Tamoxifen induced hypercalcaemia: a case report

The present case demonstrates the important of close observation of patients with cancer metastatic to bone, newly started on endocrine therapy. Nonspecific symptoms should alert the physician to the possibility of hypercalcaemia. The serum calcium is better monitored regularly during the first 2 weeks of tamoxifen therapy, especially in patients with renal impairment. Volume repletion with normal saline is the most important initial treatment for hypercalcaemia. Patients with serum calcium levels above 3.25 m mol/1 [13 mg/dl] required additional intravenous bisphosphonate treatment. Oral bisphosphonate given for two weeks may prevent possible recurrence of hyperercalcaemia when tamoxifen therapy is reinstitkuted

Early cardiac effects of radiotherapy following radial mastectomy in patients with carcinoma of the left breast

Nineteen patients with left breast cancer, who had no risk factors for coronary artery disease, underwent radical mastectomy followed by radiotherapy. Every patient received 50 Gy delivered to an inverted L-shaped field, from a cobalt-60 source. After radiotherapy, patients were followed for cardiac complications over an average observation period of 19.7 months. Of the 19 patients, five [26%] developed effusive pericarditis without cardiac tamponade. Echocardiography was superior to clinical examination and chest radiography for the detection and follow-up of pericardial effusions. Other cardiac complications reported to follow radiation injury to the heart were not observed and probably represent late effects of radiotherapy. In conclusion, patients with left breast cancer, especially those who have additional risk factors for coronary disease, may be at an increased risk of cardiac complications following radiotherapy. Suggestions for regular follow-up cardiac evaluation and irradiation treatment are discussed