Chemotherapy-induced posterior reversible encephalopathy syndrome: Three case reports.

RATIONALE: Posterior reversible encephalopathy syndrome (PRES) has been associated with the use of several medications, including chemotherapeutic agents. PATIENT CONCERNS: A 65-year-old woman was diagnosed with adenocarcinoma of the ovary, after sixth-line treatment with topotecan, at the beginning of the fourth cycle, she was admitted to the emergency room for presenting tonic-clonic seizures, visual disturbance, and hypertension. A 66-year-old woman was diagnosed with bilateral breast cancer; due to disease progression, treatment with paclitaxel and gemcitabine was started, 1 month after the last dose of chemotherapy, she was admitted to the emergency room for suffering severe headache, altered mental status, tonic-clonic seizures, and hypertension. A 60-year-old patient diagnosed with breast cancer on the left side, underwent second-line chemotherapy with gemcitabine, carboplatin, and bevacizumab, and 1 month after the last dose of chemotherapy, she was also admitted to the emergency room due to altered mental status, vomiting, tonic-clonic seizures, and hypertension. DIAGNOSIS: They were diagnosed as PRES based on physical examination, laboratory findings, and imaging techniques that revealed diffuse lesions and edema within the parieto-occipital regions. INTERVENTIONS: They received support treatment with blood pressure (BP) control, seizures were controlled with a single anti-epileptic agent, and chemotherapeutic agents from the onset of PRES to its resolution were discontinued. OUTCOMES: All these patients improved after medical treatment was started. LESSONS: Medical personnel and therapeutic establishments need to be made aware about this chemotherapy-induced neurologic complication.

Quality of Life in Brain Cancer: Clinical Validation of the Mexican-Spanish Version of the EORTC QLQ-BN20 Questionnaire.

Background: Overall survival (OS) of patients with Brain Cancer (BC) is slowly increasing. The disease itself and its treatments deeply impact patient Health-related quality of life (HRQL). Therefore, valid and reliable instruments are needed. In this study, the Mexican-Spanish version of the QLQ-BN20 instrument is psychometrically and clinically validated. Methods: Patients with brain cancer (BC) (primary or metastatic) evaluated at a tertiary cancer center, were invited to respond to the questionnaire, as well as the core-module QLQ-C30. Tests to demonstrate the instrument's internal consistency, the association of HRQL scales with clinical variables and OS were investigated. Results: One hundred and nineteen patients were included in this cohort: 77 women and 42 men (mean age, 46.2 years). Patients answered both instruments in < 30 min. Good convergent [all correlation coefficients (CC) > 0.37] and discriminant validity was observed and was associated with significant overlap (CC 0.007-0.68). All four multi-item scales of QLQ-BN20 also demonstrated good reliability (Cronbach α > 0.7). Several scales of the QLQ-BN20 were significantly associated with performance status and a modified Recursive Partition Analysis. Of the possible scale correlations, 40 of 161 (24.8%) scales in both instruments, were significantly (directly or inversely) correlated. Visual disorders, Motor dysfunction, Seizures and Weakness of the legs presented association with OS (p < 0.05). Conclusion: The Mexican-Spanish version of the BN20 instrument is valid and reliable and can be used in clinical trials in patients with BC. Some HRQL scales were associated with OS and could therefore be incorporated in future studies of prognostic models.

Neurologic manifestations of elderly patients with cancer.

BACKGROUND: The incidence of cancer is an age-related phenomenon; therefore, the interest on clinical manifestations, diagnostic approach and treatment strategies for older patients diagnosed with cancer has increased lately. Neurologic symptoms are one of the main reasons for consultation and a common cause of decreased quality of life among cancer patients. AIMS: To identify the neurologic manifestations of patients ≥ 65 years of age diagnosed with cancer and compare them to those presented by a younger population. METHODS: Cross-sectional study of cancer patients referred to neuro-oncologic consultation at a Cancer Center. Sociodemographic, health and oncologic characteristics were obtained through clinical interviews. Clinical symptoms and final diagnoses were also recorded. Bivariate logistic regression analyses were carried out. RESULTS: More than 17,000 neuro-oncologic consultations in 3015 patients were given, 27% (n = 811) of them were ≥ 65 years of age. Most frequent primary neoplasms in elderly patients were: breast cancer, hematologic neoplasms, gynecological, urologic, skin and head and neck cancers. Elderly patients had an increased risk of having the following diagnoses: abnormal movements, stroke, peripheral vertigo, dementia, degenerative spine disorder, and delirium. DISCUSSION: Elderly patients are considered a vulnerable population. The present study found that the main neoplasms associated with neurological manifestations are similar to the reported previously. We described the main symptoms that led to a neuro-oncological assessment. Moreover, we enlisted the final diagnoses made on elderly patients and compared them with others reports. To the best of our knowledge, this study provides valuable information, since there is scarce evidence in the literature about this topic. CONCLUSION: Identifying the frequency and correlation of neurologic manifestations in older cancer patients will allow for the implementation of timely multidisciplinary care in an attempt to improve these patients' health-related quality of life.

