levoleucovorin and Pain--Intractable

Results of cytotoxic chemotherapy for hormone-resistant prostate cancer are not impressive. One of the substances which seems to have a therapeutic benefit is 5-fluorouracil (5-FU). The effect of 5-FU can be modulated by addition of folinic acid (FA). We tested in a prospective, randomized phase II trial monotherapy with 5-FU versus the combination of 5-FU and high-dose FA.. 25 patients received 600 mg/m2 5-FU, and 24 patients 400 mg/m2 FA plus 600 or 400 mg/m2 5-FU. They were treated for two cycles for 5 days in a 21-day interval followed by a weekly single-day application until progression occurred. Pain remission, toxicity, time to progression and survival were evaluated.. Both regimens led to a pain remission in nearly 70% of the patients. Mucosal side effects like diarrhea and stomatitis occurred more often in the combination arm, whereas leukopenias were more frequent in the monotherapy are. We observed no statistically significant difference between the two treatment arms regarding time to progression and survival.. Although both regimens led to a pain remission, side effects are too severe to recommend these protocols for standard treatment of hormone-resistant prostate cancer.

Topics: Aged; Androgens; Antimetabolites, Antineoplastic; Drug Resistance, Neoplasm; Drug Therapy, Combination; Fluorouracil; Humans; Leucovorin; Male; Middle Aged; Pain, Intractable; Pilot Projects; Prospective Studies; Prostate-Specific Antigen; Prostatic Neoplasms; Survival Rate; Treatment Outcome

Spinal metastases are the most common of spinal neoplasms and occur predominantly in an extradural location. Their appearance in an intradural location is uncommon and is associated with a poor prognosis. Cerebrospinal fluid dissemination accounts for a significant number of intradural spinal metastases mostly manifesting as leptomeningeal carcinomatoses or drop metastases from intracranial tumors. The occurrence of local tumor dissemination intradurally following surgery for an extradural spinal metastasis has not been reported previously. The authors describe 2 cases in which local intradural and intramedullary tumor recurrences occurred following resection of extradural metastases that were complicated by unintended durotomy. To heighten clinical awareness of this unusual form of local tumor recurrence, the authors discuss the possible etiology and clinical consequences of this entity.

Topics: Antineoplastic Combined Chemotherapy Protocols; Carcinoma, Signet Ring Cell; Colorectal Neoplasms; Combined Modality Therapy; Decompression, Surgical; Disease Progression; Dura Mater; Fluorouracil; Humans; Laminectomy; Leucovorin; Magnetic Resonance Imaging; Male; Middle Aged; Neoplasm Recurrence, Local; Organoplatinum Compounds; Pain, Intractable; Radiosurgery; Spinal Cord Compression; Spinal Neoplasms