levoleucovorin and Spinal-Neoplasms

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

There are different types of skin changes associated with internal malignancy. One type is the skin involvement as a result of cutaneous metastasis from an internal tumor. The skin is an uncommon site for distant metastasis; when it is present the most common sources are breast, lung, and colon. Metastasis generally occurs after an internal malignancy had been discovered and signifies disseminated disease with a poor prognosis. We report an exuberant and rare case of cutaneous metastasis from gastric adenocarcinoma as the first sign of this serious visceral cancer.

Topics: Antineoplastic Combined Chemotherapy Protocols; Cachexia; Carcinoma, Signet Ring Cell; Etoposide; Fluorouracil; Humans; Leucovorin; Lung Neoplasms; Male; Middle Aged; Skin Neoplasms; Spinal Neoplasms; Stomach Neoplasms; Treatment Failure

Cholangiocarcinoma is a malignant neoplasm arising from the biliary epithelium. The disease is notoriously difficult to diagnose and is usually fatal because of its late clinical presentation and the lack of effective nonsurgical therapeutic modalities. The overall survival rate, including in patients who underwent tumor resections, is poor, with less than 5% surviving more than 5 years. Over the past 5 years, several important studies have yielded new insight into the molecular mechanisms involved in the development and growth of these tumors. The tumor cells of the cholangiocarcinoma express an epidermal growth factor receptor which plays an important role in the pathogenesis of these tumors.. A 49-year-old woman with cholangiocarcinoma of the liver developed spinal metastases. The antiepidermal growth factor receptor (anti-EGFR) antibody was used successfully in combination with radiotherapy. The response to treatment was assessed by magnetic resonance imaging and positron-emission tomography.. The patient with cholangiocarcinoma had a response to cetuximab-based therapies. This may lead to another option for the treatment of hepatic cholangiocarcinoma.

Topics: Antibodies, Monoclonal; Antibodies, Monoclonal, Humanized; Antineoplastic Combined Chemotherapy Protocols; Bile Duct Neoplasms; Bile Ducts, Intrahepatic; Bone Neoplasms; Cetuximab; Chemotherapy, Adjuvant; Cholangiocarcinoma; Combined Modality Therapy; ErbB Receptors; Female; Fluorouracil; Humans; Leucovorin; Liver Transplantation; Magnetic Resonance Imaging; Middle Aged; Positron-Emission Tomography; Radiotherapy, Adjuvant; Spinal Neoplasms; Thoracic Vertebrae

A 36-year-old woman was hospitalized for preoperative chemotherapy for osteosarcoma. She received intravenous fluids for 12 hours for volume expansion, then methotrexate 24 g (12 g/m2) over 6 hours. This was followed by intravenous leucovorin 200 mg over 1 hour. Two hours after the methotrexate infusion the patient developed chest pain and bradycardia. An electrocardiogram revealed sinus pauses, and telemetry recordings indicated a 4-beat run of ventricular tachycardia. A cardiac work-up consisting of cardiac enzyme level determination, two-dimensional echocardiography, and an adenosine technetium-99m tetrofosmin stress test was negative for structural and ischemic heart disease. The patient recovered without treatment and, approximately 2 weeks later, received a second course of methotrexate at half the dose without complication. One month later the patient received treatment with doxorubicin and cisplatin; 2 days later she died unexpectedly at home. Clinicians should be aware that high-dose methotrexate can cause cardiac symptoms and arrhythmias in previously healthy adults. This complication warrants attention and needs additional clinical investigation.

Topics: Adult; Antimetabolites, Antineoplastic; Bradycardia; Electrocardiography; Fatal Outcome; Female; Humans; Infusions, Intravenous; Leucovorin; Methotrexate; Osteosarcoma; Spinal Neoplasms; Tachycardia, Ventricular; Vitamin B Complex

The patient was a 49-year-old man. In 1995, he underwent left hemicolectomy for descending colon carcinoma, and in 1996, partial hepatic resection was performed for liver metastasis. Post-operative chemotherapy was performed with 5'-DFUR. Five years later, he had lumbar and femoral pain. X-ray and MRI examination revealed a compression fracture and a spinal tumor at the XII thoracic vertebra. Though chemoradiotherapy was performed, the symptoms of pain, numbness and muscle weakness progressed. A resection of the metastatic spinal tumor was performed. Following several systemic chemotherapies, such as 5-FU/l-LV, CPT-11 + 5-FU/l-LV and low-dose CPT-11/UFT, radiotherapy was performed for the progressed bone tumor. At 2 years after surgery, he is still able to walk and no other site of recurrence has been detected.

Topics: Adenocarcinoma; Adult; Antineoplastic Combined Chemotherapy Protocols; Camptothecin; Colectomy; Colonic Neoplasms; Combined Modality Therapy; Drug Administration Schedule; Fluorouracil; Hepatectomy; Humans; Irinotecan; Leucovorin; Liver Neoplasms; Male; Spinal Neoplasms

Spinal cord compression as first presentation of non-Hodgkin's lymphoma (NHL) is an uncommon event. Diagnosis of NHL usually is performed on a laminectomy specimen. Spinal cord compression has been reported in 5% of patients with solid tumors. Although this clinical picture has been considered as very unusual among NHL patients, some series regarding descompresive laminectomy indicate that NHL was the underlying cause in 15% of these cases. We report two cases of patients with NHL who presented paraparesia secondary to spinal cord compression due to lymphomatous mass in the epidural region which was showed by magnetic resonance imaging. The emergency laminectomy and treatment with chemotherapy allowed the clinical recuperation of both patients.

Topics: Antineoplastic Combined Chemotherapy Protocols; Combined Modality Therapy; Cyclophosphamide; Doxorubicin; Epidural Space; Etoposide; Female; Humans; Laminectomy; Leucovorin; Leukemia, Lymphocytic, Chronic, B-Cell; Lymphoma, Large B-Cell, Diffuse; Mechlorethamine; Methotrexate; Middle Aged; Paresis; Paresthesia; Prednisone; Procarbazine; Soft Tissue Neoplasms; Spinal Cord Compression; Spinal Neoplasms; Thoracic Neoplasms; Thoracic Vertebrae; Urinary Retention; Vincristine