CSF CA 15-3 in breast cancer-related leptomeningeal metastases.

UNLABELLED: The sensitivity of CSF cytology, the standard method for diagnosis of leptomeningeal metastases (LM), is low. Serum cancer antigen 15-3 (CA 15-3) is frequently used for the monitoring of patients with breast cancer (BC) and is a laboratory test available in most centers. The aim of the current study was to determine the feasibility of measuring CSF CA 15-3 and CA 15-3 CSF/serum ratio in patients with BC-related LM. Serum and CSF CA 15-3 values were evaluated in 20 BC patients with LM (Group 1), 20 patients with LM from other primary cancers (Group 2), 20 BC patients with parenchymal brain metastases only (Group 3) and 20 controls (Group 4). CSF and serum were collected on the same day. Serum and CSF CA 15-3 were assessed by an automatized immuno-enzymatic technology (TRACE(®) technology, KRYPTOR Automate, Brahms Society, France). In univariate analysis, BC patients with LM (Group 1) compared to other groups, a significantly elevated serum CA 15-3 (median 51 U/ml, range 12-2819) and CSF CA 15-3 (median 8.7 U/ml, range 0.1-251) was observed. Additionally, the CSF/serum ratio of CA 15-3 was significantly higher in this group of patients (median 0.18, range 0.002-4.40). Multivariate analysis identified a cut-off for CSF CA15-3 with 80 % sensitivity and 70 % specificity. CONCLUSIONS: The current study confirms the feasibility of determining CSF CA 15-3 using a widely available technology. Evaluation of the CSF CA 15-3 may be useful in the diagnosis and management of BC-related LM but further studies are needed.

Salvage intracerebrospinal fluid thiotepa in breast cancer-related leptomeningeal metastases: a retrospective case series.

There is currently a paucity of data on salvage intracerebrospinal fluid (intra-CSF) chemotherapy in leptomeningeal metastases (LM). This report is a single-institution experience with salvage treatment in patients with breast cancer (BC) and LM. This retrospective cohort describes 24 consecutive patients with BC selected for a second-line of treatment for LM. The first line of LM treatment consisted of intra-CSF liposomal cytarabine in all patients combined with systemic therapy in 18 cases and radiotherapy in four cases. Second-line (salvage) treatment utilized intra-CSF thiotepa in all and systemic chemotherapy in nine patients. No patient received CNS-directed radiotherapy. The median Eastern Cooperative Oncology Group performance status at initiation of intra-CSF thiotepa treatment was 3 (range 1-4). The median progression-free survival and median survival following intra-CSF thiotepa was 3.1 months (range 3 days-2 years) and 4.0 months (range 6 days-2.5 years), respectively. The median overall survival from LM diagnosis was 9.5 months (range 1.3 months-2.7 years). No grade 3 or higher toxicity was observed. Recognizing the limits of a retrospective study, intra-CSF thiotepa has an acceptable toxicity profile and appears to be a reasonable option for selected BC patients.

Intrathecal liposomal cytarabine plus systemic therapy versus systemic chemotherapy alone for newly diagnosed leptomeningeal metastasis from breast cancer.

BACKGROUND: DEPOSEIN (NCT01645839) was a randomized open-label phase III study to explore the role of intrathecal chemotherapy in patients with newly diagnosed leptomeningeal metastasis (LM), a common manifestation of breast cancer. METHODS: Patients with newly diagnosed LM defined by tumor cells in the cerebrospinal fluid or combination of clinical and neuroimaging signs of LM were randomized to receive systemic therapy alone (control group) or systemic therapy plus intrathecal liposomal cytarabine (experimental group). Progression-free survival related to LM (LM-PFS) was the primary endpoint. RESULTS: Thirty-seven and 36 patients were assigned to the control and the experimental groups. Median number of liposomal cytarabine injections in the experimental group was 5 (range 1-20). Focal radiotherapy was performed in 6 (16%) and 3 (8%) patients in the control and experimental groups. In the intent-to-treat population, median LM-PFS was 2.2 months (95% CI: 1.3-3.1) in the control versus 3.8 months (95% CI: 2.3-6.8) in the experimental group (hazard ratio 0.61, 95% CI: 0.38-0.98) (P = 0.04). Seventy-one patients have died. Median overall survival was 4.0 months (95% CI: 2.2-6.3) in the control versus 7.3 months (95% CI: 3.9-9.6) in the experimental group (hazard ratio 0.85, 95% CI: 0.53-1.36) (P = 0.51). Serious adverse events were reported in 22 and 30 patients, respectively. Quality of life until progression did not differ between groups. CONCLUSION: The addition of intrathecal liposomal cytarabine to systemic treatment improves LM-related PFS. Confirmatory trials with optimized patient selection criteria and more active drugs may be required to demonstrate a survival benefit from intrathecal pharmacotherapy.

