levoleucovorin and Duodenal-Ulcer

A 74-year-old female had metastatic left inguinal lymph nodes 20 months after rectal amputation for cancer, and an attempt to adapt chemotherapy of mFOLFOX6/bevacizumab was made after resection of the nodes. She felt nausea 2 days and continued 1 week after starting chemotherapy. Then, an endoscopic examination revealed both active gastric and duodenal ulcers. Clipping and proton pump inhibitor medication was started. The ulcers healed to the healing stage at 18 days and to the scar stage at 28 days. Gastrointestinal complications often occur after chemotherapy, but severe ulcers are rarely reported. The chemotherapy included anti-VEGF antibody, but the ulcers have healed back to normal.

Topics: Aged; Antibodies, Monoclonal; Antibodies, Monoclonal, Humanized; Antineoplastic Combined Chemotherapy Protocols; Bevacizumab; Duodenal Ulcer; Female; Fluorouracil; Humans; Leucovorin; Organoplatinum Compounds; Rectal Neoplasms; Stomach Ulcer

To evaluate the outcomes and toxicity of concurrent full-dose gemcitabine and intensity-modulated radiation therapy (IMRT) for patients with borderline resectable and locally advanced pancreatic adenocarcinoma after induction chemotherapy.. From 2009 to 2012, 32 patients were treated with concurrent gemcitabine and IMRT for borderline resectable or locally advanced pancreatic adenocarcinoma. All patients received induction FOLFIRINOX or gemcitabine-based chemotherapy before chemoradiation. The radiotherapy volume was limited to the primary tumor, and the median dose was 55 Gy in 25 fractions. Gemcitabine was administered weekly during radiotherapy on days 1, 8, 22, and 29 at a median weekly dose of 800 mg/m².. Twenty-five patients had locally advanced disease and 7 had borderline resectable disease. The median follow-up time was 14.6 months. The median progression-free and overall survival were 13.9 and 23.1 months, with a trend toward improved overall survival for patients receiving induction FOLFIRINOX compared with gemcitabine-based therapy. A radiographic complete or partial response was achieved in 13 patients (41%), with 4 (13%) having complete radiographic responses. Surgical resection was performed in 10 patients (31%)--6 patients with locally advanced disease and 4 with borderline resectable disease. Grade 3/4 hematologic toxicity during and up to 6 weeks after chemoradiation occurred in 12 patients (38%); grade 3 nonhematologic toxicity occurred in 7 patients (22%), with no grade 4 or 5 toxicity. All patients completed their radiotherapy.. Concurrent full-dose gemcitabine and limited-field IMRT after induction chemotherapy for the treatment of borderline resectable and locally advanced pancreatic cancer is promising with acceptable toxicity rates.

Topics: Adenocarcinoma; Adult; Aged; Anemia; Antineoplastic Combined Chemotherapy Protocols; Camptothecin; Capecitabine; Chemoradiotherapy; Cisplatin; Cohort Studies; Deoxycytidine; Disease Progression; Duodenal Ulcer; Erlotinib Hydrochloride; Female; Fluorouracil; Gastrointestinal Diseases; Gemcitabine; Humans; Induction Chemotherapy; Irinotecan; Leucovorin; Male; Middle Aged; Multivariate Analysis; Neoadjuvant Therapy; Neutropenia; Organoplatinum Compounds; Oxaliplatin; Pancreatectomy; Pancreatic Neoplasms; Proportional Hazards Models; Radiotherapy, Intensity-Modulated; Retrospective Studies; Thrombocytopenia; Treatment Outcome

We report a typical complication of hepatic artery infusion therapy (HAI) in a patient with colon cancer metastatic to the liver. One year after the last HAI-therapy the patient presented with upper gastrointestinal bleeding. Endoscopy showed a large duodenic ulcer penetrating into an adjacent hepatic colon cancer metastasis. The hepatic artery catheter was visible at the ground of the duodenic ulcer.. Thirty-five percent of patients under HAI-therapy develop gastric/duodenic ulcers. The severity of the HAI complication presented here, however, is quite uncommon.

Topics: Adenocarcinoma; Aged; Antineoplastic Combined Chemotherapy Protocols; Catheters, Indwelling; Duodenal Ulcer; Duodenum; Endoscopy, Gastrointestinal; Fluorouracil; Humans; Infusions, Intra-Arterial; Intestinal Mucosa; Leucovorin; Liver Neoplasms; Male; Peptic Ulcer Perforation; Sigmoid Neoplasms