Accompanying a Peaceful Passing

For nearly a month, Mr. A had struggled to climb the clinic staircase leading to room 307.[...

Ethical Considerations in Chemotherapy and Vaccines in Cancer Patients in Times of the COVID-19 Pandemic

The COVID-19 situation is a worldwide health emergency with strong implications in clinical oncology. In this viewpoint, we address two crucial dilemmas from the ethical dimension: (1) Is it ethical to postpone or suspend cancer treatments which offer a statistically significant benefit in quality of life and survival in cancer patients during this time of pandemic?; (2) Should we vaccinate cancer patients against COVID-19 if scientific studies have not included this subgroup of patients? Regarding the first question, the best available evidence applied to the ethical principles of Beauchamp and Childress shows that treatments (such as chemotherapy) with clinical benefit are fair and beneficial. Indeed, the suspension or delay of such treatments should be considered malefic. Regarding the second question, applying the doctrine of double-effect, we show that the potential beneficial effect of vaccines in the population with cancer (or those one that has had cancer) is much higher than the potential adverse effects of these vaccines. In addition, there is no better and less harmful known solution

Multiple nivolumab-induced CNS demyelination with spontaneous resolution in an asymptomatic metastatic melanoma patient.

Immune checkpoint inhibitors (ICPis) have revolutionised the treatment of melanoma by significantly increasing survival rates and disease control. However, ICPis can have specific immune-related adverse events, including rare but severe neurological toxicity. We report a 44-year-old man diagnosed with stage IIIB melanoma who developed metastatic disease (pulmonary and brain metastases) and was treated with stereotactic radiosurgery and nivolumab immunotherapy. He developed asymptomatic multifocal diffuse white matter lesions consistent with active central nervous system demyelination seen on brain MRI. One month after cessation of the immunotherapy, spontaneous regression of the demyelinating lesions was observed, suggesting a nivolumab-related toxicity. We report the first case of a melanoma patient with an asymptomatic and spontaneously reversible central nervous system demyelination following nivolumab immunotherapy. This case highlights the need for better recognition of such atypical and rare neurological toxicities which could be mistaken for progressive brain metastases. Early recognition and appropriate management are crucial to reduce severity and duration of these toxicities, especially for patients with less favourable evolution

Utilidad del ultrasonido en el diagnóstico de la patología pleuropulmonar

We performed ultrasound studies in 67 patients with opacities adjacent to the thoracic wall. An accurate diagnosis of the nature of the lesion was made in 95% of cases. The yield of thoracocentesis was increased by marking guided by ultrasound

Negative 18F-FET PET/CT in brain metastasis recurrence: a teaching case report.

Positron emission tomography (PET) using O-(2-[ <sup>18</sup> F]fluoroethyl)-L-tyrosine ( <sup>18</sup> F-FET) PET has been shown to be a useful tool for differentiating radiation therapy outcomes, such as brain metastasis recurrence or radiation necrosis. We present the case of a female patient with brain metastases from pulmonary mucinous adenocarcinoma with suspicion of tumor recurrence on follow-up magnetic resonance imaging (MRI) after radiosurgery. <sup>18</sup> F-FET PET/computed tomography (CT) was indicative of radiation necrosis. Due to the patient's medical history and the discrepancy between the brain MRI and PET/CT results, surgical biopsies were decided, which were positive for brain metastasis recurrence. The diagnosis of metastasis recurrence may also be challenging on <sup>18</sup> F-FET PET/CT. In case of discrepancies between MRI and PET/CT results, false-negative <sup>18</sup> F-FET PET/CT remains a possibility and requires careful follow-up or biopsy