Late dental effects of chemotherapy and radiotherapy in childhood cancer survivor: case report

Chemotherapy drugs and radiotherapy in the head and neck region are considered possible to interfere with odontogenesis. Patients may present alterations such as tooth agenesis, shortening or root malformation, enamel hypoplasia and microdontia. Such effects do not occur in adults, as they already have the dental structures formed. The objective of this study is to describe, through a case report, the dental alterations and implications for the clinical practice of a patient who received chemotherapy and radiotherapy in childhood. A 12- year-old female patient was diagnosed with embryonal rhabdomyosarcoma in the right parotid gland region at 5 years of age. Antineoplastic treatment consisted of IRS IV chemotherapy protocol: ifosfamide (IFO) - doxorubicin (DOXO) - etoposide (VP16) followed by vincristine - dactinomycin - cyclophosphamide (VAC) / vincristine - ifosfamide - etoposide (VIE) alternated, in addition to conventional radiotherapy, with a total dose of 45 Gy. The patient developed important dental alterations, such as root malformation in most teeth, microdontia and enamel hypoplasia, being essential the role of the dentist. Currently, after 6 years of anticancer treatment, she has regular dental follow-up.

A Latin-American Cancer Center Experience in the Treatment of Hodgkin's Lymphoma during a Drug Shortage

The treatment of Hodgkin's lymphoma has been characterized by a story of success with the use tried-and-true protocols. During the second half of 2019 to the first-half of the 2021 the Mexican health system experienced a shortage of drugs, which compromised the possibility of using in most of the common protocols for this cancer: ABVD, BEACOPP, IGEV, ESHAP, DHAP, GEMOX. Clinician had option of using a common protocol with incomplete doses or applying an alternative complete CHOEP protocol, which has been used with some success in exploratory studies [1,2]. For 12 months, we treated a total of 58 patients of which we compared the base characteristics and response rates to 10-year compiled data from pre-shortage patients (PS) (total 475). The baseline characteristics of the PS vs shortage (S) group showed a statistical similar gender distribution (males 55.2% vs 63.8%, P 0.21), histologic subtype (P 0.24), international prognostic score (IPS ≥3 57.7% vs 58.6%, P 0.89) and clinical stage (advanced 78.1% vs 84.5%, P 0.26). The S patients did show higher frequency of B symptoms (P 0.002), extranodal disease (P 0.0001), while the PS group had a higher frequency of bulky disease (P 0.001), ABVD protocol (96% vs 63.8%, P 0.0001) and radiotherapy use. In the S group a total of 37 ABVD (29 incomplete), 7 BEACOPP (5 incomplete) and 14 CHOEP protocols (1 incomplete) were infused, it means only 10 (17.7%) were able to receive a standard complete treatment, while the rest received an incomplete or alternative treatment. Complete response for the PS and S group were 71.4% vs 56.9% with the corresponding therapeutic failure 28.6% vs 43.1% (p 0.023) respectively. Analyzing the response rate of each chemotherapy protocol in the S group, the complete ABVD vs incomplete ABVD demonstrated an 87.5% vs 69% (p 0.28) respectively. The complete BEACOPP vs incomplete showed 50% vs 40% (p 0.7) and CHOEP exhibited an unexceptional complete response rate of 21.4%. The median follow up was 48 months (1-148) for all cohort. One year OS were 98% vs 82% on PS vs S group respectively (log rank 0.0001). One year-PFS for the PS and S group were 96% and 61% respectively (log rank 0.003). The risk factors associated with lower PFS were B symptoms (OR 1.7, 1.1-2.6), advanced disease (OR 1.66, 1-0-2.7) and IPS≥3 (OR 2.1, 1.4-3.3); as favorable factors we observed radiotherapy (OR 0.07, 0.6-0.8) and the PS group (OR 0.5, 0.3-1.0); however, in the Cox regression, only the IPS≥3 remained as an independent unfavorable factor (HR 1.8, 1.2-2.6), as did radiotherapy (HR 0.4, 0.3-0.6) as favorable. For the OS the drug shortage were an independent risk factor (HR 2.2, 1.1-4.3) like IPS ≥3 (HR 2.8, 1.5-5.1). Analyzing the 1-year PFS in the S group according to which chemotherapy protocol they received, those with ABVD or BEACOPP (regardless of the complete dose status) was of 72%, compared to 20% (P 0.001) in the CHOEP regimen. CHOEP regimen in LH patients is ineffective treatment. In times of shortages, continuing with incomplete standard schemes offers better response rates than alternative schemes. Despite Hodgkin's lymphoma is considered a neoplasm with high cure rates when an economic recession followed by an international event (for example a global pandemic) limited our availability for the use of standard treatments, an area of opportunity for considering alternative protocols has risen for resource-limited countries and institutions. [1] Walewski J,et al. CHOP-21 for unfavorable Hodgkin's lymphoma. An exploratory study. Med Oncol. 2010;27(2):262-7 [2] Kolstad A, et al. Standard CHOP-21 as first line therapy for elderly patients with Hodgkin's lymphoma. Leuk Lymphoma. 2007;48(3):570-6 Disclosures No relevant conflicts of interest to declare.

