levoleucovorin and Ileus

A 65-year-old man complaining of abdominal pain was admitted to our hospital. A diagnosis of colon ileus due to sigmoidal colon cancer was made. A stoma was created at the transverse colon, and elective surgery was scheduled. During the operation, the tumor was found to have invaded the bladder and the pelvic wall, making curative resection impossible. Chemotherapy consisting of bevacizumab/oxaliplatin, Leucovorin, and 5-fluorouracil(FOLFOX4, intravenous drip infusion every 2 weeks)was started. After 12 courses of treatment, remarkable shrinkage of the tumor was noted, which led us to perform a sigmoidectomy and partial resection of the bladder wall. A histopathological study of the surgically resected specimen showed no cancer cells. Recovery was uneventful and the patient was discharged on the 17th postoperative day. In cases of advanced colon cancer, complete response of the primary tumor with preoperative chemotherapy is very unusual. We conclude that chemotherapy with bevacizumab/FOLFOX4 plays a role in the management of advanced/unresectable colon cancer.

Topics: Aged; Antibodies, Monoclonal, Humanized; Antineoplastic Combined Chemotherapy Protocols; Bevacizumab; Combined Modality Therapy; Fluorouracil; Humans; Ileus; Leucovorin; Male; Neoplasm Invasiveness; Organoplatinum Compounds; Remission Induction; Sigmoid Neoplasms

This study evaluated a better treatment for patients with obstructive colorectal cancer (CRC) that have a poor prognosis.. This study compared the outcomes of 138 patients with obstructive CRC, including 70 primary resections, 50 resections after bowel decompression using an ileus tube, and 18 delayed resections after colostomy.. The ileus tube and delayed resection groups included more left-sided primary lesions. The physiologic POSSUM, types 3-4, tumor size, CEA, and hospital stay of the delayed resection group were different, in comparison to both the primary resection and ileus tube groups. The histopathological type and depth of invasion of the delayed resection group included less well types and more T4 than those of the ileus tube group. The operative blood loss of the delayed resection group was more than that of the ileus tube group. There were no differences in the overall and disease-free survival among the three groups.. Separately analyzing the data of the right-sided cancer group and the left-sided cancer group demonstrated that primary resection might be acceptable for right-sided obstructive CRC and delayed resection might be done for patients with poorer general conditions (high PPS) and poorer oncological prognostic factors such as more type 3/type 4 cases, a larger tumor size, a less well-differentiated histopathological type, more T4 cases, and a higher CEA level.

Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Chemotherapy, Adjuvant; Colectomy; Colorectal Neoplasms; Colostomy; Decompression, Surgical; Disease-Free Survival; Female; Fluorouracil; Humans; Ileus; Length of Stay; Leucovorin; Lymphatic Metastasis; Male; Multivariate Analysis; Neoplasm Staging; Preoperative Care; Retrospective Studies; Survival Rate

A 64-year-old woman was introduced to our hospital with liver tumors. Our examination revealed that she had advanced colon carcinoma with multiple liver metastasis. Without symptoms from the primary cancer, she underwent chemotherapy of avastin FOLFOX. After 2 courses of chemotherapy, she suffered ileus and underwent operation. The resected specimen showed marked tumor necrosis and fibrosis, but few tumor cells remained in the primary lesion. We think this was a rare case of suffered ileus because of marked response of chemotherapy in primary colon carcinoma.

Topics: Antibodies, Monoclonal, Humanized; Antineoplastic Combined Chemotherapy Protocols; Bevacizumab; Carcinoma; Cicatrix; Colorectal Neoplasms; Female; Fluorouracil; Humans; Ileus; Leucovorin; Liver Cirrhosis; Liver Neoplasms; Middle Aged; Organoplatinum Compounds

Colorectal carcinomas are among the most common tumor types and are generally treated with palliative chemotherapy in case of metastatic disease. Here, we describe the case of a 58 year old woman with metastatic rectal carcinoma who developed severe gastrointestinal toxicity when the thus far well-tolerated intravenous 5-fluorouracil (5-FU)/leucovorin containing chemotherapeutic regimen was replaced by the same chemotherapeutic regimen in combination with the oral 5-FU prodrug capecitabine. This increased toxicity is probably due to the intracellular retention of polyglutamated folates induced by prior leucovorin therapy which, upon subsequent administration of capecitabine, will result in an enhanced and prolonged inhibition of the, for DNA synthesis important, enzyme thymidylate synthase, essentially creating a situation equivalent to overdosing.

Topics: Adenocarcinoma; Antimetabolites, Antineoplastic; Antineoplastic Combined Chemotherapy Protocols; Atorvastatin; Bisoprolol; Bone Neoplasms; Capecitabine; Colic; Colorectal Neoplasms; Deoxycytidine; Female; Fluorouracil; Heptanoic Acids; Humans; Hypercholesterolemia; Ileus; Leucovorin; Lymphatic Metastasis; Middle Aged; Nausea; Pyrroles; Ventricular Premature Complexes; Vomiting

A 53-year-old man, admitted for inguinal hernia, complained of body weight loss in a preoperative condition check. We examined the digestive tract and diagnosed stage IV advanced rectal carcinoma with multiple lung metastases. It caused ileus, so emergency colostomy was performed. After that his general condition recovered, and two cycles of neoadjuvant chemotherapy (NAC) by irinotecan combined with 5-fluorouracil and l-leucovorin (IFL) therapy were performed on an outpatient basis. Lung metastatic nodules disappeared. We established a diagnosis of down staging for stage IIIa, and performed a lower anterior resection with D 2 lymph node dissection to allow a curability-A resection. The pathological effect of NAC was Grade 2. Post-operatively, two cycles of IFL therapy were then performed. There has been no sign of recurrence, and no adverse effects by chemotherapy have been seen during this treatment. Thus, NAC by IFL therapy can be one of the useful treatment approaches for patients with advanced rectal cancer.

Topics: Adenocarcinoma; Antineoplastic Combined Chemotherapy Protocols; Camptothecin; Chemotherapy, Adjuvant; Colostomy; Drug Administration Schedule; Fluorouracil; Humans; Ileus; Irinotecan; Leucovorin; Lung Neoplasms; Lymph Node Excision; Male; Middle Aged; Neoplasm Staging; Rectal Neoplasms