic intervention, were classified as severe, grade 3-4 reactions. RESULTS: Of the 2213 patients receiving chemotherapy during the study period, 138 (62%) developed an infusion reaction to the treatment. Among 138 patients most commonly treated types of carcinoma included breast (39.2%), lung (17.8%), colorectal (10%), and ovarian (8.5%) cancers. Docetaxel administration resulted in the largest number of infusion reactions, though most reactions were mild to moderate and did not require the cessation of treatment. Patients with mild to moderate reactions (89.2%) were able to continue treatment, while those who developed severe reactions (10.8%) could not continue treatment with the same agent. CONCLUSION: Although severe reactions are rare, the incidence of mild to moderate reactions against taxanes, platinum compounds, and monoclonal antibodies is quite high. Clinical symptoms do not vary widely among the agents, though the onset time of symptoms does vary. While reactions against platinum agents were of type 1 anaphylactic reactions, reactions against taxanes and monoclonal antibodies during the first infusion and in the following minutes suggest the activation of different mechanisms.

Successful treatment of aortic rupture with endovascular stent grafting in a patient with mantle cell lymphoma.

PURPOSE: To present a case of spontaneous aortic rupture in the course of mantle cell lymphoma and successful management with endovascular repair. CASE REPORT: A 69-year-old woman presented with a cervical mass. The patient was found to have stage IIIA and Mantle Cell Lymphoma International Prognostic Index (MIPI) 4. She was placed in an intermediate-risk group. The patient received an initial cycle of systemic chemotherapy consisting of rituximab, anthracycline, vincristine and methyl prednisolone. During follow-up, she developed abdominal aortic rupture secondary to intramural hematoma which was successfully managed with endovascular exclusion. CONCLUSION: Hemodynamic changes can be seen during the course of lymphoma subsequent to systemic chemotherapy. These changes might be related to the spontaneous rupture of the main vessels. Endovascular repair may be a more appropriate treatment option than open surgery, especially in a patient with multiple comorbidities.

Colon adenocarcinoma and solitary tibia metastasis: rare entity.

INTRODUCTION: Colorectal cancer is the third leading cause of cancer-related deaths in the world. Mostly, death occurs with complications of distant metastases. DISCUSSION: Effective systemic chemotherapy regimen and resultant improved survival for patients are associated with an increased incidence of metastases at uncommon sites. Therefore, incidences of osseous metastases are rising at the last decade. Osseous metastases are mostly diffuse, along with visceral metastases. CONCLUSION: Most common osseous metastatic sites are lumbal, sacral vertebrae, and pelvis region, probably because of colonic anatomical proximity to the paravertebral venous plexus. Herein, we report an uncommon case of isolated solitary tibia metastasis in the colorectal cancer patient and management of disease course.

Drug interaction between capecitabine and warfarin: a case report and review of the literature.

OBJECTIVE: To report on possible adverse interaction between capecitabine and warfarin in a patient with cancer, who developed subconjunctival and nose bleeding during treatment with these drugs and review of the previously reported five cases in the literature. CASE SUMMARY: In the second week of capecitabine treatment the patient was hospitalized owing to subconjunctival hemorrhage and nose bleeding. Her international normalized ratio (INR) level was found to have increased, and both drugs were discontinued. Fresh frozen plasma replacement was administered. Warfarin and capecitabine treatment were restarted again but the warfarin dose was decreased. The patients INR was kept between 2.5-3 with the reduced dose of warfarin. DISCUSSION: Capecitabine is an orally active prodrug of fluorouracil (FU) and is extensively used as an antineoplastic agent. It is converted to 5-FU in the liver and tumor tissues. Warfarin is an antithrombolytic agent and is metabolized by liver cytochorom P450 (CYP) isoenzymes in liver. Preclinical in vitro studies using human liver microsomes report no inhibitory effects between capecitabine and substrates of CYP. However, the concomitant administration of capecitabine and warfarin resulted in gastrointestinal, retroperitoneal bleeding and hemorrhagic blisters in the five cases previously reported. The exact mechanism of this interaction is unknown; however, a significant pharmacokinetic interaction between capecitabine and S-warfarin resulting in exaggerated anticoagulant activity has recently been demonstrated. Here, we describe another case and use of the Naranjo adverse drug reaction (ADR) probability scale, which indicated a probable relationship between subconjunctival bleeding and epistaxis in this patient after concomitant warfarin and capecitabine use. CONCLUSION: Capecitabine is extensively used in outpatient clinics, and physicians should be aware of ADRs arising from combined used of capecitabine and warfarin. In the light of the current data, INR levels should be closely monitored in patients using this medication regimen.

