Predictive factors for metastasis in patients (pts) with gastric cancer

15056

Background: Determination of patients (pts) with early stage disease who have a high risk for developing metastatic disease is crucial. We investigated the risk factors associated with metastases development in pts with operable gastric cancer. Patients and Methods: In this retrospective study, pts with stage I-III and non-metastatic stage IV gastric cancer diagnosed between 1990 and 2006 were evaluated. The medical records of all pts including patient characteristics, laboratory results, histopathological examinations, were reviewed. Logistic regression methods were used to determine the risk factors for developing metastasis and to calculate odds ratios (OR) with 95% confidence intervals (CI). Results: 184 pts (70% male, 30% female) were analyzed. The mean age ± standard deviation was 56.5±11.9. The mean age of female were higher than male (p=0.014). At the time of diagnosis, 13.6% of the pts had stage I, 19.0% had stage II, 53.3% had stage III, and 14.1% had non-metastatic stage IV disease. The tumors were distally localized in 80% of the cases. Median follow-up period was 35 months. During follow up, 51 pts developed metastases. Median time to metastases development was 14 months. Overall survival was shorter in pts who developed metastasis than those who did not. (20 months vs. not reached, respectively, p=0.002). In univariate analyses, stage (p=0.020), tumor localization (p=0.006), extracapsular lymphatic extension (ELE) (p<0.001), the number of metastatic lymph nodes (p=0.001), CEA level (p<0.001), lymphovascular invasion (LVI) (p=0.001), and perineural invasion (p=0.007) were associated with metastasis development. In multivariate analysis, elevated CEA levels (p=0.009; OR: 2.8; CI 95%: 1.29–6.19), LVI (p=0.041; OR: 2.2; CI 95%: 1.03–4.64) and ELE (p=0.029; OR: 2.3; CI 95%: 1.09–4.78) were associated with increased risk of metastasis development while distal localization (p=0.038; OR: 0.42; CI%: 0.18–0.95) was associated with decreased risk in pts with gastric cancer. Discussion: In pts with early stage or locally advanced gastric cancer, elevated CEA levels, LVI, proximal localization and ELE were associated with increased risk of developing metastasis. Aggressive treatment options and closer follow up should be considered for pts with these risk factors.

No significant financial relationships to disclose.

Rituximab-induced viral infections in lymphoma patients

18509

Background: Recently, a chimeric mouse human monoclonal antibody, rituximab, has been used successfully to treat cases of B-cell non-Hodgkin’s lymphoma (NHL) and some autoimmune diseases. However, several viral infections related to rituximab have been reported in literature, but not well characterized. Methods: To further investigate this topic, relevant English language studies were identified through Medline. For our search we used the generic name rituximab, and the key phrases virus/virus infection. The references from the identified articles were reviewed for additional sources. Results: There were 64 previously reported cases (26 male, 23 female, and 15 gender not reported) that had experienced serious viral infection after rituximab treatment. The median age of the cases was 61 years (range; 21–79 years). The median time period from the start of rituximab treatment to viral infection diagnosis was 5.0 months (range, 1–20). Most frequently experienced viral infections were hepatitis B virus infection in 25 (39.1%) cases, Cytomegalovirus infection in 15 (23.4%) cases, varicella zoster infection in 6 (9.4%) cases, and other viral infections in 18 (28.1%) cases. Thirteen (52.0%) of the patients with hepatitis B virus infection died due to hepatic failure. Thirty-nine of the cases had viral infections other than HBV and 13 of them died due to these specific infections. Conclusions: Viral infections after the rituximab treatment in lymphoma patients are important to recognize and treat early because of their association with substantial morbidity and mortality. In these case series, about 40% of these viral infections resulted in death. Close monitoring for viral infections in patients receiving rituximab is necessary.

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No significant financial relationships to disclose.

