Sina Vatandoust

Colorectal cancer: Metastases to a single organ

Colorectal cancer (CRC) is a common malignancy worldwide. In CRC patients, metastases are the main cause of cancer-related mortality. In a group of metastatic CRC patients, the metastases are limited to a single site (solitary organ); the liver and lungs are the most commonly involved sites. When metastatic disease is limited to the liver and/or lungs, the resectability of the metastatic lesions will dictate the management approach and the outcome. Less commonly, the site of solitary organ CRC metastasis is the peritoneum. In these patients, cytoreduction followed by hyperthermic intraperitoneal chemotherapy may improve the outcome. Rarely, CRC involves other organs, such as the brain, bone, adrenals and spleen, as the only site of metastatic disease. There are limited data to guide clinical practice in these cases. Here, we have reviewed the disease characteristics, management approaches and prognosis based on the metastatic disease site in patients with CRC with metastases to a single organ.

Phase II study evaluating efficacy and safety of everolimus with letrozole for management of advanced (unresectable or metastatic) non-small cell lung cancer after failure of platinum-based treatment: a preliminary analysis of toxicity.

AbstractIntroduction Lung cancer is one of the most common malignancies worldwide. Non-small cell lung cancer (NSCLC) comprises the majority of the cases of lung cancer. Previous studies have demonstrated a role for both the estrogen pathway and mammalian target of rapamycin (mTOR) in NSCLC.MethodsThis single-arm phase 2 study was designed to assess the safety and efficacy of combination treatment with aromatase inhibitor—letrozole—and mTOR inhibitor—everolimus—in the treatment of patients with advanced (unresectable stage III or stage IV) NSCLC who had failed at least one line of platinum-based chemotherapy.ResultsThe study was closed after enrolling five patients due to safety concerns. Of the five patients treated with the study combination, two patients developed grade 5 pulmonary toxicity and another patient developed reversible grade 4 pulmonary toxicity.ConclusionsThere is a probable causal relationship between the study medication and the reported serious adverse events. In the absence of additional clinical data in lung cancer patients, we recommend that extreme caution be exercised in the use of combined letrozole and everolimus regimens in patients with advanced lung cancers, active pulmonary pathologies, or both.

Guillain–Barre syndrome in colorectal cancer

Guillain–Barré syndrome has been reported in the setting of different malignancies. To the best of our knowledge, the association of Guillain–Barré syndrome and colorectal cancer has been reported in only two cases. As Guillain–Barré syndrome is potentially life threatening, it should be considered in the differential diagnosis of patients with colorectal cancer with neurological findings. Here we report two cases of Guillain–Barré syndrome in the setting of metastatic colorectal cancer.

Localised prostate cancer in elderly men aged 80-89 years, findings from a population-based registry

To investigate the rate of prostate cancer‐specific mortality (PCSM) and disease characteristics in patients diagnosed with localised prostate cancer at age 80–89 years in comparison with men diagnosed at age 70–79 years.

Goserelin Toxicities and Preferences for Ovarian Suppression Method in Pre-menopausal Women with Breast Cancer.

Goserelin, a form of medical ovarian suppression, is an effective treatment for pre‐menopausal women with breast cancer (PMBC). Meta‐analysis data showed that similar efficacy is achieved with medical ovarian suppression and non‐pharmacological ovarian suppression (NPOS) – oophorectomy or ovarian irradiation. The acceptance rate of NPOS remains low.

Acrokeratosis paraneoplastica (Bazex syndrome) associated with metastatic cutaneous squamous cell carcinoma

Acrokeratosis paraneoplastica (AP), or Bazex Syndrome, is a paraneoplastic process characterised by peripheral psoriaform lesions, palmoplantar keratosis and onychodystrophy. The majority of cases are associated with upper aerodigestive tract tumours, especially squamous cell carcinoma (SCC). Isolated cases have been reported in other tumour types. To our knowledge, there is only one other reported case of AP associated with cutaneous SCC. Here, we report a case of metastatic cutaneous SCC preceded by AP. A 69-year-old man presented with a 2-month history of a left axillary mass in the setting of previous skin malignancies. On examination, this was a 10-cm hard, non-mobile and non-tender lesion. Skin examination revealed hyperkeratosis and desquamation in a symmetrical acral distribution and nail changes, which had been present for 18months and had proven resistant to the topical therapies and oral acitretin (Fig. 1a, b). The rest of the examination was normal. A core biopsy of the axillary lesion (obtained prior to the consultation) displayed a p63-positive, poorly differentiated, large-cell carcinoma. Computed tomography scan demonstrated a suspicious area in the oesophagus. Fluorodeoxyglucose-positron emission tomography scan displayed avidity in the left axillary area with no uptake elsewhere. Endoscopy of upper gastrointestinal and upper aerodigestive tracts showed mildly inflamed Barrett’s mucosa and was negative for dysplasia or malignancy. Histology reports of previous skin excisions were followed up; these included a poorly differentiated SCC on the left forearm, which had been excised a year previously. Further review of histopathology specimens concluded that the pathologic appearance of the lesion in the left axilla was similar to the mentioned skin lesion and therefore in keeping with metastatic spread from the left forearm SCC. The patient was treated with a combination of cisplatin and 5-fluorouracil (infusion). After one cycle, the palmar lesions disappeared, and the plantar lesions improved markedly (Fig. 1c, d). After the second cycle, he underwent axillary lymphadenectomy. The histopathology did not show any viable malignancy in the lymph nodes (consistent with complete pathologic response). The pathophysiology of AP is still not well understood. It is thought to result from antibodies directed Figure 1 (a,b) Skin findings on presentation: Hyperkeratosis and desquamation in a symmetrical acral distribution. (c,d) Improvement of skin lesions after one cycle of chemotherapy: the palmar lesions disappeared and the plantar lesions improved markedly. Letters to the Editor

