Didem Sener Dede

Ifosfamide and Doxorubicin Combination Chemotherapy for Recurrent Nasopharyngeal Carcinoma Patients

BACKGROUNDnWe assessed the efficacy and toxicity of ifosfamide and doxorubicin combination chemotherapy (CT) regimen retrospectively in Turkish patients with recurrent or metastatic nasopharyngeal carcinoma (NPC) previously treated with platinum-based chemotherapy.nnnMETHODSnA total of thirty patients who had received cisplatin based chemotherapy/chemoradiotherapy as a primary treatment received ifosfamide 2500 mg/m2 days 1-3, mesna 2500 mg/m2 days 1-3, doxorubicin 60 mg/m2 day 1 (IMA), repeated every 21 days. Eligible patients had ECOG PS<2, measurable recurrent or metastatic disease, with adequate renal, hepatic and hematologic functions.nnnRESULTSnMedian age was 47 (min-max; 17-60). Twenty six (86.7%) were male. Median cycles of chemotherapy for each patient were 2 (range:1-6). Twenty patients were evaluable for toxicity and response. No patient achieved complete response, with nine partial responses for a response rate of 30.0% in evaluable patients. Stable disease, and disease progression were observed in five (16.7%) and six (20.0%) patients, respectively. Clinical benefit was 46.7%. Median time to progression was 4.0 months. Six patients had neutropenic fever after IMA regimen and there were one treatment-related death due to tumor lysis syndrome in first cycle of the CT. No cardiotoxicity was observed after CT and treatments were generally well tolerated.nnnCONCLUSIONnIfosfomide and doxorubicin combination is an effective regimen for patients with recurrent and metastatic NPC. For NPC patients demonstrating failure of cisplatin based regimens, this CT combination may be considered as salvage therapy.

Medication Errors in Chemotherapy Preparation and Administration: a Survey Conducted among Oncology Nurses in Turkey

BACKGROUNDnMedication errors in oncology may cause severe clinical problems due to low therapeutic indices and high toxicity of chemotherapeutic agents. We aimed to investigate unintentional medication errors and underlying factors during chemotherapy preparation and administration based on a systematic survey conducted to reflect oncology nurses experience.nnnMATERIALS AND METHODSnThis study was conducted in 18 adult chemotherapy units with volunteer participation of 206 nurses. A survey developed by primary investigators and medication errors (MAEs) defined preventable errors during prescription of medication, ordering, preparation or administration. The survey consisted of 4 parts: demographic features of nurses; workload of chemotherapy units; errors and their estimated monthly number during chemotherapy preparation and administration; and evaluation of the possible factors responsible from ME. The survey was conducted by face to face interview and data analyses were performed with descriptive statistics. Chi-square or Fisher exact tests were used for a comparative analysis of categorical data.nnnRESULTSnSome 83.4% of the 210 nurses reported one or more than one error during chemotherapy preparation and administration. Prescribing or ordering wrong doses by physicians (65.7%) and noncompliance with administration sequences during chemotherapy administration (50.5%) were the most common errors. The most common estimated average monthly error was not following the administration sequence of the chemotherapeutic agents (4.1 times/month, range 1-20). The most important underlying reasons for medication errors were heavy workload (49.7%) and insufficient number of staff (36.5%).nnnCONCLUSIONSnOur findings suggest that the probability of medication error is very high during chemotherapy preparation and administration, the most common involving prescribing and ordering errors. Further studies must address the strategies to minimize medication error in chemotherapy receiving patients, determine sufficient protective measures and establishing multistep control mechanisms.

Charlson Comorbidity Index, inappropriate medication use and cognitive impairment

SummaryBackgroundThe aim is to evaluate the association between the Charlson Comorbidity Index (CCI), polypharmacy, inappropriate medication use and cognitive impairment in long-term care facility patients.MethodsAxa0cross-sectional study including 105 long-term care facility residents was performed. The Charlson Comorbidity Index (CCI) was used. Inappropriate drug use (IDU) was defined according to the STOPP (Screening Tool of Older People’s Prescriptions) criteria. Univariate analysis to identify variables associated with patient outcome related with cognitive impairment was investigated with χ2, Pearson correlation, Fisher exact, and Mann–Whitney Uxa0test where appropriate. For the multivariate analysis, the possible factors identified with univariate analysis were further entered into logistic regression analysis.ResultsAxa0significant difference was found between gender, CCI and cognitive impairment (pxa0= 0.038, pxa0= 0.01). While every one point increment in the CCI increases the risk of cognitive impairment 3.1xa0fold (95% CIxa0= 1.8–5.4, pxa0< 0.001), hypertension increases the risk 12xa0fold (95% CIxa0= 2.5–67.8, pxa0= 0.002). While the correlation between Mini-Mental Status Examination (MMSE) score and polypharmacy is significant (pxa0= 0.015), the correlation between MMSE and IDU was insignificant (pxa0= 0.739). The association of urogenital system drugs and dementia was significant (pxa0= 0.044).ConclusionsComorbidities, especially hypertension and old age, are risk factors for cognitive impairment. Polypharmacy correlates with MMSE and is considered axa0risk factor for cognitive impairment. Inappropriate medication use is high among long-term care facility residents. More studies on large cohorts are needed regarding optimal drug prescription and detection of specific drugs that may have an impact on cognitive performance.

