Neurocognitive Implications in Children Undergoing Chemotherapy and Radiotherapy

Background: Radiotherapy and chemotherapy drugs were essential for increasing the survival rates of pediatric cancer patients, but dysfunctions associated with treatment, mainly neurological and cognitive, are recorded and should be considered in deciding the therapeutic plan. Objectives: Analyze the current literature on the neurocognitive effects in children undergoing chemotherapy and radiation therapy. Methods: A bibliographic review was carried out in the MEDLINE / Pubmed and LILACS databases, using the terms “cognitive effects”, “chemotherapy”, “radiotherapy” and “child”, in Portuguese and in English. 79 articles were found and 6 followed for complete analysis. Articles published more than 5 years ago and that did not address the proposed subject were not used. Results: Radiotherapy, especially cranial (CRT), is associated with serious effects, such as induction of vasculopathy, stroke, cerebrovascular malformations, in addition to an increased risk for subsequent malignant CNS tumors. Despite being a standard treatment for several neoplasms, radiotherapy has been replaced, when possible, by higher doses of chemotherapy, which has a considerable level of neurotoxicity, capable of causing coagulopathy, encephalopathy, seizures and neuropathies, both sensory and motor. However, deficits in children’s attentional capacity in both treatment categories stood out, sometimes implying educational difficulties and decline in non-verbal skills. Conclusions: Although chemotherapy and radiation therapy represent impressive advances, their consequences remain a concern. Future studies should seek strategies for prevention, early recognition and management of neurotoxicity, in order to promote better life quality for patients.

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Adjuvant Therapy for Soft Tissue Sarcoma

Journal of the National Comprehensive Cancer Network ◽

10.6004/jnccn.2005.0013 ◽

2005 ◽

Vol 3 (2) ◽

pp. 207-213 ◽

Cited By ~ 1

Author(s):

Scott M. Schuetze ◽

Michael E. Ray

Keyword(s):

Overall Survival ◽

Radiation Therapy ◽

High Risk ◽

Soft Tissue ◽

Soft Tissue Sarcoma ◽

Survival Rates ◽

Wide Resection ◽

High Grade ◽

Postoperative Radiation Therapy ◽

Increased Risk

Wide surgical excision is the backbone of therapy for localized soft tissue sarcoma and often produces excellent results. Patients with a marginal resection of disease and high-grade or large tumors are at an increased risk of recurrence. Radiation therapy (external beam or brachytherapy) has been shown to reduce the risk of local recurrence of disease and should be offered to patients with large (>5 cm) or high-grade sarcomas, especially if a wide resection cannot be performed. Use of preoperative versus postoperative radiation therapy should be planned, in consultation with a radiation oncologist and a surgical oncologist, before resection of the sarcoma if possible. Chemotherapy using an anthracycline- and ifosfamide-based regimen may improve disease-free and overall survival rates. Chemotherapy appears to be most beneficial for patients with very large (≥10 cm), high-grade sarcomas of the extremity who are at a high risk of experiencing distant recurrence of disease. The effect of adjuvant chemotherapy on overall survival remains controversial. Research is greatly needed to identify the patients who are most likely to benefit from conventional chemotherapy, improve the treatment of retroperitoneal sarcomas, and identify novel agents that may impact the natural history of high-risk soft tissue sarcoma.

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Current Treatment of Isolated Locoregional Breast Cancer Recurrences

Breast Care ◽

10.1159/000439151 ◽

2015 ◽

Vol 10 (4) ◽

pp. 265-271 ◽

Cited By ~ 8

Author(s):

Wolfgang Harms ◽

Andreas Geretschläger ◽

Corinne Cescato ◽

Martin Buess ◽

Dieter Köberle ◽

...

