Safety and efficacy of the combination of T-DM1 with radiotherapy of the central nervous system in a patient with HER2-positive metastatic breast cancer: case study and review of the literature.

Approximately 35% of patients with confirmed HER2 breast cancer progress to metastases of the central nervous system (CNS). Total cerebral radiotherapy is considered as standard treatment for these cases; however, studies have shown that some chemotherapy drugs can be used during radiotherapy without significantly increasing its toxicity. In this article, we report the case of a patient with HER2-positive breast cancer who showed isolated progression of the illness in the CNS, which was observed during the treatment period using T-DM1 concomitantly with radiotherapy of the CNS without apparent toxicity of the combination and keeping the illness controlled. Through a review of the literature on the use of radiotherapy and chemotherapy with T-DM1 for the treatment of cerebral metastases in HER2-positive breast cancer, we describe the efficacy and tolerance of the concomitant application of these treatments.

Sibilância recorrente em lactentes: mudanças epidemiológicas / Recurrent wheezing in infants: epidemiological changes

OBJETIVO: Verificar mudanças na epidemiologia da sibilância recorrente em lactentes de Curitiba (PR). MÉTODOS: Estudo transversal com aplicação do questionário Estudio Internacional de Sibilancias en Lactantes (EISL). Pais de lactentes entre 12 e 15 meses de vida preencheram o instrumento entre agosto de 2005 e dezembro de 2006 (fase I), e de setembro de 2009 a setembro de 2010 (fase III). RESULTADOS: Pais de 3.003 lactentes participaram da fase I, e 22,6% dos lactentes apresentaram sibilância recorrente (> 3 episódios). Após 5 anos, 1.003 pais preencheram o mesmo questionário na fase III, e 19,8% dos lactentes apresentaram sibilância recorrente (p = 0,1). Houve redução na gravidade dos sintomas (p = 0,001) e nas visitas a prontos-socorros (p < 0,001), mas não houve redução nas internações (p = 0,12). Ter o diagnóstico médico de asma foi mais frequente na fase III (p = 0,03). CONCLUSÕES: Não houve mudança na prevalência de sibilância recorrente em lactentes, mas ocorreu redução na gravidade, embora sem afetar o nível de internações e com aumento do diagnóstico de asma pelos clínicos.

OBJECTIVE: To determine epidemiological changes in recurrent wheezing among infants in Curitiba, Brazil. METHODS: This cross-sectional study used the questionnaire Estudio Internacional de Sibilancias en Lactantes (EISL). Parents of infants aged 12 to 15 months completed the instrument from August 2005 to December 2006 (phase I) and from September 2009 to September 2010 (phase III). RESULTS: Parents of 3,003 infants participated in phase I, and 22.6% of the infants had recurrent wheezing (> 3 episodes). After 5 years, 1,003 parents completed the same questionnaire during phase III, and 19.8% of the infants had recurrent wheezing (p = 0.1). There was a reduction in symptom severity (p = 0.001) and number of emergency department visits (p < 0.001), but not in number of hospitalizations (p = 0.12). Physician-diagnosed asthma was more frequent in phase III (p = 0.03). CONCLUSIONS: There were no changes in the prevalence of recurrent wheezing in infants, but there was an increase in physician-diagnosed asthma and a reduction in severity, which, however, did not affect the rate of hospitalizations.

Recurrent wheezing in infants: epidemiological changes.

OBJECTIVE: To determine epidemiological changes in recurrent wheezing among infants in Curitiba, Brazil. METHODS: This cross-sectional study used the questionnaire Estudio Internacional de Sibilancias en Lactantes (EISL). Parents of infants aged 12 to 15 months completed the instrument from August 2005 to December 2006 (phase I) and from September 2009 to September 2010 (phase III). RESULTS: Parents of 3,003 infants participated in phase I, and 22.6% of the infants had recurrent wheezing (≥ 3 episodes). After 5 years, 1,003 parents completed the same questionnaire during phase III, and 19.8% of the infants had recurrent wheezing (p = 0.1). There was a reduction in symptom severity (p = 0.001) and number of emergency department visits (p < 0.001), but not in number of hospitalizations (p = 0.12). Physician-diagnosed asthma was more frequent in phase III (p = 0.03). CONCLUSIONS: There were no changes in the prevalence of recurrent wheezing in infants, but there was an increase in physician-diagnosed asthma and a reduction in severity, which, however, did not affect the rate of hospitalizations.