Recombinant human erythropoietin in comparison to amifostine against cisplatin-induced peripheral sensorial neurotoxicity in rats

Cisplatin (CDDP) can cause dose-limiting neurotoxicity. We have investigated the role of recombinant human erythropoietin (rHuEPO) in the prevention of CDDP-induced peripheral sensory neurotoxicity. Wistar-albino rats were randomly assigned to three groups: Group A received only CDDP, Group B received CDDP plus amifostine and Group C received CDDP plus rHuEPO. At 7 weeks, Group C was divided into two subgroups; C1 received maintenance rHuEPO for 3 additional weeks, C2 received no treatment. Somatosensory evoked potentials (SEPs) were carried out at baseline, and at 7 and 10 weeks. At baseline, all groups were comparable in terms of area, amplitude and spinal potential normalized velocity (SPNV). The comparison of area, amplitude and SPNV data as well as their percent changes between 7 and 10 weeks showed no difference between Groups A, B, C1 and C2. We conclude that at the given dose and schedule, rHuEPO appears to have neuroprotective activity; however, maintenance rHuEPO treatment does not seem to provide further benefit.

Accelerated hepatitis C virus replication with rituximab treatment in a non-Hodgkin's lymphoma patient

The treatment of patients with non-Hodgkin's lymphoma (NHL) may be complicated by concomitant chronic hepatitis C virus (HCV) infection. Recent data suggest that HCV may also be a contributing factor to the development of this disease. Although antiviral treatment has occasionally been reported to result in the regression of lymphoma in patients with HCV infection, the importance of the control of this infection on the prognosis of lymphoma needs to be defined. Here we report a patient with diffuse large B-cell lymphoma who presented with a mass in her left breast. She had had HCV-related liver cirrhosis for 6 years. She was given rituximab monotherapy for three consecutive weeks, but treatment had to be discontinued as a result of hematological toxicity. HCV viral load also increased, but then decreased gradually after rituximab was stopped. She could be given no further therapy. Six months later she presented with spinal involvement with infiltration of the cauda equina. Though cranial-spinal radiotherapy and steroids were started, she died shortly thereafter. Though rituximab is an invaluable drug in the treatment of B-cell lymphomas, we believe that the use of such agents with potentially long-lasting effects on B lymphocytes requires extended vigilance for accelerated replication of hepatitis B and C viruses.

Early and late arrhythmogenic effects of doxorubicin

18587

Background: To determine the early and late arrhythmogenic effects of doxorubicin-containing chemotherapy regimens, and to identify associated risk. Methods: A prospective study including 29 patients who were treated with doxorubicin-containing regimens between September 2002 and September 2003. Cardiac evaluation was based on 24-hour electrocardiographic monitorization (Holter), which was performed during the first cycle of doxorubicin-containing regimens as well as after the last cycle of chemotherapy. Results: The mean age of the patients was 45.8 ± 15.1 (range 18–69) and the average dose of doxorubicin was 280.03 ± 113.50 mg/m2 (range 50–480). Holter records obtained during the first cycle of treatment revealed varying arrhythmias in 19 patients (65.5%). The most common arrhythmia was supraventricular extrasystole (n = 11, 37%). Holter records obtained after completion of therapy revealed a variety of rhythm abnormalities in 18 (62.1%) patients, with supraventricular extrasystole again being the most common arrhythmia (n = 13, 44.8%). Only 13 (44.8%) patients had arrhythmias documented in both Holter records. One patient presented with syncope during the first course of doxorubicin therapy and Mobitz type 2 atrioventricular block along with complete atrioventricular block lasting for 12 seconds were demonstrated after examination of Holter records. The patient subsequently underwent permanent pacemaker implantation. There was no correlation between the development of arrhythmia in the early and late period and sex, diagnosis, age, and previous radiotherapy history. Conclusion: Doxorubicin may result in arrhythmias both in early and late periods of treatment. These arrhythmias are rarely life threatening.

No significant financial relationships to disclose.

