Enrique Aranda Aguilar

Pseudomembranous colitis associated with chemotherapy with 5-fluorouracil

Pseudomembranous colitis is frequently associated with antibiotics and more rarely with chemotherapeutic agents such as 5-fluorouracil. The objective of this study is to show that it is possible to confuse this infection with chemotherapy associated toxicity. We present a 54 year old woman who underwent surgery for colorectal cancer and in the first cycle of chemotherapy with 5-fluorouracil developed pseudomembranous colitis. We detected the toxin B ofClostridium difficile in stools and we began early antibiotic treatment. Thus, in patients with post chemotherapy neutropenia and diarrhoea that develop negatively, we have to rule out this infection.

Adjuvant treatment in elderly patients with breast cancer: critical review of clinical practice.

Today the use of adjuvant treatment of breast cancer is unquestionable in the management of this disease. Both chemotherapy and hormonal therapy have proved to be beneficial, not only with respect to the reduction of the risk of recurrence, but also with respect to mortality. However, in elderly patients, this therapeutic approach is occasionally the subject of controversy, due to the undervaluing of the tumoral disease with respect to the multiple pathology frequently present in these patients. This study analyses a retrospective series of 100 patients more than 70 years old with breast cancer who underwent radical surgery between 1990 and 1998, with an extension study without evidence of metastasis and a minimum follow-up of 2 years. As occurs in the population of this age, in our series 77% of the patients presented with concomitant disease under medical treatment, and although the majority received adjuvant treatment with tamoxifen, the principal cause of death in this series was the breast cancer that had been diagnosed.Today the use of adjuvant treatment of breast cancer is unquestionable in the management of this disease. Both chemotherapy and hormonal therapy have proved to be beneficial, not only with respect to the reduction of the risk of recurrence, but also with respect to mortality. However, in elderly patients, this therapeutic approach is occasionally the subject of controversy, due to the undervaluing of the tumoral disease with respect to the multiple pathology frequently present in these patients. This study analyses a retrospective series of 100 patients more than 70 years old with breast cancer who underwent radical surgery between 1990 and 1998, with an extension study without evidence of metastasis and a minimum follow-up of 2 years. As occurs in the population of this age, in our series 77% of the patients presented with concomitant disease under medical treatment, and although the majority received adjuvant treatment with tamoxifen, the principal cause of death in this series was the breast cancer that had been diagnosed.

Anti-emetic efficacy of oral granisetron in the total control of late-onset emesis induced by cyclophosphamide-containing chemotherapy

