537 research outputs found
Ecthyma gangrenosum caused by Pseudomonas aeruginosa in a patient with astrocytoma treated with chemotherapy
Ecthyma gangrenosum, presenting as embolic lesions caused by Pseudomonas aeruginosa infection, has distinct pathognomonic features and a high mortality rate in patients with bacteremia, but when recognized early is easily treated. In this case report we describe this disseminated infection in an adult patient treated with chemotherapy for an astrocytoma
Toxicity of (neo)adjuvant chemotherapy for BRCA1- and BRCA2-associated breast cancer
Treatment with (neo)adjuvant chemotherapy for breast cancer, as currently given, causes cell damage by induction of double-strand DNA breaks. Because BRCA1 and BRCA2 proteins play a role in the repair of DNA damage, the efficacy of (neo)adjuvant chemotherapy may be increased in BRCA1/2-associated breast cancer patients. As a downside, acute chemotherapy-related toxicity may also be increased. We selected all female patients who were treated at the Erasmus MC Cancer Institute, with (neo)adjuvant chemotherapy for primary or locoregional recurrence of breast cancer (PBC/LR) between January 1, 2004 and December 31, 2014. The primary outcome was the relative total dose intensity (RTDI), calculated for anthracyclines and taxanes separately. Secondary outcomes were the occurrence of febrile neutropenia, delay in chemotherapy administration, and switch to another chemotherapy regimen due to toxicity. In total, 701 patients treated for PBC/LR were eligible for data analyses, among which 85 BRCA1/2 mutation carriers (n = 67 BRCA1 and n = 18 BRCA2). The mean RTDI for anthracyclines was not significantly different between both groups (98.7 % in the BRCA1/2, 96.6 % in the sporadic group, p = 0.27). Also the mean RTDI for taxanes was not significantly different between the groups (93.6 % in the BRCA1/2-associated, 90.0 % in the sporadic group, p = 0.12). Linear regression analysis revealed no significant effect of BRCA1/2 mutation carriership on the RTDIs. No significant differences were found in the percentages of patients presenting with febrile neutropenia, having a delay in chemotherapy administration or switching to an altered chemotherapy regimen. Additionally, the odds ratios showed no significant effect of BRCA1/2 mutation carriership on the secondary outcome variables. (Neo)adjuvant chemotherapy-related toxicity was not different between BRCA1/2-associated and sporadic breast cancer patients suggesting that the DNA damage repair mechanism of non-cancer cells with only one normal copy of either the BRCA1 or BRCA2 gene is sufficiently functional to handle acute chemotherapy-associated toxicity
Clinical experience with venlafaxine in the treatment of hot flushes in women with a history of breast cancer
OBJECTIVE: To obtain practical experience with venlafaxine for hot flushes
in breast cancer patients and incorporate this in a treatment protocol.
METHOD: Twenty-two women with a history of breast cancer (mean age 49.2
years, range 35-65) were referred for consideration of treatment with
venlafaxine for hot flushes. Patients received extensive information on
treatment with venlafaxine and were advised to self-monitor the frequency
of their hot flushes. RESULTS: Eight women did not start venlafaxine
because they had no postmenopausal complaints, were lost to follow-up, had
too low a frequency of hot flushes, or refused treatment. Eventually 14
women started venlafaxine. Two of them did not tolerate venlafaxine, four
reported some effect but stopped because of side effects, two women had no
effect whatsoever. Six women observed a clear ( > 50%) reduction in their
hot flush frequency that was maintained at a median follow-up of 13
months. CONCLUSION: The group of patients referred for treatment was more
heterogeneous and more patients dropped out because of side effects than
expected. Extensive patient education, patient selection and evaluation of
the treatment effect (by self-monitoring of hot flush frequency) are
mandatory to avoid useless (continuation of) treatment and to prepare
patients for side effects. Under these conditions, a substantial minority
of patients benefit from venlafaxine
Low Dose Methotrexate and Vinblastine, Given Weekly to Patients With Desmoid Tumours, is Associated With Major Toxicity
Purpose: To evaluate the tolerance of a low dose chemotherapy regimen for desmoid tumours
Neuropsychological performance in survivors of breast cancer more than 20 years after adjuvant chemotherapy