Keyword(s):

Breast Cancer ◽

Radiation Therapy ◽

Survival Rates ◽

Breast Conservation ◽

Partial Breast Irradiation ◽

Individual Treatment ◽

Severe Toxicity ◽

Curative Intent ◽

Potential Clinical Benefit ◽

Increased Risk

Patients with isolated locoregional breast cancer recurrences should be treated with curative intent. Mastectomy is regarded as the standard of care for patients with ipsilateral breast tumor recurrence. In a selected group of patients, partial breast irradiation after second breast-conserving surgery is a viable alternative to mastectomy. If a second breast conservation is performed, additional irradiation should be mandatory, especially in patients who had not been irradiated previously. In case of re-irradiation, the largest experience exists for multi-catheter brachytherapy. Prospective clinical trials are needed to clearly define selection criteria, long-term local control, and toxicity. In patients with resectable locoregional breast cancer recurrences after mastectomy, multi-modal therapy comprising complete resection, radiation therapy in previously unirradiated patients, and systemic therapy results in 5-year disease-free and overall survival rates of 69% and 88%, respectively. In radiation-naive patients with unresectable, isolated locoregional recurrences, radiation therapy is mandatory. In selected patients with previous irradiations and unresectable locoregional recurrences, a second irradiation as part of an individual treatment concept can be applied. The increased risk of severe toxicity should always be weighed up against the potential clinical benefit. A combination therapy with hyperthermia can further improve the treatment results.

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Morbidity and mortality of serious gastrointestinal complications after lung transplantation

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-019-0983-y ◽

2019 ◽

Vol 14 (1) ◽

Cited By ~ 1

Author(s):

Annette Zevallos-Villegas ◽

Rodrigo Alonso-Moralejo ◽

Félix Cambra ◽

Ana Hermida-Anchuelo ◽

Virginia Pérez-González ◽

...

Keyword(s):

Lung Transplantation ◽

Early Recognition ◽

Statistical Significance ◽

Tertiary Care ◽

Survival Function ◽

Survival Rates ◽

Late Complications ◽

Morbidity And Mortality ◽

Gastrointestinal Complications ◽

Increased Risk

Abstract Background Gastrointestinal complications after lung transplatation are associated with an increased risk of morbidity and mortality. This study aims to describe severe gastrointestinal complications (SGC) after lung transplantation. Methods We performed a prospective, observational study that included 136 lung transplant patients during a seven year period in a tertiary care universitary hospital. SGC were defined as any diagnosis related to the gastrointestinal or biliary tract leading to lower survival rates or an invasive therapeutic procedure. Early and late complications were defined as those occurring < 30 days and ≥ 30 days post-transplant. The survival function was calculated through the Kaplan-Meier estimator. Variables were analyzed using univariate and multivariate analysis. Statistical significance was defined as p < 0.05. Results There were 17 (12.5%) SGC in 17 patients. Five were defined as early. Twelve patients (70.6%) required surgical treatment. Mortality was 52.9% (n = 9). Patients with SGC had a lower overall survival rate compared to those who did not (14 vs 28 months, p = 0.0099). The development of arrhythmias in the first 48 h of transplantation was a risk factor for gastrointestinal complications (p = 0.0326). Conclusions SGC are common after lung transplantation and are associated with a considerable increase in morbidity-mortality. Early recognition is necessary to avoid delays in treatment, since a clear predictor has not been found in order to forecast this relevant comorbidity.

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Clinical Significance of Heme Oxygenase 1 in Tumor Progression

Antioxidants ◽

10.3390/antiox10050789 ◽

2021 ◽

Vol 10 (5) ◽

pp. 789

Author(s):

Mariapaola Nitti ◽

Caterina Ivaldo ◽

Nicola Traverso ◽

Anna Lisa Furfaro

Keyword(s):

Heme Oxygenase ◽

Cancer Progression ◽

Tumor Biology ◽

Survival Rates ◽

Life Quality ◽

Heme Oxygenase 1 ◽

Therapeutic Choice ◽

Increased Risk ◽

Risk Of Cancer

Heme oxygenase 1 (HO-1) plays a key role in cell adaptation to stressors through the antioxidant, antiapoptotic, and anti-inflammatory properties of its metabolic products. For these reasons, in cancer cells, HO-1 can favor aggressiveness and resistance to therapies, leading to poor prognosis/outcome. Genetic polymorphisms of HO-1 promoter have been associated with an increased risk of cancer progression and a high degree of therapy failure. Moreover, evidence from cancer biopsies highlights the possible correlation between HO-1 expression, pathological features, and clinical outcome. Indeed, high levels of HO-1 in tumor specimens often correlate with reduced survival rates. Furthermore, HO-1 modulation has been proposed in order to improve the efficacy of antitumor therapies. However, contrasting evidence on the role of HO-1 in tumor biology has been reported. This review focuses on the role of HO-1 as a promising biomarker of cancer progression; understanding the correlation between HO-1 and clinical data might guide the therapeutic choice and improve the outcome of patients in terms of prognosis and life quality.