Diagnósticos de enfermagem relacionados aos potenciais efeitos adversos da quimioterapia antineoplásica

Objetivo: Identificar posibles diagnósticos de enfermería relacionados con los efectos adversos de la quimioterapia antineoplásica en pacientes con cáncer.Método: Estudio cuantitativo, descriptivo, realizado en la consulta externa de quimioterapia de un hospital público, en Belo Horizonte, Minas Gerais, Brasil. Se incluyó a 70 pacientes en la muestra y se les entrevistó para obtener características sociodemográficas. Los datos clínicos y el protocolo de quimioterapia se obtuvieron del registro físico. Se identificaron posibles toxicidades y efectos adversos para cada protocolo de quimioterapia a través de un libro de texto y, posteriormente, se identificaron los diagnósticos de enfermería en la taxonomía de la North American Nursing Diagnosis Association International (NANDA-I), versión 2018-2020, y asociados toxicidades y efectos adversos.Resultados: El sitio primario más prevalente fue el colon y recto (30%) y la mama (30%). Todos los participantes estaban recibiendo quimioterapia con potencial toxicidad hematológica, gastrointestinal, cardiovascular y dermatológica. Se identificaron 36 diagnósticos de enfermería con base en NANDA-I, con mayor predominio de diagnósticos en el dominio de seguridad y protección, y en el dominio de eliminación e intercambio.Conclusión: La identificación de Diagnósticos de Enfermería basados en protocolos de quimioterapia permite proponer planes de atención individualizados para satisfacer las necesidades de los pacientes sometidos a quimioterapia, principalmente con un enfoque en prevenir la ocurrencia y minimizar los efectos adversos, cuando ya están presentes. chemotherapy in cancer patients.Method: Quantitative, descriptive study, performed at the chemotherapy ambulatory of a public hospital, in Belo Horizonte, Minas Gerais, Brazil. Seventy patients were included in the sample and interviewed to obtain sociodemographic characteristics. Clinical data and the chemotherapy protocol were obtained from the physical record. Possible toxicities and adverse effects were identified for each chemotherapy protocol through a textbook and, subsequently, nursing diagnoses were identified in the taxonomy of the North American Nursing Diagnosis Association International (NANDA-I), version 2018-2020, and associates toxicities and adverse effects.Results: The most prevalent primary site was colon and rectum (30%), and breast (30%). All participants were receiving chemotherapy with potential hematological, gastrointestinal, cardiovascular, and dermatological toxicity. Thirty-six nursing diagnoses were identified based on NANDA-I, with a greater predominance of diagnoses in the safety/protection domain, and the elimination and exchange domain.Conclusion: The identification of Nursing Diagnoses based on chemotherapy protocols allows the proposition of individualized care plans to meet the needs of patients undergoing chemotherapy, with a focus on preventing the occurrence and minimizing adverse effects, when already present. Objetivo: Identificar possíveis Diagnósticos de Enfermagem relacionados aos efeitos adversos da quimioterapia antineoplásica em pacientes com câncer.Método: Estudo quantitativo, descritivo, realizado no ambulatório de quimioterapia de um hospital público, de Belo Horizonte, Minas Gerais, Brasil. Setenta pacientes foram incluídos na amostra e entrevistados para obter características sociodemográficas. Os dados clínicos e o protocolo de quimioterapia foram obtidos no prontuário físico. As possíveis toxicidades e efeitos adversos foram identificados para cada protocolo de quimioterapia por meio de um livro texto e, posteriormente, foram identificados diagnósticos de enfermagem na taxonomia da North American Nursing Diagnosis Association International (NANDA-I), versão 2018-2020, e associados às toxicidades e efeitos adversos.Resultados: O sítio primário mais prevalente foi cólon e reto (30%), e mama (30%). Todos os participantes estavam recebendo quimioterapia com potencial toxicidade hematológica, gastrointestinal, cardiovascular e dermatológica. Foram identificados 36 DE com base no NANDA-I, com maior predominância de diagnósticos no domínio segurança e proteção, e no de eliminação e troca. Conclusão: A identificação dos Diagnósticos de Enfermagem baseados nos protocolos quimioterápicos permite a proposição de planos de cuidados individualizados para atender necessidades dos pacientes submetidos à quimioterapia, principalmente com foco na prevenção da ocorrência e minimização dos efeitos adversos, quando já presentes.