Vulnerabilidade funcional e queda de idosos: quais fatores estão associados? / Functional vulnerability of elderly: which facts are associated?

Objetivo: Analisar se há associação entre o nível de vulnerabilidade funcional com a ocorrência de quedas, as condições sociodemográficas e as de saúde. Método: Pesquisa transversal, de caráter analítico e abordagem quantitativa realizada com idosos de 60 anos ou mais, de ambos os sexos e cadastrados na Estratégia de Saúde da Família de Dourados, MS, no período de junho a novembro de 2018. Para avaliar a vulnerabilidade funcional utilizou-se o Vulnerable Elders Survey-13 (VES13). Resultados: Participaram do estudo 136 idosos, sendo 68,4% do sexo feminino, 30,1% sofreram quedas, 58,8% encontravam-se com nível de vulnerabilidade funcional elevado e a análise de associação destacou que sexo feminino e analfabetismo tem relação com vulnerabilidade funcional (p<0,050). Conclusão: Constatou-se elevada taxa de vulnerabilidade funcional entre os idosos, necessitando do olhar holístico da enfermagem para promover a saúde, prevenir quedas e proporcionar melhor qualidade de vida da população idosa. (AU)

Objective: Analise if there is an association between the level of Functional Vulnerability, accidents such as falling, social-demographic and health. Methods: This analytical research had in contact with 136 elderly in the age of 60 or plus, both genders, 68,4% female, 31.6% male, and registers at the Family Health Strategy, Dourados, MS, during the months of june to november of 2018. For measuring the Functional Vulnerability was used the Vulnerable Elders Survey-13 (VES 13). Results: 136 elderly people participated in the study, 68.4% of whom were female, 30.1% suffered falls, 58.8% were at a high level of functional vulnerability and the association analysis highlighted that female sex and illiteracy is related to vulnerability functional (p<0.050). Conclusion: There was a high rate of funcional vulnerability among the elderly, requiring a wide sight of nursing to promote health, prevent falls and provide a better quality of life for the elderly population. (AU)

Objetivo: Analizar si hay asociación entre el nivel de vulnerabilidad funcional con la ocurrencia de caídas, las condiciones sociodemográficas y las de salud. Métodos: Investigación transversal, de carácter analítico y enfoque cuantitativo realizada con ancianos de 60 años o más, de ambos sexos y registrados en la Estrategia de Salud de la Familia de Dourados, MS, en el período de junio a noviembre de 2018. Para evaluar la vulnerabilidad funcional se utilizó el Vulnerable Elders Survey-13 (VES13). Resultados: Participaron del estudio 136 ancianos, siendo el 68,4% del sexo femenino, 30,1% sufrieron caídas, 58,8% se encontraban con nivel de vulnerabilidad funcional elevado y el análisis de asociación destacó que sexo femenino y analfabetismo tiene relación con vulnerabilidad funcional (<0,050). Conclusión: Se constató una elevada tasa de vulnerabilidad funcional entre los ancianos, necesitando la mirada holística de la enfermería para promover la salud, prevenir las caídas y proporcionar una mejor calidad de vida a la población anciana. (AU)

Selection of ultimately ill cancer patients able to fulfill a questionnaire: Identification of inherent biases.