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ABCB1 in children's brain tumours

Biochemical Society Transactions ◽

10.1042/bst20150137 ◽

2015 ◽

Vol 43 (5) ◽

pp. 1018-1022 ◽

Cited By ~ 11

Author(s):

Beth Coyle ◽

Maya Kessler ◽

Durgagauri H. Sabnis ◽

Ian D. Kerr

Keyword(s):

Drug Resistance ◽

Adjuvant Chemotherapy ◽

Brain Tumours ◽

Survival Rates ◽

Local Relapse ◽

Drug Resistant ◽

Chemotherapy Drugs ◽

Resistant Disease ◽

Increased Risk ◽

Disseminated Disease

Tumours of the central nervous system are the most common solid tumour, accounting for a quarter of the 1500 cases of childhood cancer diagnosed each year in the U.K. They are the most common cause of cancer-related death in children. Treatment consists of surgery followed by adjuvant chemotherapy and/or radiotherapy. Survival rates have generally increased, but many survivors suffer from radiotherapy-related neurocognitive and endocrine side effects as well as an increased risk of secondary cancer. Adjuvant chemotherapy is normally given in combination to circumvent chemoresistance, but several studies have demonstrated it to be ineffective in the absence of radiotherapy. The identification of children with drug-resistant disease at the outset could allow stratification of those that are potentially curable by chemotherapy alone. Ultimately, however, what is required is a means to overcome this drug resistance and restore the effectiveness of chemotherapy. Medulloblastomas and ependymomas account for over 30% of paediatric brain tumours. Advances in neurosurgery, adjuvant radiotherapy and chemotherapy have led to improvements in 5-year overall survival rates. There remain, however, significant numbers of medulloblastoma patients that have intrinsically drug-resistant tumours and/or present with disseminated disease. Local relapse in ependymoma is also common and has an extremely poor prognosis with only 25% of children surviving first relapse. Each of these is consistent with the acquisition of drug and radiotherapy resistance. Since the majority of chemotherapy drugs currently used to treat these patients are transport substrates for ATP-binding cassette sub-family B member 1 (ABCB1) we will address the hypothesis that ABCB1 expression underlies this drug resistance.

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Chemotherapy-related striate melanonychia: a case report

Journal of Medical Case Reports ◽

10.1186/s13256-020-02612-5 ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

Fazleenah Hussain ◽

Dushyanth Gnanappiragasam ◽

Freida Shaffrali

Keyword(s):

Clinical Features ◽

Early Recognition ◽

Survival Rates ◽

Left Thumb ◽

Chemotherapy Drugs ◽

Nail Changes ◽

Dark Pigmentation ◽

Nail Pigmentation ◽

Chemotherapy Agents

Abstract Background Chemotherapy medications are reported to cause discoloration of the nails known as melanonychia. Depending on the nail structure affected and the severity of the insult, the clinical features can be variable. There are a great deal of unreported cases of pigmentary nail changes associated with chemotherapy treatment. By sharing our knowledge, we hope to raise the awareness of these nail changes amongst clinicians. Early recognition is crucial to allay anxiety among patients and avoid any unnecessary investigations. Case presentation We present a case of 36-year-old woman of south Asian origin, who developed dark pigmentation in the left thumb nail during neoadjuvant chemotherapy with 5-fluorouracil, epirubicin, cyclophosphamide, and docetaxel (FEC-D) for triple negative breast cancer. Upon examination, the left thumb nail pigmentation was strikingly linear, uniform, and well demarcated extending from proximal nail fold to free margin. Despite the reassuring clinical features, the patient was understandably anxious that this could be a presentation of acral melanoma and was referred to the plastic surgeons for a nail matrix biopsy. Biopsy reassuringly was reported as melanosis and a diagnosis of striate melanonychia was made. The patient was discharged after 2-year follow-up. Conclusion Chemotherapy medications have improved survival rates and patient outcomes. It is important for clinicians to be aware of the association of melanonychia with certain chemotherapy medications to reduce anxiety and allow successful management of these patients without delay. Striate melanonychia in this patient was felt most likely due to the synergistic effect of chemotherapy drugs compounded with racial predisposition. Chemotherapy agents most likely to have contributed include cyclophosphamide, docetaxel, and 5-fluorouracil.

