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

Role of whole brain radiotherapy in the management of infratentorial metastases from lung and breast cancer

BACKGROUND: Brain metastases (BM) occur in almost one third of patients with systemic malignancies. Only a small number of studies focus on infratentorial location and whole brain radiotherapy (WBRT) as the main non-surgical management. The aim of the study was to compare the prognosis of patients treated with WBRT among patients with supra- or infratentorial lesions. MATERIALS AND METHODS: At a single center, 263 patients with either breast (BC) or lung (LC) cancer, that had developed BM and received treatment with WBRT, were analyzed during an 8-year period. RESULTS: A total of 152 patients with BC and 111 with LC were analyzed, median age at the time of BM was 50.7 years, systemic activity other than BM was detected in 91%. Newly diagnosed BM were supratentorial in 40%, infratentorial in 10% and 51% in both locations. Median overall survival was 13 months (95% CI: 11.1–14.8 months), without significant difference between supra- or infratentorial location. WBRT alone was administered in 79% of patients, whereas WBRT with chemtoreapy was provided for 21%. CONCLUSION: In patients with BM from LC or BC that were not candidates for surgical resection, palliative WBRT appears to be equally effective in those with supra- or infratentorial locations

The Comparative Treatment of Intraventricular Chemotherapy by Ommaya Reservoir vs. Lumbar Puncture in Patients With Leptomeningeal Carcinomatosis

Object: Leptomeningeal Carcinomatosis (LCM) represents a state of systemic malignant disease with poor prognosis. The purpose of this study is to compare overall survival (OS) between intraventricular chemotherapy through Ommaya reservoir (OR) and chemotherapy through lumbar puncture (LP) in LCM.Patients and Methods: Forty adult patients with LCM were included. All patients underwent lumbar puncture and Magnetic resonance imaging (MRI). Thirty patients received chemotherapy through LP and 10 undergone colocation of Ommaya reservoir for intraventricular chemotherapy.Results: The most common symptom was headache (Present in 50%). The cranial nerves most affected were VI and VII. Leptomeningeal enhancement was the most frequent finding in MRI. The OS in the LP group was 4 months and Ommaya group was 9.2 months (p = 0.0006; CI:1.8-3), with statistical differences in favor to Intraventricular treatment. Proportional hazard regression showed that receiving chemotherapy through Ommaya reservoir was a protective factor (Hazard ratio = 0.258, Standard Error = 0.112, p = 0.002 and 95% CI 0.110-0.606). Using KPS as a factor did not affect the hazard ratio of Ommaya reservoir itself.Conclusions: OS was significantly higher in patients with Ommaya reservoir in spite of Karnofsky Performance Status (KPS) previous to chemotherapy. Therefore, intraventricular chemotherapy should be preferred over lumbar puncture chemotherapy administration if there are resources available

Relación entre síntomas autonómicos con niveles de ansiedad y depresión en mujeres con cáncer de mama

Abstract: Breast cancer presents a threat to women who experience stress. Stress can cause anxiety, depression and even deregulate autonomic functioning. Objective: to evaluate the relationship between autonomic symptoms and levels of anxiety and depression reported by women with breast cancer. Method: application of the Autonomic Symptom Profile (ASP) and Hospital Anxiety and Depression Scale (HADS) to 59 women. Results: We found that 49% and 24% of women obtained scores from moderate to severe anxiety and depression, respectively. Pearson correlation analysis found a positive correlation in secretory symptoms, bladder symptoms and sleep disturbances, as well as total ASP score with scores of HADS. In addition, a positive correlation between symptoms of anxiety and depression was found. Conclusion: autonomic manifestations are associated with affective symptoms, thereby signaling the need for a psychophysiological approach to integrate affective and autonomic symptoms.Resumen: El cáncer de mama es una amenaza debido al estrés que confrontan las mujeres. Éstos pueden generar ansiedad, depresión e incluso, desregular el funcionamiento autonómico. Objetivo: evaluar la relación entre síntomas autonómicos y, síntomas de ansiedad y depresión en mujeres con cáncer de mama. Método: se evaluaron 59 mujeres a quienes se les aplicó el Perfil de Síntomas Autonómicos (PSA) y la Escala de Ansiedad y Depresión Hospitalaria (HADS). Resultados: el 49% y el 24% de las mujeres obtuvieron puntajes de moderado a severo para ansiedad y depresión respectivamente. En el análisis de correlación de Pearson se encontró una correlación positiva en los síntomas secretomotores vejiga, sueño y el puntaje total del PSA con los puntajes de HADS. Además de una correlación positiva entre ansiedad y depresión. Conclusión: ante la presencia de manifestaciones autonómicas relacionadas con síntomas afectivos se observa la necesidad de un abordaje psicofisiológico integral

Add-on Pyridostigmine Enhances CD4+ T-Cell Recovery in HIV-1-Infected Immunological Non-Responders: A Proof-of-Concept Study

BackgroundIn human immunodeficiency virus (HIV)-infection, persistent T-cell activation leads to rapid turnover and increased cell death, leading to immune exhaustion and increased susceptibility to opportunistic infections. Stimulation of the vagus nerve increases acetylcholine (ACh) release and modulates inflammation in chronic inflammatory conditions, a neural mechanism known as the cholinergic anti-inflammatory pathway (CAP). Pyridostigmine (PDG), an ACh-esterase inhibitor, increases the half-life of endogenous ACh, therefore mimicking the CAP. We have previously observed that PDG reduces ex vivo activation and proliferation of T-cells obtained from people living with HIV.MethodsWe conducted a 16-week proof-of-concept open trial using PDG as add-on therapy in seven HIV-infected patients with discordant immune response receiving combined antiretroviral therapy, to determine whether PDG would promote an increase in total CD4+ T-cells. The trial was approved by the Institutional Research and Ethics Board and registered in ClinicalTrials.gov (NCT00518154).ResultsSeven patients were enrolled after signing informed consent forms. We observed that addition of PDG induced a significant increase in total CD4+ T-cells (baseline = 153.1 ± 43.1 vs. week-12 = 211.9 ± 61.1 cells/µL; p = 0.02). Post hoc analysis showed that in response to PDG, four patients (57%) significantly increased CD4+ T-cell counts (responders = 257.8 ± 26.6 vs. non-responders = 150.6 ± 18.0 cells/µL; p = 0.002), and the effect persisted for at least 1 year after discontinuation of PDG.ConclusionOur data indicate that in patients with HIV, add-on PDG results in a significant and persistent increase in circulating CD4+ T-cells

Cervical Intramedullary Schwannoma: Case Report and Review of the Literature

Cervical intramedullary schwannomas are extraordinarily rare. Gross total resection is the best therapeutic option for these types of tumors. Although rare, intramedullary schwannomas should be considered as a differential diagnosis of intramedullary lesions since a good prognosis can be guaranteed to the majority of these patients. We present a case of a cervical intramedullary schwannoma surgically treated in a 19-year-old male patient who initially presented with motor neuron disease