Gallbladder adenosquamous cell carcinoma: report of two cases.

Adenocarcinoma is the usual histological presentation of the very rare gallbladder carcinoma. Adenosquamous cell carcinoma accounts for less than 3.5% of gallbladder carcinomas, and is characterised by invasive growth, a reduced tendency for lymph node metastasis, an increased tendency for hepatic infiltration or liver metastasis, and a poorer prognosis than adenocarcinoma. We present two cases. The first patient presented to our institution with increased bilirubin levels and dilated intra- and extrahepatic bile ducts. Adenosquamous carcinoma of the gallbladder was diagnosed on the post-operative pathological specimen. After surgery, bilirubin levels decreased, but hepatic metastases occurred that did not respond to conventional chemotherapy. The second patient was admitted to our hospital with jaundice and abdominal pain. Abdominal computed tomography (CT) imaging showed marked thickening of the gallbladder with direct extension of a mass into the left liver lobe. Cytology specimens obtained with an endoscopic retrograde cholangiopancreatography (ERCP) procedure revealed a malignant epithelial tumour. The patient underwent surgery but the tumour was incompletely resected. A regimen of oral UFT (Tegafur + uracil) chemotherapy was begun. Serum bilirubin levels increased due to occlusion in the surgical area 15 weeks after the start of chemotherapy.

Acute interstitial pneumopathy associated with docetaxel hypersensitivity.

BACKGROUND: Acute pulmonary toxicity in cancer patients treated with docetaxel has been reported in previous phase II studies and case reports. Unlike transient pulmonary infiltrates, it is demonstrated that docetaxel-induced interstitial pneumopathy is a severe clinical condition that generally leads to respiratory failure. CASE REPORT: We report a patient with breast cancer who received 2 cycles of docetaxel in 3-week intervals and developed respiratory failure. The clinical, pathologic, and radiographic data supported pulmonary toxicity caused by a hypersensitivity reaction to docetaxel as the most likely etiology. The patient developed the same symptoms and radiological findings after 1 cycle of paclitaxel administration. Unlike other more severe examples in the literature, this patient's condition did not require mechanical ventilation, and she recovered after corticosteroid treatment. CONCLUSION: The present case raises the possibility that taxanes, as a group of chemotherapeutic agents, may cause the same type of adverse reaction in the pulmonary parenchyma. The authors recommend that any patient who develops a taxane-induced pulmonary toxic reaction, not be rechallenged or treated with another agent of the same class.

Primary thyroid lymphoma: report of two cases.

Primary thyroid lymphoma is a rare disease. Most of the patients have a history of Hashimoto's thyroiditis. Main histopathologic subtypes are either mucosa-associated lymphoid tissue (MALT) or diffuse large cell lymphomas. Treatment options are surgical resection in localised, low-grade MALT lymphomas or systemic chemotherapy in aggressive, diffuse large cell lymphomas. But, sometimes other histopathologic subtypes can be seen and therapeutic approaches must be done. We report two patients who have primary thyroid lymphoma. There was no history of Hashimoto's thyroiditis in either case, and neither of them had MALT histologic subtype. First patient a sixty four year old woman, admitted to hospital because of bilateral thyroid nodules. Histological subtype was B cell follicular lymphoma. Subtotal thyroidectomy was performed and radiotherapy was administered to the entire neck region. Second patient, a 50 year old man, presented with complaints of a left thyroid mass and dyspnoea. Total thyroidectomy was carried out and chemotherapy was given. Histological diagnosis was diffuse large B cell lymphoma. Thyroid lymphomas had heterogenous histological and clinical characteristics. In localised, non-aggressive subtypes, surgical treatment must be considered. Postoperative chemotherapy or radiotherapy may be necessary in some patients.

Acute myeloid leukemia 4 years after Kaposi's sarcoma in a renal transplant recipient.

