Octogenarian patients with colorectal cancer: Characterizing an emerging clinical entity

To characterize colorectal cancer (CRC) in octogenarians as compared with younger patients.METHODSA single-center, retrospective cohort study which included patients diagnosed with CRC at the age of 80 years or older between 2008-2013. A control group included consecutive patients younger than 80 years diagnosed with CRC during the same period. Clinicopathological characteristics, treatment and outcome were compared between the groups. Fisher’s exact test was used for dichotomous variables and χ2 was used for variables with more than two categories. Overall survival was assessed by Kaplan-Meier survival analysis, with the log-rank test. Cancer specific survival (CSS) and disease-free survival were assessed by the Cox proportional hazards model, with the Fine and Gray correction for non-cancer death as a competing risk.RESULTSThe study included 350 patients, 175 patients in each group. Median follow-up was 40.2 mo (range 1.8-97.5). Several significant differences were noted. Octogenarians had a higher proportion of Ashkenazi ethnicity (64.8% vs 47.9%, P < 0.001), a higher rate of personal history of other malignancies (22.4% vs 13.7%, P = 0.035) and lower rates of family history of any cancer (36.6% vs 64.6%, P < 0.001) and family history of CRC (14.4% vs 27.3%, P = 0.006). CRC diagnosis by screening was less frequent in octogenarians (5.7% vs 20%, P < 0.001) and presentation with performance status (PS) of 0-1 was less common in octogenarians (71% vs 93.9%, P < 0.001). Octogenarians were more likely to have tumors located in the right colon (45.7% vs 34.3%, P = 0.029) and had a lower prevalence of well differentiated histology (10.4% vs 19.3%, P = 0.025). They received less treatment and treatment was less aggressive, both in patients with metastatic and non-metastatic disease, regardless of PS. Their 5-year CSS was worse (63.4% vs 77.6%, P = 0.009), both for metastatic (21% vs 43%, P = 0.03) and for non-metastatic disease (76% vs 88%, P = 0.028).CONCLUSIONOctogenarians presented with several distinct characteristics and had worse outcome. Further research is warranted to better define this growing population.

Cisplatin-Induced Posterior Reversible Encephalopathy Syndrome—Brief Report and Review of the Literature

Cisplatin is one of the most broadly used chemotherapeutic agents. Several central nervous system toxicities have been attributed to this agent, among which is a rare clinicoradiological condition referred to as posterior reversible leukoen-cephalopathy syndrome (PRES) or reversible posterior leukoencephalopathy syndrome (RPLS). PRES is characterized by subacute onset of headache, visual disturbances, confusion, seizures and rarely, coma. This usually reversible syn-drome was associated in the past mainly with hypertension. Several reports have associated the syndrome with several immunosuppressive and chemotherapeutic agents suggesting a disruption of the blood brain barrier due to direct damage to the endothelium and vasogenic edema. This syndrome is readily diagnosed with Computed Tomography (CT) or Magnetic resonance imaging (MRI) studies and quick withdrawal of the causative agent in conjunction with supportive care including rapid hypertension control and reduction of elevated intracranial pressure when needed, usually reverse the neurological symptoms with minimal or even no sequela within several days. In this brief report and review of the literature we describe two cases of PRES in two female patients that occurred a few days after receiving Cisplatin-based chemotherapy. We discuss the clinical presentation, diagnosis and treatment of this syndrome by reviewing the literature. The escalating number of clinical reports of PRES merit further studies of the mechanism of toxicity, appropriate treatment and awareness of physicians to this life threatening