levoleucovorin and Lymphangitis

A 51-year-old man was referred to our hospital with adenocarcinoma of sigmoid colon with multiple lymph node metastasis. At the time of admission, he had dyspnea, and computed tomography (CT) showed typical signs of lymphangitis carcinomatosa of the lung. Combination of mFOLFOX6 and bevacizumab was started. After start of the therapy, CT revealed an improvement in lymphangitis carcinomatosa. 8 months later, the tumor assessment became progressive disease. FOLFIRI was started as the second-line chemotherapy, but the patient did not respond. Then, dyspnea emerged again, and CT indicated the lymphangitis carcinomatosa had become worse. So as the third-line chemotherapy, combination of irinotecan and cetuximab was started. Dyspnea immediately disappeared, and CT showed an improvement of lymphangitis carcinomatosa. In the previous literature, malignant tumor cases which accompany lymphangitis carcinomatosa might always have a poor course. Our case dramatically responded to the chemotherapy including molecular targeting drug and showed a long survival. So we conclude that aggressive chemotherapy including a molecular targeting drug may be recommended in a case of colorectal cancer which accompanies lymphangitis carcinomatosa of the lung.

Topics: Adenocarcinoma; Antibodies, Monoclonal; Antibodies, Monoclonal, Humanized; Antineoplastic Agents; Antineoplastic Agents, Phytogenic; Antineoplastic Combined Chemotherapy Protocols; Bevacizumab; Camptothecin; Cetuximab; Drug Delivery Systems; Fluorouracil; Humans; Irinotecan; Leucovorin; Lung Neoplasms; Lymphangitis; Male; Middle Aged; Organoplatinum Compounds; Sigmoid Neoplasms

We report a case of diffusely infiltrating rectal cancer with pulmonary lymphangitis carcinomatosa that responded to mFOLFOX6 chemotherapy and enabled survival for 19 months. A 68-year-old man was admitted to our hospital for a dry cough and dyspnea. Chest X-ray and CT examination revealed prominent pulmonary markings and abnormal infiltrating shadows. Interstitial pneumonia was suspected, and we started treatment with steroid medication, but this had no effect. A colonoscopy and barium enema revealed diffusely infiltrating rectal cancer. Abdominal CT and PET showed lymphangitis carcinomatosa of the lung, paraaortic lymph node swelling, and left hydronephrosis due to rectal cancer. The patient was diagnosed with stage IV rectal cancer. Thus, a curative operation was deemed impossible. Because of subileus, we performed a decompression loop colostomy in the transverse colon, and started treatment with mFOLFOX6 chemotherapy as salvage in spite of the patient's poor respiratory condition. Though the patient's tumor markers were very high (CEA 107 ng/mL, CA19-9 7,940 U/mL) prior to chemotherapy, they decreased dramatically (CEA 49.7 ng/mL, CA19-9 772 U/mL), and subjective symptoms (dry cough and dyspnea) also improved after 2 courses. After 3 courses of treatment the patient was discharged. After 7 courses, pulmonary markings and abnormal infiltrating shadows had disappeared on chest X-ray and CT. This condition was maintained for 19 months by ambulant chemotherapy without sacrificing high quality of life. Thus, mFOLFOX6 chemotherapy could be an effective salvage regimen in cases of diffusely infiltrating rectal cancer with pulmonary lymphangitis carcinomatosa.

Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Carcinoembryonic Antigen; Fluorouracil; Humans; Leucovorin; Lung Diseases, Interstitial; Lymphangitis; Male; Organoplatinum Compounds; Rectal Neoplasms; Salvage Therapy; Tomography, X-Ray Computed

Metastatic/advanced colorectal cancer is considered a resistant disease and oncologic emergencies secondary to advanced disease may be regarded with a nihilistic attitude. The objective of this report is to emphasize the efficacy of the oxaliplatin/5-fluorouracil/leucovorin regimen (FOLFOX-4) in three patients presenting oncologic emergencies secondary to advanced colon cancer. The first case was a 40-year-old man with severe respiratory insufficiency due to massive carcinomatous lymphangitis; subsequently a cecal adenocarcinoma was diagnosed. The patient's conditions became life-threatening and he was admitted to the intensive care unit. The second case was a 41-year-old woman presenting with fever, abdominal mass and pain. Ultrasound and CT-scan revealed two hepatic masses (13 x 15 and 15 x 20 cm), diagnosed as liver metastases from colon cancer. The patient's condition deteriorated with intestinal obstruction secondary to the large left liver mass. The third case was a 58-year-old woman presenting with hepatic mass, fever and weight loss. Ultrasound and CT-scan showed a liver lesion occupying the right lobe (12 x 14 cm). Ultrasonically-guided biopsy and colonoscopy showed liver metastases from cecal cancer. A 5-fluorouracil/leucovorin regimen failed to improve her clinical condition and she had disease progression, inferior vena cava neoplastic thrombosis and right hydronephrosis. All three patients rapidly improved after a few cycles of oxaliplatin-containing chemotherapy. These cases demonstrate that even patients with advanced colorectal cancer presenting with oncologic emergencies and life-threatening conditions can be successfully treated with the FOLFOX-4 regimen.

Topics: Acute Disease; Adult; Antineoplastic Combined Chemotherapy Protocols; Colorectal Neoplasms; Female; Fluorouracil; Humans; Intestinal Obstruction; Leucovorin; Liver Neoplasms; Lymphangitis; Male; Middle Aged; Organoplatinum Compounds; Treatment Outcome