Risk Factors for Oral Mucositis During Chemotherapy Treatment for Solid Tumors: A Retrospective STROBE-Guided Study

Purpose This study retrospectively analyzed the risk factors for transchemotherapy oral mucositis (OM). Methods Before each chemotherapy cycle, patients were routinely evaluated for the presence/severity of OM based on the Common Terminology Criteria for Adverse Events (CTCAE) v5.0 scale for adverse effects and graded as follows: However, specific conditions such as mucositis are graded on a five-point scale: 0, absence of mucositis, grade 1 (Asymptomatic or mild), 2 (Presence of pain and moderate ulceration, without interference with food intake), 3 (severe pain with interference with food intake) or 4 (Life-threatening with the need for urgent intervention). Information from 2 years of evaluations was collected and patient medical records were reviewed to obtain data on chemotherapy cycle, sex, age, body mass index, body surface area, primary tumor, chemotherapy protocol, and history of head and neck radiotherapy. The X² test and multinomial logistic regression were used for statistical analysis (SPSS 20.0, p < 0.05). Results Among 19,000 total evaluations of 3,529 patients during 5.32 ± 4.7 chemotherapy cycles (CT) the prevalence of OM was 6.3% (n = 1,195). Chemotherapy duration (p < 0.001), female sex (p = 0.001), adjuvant intention (p = 0.008) and the use of carboplatin (p = 0.001), cisplatin (p = 0.029), docetaxel (p < 0.001) and bevacizumab (p = 0.026) independently increased the risk of mucositis. In head and neck tumors, 2018 year (p = 0.017), chemotherapy duration (p = 0.018), BMI > 30 (p = 0.008), radiotherapy (p = 0.037) and use of carboplatin (p = 0.046) and cyclophosphamide (p = 0.010) increased this prevalence. Conclusion Cycles of chemotherapy, sex, cytotoxicity drugs, bevacizumab and head and neck radiotherapy increase the risk of OM in solid tumors.

Hyperosmolar Hyperglycaemic State and Diabetic Ketoacidosis in Nivolumab-Induced Insulin-Dependent Diabetes Mellitus

Nivolumab is a monoclonal antibody directed against programmed cell death-1 receptor. It has an increasing application in the treatment of various advanced metastatic cancers. The incidence of autoimmune side effects associated with such agents is expected to increase. New-onset autoimmune diabetes mellitus associated with immune checkpoint inhibitor treatment is rare, occurring in less than 1% of patients. Nivolumab-induced diabetes often presents as diabetic ketoacidosis, which could be life-threatening if not recognized and treated promptly. We present the case of a patient who developed severe diabetic ketoacidosis concomitant with hyperosmolar hyperglycaemic state (HHS) after receiving nivolumab for metastatic testicular lymphoma. Pre-nivolumab blood glucose levels were normal, apart from transient hyperglycaemia related to steroids as part of the chemotherapy protocol. The diagnosis was confirmed with extremely low C-peptide in the clinic.

Surgical treatment associated with adjuvant chemotherapy with cyclophosphamide and piroxicam in cervical sarcoma of a blue-fronted amazon (Amazona aestiva): case report

The occurrence of neoplasms in birds is still unknown, with the literature based mainly on scarce reports, in this context, data about epidemiology in specific species are almost nonexistent. Sarcomas are malignant mesenchymal origin neoplasms, which can develop from different tissues, such as adipose, cartilage, bone, among others. The occurrence of sarcomas in birds has been previously described, with different therapeutic approaches. The present report describes the clinical approach in a blue-fronted amazon (Amazona aestiva) diagnosed with a soft tissue sarcoma in the dorsal cervical region, with surgical excision associated with a metronomic chemotherapy protocol as an adjuvant. The therapeutic combination proved to be effective in controlling the disease, guaranteeing important survival, with clinical absence of side effects.