Clinical manifestations and location of brain metastases as prognostic markers.

BACKGROUND: Brain metastases (BM) are a frequent complication of cancer and are regularly seen in clinical practice. New treatment modalities are improving survival after diagnosis of BM. However, symptoms are rarely reported and their significance is not well established. The aim of the present study was to investigate neurologic indicators as prognostic markers in patients with brain metastases. PATIENTS AND METHODS: A prospectively acquired database from 2 referral centers was analyzed. All patients had had at least 2 neuro-oncologic consultations and magnetic resonance imaging to confirm the diagnosis. Patients were classified according to universally used prognostic scores, gender, primary tumor, localization of BM, and clinical complaints. Univariate and multivariate analysis was used to evaluate associations. RESULTS: A total of 570 patients were included; 71% were female, and 91% had solid tumors. Median survival was 11 months (95% confidence interval 9.4-12.6). Of 1322 parenchymal lesions, 78% were supratentorial, and were most commonly in the frontal lobe. The most common symptoms were headache, vision changes, and weakness. Brain metastases in the brainstem were associated with a worse prognosis (P = 0.04). Visual complaints (P = 0.005), altered mental status, (P < 0.0001) and cranial neuropathy (P 0.001) were also associated with a poor outcome, as were poor performance status, more than 1 brain metastases, meningeal carcinomatosis, and uncontrolled primary cancer. CONCLUSIONS: Both presenting symptoms and the location of brain metastases have prognostic significance and should be further studied, both as independent prognostic predictors and in conjunction with other factors used in prognostic scores.

Myasthenia gravis as a prognostic marker in patients with thymoma.

BACKGROUND: Thymoma is the most common mediastinal tumor, representing <1% of all cancers. It is usually associated with paraneoplastic disorders, mainly myasthenia gravis (MG). The aim of the present study was to describe patients with thymoma and the differences between those with MG and those without it. METHODS: A retrospective 10-year database of the patients with thymoma treated at a single cancer referral hospital (National Institute of Cancer, Mexico City), was analyzed. RESULTS: Sixty-four files from patients with thymoma were analyzed, 18 of them had MG. The symptoms that occurred most frequently in patients with MG were ptosis, diplopia, appendicular weakness, dysphonia and dysphagia. The most frequent Myasthenia Gravis Foundation of America (MGFA) stage was IIIb followed by stage I. Almost all the patients with MG had positive Acetylcholine Receptor antibodies (P<0.001), with not specified antibodies in four patients. The median overall survival showed a trend to be higher among the patients with MG, but there were no significant differences. CONCLUSIONS: In patients with thymoma MG manifests with different clinical and autoimmune traits, but not survival differences. A larger multi-centric study should be encouraged to evaluate the prognostic implications of having MG in patients with thymoma.

Lactate dehydrogenase as a prognostic marker in neoplastic meningitis.

This study aimed to establish the prognostic utility of lactate dehydrogenase (LDH) levels in the cerebrospinal fluid (CSF) of patients with neoplastic meningitis (NM). Patients with a confirmed diagnosis of NM at a cancer referral center were included. Data on demographic and oncological background, clinical symptoms, diagnostic tests, treatment, and survival were analyzed. In total, 119 patients were included, 74% of whom were females. The mean age was 44.2 years at the time of cancer diagnosis and 46.6 years at the time between NM diagnosis. Primary cancers were mostly breast cancer, lung cancer, or hematologic malignancies. The mean Karnofsky performance score (KPS) was 65. Frequent clinical symptoms were visual complaints, headache, cranial neuropathy, focal weakness, and decreased awareness. Diagnosis was made based on clinical symptoms, cytological CSF analysis results, and/or magnetic resonance imaging findings. The median overall survival (OS) was 4 months (95% CI 2.48-5.52). Prognostic variables associated with a better OS were hematopoietic malignancies, KPS ≥ 70, absence of meningeal signs, receiving any form of treatment, normal CSF glucose levels, and normal CSF LDH levels. After bivariate analysis, high LDH in the CSF remained statistically significant as a poor prognostic indicator. The LDH level is a useful parameter to assess the prognosis of patients with NM. Other factors associated with the prognosis of these patients were tumor type, CSF glucose levels, performance status, and receiving any form of treatment.

Comorbidities, Clinical Features, and Prognostic Implications of Cancer Patients with Cerebrovascular Disease.

