Cardiac safety of adjuvant non-pegylated liposomal doxorubicin combined with cyclophosphamide and followed by paclitaxel in older breast cancer patients.

PURPOSE: To investigate the cardiac safety of adjuvant Non-Pegylated Liposomal Doxorubicin (NPL-DOX) combined to Cyclophosphamide (CTX) and followed by weekly Paclitaxel, in older patients (≥65 years) with diagnosis of high risk breast cancer. The main end point of this prospective study was the detection of early episodes of symptomatic congestive heart failure (CHF). METHODS: The cardiac function was evaluated by left ventricular ejection fraction (LVEF) measurements with repeated echocardiograms, performed 2 weeks before the beginning of chemotherapy and every 6 months, until 30 months after the study entry; then yearly for at least 5 years. RESULTS: Forty-seven patients were enrolled from two Italian Divisions of Medical Oncology. Final results revealed no early episodes of symptomatic CHF within the first 12 months from the enrolment. Only two cardiac events were observed: an episode of atrial flutter after the first cycle of NPL-DOX and CTX, with a quick return to normal rhythm, and a grade 3 (scored to NCI-CTCAE, version 3.0) CHF episode, 18 months later chemotherapy start. No other relevant toxicities were reported. CONCLUSIONS: This adjuvant combination including NPL-DOX in elderly patients, resulted in a low rate of cardiac toxic effects. Comparative trials should be encouraged to confirm these findings.

[Spontaneous rupture of the spleen in non-hodgkin lymphoma: a case report]. / Rottura spontanea di milza in linfoma non Hodgkin: caso clinico.

Spontaneous rupture of the spleen without a history of trauma is a rare clinical entity and represents a dramatic abdominal emergency. Most cases of spontaneous rupture occur in a diseased spleen (pathological spontaneous rupture). The authors present the case of a 20-year-old man who presented with pain in the left upper quadrant and clinical signs of haemorrhagic shock. The execution of focused assessment with sonography for trauma in the emergency room revealed the rupture of a pathological spleen with massive haemoperitoneum. The patient underwent emergency splenectomy. Histological examination of the spleen diagnosed infiltration of B cell lymphoma. Spontaneous rupture of the spleen must be considered in patients with acute abdominal pain and haemorrhagic shock. The role of focused assessment with sonography for trauma in the emergency room is discussed.