Erectile dysfunction (ED) in successfully treated lymphoma patients

18570

Background: Information on male potency in lymphoma survivors is insufficient. In this study, we assessed male sexual function in successfully treated lymphoma patients (pts). Methods: Fifty-nine pts treated for Hodgkin’s (HL) or non-Hodgkin’s lymphoma (NHL) with chemotherapy ± radiotherapy were recruited. Pts older than 55 years and those with a history of pelvic/inguinal radiotherapy or surgery were excluded. Study pts had to be disease-free and off-treatment for at least 6 months at the time of evaluation. Pts completed a survey questionnaire that consisted of demographic characteristics, risk factors for ED and the International Index of Erectile Function (IIEF) to assess their current level of sexual function. Serum luteinizing hormone (LH), follicle-stimulating hormone (FSH), and testosterone levels were also determined. Results: The mean age of the 59 pts was 40.2 ± 11.0 (range, 18–55 years). Thirty-eight (64.4%) had HL and 21 (35.6%) NHL. The mean interval between the end of active treatment and study evaluation was 7.7 years (range: 10 mths to 20 yrs). According to the IIEF score, 61.0% had some degree of ED (IIEF score <26): 33.9% had mild ED (IIEF score 17–25), 15.2% moderate ED (IIEF score 11–16) and 11.9% severe ED (IIEF score 6–10). Mean total scores of sexual desire, sexual satisfaction, orgasm and overall satisfaction domains of IIEF were significantly lower in pts with ED than those with normal ED (26.0 ± 1.8 and 39.0 ± 0.8, respectively; p < 0.001). Nine (18.4%) of 49 pts had an elevated FSH, 7 (14.2%) had elevated LH, and 3 (6.1%) had decreased testosterone levels. These hormonal disturbances did not affect the presence of ED and its severity. Six (10.2%) pts had hypertension and 3 (5.1%) had diabetes mellitus. Forty (57.6%) pts were ever-smokers, 29 (49.2%) were overweight or obese (BMI >25), but none had coronary artery disease. These risk factors did not statistically affect the presence of ED or its severity in our pts. Conclusions: These findings suggest that diagnosis and treatment of lymphoma may be a risk factor per se for the development of ED. Therefore, the underlying pathology, either organic or psychological, remains to be defined. Clinicians should be aware of this problem in lymphoma survivors and offer these pts adequate treatment options.

No significant financial relationships to disclose.

cTnT can be a useful marker for early detection of anthracycline cardiotoxicity

BACKGROUND

The level of serum cardiac troponin-T (cTnT) increases with myocardial damage. We sought to assess whether cTnT level could be a useful marker for the early detection of anthracycline cardiotoxicity.

PATIENTS AND METHODS

Forty-one patients who had been scheduled to receive anthracycline-containing combination chemotherapy were included in the study. Serum cTnT levels were measured before (baseline) and after the first cycle of chemotherapy, and again, after the last cycle of chemotherapy. In all patients, the left ventricular ejection fraction (LVEF), fractional shortening (FS), early peak flow/atrial flow velocity (E/A) ratio, and the isovolemic relaxation time (IRT) were measured echocardiographically, both before and after the completion of chemotherapy.

RESULTS

LVEF and FS did not change in any patients. In 21 patients (49%), the E/A ratio decreased after therapy as compared to the pre-treatment values. The decrease in E/A ratio was more prominent in patients who were older than the mean age of our study group, which was 44 years. The post-treatment IRT was prolonged compared with the pretreatment IRT (94.0 +/- 2.0 versus 85.6 +/- 10.5 ms, respectively). cTnT levels after completion of therapy were elevated in 14 (34%) patients, and exceeded the upper limit of the normal range (>0.1 ng/ml) in only one patient. cTnT levels measured after completion of therapy were significantly higher, compared with those measured at baseline and after the first cycle of therapy. In the younger age group (< or =44 years old), there was a two-fold decrease in the E/A ratio in those patients whose cTnT levels increased during the therapy, when compared with those whose cTnT levels did not change (21% versus 43%, respectively).

CONCLUSION

Increased serum cTnT level can be detected in the early stages of anthracycline therapy and it is associated with diastolic dysfunction of the left ventricle. Therefore, serum cTnT level could be a useful measure for early detection of anthracycline-induced cardiotoxicity.