PURPOSE: The objective of this study was to identify and describe the comorbidities, clinical features, and prognostic implications of cancer patients with cerebrovascular disease. MATERIALS AND METHODS: All patients with cerebrovascular disease (CVD) seen in the neuro-oncology unit at a cancer referral center from April 2010 to November 2016 were included; demographic, oncologic diagnosis, risk factors, and prognostic considerations were presented as well. RESULTS: We report on 256 patients with CVD and cancer, of whom 66% were women. The mean age at the time CVD occurred was 56 years. The most frequently associated malignancies were gynecologic (including breast cancer), hematologic, head and neck, and urologic. The men had more smoking and alcohol consumption history, hemorrhagic CVD, and urologic and hematologic malignancies. The women, besides gynecologic cancer, had more ischemic CVD. Thrombotic CVD, followed by embolic and hemorrhagic CVDs, was more frequent. A comorbid condition besides cancer was found in 71% of the patients. The most frequent clinical presentation was focal motor weakness, altered mental status, and aphasia. The 10-year mortality was 59%; higher rates were found in men, in those with hemorrhagic CVD, in tobacco users, and in those with altered mental status. CONCLUSIONS: Cancer is a well-known risk factor for stroke, which has been associated with a higher frequency in cancer. We found that ischemic stroke due to thrombosis and cardioembolism was more common, and gender, comorbidities, clinical presentation, and type of CVD, but not cancer type, were elements associated with prognosis.

Central Nervous System Metastases in Patients With Cervical Carcinoma.

INTRODUCTION: Cervical cancer (CC) is the most common malignancy throughout developing countries, although considered rare, central nervous system metastasis (CNSm) does occur. OBJECTIVE: This study aimed to describe our experiences and compare them to other published cases. MATERIALS AND METHODS: From May 2009 to August 2015, the files of all patients with CC treated at our referral center were reviewed. RESULTS: We found 27 patients with CC and CNSm. Mean age at the time of CNS diagnosis was 50 ± 11 years, mean interval between initial CC and CNSm was 46 months; the most frequent initial International Federation of Gynecology and Obstetrics stage was IIB with 17 patients followed by IB in 4. Fifty-nine percent of patients had lung metastases at the time CNSm were diagnosed. Headache was the most common symptom, followed by weakness, altered mental status, and ataxia/cerebellar. Mean survival was 8.2 months after CNSm was discovered; 3 patients are still alive. CONCLUSIONS: The present study describes the largest series of patients with CNSm from CC; this rare complication should be suspected in patients with CC who present with headache, ataxia, cranial nerve palsy, visual disturbance, altered mental status, focal weakness, or other neurological symptom, without other plausible explanation.

Manifestaciones neurológicas en pacientes con cáncer: más de 17.000 motivos de consulta / Neurological manifestations in patients with cancer: more than 17, 000 reasons for consultation

Introducción. El cáncer es una de las primeras causas de muerte en nuestra población. Las complicaciones neurológicas asociadas son frecuentes e incrementan significativamente la morbilidad y la mortalidad de estos pacientes. Objetivo. Describir las manifestaciones neurológicas en pacientes con cáncer. Pacientes y métodos. Desde enero de 2010 hasta diciembre de 2014 se creó una base de datos de pacientes con cáncer que merecían una valoración por neurooncología en un centro de referencia. Resultados. Se describen 17.092 motivos de consulta de neurooncología. Las neoplasias que más se relacionaron con manifestaciones neurológicas fueron: cáncer de mama, neoplasias hematológicas, tumores primarios del sistema nervioso central, cáncer de pulmón y neoplasias ginecológicas. Las manifestaciones neurológicas más frecuentes fueron: afección neuromuscular, actividad tumoral en el sistema nervioso central, cefalea primaria, crisis convulsivas, enfermedad vascular cerebral y tumores neurológicos primarios. Conclusiones. Es importante que los neurólogos, médicos de distintas áreas de la medicina y personal paramédico, involucrados en el manejo de estos pacientes, reconozcan las complicaciones neurológicas de manera temprana (AU)

Introduction. Cancer is one of the leading causes of death in our population; neurologic manifestations are frequent and are associated with higher rates of morbidity and mortality. Aim. To describe the neurological manifestations in patients with cancer. Patients and methods. From January 2010 to December 2014 a database was created from patients with cancer, required a neuro-oncological assessment at a referral cancer center. Results. 17,092 reasons for neuro-oncological consultation are described. Neoplasms most frequently associated with neurological manifestations were: breast cancer, hematologic malignancies, primary central nervous system tumors, lung cancer and gynecological malignancies. The most frequent neurological manifestations were: neuromuscular disease (including neuropathy), central nervous system metastasis, primary headaches, seizures, stroke and primary neurological tumors. Conclusion. It is important that neurologists, physicians and those involved in the management of patients with cancer recognize and get to know the neurological complications (AU)