ONCOCASE

Four case reports of arterial thromboembolism and cisplatin administration

Cisplatin is one of the frequently used chemotherapeutic agents. Common side effects such as vomiting, nephrotoxicity, ototoxicity and neurotoxicity are well known, though Cisplatin is also thought to activate destructive processes in blood vessels, including all types of arteries. Not only can it cause long-term cardiovascular complications (myocardial infarction, hypertension, and stroke), but also such complications during or shortly after its systemic administration. In a significant portion of patients, with up to 9% in some studies, thromboembolic events are encountered.^1,2 In most of the cases, this concerns a venous thromboembolic event, though arterial thromboembolic events should not be neglected as it predicts a bad prognosis and significantly increased mortality risk, especially in cancer patients receiving other prothrombotic chemotherapies or when certain comorbidities are present that enhance the risk of thromboembolism.³ During a short period, we encountered four patients with arterial thromboembolic events while receiving Cisplatin-based therapy, of which three patients had a renal infarction. It should be noted that each patient had a different type of malignancy and Cisplatin was administered in combination with other therapeutic agents.

(BELG J MED ONCOL 2018:12(3):125–129)

Primary leiomyosarcoma of the thyroid: case report and review of the literature

Summary

Primary leiomyosarcoma of the thyroid is a very rare tumour with an unfavourable prognosis. We present a sixty-year-old woman with a localised primary thyroid leiomyosarcoma. Despite a complete resection, a recurrence of the tumour was noticed six months later. After induction chemotherapy with ifosfamide and doxorubicin, the patient had renewed extensive surgery with removal of a tumour remnant and several lymph nodes. This was followed by radiotherapy. Eighteen months after diagnosis the patient is still alive and free of tumour on PET-CT. The case illustrates the high recurrence potential of a primary thyroid leiomyosarcoma despite a complete initial resection, but also the success of aggressive combined treatment.

(BELG J MED ONCOL 2018;12(2):75–78)

Acute cerebral toxicity during concurrent anti-HER2 therapy and radiotherapy for breast cancer brain metastases

Summary

Patients with HER2-positive advanced breast cancer frequently develop brain metastases. Dual anti-HER2 therapy significantly prolongs survival in previously untreated metastatic disease. However, no safety data exist on the concurrent use of pertuzumab, trastuzumab and brain radiotherapy. We describe two cases of previously untreated HER2-positive breast cancer and brain metastases, who developed acute cerebral toxicity during the concomitant administration of anti-HER2 therapy and whole-brain radiotherapy. Systematic clinical data is warranted to prove the safety of this association.

(BELG J MED ONCOL 2018;12(1):22–25)

TPFE (docetaxel, cisplatin, 5-FU and cetuximab) for recurrent mucoepidermoid carcinoma of the parotid gland: an aggressive strategy for an aggressive disease

SUMMARY

The prognosis of patients with advanced malignant salivary gland cancer is usually poor. Systemic therapy combined with best supportive care is recommended for patients with metastatic or recurrent advanced salivary gland cancer ineligible for surgery or radiotherapy. Sensitivity to chemotherapy is thought to be histotype specific. However, to date, none of the systemic therapies, whether cytotoxic or non cytotoxic, can be considered standard for these tumours.

We report the case of a 43 year-old male patient with a third (loco)regional recurrence and metastases in lymph nodes below the clavicles of a mucoepidermoid carcinoma of the right parotid gland. He participated in a feasibility study and was treated with 3-weekly cycles of docetaxel, cisplatin, 5-fluorouracil plus weekly cetuximab (TPFE). After four TPFE cycles, additional radiation was given to the left neck. A complete response was reached which is ongoing for ten years. TPFE induced acute toxicities: skin rash grade 3, hypotension grade 3, neutropenia grade 3, anaemia grade 2 and alopecia grade 2. This observation underlines the importance of offering patients the possibility to participate in clinical trials. International collaboration for rare head and neck cancers, such as mucoepidermoid carcinoma, is urgently needed.

(BELG J MED ONCOL 2017;11(8):386-392)

Brain metastases: an unusual dissemination of heterologous carcinosarcoma of the uterus

SUMMARY

Uterine carcinosarcomas or mixed malignant mullerian tumours (MMMT) are rare gynaecological tumours with mixed carcinomatous and sarcomatous components. They are aggressive with a high risk of loco-regional and distant recurrence. Central nervous system (CNS) invasion by gynaecological malignancies is unusual and is exceptional in MMMT. There are eight reported cases of CNS metastases secondary to uterine MMMT with six cases of brain and two cases of spinal cord metastases. Here we report the case of a 50 year old woman, previously healthy, who was diagnosed with an aggressive heterologous 17x14x10 cm MMMT of the uterus, invading the whole endometrial wall, with lympho-vascular invasion and associated rhabdomyosarcoma elements. She underwent radical surgical resection followed by adjuvant radiation and chemotherapy. She recurred for the first time locally, and was treated with wide surgical resection. Six months later, she developed metastases in supra and infra-diaphragmatic lymph nodes, peritoneum and lungs. While being on palliative chemotherapy for her disseminated disease, she suffered from headache, and unfortunately 4 brain metastatic lesions were seen on brain MRI. Clinicians must be aware of this exceptional metastatic location of MMMT. However, there are no guidelines to screen, prevent or treat CNS metastases secondary to MMMT.

(BELG J MED ONCOL 2017;11(6):284–288)

A rare case of breast malignancy associated with hypercalcemia: double hit lymphoma

SUMMARY

Introduction: primary breast lymphoma is a rare malignancy representing less than 1% of all tumours presenting in the breast.

Case report: a 64 year-old woman presented with altered mental status due to severe hypercalcemia and was found to have a large breast mass with lytic bone lesion of the skull. Biopsy of the mass revealed double hit lymphoma.

Conclusion: we discuss a rare case of breast malignancy with atypical clinical presentation and the literature concerning the characteristics and therapeutic options available for double hit lymphomas.

(BELG J MED ONCOL 2017;11(3):122–125)

Metastatic breast phyllodes tumour: is chemotherapy effective?

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)