Articles

Spinal dissemination of glial tumours: Two case reports and review of the literature

BJMO - volume 15, issue 7, november 2021

A. Balland MD, P-A. Poncelet MD, L. Renard MD, N. Whenham MD

SUMMARY

Glioblastoma rarely metastasise outside the brain. Mechanisms of distant dissemination are unclear, therapeutic options limited and prognosis poor. Here we report two cases of glial tumour with a secondary spinal spread. During their follow-up, patients developed neurological symptoms suggestive of a medullary affection. Diagnosis was based on spine MRI with demonstration of intramedullary or leptomeningeal enhancing lesions. Disease rapidly developed with an unfavourable outcome, despite oncological and best supportive treatments. We present a review of the literature focused on spinal dissemination of primary intracranial glioblastoma. We analyse the pathogenesis and the genetic mutations which might be involved. Finally, we discuss symptoms and possible treatments.

(BELG J MED ONCOL 2021;15(7):374-9)

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Corticosteroids as treatment of viral induced haemophagocytic lymphohistiocytosis in a patient with breast cancer

BJMO - volume 15, issue 4, june 2021

S. Wautier MD, C. Mahiat MD, T. Connerotte MD, PhD, N. Whenham MD, R. Poncin MD, L. Duck MD

SUMMARY

Haemophagocytic lymphohistiocytosis (HLH) is a rare life-threatening disease characterised by cytotoxic immune deregulation leading to hypercytokinaemia and macro-phage activation. Given the high mortality rate, HLH must be suspected in nonspecific situations and promptly confirmed based on 2004-HLH criteria. In adult patients, HLH is usually secondary to infection, malignancy or underlying autoimmune diseases. As treatment, paediatric protocol consists of immuno-therapy and chemotherapy, followed by a haematopoietic stem cell transplant (HSCT). In adults, individualised modified treatment is recommended because of the variable cause and severity of situation. Corticosteroids are the mainstay. We report the case of a patient with breast cancer, for whom we made the diagnosis of HLH during her neoadjuvant chemotherapy based on the 2004-HLH criteria. A viral aetiology was suspected with reactive lymphocytes found on the blood smear, and we promptly initiate treatment of dexamethasone. Our patient fully recovered both from her HLH and breast cancer.

(BELG J MED ONCOL 2021;15(4):186-91)

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A case of a life-threatening toxicity following capecitabine treatment: advocacy for dihydropyrimidine dehydrogenase deficiency screening

BJMO - volume 14, issue 4, june 2020

H. Houssiau MD, L. Duck MD, S. Carlier MD, R. Poncin MD, N. Whenham MD, V. Haufroid PhD

SUMMARY

We discuss a life-threatening case of capecitabine toxicity due to the presence of a heterozygous variant on exon 14 (c.1905+1G>A, rs3918290) of the dihydropyrimidine dehydrogenase gene (DPYD). We advocate the need for dihydropyrimidine dehydrogenase deficit screening, which could become mandatory in Belgium, as in France, before any fluoropyrimidine administration to avoid cases of foreseeable toxicity.

(BELG J MED ONCOL 2020;14(4):151–4)

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Low Grade Glioma: towards a personalised treatment

BJMO - volume 13, issue 6, october 2019

S. Dingenen MD, L. Renard MD, T.M. Lawson MD, N. Whenham MD

SUMMARY

This review is designed to help the management of low grade glioma and is based on literature regarding molecular characterisation, surgery, radiotherapy, chemotherapy and neurocognitive preservation.

(BELG J MED ONCOL 2019;13(6): 213–218)

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Brain metastases: Systemic treatment approach in 2017

BJMO - volume 12, issue 3, may 2018

S. Demartin , L. Duck MD, L. Carestia , T. Connerotte MD, PhD, R. Poncin MD, N. Whenham MD

This review proposes to go through reasonable systemic therapy options in brain metastases, notably immune checkpoint inhibitors and oncogen-driven targeted therapies. We deliberately focus on drugs currently available in Belgium in clinical practice. In the large majority of cases, clinical trials – in particular registration trials – exclude patients with brain metastases. Therefore we have to deal with small size non-randomised phase II trials or retrospective analysis with the known caveats of highly selected patients and numerous biases.

(BELG J MED ONCOL 2018:12(3):96–102)

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Metastatic breast phyllodes tumour: is chemotherapy effective?

BJMO - volume 11, issue 1, february 2017

C. Quaghebeur MD, N. Whenham MD, J.P. Machiels MD, PhD, J-P. Haxhe MD, A-P. Schillings MD, E. Laterre MD, X. Catteau MD, R. Poncin MD, L. Duck MD

SUMMARY

Breast phyllodes tumours account for less than 0.5% of breast tumours, their diagnosis is therefore often made after pathological exam. They are fibroepithelial lesions of the breast, and are classified as benign, borderline or malignant. For malignant phyllodes tumours, aggressive behaviour with risk of local and distant recurrence may be seen. Therefore, at least one centimetre free-margins, or mastectomy, should be preferred for local malignant tumours. No prospective randomised data exist to elucidate the role of adjuvant chemotherapy, but radiotherapy should probably be offered after breast conservative surgery for borderline and malignant tumours. For metastatic disease, there is no standard chemotherapy regimen. Doxorubicin is the main recommended drug, based on scarce data. Palliative surgery or radiotherapy may also be offered. We present here a patient with lung metastatic disease who partially responded to a platin-etoposide regimen after doxorubicin failure, and make a short review of the literature.

(BELG J MED ONCOL 2017;11(1):26–28)

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