While 22 articles have reported on sacral stress fractures, it is a rare injury and its etiology is not well known. We present the case of a 16-year-old male who presented with low back pain in 2015. He was a high school soccer player with a previous history of a bilateral L5 lumbar spondylolysis in 2014. The patient refrained from soccer and wore a brace for six months. Two months after restarting soccer, he again complained of low back pain. After 1 year, a lumbar spine computed tomography revealed the bone union of the spondylolysis. At his first visit to our hospital, his general and neurological conditions were normal and laboratory data were within the normal range. Sacral coronal magnetic resonance imaging (MRI) of the left sacral ala revealed an oblique lineal signal void surrounding bone marrow edema. Based on his symptoms, sports history, and MRI, he was diagnosed with a sacral stress fracture. He again refrained from soccer; his low back pain soon improved, and, after 1 year, the abnormal signal change had disappeared on sacral MRI. Recurrent low back pain case caused by a sacral stress fracture occurring after the bone union of lumbar spondylolysis is uncommon.
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Cancer Medicine by Alexandros G.Sfakianakis,Anapafseos 5 Agios Nikolaos,Crete 72100,Greece,tel :00302841026182 & 00306932607174
Τρίτη 6 Δεκεμβρίου 2016
Sacral Stress Fracture following the Bone Union of Lumbar Spondylolysis
Extravasation emergencies: state-of-the-art management and progress in clinical research
Summary
In cancer treatment, extravasation is defined as an inadvertent instillation or leakage of cytotoxic drugs into the perivascular space during infusion. As a dreaded complication of chemotherapy, extravasation has gained increasing attention in recent years. Classified according to their subcutaneous toxicity, three types of cytotoxins have been established: vesicants, irritants and nonvesicant drugs. Vesicant cytotoxic drugs may induce tissue damage, ulceration and tissue necrosis. Although we have established measures to manage extravasation emergencies, prevention is of paramount importance. This may be achieved within hospitals through regular training and education, which is best provided by a specialised and experienced task force including all disciplines involved in cancer therapy. Moreover, clinical and translational studies contribute to a better management of chemotherapy-induced extravasation as shown by our group in recent years. We were able to demonstrate that the evaluation of blood flow by indocyanine green angiography in the extravasation area predicts the extent of damage and the need of future surgical intervention. When a Port-a-Cath® extravasation is detected early, a subcutaneous wash-out procedure was found to be beneficial, corroborated by the analytical evaluation of the removed cytotoxic compound epirubicin. In another study, the tissue distribution of platinum was quantified at the anatomic level in cryosections of various tissues. This novel knowledge complements and supports our current efforts to handle extravasations better. On the other hand, a number of new drugs (chemotherapy, monoclonal antibodies, checkpoint inhibitors etc.) with many open issues to reliably classify their tissue toxicity still require our attention.
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Post ASCO update 2016—lung cancer
Summary
The aim of this short review is to summarize the most important data relating to the field of thoracic tumors presented at the 2016 ASCO annual meeting. For small cell lung cancer (SCLC) the treatment algorithms once again remain unchanged. The CONVERT study was not able to show superiority of a modern chemoradiotherapy regimen using once daily fractionation over the historical standard of hyperfractionated chemoradiotherapy. With rovalpituzumab tesirine a promising new agent is in development, leading to encouraging treatment results in patients with pretreated, extensive SCLC disease on phase IB level. Regarding nonsmall cell lung cancer (NSCLC) a phase II trial was able to confirm high efficacy of the combination dabrafenib/trametinib if a BRAF-V600E mutation is detectable. These data should lead to more widespread implementation of BRAF mutation testing in routine diagnostic work-up. In the J‑ALEX trial alectinib outperformed crizotinib in the first-line treatment of Asian patients with ALK-rearranged metastatic NSCLC. However, further data from ongoing studies will be necessary to better define the optimal sequencing of treatments for this genetically defined subgroup of patients.
