levoleucovorin and Jaundice--Obstructive

Chemotherapy is potentially hazardous for patients with liver dysfunction. Although FOLFOX regimen is one of the standard chemotherapies for nonresectable liver metastases of colorectal cancer, the safety of this regimen has not been established yet in patients with obstructive jaundice associated with multiple liver metastases. We report a case of nonresectable liver metastases of rectal cancer treated by modified FOLFOX6 regimen after percutaneous transhepatic biliary drainage for obstructive jaundice, which was caused by hepatic lymph-node metastasis. Five days after giving a birth, a 32-year-old woman underwent Hartmann's procedure for perforation of rectal cancer associated with multiple liver metastases. She was admitted again to receive chemotherapy 35 days after surgery, but the level of total bilirubin was elevated (3.9 mg/dL). Since the total bilirubin level was not rapidly decreased after PTBD, the modified FOLFOX6 regimen was started with a 70% dose. After an introduction of mFOLFOX6 treatment, a biliary-stenting was successfully performed, and the mFOLFOX6 continued with a full dose starting from the 5th cycle. Although the therapeutic efficacy after an additional 8-cycle was classified as stable disease (SD), she did not show any sign of adverse effects except for grade 1 neurotoxicity.

Topics: Adult; Antineoplastic Combined Chemotherapy Protocols; Biomarkers, Tumor; Female; Fluorouracil; Humans; Jaundice, Obstructive; Leucovorin; Liver Neoplasms; Lymphatic Metastasis; Organoplatinum Compounds; Rectal Neoplasms; Stents; Tomography, X-Ray Computed

A 46-year-old male patient underwent sigmoidectomy with D2 lymph node dissection and partial resection of the bladder for advanced colon cancer in January 2000. The lesion was judged to be pT2, pN0, sP0, sH0, sM0 and Stage II, and the patient was treated on a regular schedule as an outpatient. Fourteen months after the first operation, liver metastases (S4, S5) were found and partial resections of the liver were performed. However, a recurrence had often been detected in the residual liver for five years afterwards. Liver resections had been repeated for four times before radiofrequency ablation was performed in January 2005. The patient received adjuvant chemotherapy with 5'-DFUR, 5-FU/l-LV (RPMI method), and TS-1. In January 2006, obstructive jaundice due to tumor growth occurred and a self-expandable metallic stent was placed in the narrowed portion of the intrahepatic bile duct. The patient is,currently undergoing FOLFOX4 and FOLFIRI regimens.

Topics: Antineoplastic Combined Chemotherapy Protocols; Catheter Ablation; Chemotherapy, Adjuvant; Colon, Sigmoid; Combined Modality Therapy; Floxuridine; Fluorouracil; Hepatectomy; Humans; Jaundice, Obstructive; Leucovorin; Liver Neoplasms; Lymph Node Excision; Male; Middle Aged; Sigmoid Neoplasms; Stents; Tegafur