Selective internal radiation therapy in untreated patients with unresectable liver dominant metastatic colorectal cancer.

10.2217/fon-2016-0276

Expectations of response from octreotide therapy in recurrent phosphaturic mesenchymal tumors--do they reflect reality?

Phosphaturic mesenchymal tumor (PMT) is a rare and small tumor leading to oncogenic osteomalacia and deriving mostly from benign mesenchymal origin. The tumor may originate in any part of the body such as soft tissue or bone site, but is more frequent in the upper and lower extremities and craniofacial sinuses. Its most common type is oncogenic osteomalacia (OO) associated phosphaturic mesenchymal tumor, mixed connective tissue type (Weider and Santa Cruz, 1987). Pathological mechanisms underlying OO associated PMTs still remain unknown, but recently it has been found that these tumors express metabolically active fibroblast growth factor-23 (FGF-23) termed as phosphatonins. FGF23 gene, which is expressed at low level in normal tissue, has a high rate of expression in these tumors (Jonsson et al., 2003). FGF-23 protein phosphate in secreted by mesenchymal tumor inhibits renal tubular epithelial absorption, which in turn results in renal phosphate wasting and developing hypophosphatemia leads to osteomalacia with bone fractures and widespread muscular weakness (Carpenter, 2003). In-vitro studies have demonstrated that many mesenchymal tumours express somatostatin receptors (Reubi et al., 1996). Treatment with somatostatin analogue octreotide is an alternative form of medical therapy that may be considered when the tumor cannot be found despite intensive search. In the present report, the response of a case with phosphaturic mesenchymal tumor secreting FGF-23 and associated with oncogenic osteomalacia that has been followed for 7 years to octreotide treatment is evaluated. It is difficult to diagnose PMTs, since they are of small size, grow slowly and frequently has unusual locations, leading to delay in treatment (Jan de Beur et al., 2002). This disease courses with local recurrences and tumor resection brings about improvement of symptoms by correcting metabolic imbalance (Folpe AL., et al (2004). Positive staining was detected in a current study for somatostatin receptor in 14 PMT patients secreting FGF23 (Houang et al., 2013). It was demonstrated that in PMTs expressing somatostatin receptors (SSTRS), wholebody Tc-octreotide scintigraphy with SPECT/CT can demonstrate occult oncogenic osteomalacia (Rodrigues et al., 2014). In 6 patients whose diagnosis was delayed in spite of serious symptoms, gallium-68 DOTATATE PET/ CT detected localized phosphaturic mesenchymal tumors LETTER TO THE EDITOR

Non-metastatic Upper Tract Transitional Cell Carcinoma: Single Center Experience

BACKGROUNDnUpper tract transitional cell carcinomas (UTCC) are relatively uncommon but prognosis is generally worse than TCC of bladder.nnnMETHODSnBetween March 2004 and June 2012, patients with initial non- metastatic UTCC were assessed in the Medical Oncology and Urology Departments of Ataturk Training and Research Hospital.nnnRESULTSnA total of 11 patients with initially non-metastatic UTCC were detected in the 8 year period, all males. Median age of was 62 (range, 38-74). Six lesions were located in the renal pelvis and 5 in the ureter. Nephroureterectomy was performed in 9 patients, and distal ureterectomy and cuff excision of the bladder in the remaining 2. The majority (n= 9) had high grade tumors. Median primary tumor diameter was 3.5 cm (range, 0.7-10). Five patients (45.5%) were stage I, 2 (18.2%) were stage II, and 4 (36.4%) were stage III. While adjuvant chemotherapy was not applied for stage I and II disease (n= 7), 4 to 6 courses were applied for 3 of the stage III patients. Also one stage III case received adjuvant radiotherapy. Up to 100 months follow-up, median overall survival was 13 months (range, 5-100 months). While stage I and II patients are following-up without muscle-invasive progression, 2 of stage III patients demonstrated progression.nnnCONCLUSIONnWe need more collaborative studies to determine management of especially pT3-pT4 patients with UTCC.