This is a 13-year-old boy with no pathological history, hospitalized in the\nhematology-oncology department for abdominal rhabdomyosarcoma. The history of the disease\ngoes back to 3 months of his hospitalization by the installation of abdominal pains with\nprogressive deterioration of the general condition. On admission, the patient was conscious\nwith a GCS score 15/15, apyretic with impaired general condition, weight = 30 kg. Physical\nexamination revealed a large papable abdominal mass extending from the epigastric to the\nright hypochondrium. Ultrasound then abdomino-pelvic Computed tomography (CT) scan confirmed\nthe diagnosis by objectifying a median retro-peritoneum mass. The biological assessment was\nnormal. An ultrasound-guided biopsy was performed. The histological diagnosis was in favor\nof an undifferentiated sarcoma. Extension workup revealed lung micronodules and peritoneal\nnodules under the liver. The child was put on anti-cancer treatment combining\nifosfamide-vincristine-actinomycin (IVA) and MesnaR to prevent urological\ntoxicity. The dosages of these molecules were: Ifosfamide (3 g/m2/day) 3 g/day as\nan infusion administered over 3 hours, vincristine (1.5 mg/m2/day) 1.5 mg by slow\ndirect intravenous injection, actinomycine (1.5 mg/m2/day) 1.5 mg as a slow\ndirect intravenous injection and MesnaR at a dose of 900 mg/day. Ten days after\ntreatment, the child developed seizures. An emergency computed tomography was performed\nshowing hypo-dense right frontal brain lesions (). There was no sensory or motor deficit. To\nbetter characterize, we performed a cerebral magnetic resonance imaging (MRI) which\nobjectified the subcortical lesions in T2 and FLAIR hyper signal, in T1 hypo signal, without\nrestriction of the diffusion sequence and without enhancement after injection of gadolinium\n(). Knowing the side\neffect of ifosfamide, the IVA-based protocol was stopped and modified by the\nVincristine-Actinomycin-Cyclophosphamide (VAC) protocol. The evolution was marked by the\ndefinitive cessation of seizures without other signs. No biological abnormality was detected\nand no specific treatment was added outside of the new protocol. Two weeks after stopping\nifosfamide, we performed a control brain MRI which revealed that the previously described\nbrain lesions had disappeared (). Faced with the favorable clinical course and the disappearance of the brain\nlesions, the diagnosis of IIE was retained.
A 39-year-old woman had a surgical resection for a uterine leiomyosarcoma in February 2011. A local relapse was treated by resection in March 2012, and the patient was referred for adjuvant chemotherapy in May 2012. Because of the deterioration of her general condition due to an early local relapse, she received first doxorubicin 75 mg/m2 alone. Improvement of her general condition allowed for a combined treatment with doxorubicin (60 mg/m2) and IFO (9 g/m2) for the next 4 cycles. In the 5th and 6th cycles, IFO alone was used because of the cumulative dose of anthracyclines (adjuvant epirubicin had previously been given for a breast cancer). A partial response was obtained, but the tumor remained unresectable and a therapeutic break was decided. In February 2013, CT scan showed progression, and IFO (5 g/m2/day) was started again. Aprepitant (125 mg on day 1 and 80 mg on days 2 and 3) was given with steroids to prevent nausea. Within a few hours after the 2nd cycle, the patient had obnubilation and awareness troubles without any other symptoms. These troubles did not improve with the evacuation of a vesical globe or the cessation of neurodepressing drugs (oxycodone and chlorpromazine). There was no hydroelectrolytic disorder. Encephalic MRI did not show bleeding or a cerebrovascular event. IFO-induced encephalopathy was suspected, and a treatment with methylene blue was started. Improved awareness was transiently observed, but the patient remained disoriented and died 8 days later, without return to normal consciousness.