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Discovery of predictors of sudden cardiac arrest in diabetes: rationale and outline of the RESCUED (REcognition of Sudden Cardiac arrest vUlnErability in Diabetes) project

Open Heart ◽

10.1136/openhrt-2020-001554 ◽

2021 ◽

Vol 8 (1) ◽

pp. e001554

Author(s):

Laura H van Dongen ◽

Peter P Harms ◽

Mark Hoogendoorn ◽

Dominic S Zimmerman ◽

Elisabeth M Lodder ◽

...

Keyword(s):

Cardiac Arrest ◽

Prognostic Model ◽

Early Recognition ◽

Sudden Cardiac Arrest ◽

Clinical Genetic ◽

Innovative Strategy ◽

Rare Variant Analysis ◽

Increased Risk ◽

Gp Care

IntroductionEarly recognition of individuals with increased risk of sudden cardiac arrest (SCA) remains challenging. SCA research so far has used data from cardiologist care, but missed most SCA victims, since they were only in general practitioner (GP) care prior to SCA. Studying individuals with type 2 diabetes (T2D) in GP care may help solve this problem, as they have increased risk for SCA, and rich clinical datasets, since they regularly visit their GP for check-up measurements. This information can be further enriched with extensive genetic and metabolic information.AimTo describe the study protocol of the REcognition of Sudden Cardiac arrest vUlnErability in Diabetes (RESCUED) project, which aims at identifying clinical, genetic and metabolic factors contributing to SCA risk in individuals with T2D, and to develop a prognostic model for the risk of SCA.MethodsThe RESCUED project combines data from dedicated SCA and T2D cohorts, and GP data, from the same region in the Netherlands. Clinical data, genetic data (common and rare variant analysis) and metabolic data (metabolomics) will be analysed (using classical analysis techniques and machine learning methods) and combined into a prognostic model for risk of SCA.ConclusionThe RESCUED project is designed to increase our ability at early recognition of elevated SCA risk through an innovative strategy of focusing on GP data and a multidimensional methodology including clinical, genetic and metabolic analyses.

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Upper GI Bleeding Secondary to Radiation Gastritis in a Patient with Preexisting Portal Hypertensive Gastropathy

Case Reports in Gastroenterology ◽

10.1159/000516569 ◽

2021 ◽

pp. 513-518

Author(s):

Samragnyi Madala ◽

Abhishek Polavarapu ◽

Dhineshreddy Gurala ◽

Vivek Gumaste

Keyword(s):

Radiation Therapy ◽

Gastrointestinal Bleeding ◽

Argon Plasma Coagulation ◽

Argon Plasma ◽

Laser Coagulation ◽

Portal Hypertensive Gastropathy ◽

Gastrointestinal Malignancy ◽

Nonalcoholic Fatty Liver ◽

Increased Risk ◽

Radiation Induced

We commonly see patients presenting with either portal hypertensive gastropathy (PHG) or radiation gastritis. Radiation-induced hemorrhagic gastritis is an unusual lethal complication postradiation. Patients with preexisting PHG have very friable mucosa that can easily bleed after radiation for cancer treatment. There is an increased risk of bleeding with both entities present together. Our aim is to focus on treatment and possible prevention of gastrointestinal bleeding in patients with preexisting PHG undergoing radiation therapy for newly diagnosed cancer. Several therapies like prednisolone, argon plasma coagulation, laser coagulation have been proposed. There are no set guidelines for treatment. In these patients, if radiation therapy is indicated either for hepatic or gastrointestinal malignancy, it is suggested to premedicate with proton pump inhibitors or sucralfate. We describe a case of 73-year-old female who presented with upper gastrointestinal bleeding. She had liver cirrhosis secondary to nonalcoholic fatty liver disease and diagnosed with pancreatic cancer, for which she received chemoradiation. She was found to have both radiation gastritis and PHG with diffuse erythematous, edematous, congested mucosa with diffuse oozing blood in the antrum making it very challenging to treat.

