1/18. The effectiveness of chemotherapy with cisplatin and 5-fluorouracil for recurrent small cell neuroendocrine carcinoma of the rectum: report of a case.We report herein the case of a 46-year-old-man with small cell neuroendocrine carcinoma (NEC) concomitant with large villous adenoma of the rectum, who underwent abdominoperineal resection with regional lymphnode dissection. The resected specimen was histologically found to contain a small lesion of NEC confined to the submucosa in the large adenoma. A computed tomography scan done 4 months postoperatively revealed recurrences in the liver, lymph nodes, and bone. Therefore, two cycles of sequential intravenous combined chemotherapy with standard doses of cisplatin and 5-fluorouracil (5-FU) were administered, after which the size of each tumor decreased remarkably. Nevertheless, the patient died 8 months after the operation. As there was a fair response of this tumor to the combined chemotherapy of cisplatin and 5-FU, this regimen against NEC of the colon and rectum should be given consideration.- - - - - - - - - - ranking = 1keywords = cycle (Clic here for more details about this article) |
2/18. Complete remission of the liver metastases of anorectal malignant melanoma with regional chemotherapy: a case report.The prognosis of anorectal malignant melanoma is very poor. We present a 48-year-old male patient with anorectal malignant melanoma and multiple liver metastases who underwent abdominoperineal resection. A port system was implanted to the gastroduodenal artery for regional chemotherapy for liver metastases. Histopathological findings of tumor were 5 cm diameter and 2 cm depth, invading to the external sphincter. Both regional chemotherapy and immunotherapy were initiated 4 weeks postoperatively. The immunochemotherapy regimen included cisplatin (via port system) 50 mg/m2 once in 2 weeks, x 8 cycles, alpha-interferon 5 x 10(6) U subcutaneously on days 1-7 in 4 weeks, x 8 cycles, interleukin-2 9 x 10(6) U subcutaneously on days 5-9 in 4 weeks, x 8 cycles. Computed tomography scan was taken after the 2nd and 4th cycles of chemotherapy and the tumor had not responded to chemotherapy. dacarbazine 200 mg/m2 intravenously on days 1-5 in a month, x 4 cycles, was added to the previous immunochemotherapy regimen. Computed tomography and magnetic resonance imaging scans were taken on the 10th and 12th months after operation, respectively, no evidence of metastases in the liver was noted. No case of complete remission of liver metastases of anorectal malignant melanoma with regional intraarterial chemotherapy and systemic immunochemotherapy has been previously reported in the literature.- - - - - - - - - - ranking = 5keywords = cycle (Clic here for more details about this article) |
3/18. Neoadjuvant chemotherapy of irinotecan, 5-fluorouracil and leucovorin in patients with advanced rectal cancer. Report of two cases.We report on two patients with T3N1 rectal cancer treated with a combination of irinotecan, 5-fluorouracil and leucovorin as neoadjuvant chemotherapy. On days 1, 8 and 15 of this 4-week cycle, leucovorin (250 mg/m2) was administered in a 2-hour intravenous infusion, followed by 5-fluorouracil (500 mg/m2) in a 10-min intravenous bolus, and then irinotecan (80 mg/m2) in a 90-min intravenous infusion. During the chemotherapy, no grade 3-4 toxicities were observed. Two weeks after the completion of 2 cycles of this regimen, both patients underwent surgery without postoperative complications. The responses were one pathological and one macroscopic complete response. Both patients with T3 tumors were down-staged to pT0 and pT2, respectively. As for the N stage, both patients were down-staged to pN0. The combination of irinotecan/5-fluorouracil/leucovorin appears to be feasible and effective, and to have a potential as an optimal neoadjuvant therapy in patients with advanced rectal cancer.- - - - - - - - - - ranking = 2keywords = cycle (Clic here for more details about this article) |
4/18. Anorectal melanoma: successful treatment by surgical excision and combination chemoimmunotherapy.Anorectal melanoma is an extremely rare malignancy, and has a poor prognosis mainly due to delays in diagnosis and lack of effective systemic therapy. We report the case of a 63-year-old female patient with anorectal melanoma. diagnosis was established after surgery by histology and immunohistochemistry. Surgical management consisted of abdominoperineal resection of the rectum. Postoperatively, the patient received combination therapy of dacarbazine, nimustine hydrochloride, vincristine sulfate, and interferon-beta for 3 cycles. Ten months later, a solitary brain metastatic tumor was noted in the left occipital region, which was resected surgically followed by the above combination therapy for 2 cycles. The last metastatic work-up was normal, and no evidence of recurrence was observed at 2-year follow-up. In our case, abdominoperineal resection of the rectum appears to have some effect in preventing regional and lymph node recurrence. Furthermore, our case suggests that prolongation of survival may depend on extensive block resection and combination therapy of DAV and interferon-beta.- - - - - - - - - - ranking = 2keywords = cycle (Clic here for more details about this article) |
