Table of Contents Table of Contents
Previous Page  110 / 154 Next Page
Information
Show Menu
Previous Page 110 / 154 Next Page
Page Background

S80

A B S T R A C T S

a 1200 bed teaching hospital in the Netherlands. Data on

epidural and surgical techniques, ASA (American Society of

Anesthesiologists) and ISAR-HP (Identification of Seniors

at Risk) scores, epidural failure, need for perioperative

vasopressors, length of stay and complicationswere evaluated.

Results:

Our study included 27 patients undergoing

29 operations, for breast cancer under thoracic epidural

anesthesia between 8-2013 and 11-2015. The mean age was 85

years [range: 70-94]. Eight patients underwent a mastectomy,

20 a lumpectomy and 1 reoperation was performed because

of a post-operative breast hematoma. Three patients had an

ASA-score of I (11%), 10 (37%) of II, 13 (48%) of III and 1 (4%)

of IV. The mean ISAR-HP score was 3.3. In 67% a preoperative

consultation by a geriatrician was performed.

The epidural catheter was placed between T

3-4

to T

6-7

,

epidural anesthesia typically required 10 ml of ropivacaine

0.75%. In 3 patients (10%) the epidural access failed; 2 patients

received a paravertebral block, in the other case surgery

was performed under sedation in combination with local

infiltration by the surgeon with ropivacaine 0.2%.

Most patients developed some degree of hypotension

due to sympathetic block, caused by the epidural analgesia.

More than 80% of patients received intravenous vasopressors

norepinephrine or phenylephrine, hemodynamics remained

stable with this treatment. In our retrospective study no

patients had clinically relevant hypotension. 58% received

light sedation with propofol or midazolam.

After surgery, the epidural catheter was removed in

the recovery room and pain was treated with minor oral

analgesics. The median stay in the hospital was 1 night [0-13].

In 2 of 25 patients (8%) delirium was diagnosed. Two patients

developed a hematoma after surgery requiring reoperation,

one patient received epidural anesthesia again. In the other

case, the hematoma developed after a warfarine-derivate

was starting due to newly diagnosed atrial fibrillation and

myocardial ischemia 2 days after surgery. She was not exposed

to hypotension during the primary breast surgery.

Conclusion:

Thoracic epidural based anesthesia is feasible

and should be considered as a potentially optimal method

for breast cancer surgery in the frail elderly patient. Hence,

epidural anesthesia may give treatment options for patients

who do not prefer general anesthesia or previously were

excluded from surgery.

Disclosure of interest:

None declared

Keywords:

Breast surgery, complications, epidural

anesthesia, vasopressors

P075

MAY THERAPEUTIC DRUG MONITORING OF 5FU DECREASE

TOXICITY IN ELDERLY? A RETROSPECTIVE STUDY

L. Bengrine Lefevre

1,2,

*, V. Quipourt

2,3

, J. Vincent

1

, A. Cueff

4,5

,

L. Marceau

5

, M. Deveaux

5

, S. Marilier

2,3

, F. Ghiringhelli

1,6

,

A. Schmitt

5,7

1

Medical oncology, Centre Georges François Leclerc,

2

UCOG

Bourgogne,

3

Geriatric department, CHU Champmaillot,

4

statistic

department, Centre Georges François Leclerc,

5

EA 4184, Burgundy

University,

6

UMR 866, INSERM,

7

Pharmacy department, Centre

Georges François Leclerc, Dijon, France

Introduction:

The clinical benefit of the use of 5FU in

monotherapy, doublet or triplet (with oxaliplatin and/or

irinotecan) is now recognized in patients with colorectal

or pancreatic cancer. However, in order to limit its toxicity,

in elderly, doses are frequently reduced by clinicians in an

empirical manner (i.e., without pharmacological rationale).

Objectives:

The objective of this study was to confirm that

therapeutic dose monitoring (TDM) of 5FU, based on Gamelin

et al. Methodology would help to decrease toxicity in elderly.

Methods:

At Georges Francois Leclerc center in France,

all colorectal and pancreatic cancer patients (adjuvant

or metastatic disease) benefit of a 5FU concentration

measurement during the 46h infusion of the first cycle. The

aim is to rationally adapt the dose for the next cycles in

addition to side effects observed or described by the patient.

Exposures (Area Under the Curve, AUC) were derived from

those concentrations and compared to the therapeutic

window (i.e., 18 mg.h/L <AUC <28 mg.h/L). A lower or higher

AUC than expected gives the opportunity to the clinicians to

adapt 5FU dose according to a special algorithm. In this study,

we retrospectively analyzed dose adaptations for patients

above 70 years old, from April 1

st

2014 to February 1

st

2016.

Results:

Seventy-two patients (28 males and 44 females)

were included. Chemotherapy regimens were mainly FOLFOX

(34 patients) or FOLFIRI (14 patients). Most of patients are treated

on first line in metastatic disease. Forty percent of the AUC were

within the target AUC during the first cycle. Dose adaptation for

60% of patient is needed. Target AUC was obtained for 65.85%

of patient without increasing clinical toxicities. Six patients

experienced a grade 3 or higher toxicity during the first cycle

(i.e., 2 patients with grade 3 or 4 diarrhea, 1 patient with grade

3 neutropenia, 2 patients with grade 3 mucositis and 1 patient

with grade 4 neutropenia and mucositis). After dose adaptation,

only 2 patients experienced grade 3 neutropenia.

Conclusion:

Therapeutic dose monitoring of 5FU may help

clinicians to optimize dose adaptation in elderly patients

for reduced toxicities. In particular, dose may be increased

without inflating toxicity for patient with no observed toxicity

on first cycle and could be rationally decreased in patient

with toxicity. Others studies are needed to correlate this

adjustement to chemotherapy efficacy.

References

:

[1] Gamelin et al. Individual Fluorouracil Dose Adjustment

Based on Pharmacocinetic Follow-up Compared With

Conventional Dosage: Results of a Multicenter Randomized

Trial of Patients with metastatic Colorectal Cancer. J of Clin

Oncol 2008; 13: 2099-2105.