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Microbial Associations with Pancreatic Cancer: A New Frontier in Biomarkers

Cancers ◽

10.3390/cancers13153784 ◽

2021 ◽

Vol 13 (15) ◽

pp. 3784

Author(s):

Mark Stasiewicz ◽

Marek Kwaśniewski ◽

Tomasz M. Karpiński

Keyword(s):

Pancreatic Cancer ◽

Helicobacter Pylori ◽

Survival Rates ◽

Health Concern ◽

Current State ◽

Increased Risk ◽

Microbial Biomarkers ◽

New Frontier ◽

Microbial Associations ◽

Fungal Genus

Pancreatic cancer (PC) remains a global health concern with high mortality and is expected to increase as a proportion of overall cancer cases in the coming years. Most patients are diagnosed at a late stage of disease progression, which contributes to the extremely low 5-year survival rates. Presently, screening for PC remains costly and time consuming, precluding the use of widespread testing. Biomarkers have been explored as an option by which to ameliorate this situation. The authors conducted a search of available literature on PubMed to present the current state of understanding as it pertains to the use of microbial biomarkers and their associations with PC. Carriage of certain bacteria in the oral cavity (e.g., Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans, Streptococcus sp.), gut (e.g., Helicobacter pylori, Synergistetes, Proteobacteria), and pancreas (e.g., Fusobacterium sp., Enterobacteriaceae, Pseudomonadaceae) has been associated with an increased risk of developing PC. Additionally, the fungal genus Malassezia has likewise been associated with PC development. This review further outlines potential oncogenic mechanisms involved in the microbial-associated development of PC.

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Clinical long-term and patient-reported outcomes of dental implants in oral cancer patients

International Journal of Implant Dentistry ◽

10.1186/s40729-021-00373-4 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Eik Schiegnitz ◽

Lena Katharina Müller ◽

Keyvan Sagheb ◽

Lisa Theis ◽

Vahide Cagiran ◽

...

Keyword(s):

Radiation Therapy ◽

Oral Cancer ◽

Cancer Patients ◽

Dental Implants ◽

Survival Rates ◽

Implant Survival ◽

Implant Placement ◽

Patient Reported ◽

Oral Cancer Patients

Abstract Background and purpose The aim of this clinical study was to investigate the clinical long-term and patient-reported outcome of dental implants in patients with oral cancer. In addition, analysis of the influence of radiation therapy, timing of implant insertion, and augmentation procedures on implant survival was performed. Material and methods This retrospective study investigated the clinical outcome of 711 dental implants in 164 oral cancer patients, inserted by experienced surgeons of the Department of Oral and Maxillofacial Surgery, University Medical Center Mainz, Germany. Oral health-related quality of life (OHRQoL) was evaluated. Results Cumulative 5-year and 10-year implant survival rates for all included implants were 87.3% and 80.0%. Implants placed straight after ablative surgery (primary implant placement) and implants placed after completing the oncologic treatment (secondary implant placement) showed a comparable implant survival (92.5% vs. 89.5%; p = 0.635). Irradiation therapy had no significant influence on implant survival of secondary placed implants (p = 0.929). However, regarding implant site (native bone vs. augmented bone) and radiation therapy (non-irradiated bone vs. irradiated bone), implants inserted in irradiated bone that received augmentation procedures showed a statistically significant lower implant survival (p < 0.001). Patients reported a distinct improvement in OHRQoL. Conclusions Promising long-term survival rates of dental implants in patients after treatment of oral cancer were seen. In addition, patients benefit in form of an improved OHRQoL. However, bone augmentation procedures in irradiated bone may result in an impaired implants’ prognosis.

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