AIM: Physical or psychological well-being is an essential component of quality care assessment in palliative unit. This assessment is mainly based on self-assessment (questionnaires or interviews). The aim of this study is to compare the clinical characteristics of patients able to fulfill a questionnaire and those not able to do that. METHODS: The clinical characteristics of 166 cancer patients admitted in palliative care unit from December 2006 to February 2008 have been collected. Characteristics of patients able to fulfill a questionnaire (80, 48.2%) have been compared to other patients (86, 51.8%). Moreover, functional independence measure (FIM) had been evaluated by nurses. RESULTS: Median age (60 versus 62) and sex ratio (40/40 versus 42/44) are similar in both groups. Lung primaries are significantly less frequent in patients able to fulfill the questionnaire (4% versus 17%, P=0.005). Patients able to fulfill the questionnaire had had better performance status (Karnofsky Index≤30%: 54% versus 21%, P<0.0001). The total score of FIM (56.0 versus 91.5, P<0.00001) and the median overall survivals (2.3 weeks versus 6.6 weeks, P=0.0001) were significantly lower in the group of patients non able to fulfill the questionnaire. CONCLUSIONS: Patients able to fulfill a questionnaire represent only 48.2% of all consecutive admitted patients. These patients are not representative of all patients since they had better performance status, they are less dependent and they display significant better survival. We have to think about new methods to avoid the biases generated by the use of patient-reported outcomes.

Sinais preditores de depressão em escolares com transtorno de aprendizagem / Predicting signs of depression in children with specific learning disorders

RESUMO Objetivo: comparar os sinais de depressão entre crianças com e sem transtornos de aprendizagem, e ainda, investigar se há diferenças nos sinais depressivos em relação ao gênero entre os grupos. Métodos: participaram do estudo 20 crianças com transtorno de aprendizagem e 20 crianças com desempenho escolar típico, entre 9 e 12 anos de idade. A investigação dos sinais de depressão foi realizada por meio da aplicação do Inventário de Depressão Infantil. Resultados: verificou-se que as crianças diagnosticadas com transtorno de aprendizagem apresentam maior frequência de sintomas depressivos em relação às crianças sem dificuldades escolares. Conclusão: os sinais de depressão variaram de acordo com a faixa etária. A comparação entre os gêneros revelou que as meninas apresentaram maior incidência dos sintomas depressivos, principalmente no grupo de crianças com o transtorno.

ABSTRACT Purpose: to compare signs of depression among children with and without learning disorders, and also to investigate whether there are gender-based differences in depressive signs between these groups. Methods: 20 children with learning disorders and 20 children with a typical school performance, aged between 9 and 12 years old, were studied. The investigation of the depression signs was performed by applying the Child Depression Inventory. Results: children diagnosed with learning disorders have a higher frequency of depressive symptoms compared to children without learning difficulties. Conclusion: the signs of depression varied according to age. Gender comparison revealed that girls had a higher incidence of depressive symptoms, especially in the group of children with the disorder.

Oral moxifloxacin or intravenous ceftriaxone for the treatment of low-risk neutropenic fever in cancer patients suitable for early hospital discharge.

GOALS OF WORK: Patients with low-risk neutropenic fever as defined by the Multinational Association of Supportive Care in Cancer (MASCC) score might benefit from ambulatory treatment. Optimal management remains to be clearly defined, and new oral antibiotics need to be evaluated in this setting. MATERIALS AND METHODS: Cancer patients with febrile neutropenia and a favorable MASCC score were randomized between oral moxifloxacin and intravenous ceftriaxone. All were fit for early hospital discharge. The global success rate was related to the efficacy of monotherapy, as well as to the success of ambulatory monitoring. MAIN RESULTS: The trial was closed prematurely because of low accrual. Ninety-six patients were included (47 in the ceftriaxone arm and 49 in the moxifloxacin arm). A total of 65% were women, 30.2% had lymphoma, 34.4% had metastatic, and 35.4% had non-metastatic solid tumors. The success rates of home antibiotics were 73.9% and 79.2% for ceftriaxone and moxifloxacin, respectively. Seven patients were not discharged, and 14 required re-hospitalization. There were 17% of microbiologically documented infections that were, in most cases, susceptible to oral monotherapy. CONCLUSIONS: These results suggest that MASCC is a valid and useful tool to select patients for ambulatory treatments and that oral moxifloxacin monotherapy is safe and effective for the outpatient treatment of cancer patients with low-risk neutropenic fever.