Pregnancy screening prior to chemotherapy administration

A retrospective case notes review was performed to determine compliance with screening for undetected pregnancy prior to commencement of chemotherapy at Flinders Medical Centre. All female patients aged 18–55 who commenced chemotherapy between January and December 2014 were included. During the first 12 months, for women identified as having childbearing potential, pre‐chemotherapy pregnancy screening was performed only in 40% of patients under 40 years and in 20.5% of the entire age range.

Prostate cancer mortality is high in the elderly and can be reduced by selective individualized curative treatment

We read with interest, Bandini et al’s paper which, using a SEER-based cohort, reports radical prostatectomy (RP) or radiotherapy (RT) reduces prostate cancer (PCa) mortality in the elderly, and concludes curative therapy for localized prostate cancer should not be denied on the basis of chronological age alone [1]. We inform on our real-world data which supports these results [2]. The South Australian Prostate Cancer Clinical Outcomes Collaborative (SAPCCOC) is the longest running prostate cancer registry in the Southern Hemisphere. It commenced in 1998 and is a prospective, third-party collected-, longitudinal, observational registry which follows participants until death or withdrawal. We examined men from our registry between 2005 and 2014, aged 70–89 without evidence of metastatic disease at presentation, identifying 1888 participants and dividing them into two cohorts based on age at diagnosis. Cohort 1(“Co1”)—1428(76%) were aged 70–79, and cohort 2(“Co2”)—460(24%) aged 80–89. Differences associated with age were examined by 5-year groupings. We compared patient and disease demographics, treatments and survival outcomes. Curative intent included RP, external beam radiotherapy and brachytherapy. Non-curative therapies included hormonal treatments and observation. Pair-wise interaction with age, Charlson co-morbidity scores and year of diagnosis were included as covariates. Additionally, a propensity score-matched conditional binomial logistic regression was employed. Median follow-up was similar at 7.3 and 7.0 years. Causes of death were obtained based on mandatory reporting to the state Births, Deaths and Marriages registry. Co2 had higher Gleason scores, and pre-treatment PSA values (p < 0.001), but not T-stage (p = 0.17). The odds of receiving curative treatment in Co2 was lower than in Co1 (OR = 0.12; 95% CI = 0.09, 0.16; p < 0.001). Curative intent treatments (RP and RT) were used more frequently in Co1 (62%) compared with the older group (18%). There was a higher rate of RP in the younger group (18 vs 0%). Similarly, the rate of radiotherapy was higher in Co1 (44 vs 18%). In contrast, primary hormonal therapy (21 vs 4%) and watchful waiting (22 vs 16%) were more frequent in Co2. At the time of analysis, there were 310 deaths (22%) in Co1 of which 97 (31%) were due to PCa. In Co2 there were 263 deaths (57%) of which 73 (28%), were attributable to PCa. The younger group (Co1) had had better overall survival, with 87% 5-yearand 68% 10-year survival, vs 55% 5-year and 26% 10-year survival in older, which is not unexpected in view of the differential Charlson scores (Co1-mean score 1.3; Co2-mean score 1.9, p < 0001), however, the proportion of deaths due to prostate cancer was the same in each group (31 vs 28%). Older patients were at * Kim Moretti kim@theurologist.net.au

Online information and support needs of women with advanced breast cancer: a qualitative analysis

PurposeWomen with advanced breast cancer (ABC) face significant adjustment challenges, yet few resources provide them with information and support, and attendance barriers can preclude access to face-to-face psychosocial support. This paper reports on two qualitative studies examining (i) whether information and support-seeking preferences of women with ABC could be addressed in an online intervention, and (ii) how an existing intervention for patients with early stage cancer could be adapted for women with ABC.MethodsWomen with ABC participated in telephone interviews about their information and support-seeking preferences (N = 21) and evaluated an online intervention focused on early-stage cancer (N = 15). Interviews were transcribed and underwent thematic analysis using the framework method to identify salient themes.ResultsParticipants most commonly sought medical, lifestyle-related, and practical information/support; however, when presented with an online intervention, participants most commonly gave positive feedback on content on coping with emotional distress. Difficulty finding information and barriers to using common sources of information/support including health professionals, family and friends, and peers were reported; however, some women also reported not wanting information or support. All participants evaluating the existing intervention gave positive feedback on various components, with results suggesting an online intervention could be an effective means of providing information/support to women with ABC, given improved specificity/relevance to ABC and increased tailoring to individual circumstances and preferences.ConclusionsAdaptation of an existing online intervention for early stage cancer appears to be a promising avenue to address the information and support needs of women with ABC.

Patterns of care in Jehovah's Witnesses patients with solid tumours and lymphoma

Supportive care of Jehovahs Witnesses (JWs) diagnosed with cancer can be challenging, as they do not accept red blood cell (RBC) transfusions.