Spanish Society of Medical Oncology consensus on the use of erythropoietic stimulating agents in anaemic cancer patients

Treatment of anaemia is a very important aspect in the management of cancer patients. In order to carry out a consensus process about the use of erythropoietic stimulating agents (ESAs) in cancer patients, the Spanish Society of Medical Oncology (SEOM) elaborated a working group which coordinated a panel of medical oncology specialists. This working group has reviewed the main issues about the use of ESAs. In addition a consensus meeting was held in Madrid on 25 April 2007. The following conclusions were made: Since ESA treatment increases the haemoglobin (Hb) level and decreases the red blood cell (RBC) transfusion requirements, ESAs should be used within the approved indications in patients undergoing chemotherapy treatment, beginning at a Hb level below 11 g/dl and maintaining it around 12 g/dl, with iron supplements if necessary. Neither increasing the ESA dose in nonresponders nor the use of ESAs in the treatment of chronic cancer-related anaemia is recommended (AU)

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[The clinical and radiological characteristics and evolution of incidentally diagnosed pulmonary thromboembolism]. / Diagnóstico casual de tromboembolismo pulmonar: descripción de las características clínicas y radiológicas y su evolución.

OBJECTIVES: To evaluate the cases of pulmonary embolism (PE) detected incidentally in our hospital, the associated risk factors, clinical and radiological characteristics, and evolution. MATERIAL AND METHODS: We retrospectively reviewed the reports of routine contrast-enhanced chest CT examinations performed during a 19-month period to detect cases in which PE was diagnosed incidentally. We found 18 cases of incidentally diagnosed PE and we reviewed the clinical histories and CT images of these patients to analyze the risk factors, clinical presentation, radiological characteristics, treatment, and evolution of PE in these cases. RESULTS: We found 18 patients (9 men and 9 women; mean age: 61 years) with incidentally detected PE. The main risk factor for developing PE was the presence of a neoplasm (n = 16). No PE-related symptoms were present in 12 patients. A multidetector CT scanner was used for the examination in most cases (n = 16). PE was centrally located in 16 patients. Five patients were not treated with anticoagulation and no embolic events occurred in these patients. Two of the remaining patients died because of PE. CONCLUSIONS: The incidental finding of PE can be common in oncological patients. Multidetector CT probably has a greater capacity for the incidental detection of PE in these patients. The outcome of incidentally detected PE can vary from death to remaining stable to spontaneous resolution.

Diagnóstico casual de tromboembolismo pulmonar: descripción de las características clínicas y radiológicas y su evolución / The clinical and radiological characteristics and evolution of incidentally diagnosed pulmonary thromboembolism

Objetivos. Evaluar a los enfermos con tromboembolismo pulmonar (TEP) detectados de forma casual en nuestro hospital, los factores de riesgo asociados, sus características clínicas y radiológicas y su evolución. Material y métodos. Se revisaron de forma retrospectiva los informes de tomografías computarizadas (TC) torácicas de rutina con contraste intravenoso de un periodo de 19 meses, para detectar aquellos casos en los que se estableció un diagnóstico de TEP de forma casual. Se detectaron 18 pacientes con ese diagnóstico y se revisaron los estudios de TC y las historias clínicas de esos pacientes para analizar las características radiológicas del TEP, los factores de riesgo, la clínica que presentaban, si recibieron tratamiento y su evolución. Resultados. De los 18 pacientes 9 eran mujeres y 9 varones con una edad media de 61 años. El principal factor de riesgo de desarrollar TEP fue la existencia de una neoplasia, presente en 16 enfermos. El 66% de los pacientes no presentaban síntomas en relación con el TEP. En la mayoría de los pacientes (16) la TC fue realizada en un aparato multidetector (TCMD) y en el mismo número la extensión del TEP fue central. Cinco pacientes no fueron tratados con anticoagulación y en su evolución no se produjeron eventos embólicos. Del resto de pacientes dos fallecieron debido al TEP. Conclusiones. El hallazgo casual de un TEP puede ser frecuente en pacientes oncológicos. Probablemente la TCMD tiene una mayor capacidad de detección casual de estos TEP. Su evolución puede ser variable, desde causar la muerte hasta permanecer estables o resolverse sin tratamiento (AU)

Objectives. To evaluate the cases of pulmonary embolism (PE) detected incidentally in our hospital, the associated risk factors, clinical and radiological characteristics, and evolution. Material and methods. We retrospectively reviewed the reports of routine contrast-enhanced chest CT examinations performed during a 19-month period to detect cases in which PE was diagnosed incidentally. We found 18 cases of incidentally diagnosed PE and we reviewed the clinical histories and CT images of these patients to analyze the risk factors, clinical presentation, radiological characteristics, treatment, and evolution of PE in these cases. Results. We found 18 patients (9 men and 9 women; mean age: 61 years) with incidentally detected PE. The main risk factor for developing PE was the presence of a neoplasm (n = 16). No PE-related symptoms were present in 12 patients. A multidetector CT scanner was used for the examination in most cases (n = 16). PE was centrally located in 16 patients. Five patients were not treated with anticoagulation and no embolic events occurred in these patients. Two of the remaining patients died because of PE. Conclusions. The incidental finding of PE can be common in oncological patients. Multidetector CT probably has a greater capacity for the incidental detection of PE in these patients. The outcome of incidentally detected PE can vary from death to remaining stable to spontaneous resolution (AU)

Granisetron plus methylprednisolone for the control of high-dose cisplatin-induced emesis.

This double-blind, double-dummy, randomized study compared the 24 h efficacy and safety of granisetron alone (3 mg i.v. over 30 s) or in combination with methylprednisolone (250 mg i.v. twice daily) in preventing nausea and vomiting in 308 patients (254 males) receiving high-dose cisplatin (100 mg/m2 or above) for mainly lung, and head and neck cancers. All patients received oral follow-on therapy comprising oral granisetron and methylprednisolone during the following 6 days. Primary efficacy variables were the proportions of complete responses (CR; no vomiting, no worse than mild nausea, no rescue and no withdrawal), no vomiting and no nausea over the first 24 h following initiation of the cisplatin infusion. The two treatment groups were well matched for demographics, cancer site, cisplatin dose and duration of infusion. Granisetron plus methylprednisolone was significantly more effective than granisetron alone for all primary efficacy variables: CR 78 versus 59% (p<0.001), no vomiting 80 versus 61% (p<0.001) and no nausea 74 versus 57% (p<0.002). Significantly more patients receiving the combination were free of any emetic symptoms (74 versus 54%, p<0.001). Significantly fewer patients receiving combination therapy also required rescue therapy with i.v. granisetron (12.2 versus 21.7%, p=0.026). During the follow-on period, complete response rates varied day by day from 50 to 71%. Both treatments were well tolerated, with constipation, abdominal pain and headache as the most frequent adverse events.

[Hemangiopericytoma of the soft palate and mediastinum: a case report]. / Hemangiopericitoma de paladar blando y mediastino. A propósito de un caso.

We report a case of hemangiopericytoma with simultaneous affectation of soft palate and mediastinum in a 46-year-old male. We describe the outstanding histologic features of this uncommon tumor, as well as its treatment and evolution. This case had a 5-year survival in spite of pulmonary metastases. We also reviewed the literature and discussed this rare clinical presentation of hemangiopericytoma.