Diagnostic and therapeutic management of vesico-ureteral reflux in pediatric kidney transplantation-Results of an online survey on behalf of the European Society for Paediatric Nephrology

BACKGROUND

Vesico-ureteral reflux (VUR) is considered to be a risk factor for recurrent febrile urinary tract infections and impaired renal transplant survival.

METHODS

An online survey supported by the European Society for Paediatric Nephrology was designed to evaluate current management strategies of VUR in native and transplanted kidneys of recipients aged <18 years.

RESULTS

Seventy-three pediatric transplant centers from 32 countries contributed to the survey. All centers performed urological evaluation prior to pediatric kidney transplantation (KTx) with subsequent interdisciplinary discussion. Screening for VUR in native kidneys (30% in all, 70% in selected patients) led to surgical intervention in 78% (11% in all, 89% in selected patients) with a decided preference of endoscopic intervention over ureterocystoneostomy. Following KTx, continuous antibiotic prophylaxis was applied in 65% of the patients and screening for allograft VUR performed in 93% of selected patients. The main management strategies of symptomatic allograft VUR were continuous antibiotic prophylaxis (83%) and surgical treatment (74%) (endoscopic intervention 55%, redo ureterocystoneostomy 26%).

CONCLUSIONS

This survey demonstrates the high variability in the management of VUR in pediatric KTx recipients, points to knowledge gaps, and might serve as a starting point for improving the care for patients with VUR in native and transplanted kidneys.

Triple-negative metastatic/recurrent breast cancer: Treatment with paclitaxel/carboplatin combination chemotherapy

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Background: Patients with triple negative (ER, PR, Her2 negative) breast cancers do not derive benefit from Herceptin or hormonal agents. For them, conventional chemotherapy remains the only option. Recent data suggests that triple negative breast cancers (TNBC) have increased sensitivity to platinum agents. We conducted a retrospective analysis to determine the response rates of such patients treated with paclitaxel and carboplatin (TC) chemotherapy. Methods: Patients with metastatic/recurrent TNBC were included in our study. Chemotherapy administered at weekly (paclitaxel 80mg/m2 and carboplatin AUC2 on D1, D8, D15) or 3 weekly intervals (paclitaxel 175mg/m2 and Carboplatin AUC 5 on D1). ER and PR status was defined using IHC. Her 2 positive was defined by a positive FISH or 3+ IHC staining. Results: 101 patients with TNBC were diagnosed at our centre from 2002 to 2005 and of these only 23 patients had metastatic/ recurrent disease. 14 patients were treated with TC and therefore included in our analysis. Median age of patients was 53 yrs (range 36 to 68yrs). 3 patients had metastatic disease at diagnosis and 11 patients were treated for recurrent disease. Median time to recurrence for this subgroup was 20 months (range 8 to 224mths). 4 and 6 patients had prior adjuvant exposure to taxanes and anthracyclines respectively. Median prior lines of chemotherapy was 1 (range 0–4). Median number of disease sites in patients was 4. Eight patients (57%) experience a partial response (PR) with TC. 2 patients had stable disease and 4 progressive disease. Although no patients experienced complete response, 3 patients had good PR. One patient with metastatic disease had complete resolution of a large, 9cm locally invasive breast tumor after 3 cycles of TC. The second had a 90% reduction in volume of a large chest wall recurrence after 2 cycles TC. Patients who had 2 or 3 prior lines of chemotherapy also continued to show response. The median time to tumor progression was 16 weeks (range 4–28 wks). Conclusions: TC gives a high response rate in patients with metastatic/ recurrent TNBC. Patients with prior exposure to taxanes and those with large volume disease showed good response. Randomised trials are underway to compare the TC regimen with non-platinum containing doublets.

No significant financial relationships to disclose.

Spontaneous umbilical CSF fistula in an adult as a complication of a ventriculoperitoneal shunt

Ventriculoperitoneal (VP) shunt is the most commonly used CSF shunt in the modern era and widely accepted for the management of hydrocephalus. Numerous abdominal complications have been reported in the literature. Spontaneous umbilical fistula from VP shunt, although uncommon, has been reported previously in children, but never in an adult. This is a case report on an adult who was treated for spontaneous umbilical fistula at our unit.

Clinical efficacy of capecitabine as first-line chemotherapy in metastatic breast cancer

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Background: Capecitabine is commonly used in metastatic breast cancer (MBC), but there are limited data on its efficacy in the first-line setting. The clinical efficacy of capecitabine monotherapy was evaluated in our institution. Methods: Patients who received capecitabine monotherapy (starting dose 1 g/m2 twice daily every 2 out of 3 weeks) between April 2001 and April 2005 as first-line treatment for advanced disease were retrospectively identified from our prospectively maintained database. Endpoints included response rate (RR), response duration, time to progression (TTP) and overall survival (OS). Results: 63 patients were evaluated. The median age was 57 (30–79) years. The sites of disease were soft tissue and/or bone only in 24 (38%) patients, and involved visceral sites in 39 (62%) patients. 45 (71%) patients had previously received adjuvant or neoadjuvant chemotherapy. The median number of cycles administered was 5 (1–40). 48 (76%) had measurable disease with a RR of 29% (14/48). Chemotherapy-naive patients with measurable disease had a RR of 33% (5/15), while patients previously exposed to neoadjuvant or adjuvant chemotherapy had a RR of 27% (9/33). The median response duration was 24(9–68) weeks. The median TTP was 18 (range 2–122) weeks. However 12(19%) had a TTP of 9 months or more, including 7 (11%) with a TTP of >1 year (14–28 months). Of these, 6/7 were oestrogen receptor +ve and 5/7 had bone and/or soft tissue disease only. 21 (33%) patients developed disease progression on treatment, and response was not evaluable in 4 (6%) patients who stopped capecitabine after 2 or fewer cycles due to medical co-morbidities. Conclusions: These audit results on first line capecitabine monotherapy in MBC are consistent with a previously published study(1). The overall RR may be less than for anthracyclines and taxanes (generally 30–50%) in this setting, but for a subgroup of patients with predominantly soft tissue/bone disease capecitabine can result in prolonged TTP with minimal toxicity. This should be evaluated further in a randomized clinical trial. References 1. O’Shaughnessey JA et al. Ann Oncol 2001 Sept; 12 (9): 1247–54.

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