5/18. Primary rectal lymphoma as a cause of bowel obstruction. Report of a case.BACKGROUND: Malignant lymphoma involving the rectum either as a localized process or as a manifestation of disseminated disease is rare. Several treatments have been proposed and reported, including surgical resection alone or associated with adjuvant chemoradiation, chemotherapy alone, and radiotherapy alone. methods: A case of bowel obstruction caused by a primary rectal MALT lymphoma is reported. Following emergency loop sigmoid colostomy the patient was started on multiple specific cycles of chemotherapy according to the MACOP-B protocol. RESULTS: At the end of chemotherapy a remarkable reduction in the size of the tumor was noted. Subsequently the patient underwent an ultralow anterior resection followed by a straight coloanal anastomosis. At 36 months of follow-up the patient is alive with no tumor recurrence. CONCLUSIONS: The present report describes the unique case of a patient with primary obstructing rectal lymphoma treated with neoadjuvant chemotherapy and sphincter-saving curative surgery.- - - - - - - - - - ranking = 1keywords = cycle (Clic here for more details about this article) |
6/18. Physical training during intrahepatic chemotherapy.OBJECTIVE: To evaluate the role of strength and endurance training for the muscular, cardiac, respiratory, and immune systems and the quality of life (QOL) during intrahepatic chemotherapy (folinic acid, 5-fluorouracil). DESIGN: Single case. SETTING: teaching hospital in germany. PARTICIPANT: An elderly athlete with liver metastasis after resection of a carcinoma of the rectum (pT3, N0, M-liver, G2). INTERVENTION: Strength and endurance training during chemotherapy. MAIN OUTCOME MEASURES: During the intervals between training cycles (14d), beginning in postoperative week 6, a strength and endurance training regimen was performed twice weekly for 13 weeks, with an intensity of 40% to 60% of the maximum postoperative individual power and endurance. Before and after chemotherapy, we checked echocardiograms, resting and exercise electrocardiograms, lung function, natural killer (NK) cells, and the Gastrointestinal quality of life Index (GIQLI) scores. RESULTS: The increase in strength was between 0% and 144%. The improvement in endurance expressed by reduction of heart rate and lactate concentration was 10% and 21.5%, respectively. lung function also improved with regard to forced expiratory volume in 1 second (12.9%), forced vital capacity (11.3%), and inspiratory vital capacity (11.4%). The relative count of the NK cells increased to 27.2%. An improvement in the GIQLI was observed from 109 points (pathologic) to 129 points. CONCLUSION: Strength and endurance training was associated with an increase of physical strength and endurance with positive influence on illness-related QOL. Postoperative physical exercise during regional chemotherapy is beneficial.- - - - - - - - - - ranking = 1keywords = cycle (Clic here for more details about this article) |
7/18. Primary B cell lymphoma of the rectum in a patient coinfected with hiv-1 and HTLV-I.This report describes a clinical case of a large cell, immunoblastic plasmacytoid malignant B-cell lymphoma of the rectum in an AIDS patient coinfected with HTLV-I. The malignant cells showed clonal genetic rearrangement of the HC (JH) and LCK genes. infection by EBV was demonstrated serologically and with slot blots using genomic dna of the cancer cells. Southern blot analysis with dna extracted from the lymphoma cells were negative for HTLV-I. The patient received seven cycles of VACO-B which induced complete but transient clinical remission of the tumor. The final outcome of the patient is unknown.- - - - - - - - - - ranking = 1keywords = cycle (Clic here for more details about this article) |