BACKGROUND: Leukemia is a well-known complication of cancer therapy, but development of acute myeloid leukemia (AML) after renal transplantation is rare. Immunosuppressive therapy for organ transplant recipients is complicated by high rates of malignant disease, one condition being Kaposi's sarcoma (KS). CASE REPORT: A 22-year-old woman developed KS 1 year after renal transplantation, and then developed AML another 4 years later. When KS was diagnosed it was already in extensive stage, and she received ABV combination chemotherapy with doxorubicin plus bleomycin plus vincristine intravenously (i.v.) once daily every 2 weeks. She entered remission but the KS relapsed and 8 cycles of i.v. etoposide monotherapy were given and she re-entered remission. 19 months later, the patient was admitted to hospital with severe malaise, leukocytosis, thrombocytopenia, and anemia. The diagnosis was AML (FABM4). The patient received induction chemotherapy consisting of cytarabine and idarubicin. After completion of this induction therapy she developed neutropenic infection, dyspnea and confusion. Her condition deteriorated rapidly after that, and she died. CONCLUSION: KS is one of the most common malignancies in renal allograft recipients, whereas AML is a less frequent problem. To our knowledge, this is the first published case of these two different malignancies developing after renal transplantation. The pathogenesis of the AML is discussed.

Treatment results in renal transplant recipients with non-Hodgkin's lymphoma.

The purpose of this study was to investigate the incidence of non-Hodgkin's lymphoma (NHL), response to treatment, and survival time in renal transplant recipients at our center who developed this form of neoplasia. Between October 1985 and August 2002, 1077 renal transplantations were carried out at our center. The incidence of NHL after transplantation was 1.1% (12/1077). All patients had their immunosuppressive doses reduced after they were diagnosed with NHL. Complete remission was achieved in eight cases, and five of these individuals were still alive at the time of writing. The circumstances for each of the three deaths in this group were as follows: (1) progressive gastric adenocarcinoma 9 years after being diagnosed with NHL, (2) stage III NHL cured with chemotherapy, but died of infection 2 years after NHL diagnosis, and (3) recurrent intestinal lymphoma, with death during second line chemotherapy. Of the five survivors in the remission group, one had to return to hemodialysis. The four patients who did not enter remission all died. The median time from transplantation to diagnosis of NHL was 66 months. At the time of writing, the median survival time for the eight patients who achieved complete remission was 41.5 months. The study showed that treatment of localized disease (skin or intestinal NHL) with surgery and/or radiotherapy/chemotherapy leads to complete remission and long survival times; however, patients in remission are at risk for other causes of death.

CA 15-3, ceruloplasmin and tissue polypeptide specific antigen as a tumour marker panel in breast cancer.

BACKGROUND: Tumour markers along with other tests, may be useful in the assessment of the prognosis, monitoring response to treatment and early detection of metastases in breast cancer. The most commonly used breast cancer antigen is CA 15-3. OBJECTIVE: To examine the value of CA 15-3, ceruloplasmin and tissue polypeptide specific antigen (TPS) panel in the monitoring of breast cancer. SUBJECTS: Serum concentrations of CA 15-3, ceruloplasmin and TPS were measured in 90 women: Fifteen controls, sixteen patients with benign breast disease (BBD), thirty one patients in remission and twenty eight patients with active breast cancer. RESULTS: The results of CA 15-3, ceruloplasmin and TPS estimates were separated into four groups. The patients not in remission were found to have significantly higher levels of CA 15-3 (p<0.0001) and ceruloplasmin (p<0.0001) compared with the other three groups. The difference between the patients in remission, BBD and the control group was not statistically significant (p>0.05) for CA 15-3 and ceruloplasmin. The difference for TPS between the patients in remission and the patients with active breast cancer was not statistically significant (p>0.05). The sensitivities of CA 15-3, ceruloplasmin, and TPS for detecting active breast cancer were 75.0%, 75.0%, and 78.0%, respectively. CONCLUSION: The highest sensitivity for active breast cancer detection was obtained by the combined use of three tumour markers. We concluded that there may be an advantage in using panels in the follow up of breast cancer patients, although so far such tests have too low a specificity to be of practical value in screening.

Imipenem-cilastatin versus sulbactam-cefoperazone plus amikacin in the initial treatment of febrile neutropenic cancer patients.

The treatment of infectious complications in cancer patients has evolved as a consequence of the developments in the chemotherapy of cancer patients. In this prospective, randomized study, we compared imipenem-cilastatin and sulbactam-cefoperazone with amikacin in the empiric therapy of febrile neutropenic (< 1000/mm3) patients with liquids and solid tumours. Of 30 evaluable episodes, 15 were treated with imipenem-cilastatin and 15 were treated with sulbactam-cefoperazone plus amikacin. 73% of episodes were culture-positive: gram-positive pathogens accounted for 62% of the isolates. Bacteremia was the most frequent site of infection. The initial clinical response rate for both regimens was 60% (p > 0.05). No major adverse effects occurred. This study demonstrated that imipenem-cilastatin monotherapy and combination therapy of sulbactam-cefoperazone plus amikacin were equally effective empiric therapy for febrile granulocytopenic cancer patients.