A Case of Sarcoidosis with Unusual Radiographic Findings that Developed 5 Years after Silicone Augmentation Mammoplasty Complicated by Miliary Tuberculosis during Corticosteroid Treatment

A 54-year-old woman with a past history of silicone augmentation mammoplasty was admitted with fever and dyspnea with diffuse interstitial shadows on computed tomography (CT). Although radiological findings were atypical, we diagnosed sarcoidosis by laboratory, microbiological, and bronchoalveolar lavage fluid analysis. Corticosteroids ameliorated the condition, but she had recurrent of fever and CT revealed miliary nodules while interstitial shadows disappeared. Liver biopsy showed that noncaseating granuloma and Ziehl-Neelsen stain was positive. We diagnosed miliary tuberculosis which developed during corticosteroid therapy. Antituberculotic therapy resulted in favorable outcome. Possibility exists that onset of sarcoidosis was induced by mammoplasty, namely, human adjuvant disease.

Chemotherapy Dosing Strategies in the Obese, Elderly, and Thin Patient: Results of a Nationwide Survey

Purpose Determining the optimal starting dose of chemotherapy (CHT) presents a considerable challenge when using body-surface area (BSA)–based dosing, particularly in obese, elderly, or thin patients. We sought to document the range of approaches employed when administering CHT to these patients. Methods A questionnaire was developed by a panel of oncologists and mailed to all members of the Medical Oncology Group of Australia. Results From 315 oncologists, 188 responded (response rate 59.7%). BSA-based dosing is standard practice for 176 (97.2%) of the responding oncologists. In the adjuvant disease setting, 23 (12.7%) use ideal rather than actual body weight (BW) to calculate BSA, or choose whichever is less. When treating obese patients, only 6.1% of respondents routinely use actual BW. Of the remainder, 69.5% either cap the dose at 2 m2 or use ideal BW. In underweight patients, 95% (n = 171) routinely calculate BSA using actual BW. Forty one respondents (22.7%) routinely reduce dose in the fit elderly. Conclusion This analysis of BSA-based CHT dosing methods demonstrates significant variability in practice. Based on evidence from adjuvant studies showing that actual BSA-based dosing is desirable, a substantial number of Australian patients are being underdosed. Further education, together with ongoing research, is required to optimize individualized dosing for efficacy and tolerability.

Chemotherapy (CT) dose adjustment for obese or elderly patients: How often does it occur, and should it? Results of an Australian survey

6539 Background: Determining the optimal starting dose of chemotherapy (CT) for an individual patient (pt) presents a considerable challenge and is generally empirical. While body surface area (BSA)-based dosing has major limitations, it is standard practice worldwide. It may perform particularly poorly in certain scenarios, including the obese or elderly pt, representing an increasing area of clinical practice. We sought to determine the range of approaches employed by medical oncologists Australia-wide when administering CT to these pts. Methods: A questionnaire was developed by a panel of oncologists and mailed to all members of the Medical Oncology Group of Australia. The survey was designed to document the methods of calculating CT doses, with an emphasis on the parameters utilised and also factors considered in a variety of settings, including obese and elderly pts. Results: Evaluable responses were obtained from 181 of 315 medical oncologists and fellows (RR 57.5%). BSA-based dosing was reported as standard practice by 176 (97.2%). In the adjuvant disease setting, 23 (12.7%) use ideal rather than actual body weight (BW), or whichever is less, when prescribing CT. 14.5% (n=25) defined ideal BW as a body mass index (BMI) of 27, while 41% chose BMI 20–25 as ideal. When treating the obese pt (BMI>30), only 6.2% of respondents routinely use actual BW. Of the remainder, 69.5% either routinely cap the dose at 2m2 or use ideal BW, and 16.4% cap at a maximum dose or at a different BSA. In underweight (BMI<18.5) pts conversely, 95% (n=171) routinely use BSA based on actual BW. 41 respondents (22.7%) routinely dose reduce in the fit elderly population. Conclusions: Many current methods of BSA-based CT dosing demonstrated in this survey are not supported by the available literature. There is strong evidence from adjuvant studies in breast and bowel cancer that actual BSA is desirable; we clearly demonstrate that a substantial number of Australian patients, especially the obese, are being under-dosed, potentially leading to inferior outcomes. Until alternative methods to BSA-based CT dosing are available, education regarding the appropriateness of routine dose adjustments in specific circumstances is urgently required. No significant financial relationships to disclose.