8/18. hypersensitivity reactions to oxaliplatin: a case report and the success of a continuous infusional desensitization schedule.Oxaliplatin is a third-generation platinum analog that is used mainly to treat advanced colorectal cancer. The reported incidence of hypersensitivity reactions to oxaliplatin, especially after multiple cycles of therapy, is less than 1%. We report a patient with metastatic colon cancer who developed a hypersensitivity reaction to oxaliplatin during the sixth cycle of combination chemotherapy with oxaliplatin, high-dose 5-fluorouracil and leucovorin. The same reaction occurred again after re-exposure to oxaliplatin 2 weeks later even with prophylactic administration of steroids and H1 antihistamines. After failing third-line treatment with oral tegafur-uracil, we desensitized the patient by using a fixed-rate 24-h continuous infusion of dilute oxaliplatin (0.15 mg/ml), in addition to steroids and H1 antihistamines. He had no hypersensitivity reaction during or after that infusion or when the same concentration was infused in the same way 2 weeks later. Because his condition subsequently deteriorated and the cancer progressed, no further oxaliplatin was given. Our experience does demonstrate, however, that a fixed-rate 24-h continuous infusion of oxaliplatin in a low concentration may prevent a hypersensitivity reaction in a previously sensitized patient.- - - - - - - - - - ranking = 2keywords = cycle (Clic here for more details about this article) |
9/18. Regression of rectal mucosa-associated lymphoid tissue lymphoma but persistence of helicobacter pylori infection of gastric mucosa after administration of levofloxacin: report of a case.PURPOSE: Several articles have reported regression of rectal lymphoma of mucosa-associated lymphoid tissue after anti- helicobacter pylori therapy. It remains unclear, however, whether lymphoma of rectal mucosa-associated lymphoid tissue is related to helicobacter pylori infection. methods: A 60-year-old woman visited our hospital with a complaint of hematochezia. On colonoscopy a pale, ulcerated protrusion approximately 3.5 cm in diameter was found in the rectum. Pathologic diagnosis of a biopsy specimen was low-grade mucosa-associated lymphoid tissue lymphoma. The patient received a ten-day course of levofloxacin, and the cycle was repeated three times over seven months. RESULTS: Although persistence of helicobacter pylori infection was confirmed, the tumor regressed completely. CONCLUSION: Our findings in this case suggest that rectal lymphoma of mucosa-associated lymphoid tissue may be related to unknown microorganisms other than helicobacter pylori. levofloxacin may be effective for treatment of rectal lymphoma of mucosa-associated lymphoid tissue regardless of helicobacter pylori infection.- - - - - - - - - - ranking = 1keywords = cycle (Clic here for more details about this article) |
10/18. Rectal adenocarcinoma with choriocarcinomatous differentiation: clinical and genetic aspects.Nongestational choriocarcinomas are rare tumors. In the gastrointestinal tract, they are characterized by a biphasic tumor growth with separated areas of adenocarcinomatous and choriocarcinomatous differentiation. We here report a case of a combined adenocarcinoma-choriocarcinoma of the rectum. The tumor showed an aggressive clinical behavior with metastasis to the liver and lungs. A transient partial remission was achieved after 4 cycles of cisplatinum, etoposide, and ifosfamide chemotherapy, with normalization of serum beta-human chorionic gonadotropin levels. At this time, viable residual choriocarcinoma cells were found in surgically resected lung metastasis. The patient succumbed 8 months after initial diagnosis to a rapid abdominal relapse. We used comparative genomic hybridization (CGH) and fluorescence in situ hybridization to elucidate the genetic relationship of adenocarcinoma and choriocarcinoma in this neoplasm. We found genetic changes characteristic for colorectal adenocarcinomas, a loss of chromosomal regions 8p21-pter as well as 18q21-pter, and a gain of 5p and 20q, in both tumor parts. This provides evidence for the common origin of both components. A differential pattern of additional genetic changes suggests a clonal evolution from a common ancestor cell. In contrast to findings from a comparative study on a choriocarcinoma of the renal pelvis, we did not find an amplification of the germ cell cancer-associated chromosomal region 12p11.2-p12.1 in the areas of choriocarcinoma but found instead a loss of Xp11.3-pter. To our knowledge, this is the first report of a CGH comparison of the adenocarcinomatous and choriocarcinomatous tumor parts in a nongestational choriocarcinoma of the gastrointestinal tract.- - - - - - - - - - ranking = 1keywords = cycle (Clic here for more details about this article) |
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