Vincristine induced neurotoxicity in children who underwent chemotherapy for acute lymphoblastic leukemia and Wilms tumor

Background & Objectives: Vincristine has been used as chemotherapeutic agent for many decades. It implements its function by inhibiting the duplication of tumor cells by destroying the DNA. However, like all other drugs, its administration is not without any side effects. The most important of these are being the neurotoxic side effects. This study evaluated the degree of neurotoxicity induced by vincristine in children who underwent chemotherapy for acute lymphoblastic leukemia and Wilms tumor. Methods: A quasi experimental study was conducted at Children Hospital & the Institute of Child Health, Multan from January 2020 to October 2020 after taking informed written consent. In this study, 150 children of age group 1—12 years with pathological confirmation of acute lymphoblastic leukemia and Wilms tumor who had undergone a chemotherapy protocol including at least four consecutive weekly Vincristine injections were included, using probability consecutive sampling technique. Neurological examination was conducted on them on weekly basis. Results: There were 150 patients,90(60%) males and 60(40%) females with mean age of (5.5±2.2). Diminished patellar and Achilles tendon reflexes were seen in 48% and 52% of patients. Muscular weakness was seen in 60% of patients. Other side effects like hoarseness, jaw pain, constipation and petosis were observed in 10%, 8%,40% and 10% of patients respectively. Frequency of side effects was equally observed in both sexes and it was more among age group older than five years (p= 0.01). Conclusion: Vincristine regimen produces some neurotoxic side effects in children but nearly all of these are of mild to moderate in nature. doi: https://doi.org/10.12669/pjms.37.5.4169 How to cite this:Adil MK, Ali Z, Arshad U, Fawad U. Vincristine induced neurotoxicity in children who underwent chemotherapy for acute lymphoblastic leukemia and Wilms tumor. Pak J Med Sci. 2021;37(5):---------. doi: https://doi.org/10.12669/pjms.37.5.4169 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Clinical and Laboratory Findings in Dogs Undergoing Adjuvant Chemotherapy with Gemcitabine/Carboplatin Combination for Mammary Neoplasia

Adjuvant chemotherapy might be indicated in some canine mammary cancer cases due to metastatic potential. In this regard, studies to determine adverse events following chemotherapy protocols are valuable. The purpose of this prospective clinical trial was to evaluate the safety and tolerability of gemcitabine and carboplatin combination in dogs with malignant mammary tumors. For this prospective clinical trial, 21 female dogs mastectomized due to malignant mammary neoplasia underwent adjuvant chemotherapy with gemcitabine (3 mg/kg, 60-minute IV infusion) and carboplatin (10 mg/kg, 20-minute IV infusion) based protocol every 21 days for three cycles. They were monitored periodically for treatment-related adverse events by clinical and laboratory evaluations. A total of 17 (80.9%) dogs developed leukopenia, 10 (47.6%) neutropenia, and 15 (71.4%) thrombocytopenia at least once along with the three chemotherapy cycles. All these hematologic toxicities were grade 1, 2, or 3. Two (9.5%) animals had evidence of gastrointestinal toxicity; however, clinical signs were mild to moderate (grades 1 and 2). No dog had life-threatening adverse events (grade 4) or even died (grade 5) of treatment-related complications. The adjuvant chemotherapy protocol with gemcitabine and carboplatin was well-tolerated and safe in female dogs for mammary cancer treatment with self-limiting hematological and gastrointestinal adverse events.

Bilateral ovarian dysgerminoma with metastasis in female dog's mesenteric lymph node: a case report

Dysgerminoma is a rare malignant neoplasm, associated with hormonal dysfunctions, which occurs in canine and feline females from middle age to elderly, without racial predisposition. In the present report, we described a case of ovarian dysgerminoma in a dog, only abdominal distension, persistent vulvar bloody discharge and apathy. The animal in question underwent exploratory laparotomy, where general neoformations were detected in the ovaries, and a lymph node with abnormal characteristics was also found. Therefore, surgery for ovariosalpingoisterectomy and puncture of a fragment of the lymph node altered for incisional biopsy was performed. The diagnosis was made through histopathological examination of the ovaries of the fragment derived from the lymph node, the result of which indicated the presence of dysgerminoma in both ovaries and in the lymph node, characterizing a metastasis. In view of this result, the chemotherapy protocol with the association of carboplatin and vinblastine was instituted, which proved to be effective and not very toxic to the animal, with no clinical sign of metastasis being identified after its use.