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Extravasation emergencies: state-of-the-art management and progress in clinical research
Summary
In cancer treatment, extravasation is defined as an inadvertent instillation or leakage of cytotoxic drugs into the perivascular space during infusion. As a dreaded complication of chemotherapy, extravasation has gained increasing attention in recent years. Classified according to their subcutaneous toxicity, three types of cytotoxins have been established: vesicants, irritants and nonvesicant drugs. Vesicant cytotoxic drugs may induce tissue damage, ulceration and tissue necrosis. Although we have established measures to manage extravasation emergencies, prevention is of paramount importance. This may be achieved within hospitals through regular training and education, which is best provided by a specialised and experienced task force including all disciplines involved in cancer therapy. Moreover, clinical and translational studies contribute to a better management of chemotherapy-induced extravasation as shown by our group in recent years. We were able to demonstrate that the evaluation of blood flow by indocyanine green angiography in the extravasation area predicts the extent of damage and the need of future surgical intervention. When a Port-a-Cath® extravasation is detected early, a subcutaneous wash-out procedure was found to be beneficial, corroborated by the analytical evaluation of the removed cytotoxic compound epirubicin. In another study, the tissue distribution of platinum was quantified at the anatomic level in cryosections of various tissues. This novel knowledge complements and supports our current efforts to handle extravasations better. On the other hand, a number of new drugs (chemotherapy, monoclonal antibodies, checkpoint inhibitors etc.) with many open issues to reliably classify their tissue toxicity still require our attention.
http://ift.tt/2g4SrUC
Post ASCO update 2016—lung cancer
Summary
The aim of this short review is to summarize the most important data relating to the field of thoracic tumors presented at the 2016 ASCO annual meeting. For small cell lung cancer (SCLC) the treatment algorithms once again remain unchanged. The CONVERT study was not able to show superiority of a modern chemoradiotherapy regimen using once daily fractionation over the historical standard of hyperfractionated chemoradiotherapy. With rovalpituzumab tesirine a promising new agent is in development, leading to encouraging treatment results in patients with pretreated, extensive SCLC disease on phase IB level. Regarding nonsmall cell lung cancer (NSCLC) a phase II trial was able to confirm high efficacy of the combination dabrafenib/trametinib if a BRAF-V600E mutation is detectable. These data should lead to more widespread implementation of BRAF mutation testing in routine diagnostic work-up. In the J‑ALEX trial alectinib outperformed crizotinib in the first-line treatment of Asian patients with ALK-rearranged metastatic NSCLC. However, further data from ongoing studies will be necessary to better define the optimal sequencing of treatments for this genetically defined subgroup of patients.
http://ift.tt/2hcZjV8
Effect of radium-223 dichloride (Ra-223) on hospitalisation: An analysis from the phase 3 randomised Alpharadin in Symptomatic Prostate Cancer Patients (ALSYMPCA) trial
Publication date: January 2017
Source:European Journal of Cancer, Volume 71
Author(s): Christopher Parker, Lin Zhan, Paul Cislo, Jonathan Reuning-Scherer, Nicholas J. Vogelzang, Sten Nilsson, Oliver Sartor, Joe M. O'Sullivan, Robert E. Coleman
Symptomatic skeletal events (SSEs) commonly occur in patients with bone metastases, often leading to hospitalisations and decreased quality-of-life. In the ALSYMPCA trial, radium-223 significantly improved overall survival (hazard ratio 0.70, 95% confidence interval [CI] 0.58–0.83, P < 0.001) and prolonged time to first SSE (hazard ratio 0.66, 95% CI 0.52–0.83, P = 0.00037) and subsequent SSE (hazard ratio 0.65, 95% CI 0.51–0.83, P = 0.00039) versus placebo in patients with castration-resistant prostate cancer with symptomatic bone metastases and no known visceral metastases. Health care resource use (HCRU), including hospitalisation events and days, were prospectively collected in ALSYMPCA. We assessed health care resource use for the first 12 months post-randomisation. Significantly fewer radium-223 (218/589; 37.0%) versus placebo patients (133/292; 45.5%) had at least one hospitalisation event (P = 0.016). However, mean number of hospitalisation events per patient was similar (radium-223 0.69 versus placebo 0.79, P = 0.226), likely due to the significantly longer follow-up time for radium-223 (7.82 months versus 6.92 months for placebo; P < 0.001). There were significantly fewer hospitalisation days per patient for radium-223 (4.44 versus 6.68, respectively, P = 0.004). The reduction in hospitalisation days with radium-223 was observed both before first SSE (2.35 days versus 3.36 days, respectively) and after SSE (7.74 days versus 9.19 days, respectively). Our data suggest that this reduced hospital days along with the survival benefit and reduction in time to SSEs with radium-223 treatment may contribute to improvements in health-related quality-of-life in patients with castration-resistant prostate cancer with symptomatic bone metastases (ALSYMPCA ClinicalTrials.gov number, NCT00699751.).
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