IntroductionEffectiveness of 5-HT3 receptor antagonists in preventing cyclophosphamide-induced emesis suggests that it is mediated by serotonin release. Since urinary 5-hydroxyindoleacetic acid (5-HIAA) is not significantly increased, the mechanism of emesis induction remains poorly understood, and the usefulness of these drugs in late-onset emesis prevention remains controversial.Material and methodsIn this randomised, double-blind, and placebo-controlled trial, 139 chemotherapy-naïve breast cancer patients received intravenous chemotherapy combinations containing cyclophosphamide at doses ≥500 mg/m2. Total antiemetic control was the primary efficacy parameter. On day 0 all patients received intravenous granisetron (3 mg) prior to chemotherapy. On day 1 patients were randomly assigned either to oral granisetron (1 mg bid) or to placebo, for a 2-day course. Patients remained hospitalised during the study period. Rescue therapy (up to 2 doses of i.v. granisetron 3 mg) was promptly administered should there be a second episode of vomiting. Twenty-four hour urine samples were collected on days −1 to +2, for analysis of 5-HIAA excretion.ResultsRelative to the control group, significantly more patients in the oral granisetron group experienced total control of emesis on day 1 (67% versus 49%; p=0.04), on day 2 (76% versus 52%; p<0.01), and on days 1–2 (60% versus 42%; p=0.04). Excretion of 5-HIAA was significantly increased on day 0, day 1 and day 2 compared to levels on day −1 (p<0.01 for all paired comparisons). The type of chemotherapy administered and the patients history of vomiting were the variables influencing the total control of emesis.ConclusionsOral granisetron provided high rates of effective and safe control of late-onset emesis induced by cyclophosphamide-based chemotherapy. Urinary excretion of 5-HIAA was significantly increased during the entire emesis period.ResumenIntroducciónLa eficacia de los antagonistas de los receptores 5-HT3 en la prevención de la emesis inducida por ciclofosfamida sugiere que ésta es originada por la liberación de serotonina. Dado que hasta el momento no se ha constatado incremento en los niveles urinarios de ácido 5-hidroxiindolacético (ác. 5-HIA), el mecanismo de inducción de la emesis por ciclofosfamida se conoce pobremente y la utilidad de estos agentes en el control de su emesis diferida sigue siendo controvertida.Materiales y métodosEn este estudio multicéntrico, randomizado, doble ciego y controlado, se incluyeron 139 pacientes con cáncer de mama que recibían por primera vez combinaciones de quimioterapia que contenían ciclofosfamida por vía intravenosa a dosis ≥500 mg/m2. El control antiemético total fue definido como parámetro de eficacia primaria. El día 0 todos los pacientes recibieron granisetrón por vía intravenosa (3 mg) antes de la administración de la quimioterapia. El día 1 los pacientes fueron asignados aleatoriamente para recibir granisetrón por vía oral (1 mg dos veces al día) o placebo durante 2 días consecutivos. Los pacientes permanecieron hospitalizados durante el período de estudio. Se administró tratamiento antiemético de rescate (hasta dos dosis consecutivas de 3 mg de granisetrón por vía intravenosa) inmediatamente después del segundo episodio de vómito. Asimismo se recogió la orina de 24 horas entre los días −1 a 2 para determinar la excreción de ác. 5-HIA.ResultadosDe manera significativa, más pacientes en el grupo de granisetrón administrado por vía oral que en el de placebo mostraron control total en el día 1 (67% frente al 49%; p=0,04), en el día 2 (76% frente al 52%; p<0,01), y en los días 1–2 (60% frente al 42%; p=0,04). En comparación con los niveles basales del día −1, se observaron incrementos significativos de la excreción de ác. 5-HIA en el día 0, en el día 1 y en el día 2 (p<0,01 para todas las comparaciones). El tipo de quimioterapia administrada y los antecedentes de hiperemesis gravídica condicionaron el control total como respuesta.ConclusionesDe forma eficaz y segura, granisetrón oral mostró una elevada tasa de control total en la prevención de la emesis diferida inducida por quimioterapia con ciclofosfamida. Se evidenció un incremento significativo de la eliminación urinaria de ác. 5-HIA a lo largo de todo el período emético.

Breast cancer screening: another point of view

The breast cancer screening programmes (BCSP) are very controversial at the present time. They are evaluated by different socio-economic sectors, each with its own particular point of view. Large numbers of breast cancer cases are concentrated in the Oncology Services, which are, therefore, sensitive to the changes that these programmes could bring about. All patients attending the medical oncology and radiotherapy services of the Reina Sofia University Hospital, Córdoba from January 1994 until January 2003 were reviewed. Of 1785 patients, 829 went to these services after the start of the BCSP introduced in March 1999 and 956 before it. The variables analysed were age, presentation form, stage and treatment received. In conclusion, the BCSP has produced favourable changes with respect to stage (increasing the percentage of early breast cancer) and therapeutic management (increasing conservative surgery and decreasing the number of adjuvant treatments (radiotherapy and chemotherapy)). These changes are more outstanding in the population group covered by the BCSP.

Reactivación del virus de la hepatitis B en paciente oncológico tras tratamiento con quimioterapia: hepatitis fulminante

Re-activation of the hepatitis B virus is very unusual, but has been described as a complication of chemotherapy. Most reported cases are related to haematological malignancies and, occasionally, to solid tumours.We report a case of hepatitis B virus re-activation resulting in fulminant hepatitis in a patient with non-small-cell lung cancer following chemotherapy with cisplatin and gemcitabine.Risk-factors associated with the re-activation were gender, age and the administration of cortico-steroids.During chemotherapy administered to patients with a history of chronic hepatitis B, care must be taken to avoid the administration of cortico-steroids as anti-emetics, and to monitor the patients transaminase concentrations.