Purpose: Adjuvant chemotherapy for breast cancer can have adverse effects on cognition shortly after administration. Whether chemotherapy has any long-term effects on cognition is largely unknown, yet it becomes increasingly relevant because of the widespread use of chemotherapy for early-stage breast cancer and the improved survival. We investigated whether cyclophosphamide, methotrexate, and fluorouracil (CMF) chemotherapy for breast cancer is associated with worse cognitive performance more than 20 years after treatment. Patients and Methods: This case-cohort study compared the cognitive performance of patients with breast cancer who had a history of adjuvant CMF chemotherapy treatment (six cycles; average time since treatment, 21 years; n = 196) to that of a population-based sample of women never diagnosed with cancer (n = 1,509). Participants were between 50 and 80 years of age. Exclusion criteria were ever use of adjuvant endocrine therapy, secondary malignancy, recurrence, and/or metastasis. Results: The women exposed to chemotherapy performed significantly worse than the reference group on cognitive tests of immediate (P = .015) and delayed verbal memory (P = .002), processing speed (P < .001), executive functioning (P = .013), and psychomotor speed (P = .001). They experienced fewer symptoms of depression (P < .001), yet had significantly more memory complaints on two of three measures that could not be explained by cognitive test performance. Conclusion: Survivors of breast cancer treated with adjuvant CMF chemotherapy more than 20 years ago perform worse, on average, than random population controls on neuropsychological tests. The pattern of cognitive problems is largely similar to that observed in patients shortly after cessation of chemotherapy. This study suggests that cognitive deficits following breast cancer diagnosis and subsequent CMF chemotherapy can be long lasting
Toxicity of (neo)adjuvant chemotherapy for BRCA1- and BRCA2-associated breast cancer
Treatment with (neo)adjuvant chemotherapy for breast cancer, as currently given, causes cell damage by induction of double-strand DNA breaks. Because BRCA1 and BRCA2 proteins play a role in the repair of DNA damage, the efficacy of (neo)adjuvant chemotherapy may be increased in BRCA1/2-associated breast cancer patients. As a downside, acute chemotherapy-related toxicity may also be increased. We selected all female patients who were treated at the Erasmus MC Cancer Institute, with (neo)adjuvant chemotherapy for primary or locoregional recurrence of breast cancer (PBC/LR) between January 1, 2004 and December 31, 2014. The primary outcome was the relative total dose intensity (RTDI), calculated for anthracyclines and taxanes separately. Secondary outcomes were the occurrence of febrile neutropenia, delay in chemotherapy administration, and switch to another chemotherapy regimen due to toxicity. In total, 701 patients treated for PBC/LR were eligible for data analyses, among which 85 BRCA1/2 mutation carriers (n = 67 BRCA1 and n = 18 BRCA2). The mean RTDI for anthracyclines was not significantly different between both groups (98.7 % in the BRCA1/2, 96.6 % in the sporadic group, p = 0.27). Also the mean RTDI for taxanes was not significantly different between the groups (93.6 % in the BRCA1/2-associated, 90.0 % in the sporadic group, p = 0.12). Linear regression analysis revealed no significant effect of BRCA1/2 mutation carriership on the RTDIs. No significant differences were found in the percentages of patients presenting with febrile neutropenia, having a delay in chemotherapy administration or switching to an altered chemotherapy regimen. Additionally, the odds ratios showed no significant effect of BRCA1/2 mutation carriership on the secondary outcome variables. (Neo)adjuvant chemotherapy-related toxicity was not different between BRCA1/2-associated and sporadic breast cancer patients suggesting that the DNA damage repair mechanism of non-cancer cells with only one normal copy of either the BRCA1 or BRCA2 gene is sufficiently functional to handle acute chemotherapy-associated toxicity
Curatieve resectie van solitaire claviculametastase
Achtergrond
Het gemetastaseerd mammacarcinoom wordt beschouwd als niet-curabele ziekte waarbij patiënten
alleen in aanmerking komen voor palliatieve systemische behandeling. Bij geselecteerde
patiënten met beperkte metastasen wordt echter langdurige ziektevrije overleving
beschreven na chirurgische resectie als onderdeel van de multidisciplinaire behandeling.
Casus
Een 49-jarige vrouw had pijn en een zwelling ter plaatse van haar linker sleutelbeen. Zij was 4
jaar eerder behandeld met mammasparende therapie en adjuvante systemische therapie
voor een lobulair mammacarcinoom links (stadium pT1N0M0). Aanvullend beeldvormend
onderzoek en histologisch onderzoek van een biopt resulteerden in de diagnose ‘solitaire
claviculametastase’. Er werd besloten in opzet curatief te behandelen met inductiechemotherapie
gevolgd door een mediale clavicularesectie en aanvullende radiotherapie, en een
wijziging van de endocriene therapie.
Conclusie
Een solitaire claviculametastase van een mammacarcinoom is zeldzaam. Bij patiënten met een
solitaire ossale metastase van een mammacarcinoom met gunstige prognostische factoren
kan chirurgische resectie worden overwogen als onderdeel van een multidisciplinaire
behandeling met curatieve intentie
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