levoleucovorin and Abdominal-Abscess

A 76-year-old woman was diagnosed of mucinous cystadenocarcinoma of the appendix. Since there was wide direct invasion into the right psoas muscle, she was judged as inoperable although she had no bowel obstruction. She was received FOLFIRI and bevacizumab treatment. After the first cycle, the tumor progressed rapidly and formed the abdominal wall abscess at the right groin. Since she had a fever and pain at the right groin and the abscess reached the hypodermic, we put a drainage tube into the abscess. The tube was placed, which made her symptoms improved markedly. We have been continuing with FOLFIRI treatment and drainage for 10 months without progressive disease. We report a rare case of the conservative therapy of mucinous cystadenocarcinoma of appendix with abdominal wall abscess.

Topics: Abdominal Abscess; Aged; Antineoplastic Combined Chemotherapy Protocols; Appendiceal Neoplasms; Biopsy; Camptothecin; Cystadenocarcinoma, Mucinous; Drainage; Female; Fluorouracil; Humans; Leucovorin; Tomography, X-Ray Computed

Primary appendiceal adenocarcinoma is a rare tumor, mucinous variety being common. This case is reported to highlight the unusual presentation and diagnostic difficulty of appendiceal adenocarcinoma.. Patient presented with acute appendicitis with ill-defined tender lump which responded to conservative management.. High index of suspicion should be kept in mind for elderly patients presenting with appendicular lump. Every effort should be made during elective appendectomy to remove stump in case of sloughed out appendix.

Topics: Abdominal Abscess; Adenocarcinoma; Age Factors; Antineoplastic Combined Chemotherapy Protocols; Appendectomy; Appendiceal Neoplasms; Appendicitis; Appendix; Carcinoembryonic Antigen; Chemotherapy, Adjuvant; Colectomy; Diagnosis, Differential; Elective Surgical Procedures; Female; Fluorouracil; Humans; Leucovorin; Lymph Node Excision; Lymph Nodes; Middle Aged; Neoplasm Staging; Organoplatinum Compounds; Rare Diseases; Tomography, X-Ray Computed; Ultrasonography

Patients with stage IV colorectal cancer and peritoneal carcinomatosis are increasingly treated with curative intent and perioperative systemic chemotherapy combined with targeted therapy. The aim of this study was to analyze the potential impact of bevacizumab on early morbidity after cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with peritoneal carcinomatosis of colorectal origin.. From 2004 to 2010, in three referral centers, 182 patients with colorectal carcinomatosis were treated with complete cytoreduction followed by HIPEC after either preoperative systemic chemotherapy alone or in combination with bevacizumab. Because there was no control on treatment allocation, propensity score methods were used to control for this bias.. The median time from discontinuation of bevacizumab to HIPEC was 7 weeks (range 6-10 weeks). Major morbidity was greater in the bevacizumab group (34 vs. 19 %, p = 0.020). Nine patients died postoperatively, 5 (6.2 %) in the bevacizumab group (n = 80) and 4 (3.9 %) in the group treated with chemotherapy alone (n = 102) (p = 0.130). The rate of digestive fistulas was greater in the bevacizumab group, although not statistically significant (18 vs. 10 %, p = 0.300). The effect of bevacizumab on major morbidity (including death) was found to be statistically significant (odds ratio 2.28, 95 % confidence interval 1.05-4.95) (p = 0.04).. Administration of bevacizumab before surgery with complete cytoreduction followed by HIPEC for colorectal carcinomatosis is associated with twofold increased morbidity. The oncologic benefit of bevacizumab before HIPEC remains to be evaluated.

Topics: Abdominal Abscess; Angiogenesis Inhibitors; Antibodies, Monoclonal, Humanized; Antineoplastic Combined Chemotherapy Protocols; Bevacizumab; Camptothecin; Carcinoma; Chemotherapy, Adjuvant; Colorectal Neoplasms; Cytoreduction Surgical Procedures; Digestive System Fistula; Female; Fluorouracil; Hematoma; Humans; Hyperthermia, Induced; Length of Stay; Leucovorin; Male; Middle Aged; Neoadjuvant Therapy; Organoplatinum Compounds; Peritoneal Neoplasms; Wound Healing