levoleucovorin and Syndrome

The growing teratoma syndrome is a recognized complication of metastatic nonseminomatous germ cell tumors of the testis and is managed surgically. It may also occur in intracranial nongerminomatous germ cell tumors.. The authors performed an English language computer search using the EMBASE data base (from January 1980 to December 1996) for pineal tumors, read all abstracts, and then selected all articles pertaining to germ cell tumors at this site.. The case history of a 19-year-old male who presented with a pineal nongerminomatous germ cell tumor, which was treated with chemotherapy, is reported. Despite normalization of raised tumor marker levels, the pineal mass enlarged during chemotherapy. This was excised and proved to be a mature teratoma. A review of the literature regarding this complication of intracranial germ cell tumors is also presented.. The authors believe this to be the first reported case of growing teratoma syndrome in the pineal gland of an adult patient, two previously reported cases occurred in children. The authors conclude that the pineal gland is an unusual but important site in which to recognize the growing teratoma syndrome.

Topics: Adult; Antineoplastic Combined Chemotherapy Protocols; Bleomycin; Cisplatin; Diagnosis, Differential; Endodermal Sinus Tumor; Etoposide; Humans; Leucovorin; Male; Methotrexate; Neoplasms, Germ Cell and Embryonal; Neoplasms, Second Primary; Pineal Gland; Syndrome; Teratoma; Vincristine

To compare the efficacy and toxicity of capecitabine plus oxaliplatin (XELOX) versus 5-fluorouracil/leucovorin (5-Fu/LV) plus oxaliplatin (FOLFOX4) regimens as adjuvant chemotherapy for stage III colorectal cancer.. The clinicopathological data of 118 patients with stage III colorectal cancer were studied retrospectively. The patients were assigned to receive either FOLFOX4 regimen (n = 76) or XELOX regimen (n = 42). 3-year disease-free survival (DFS) and adverse events as end points were compared between the two groups.. The number of patients that failed to finish 8 cycles was higher in FOLFOX4 group (28 vs. 8, P = 0.044). There was no significant difference for 3-year DFS and all grades adverse events between the two groups. However, the FOLFOX4 group showed more grade 3/4 neutropenia (31.6% vs. 14.3%, P = 0.039) and central venous catheter-associated complication (11.8% vs. 4.8%, P = 0.205), while XELOX showed more grade 3/4 thrombocytopenia (19.0% vs. 6.6%, P = 0.038) and hand-foot syndrome (11.9% vs. 1.3%, P = 0.012).. The results of this analysis indicate that XELOX and FOLFOX4 regimens have very similar efficacy as an adjuvant chemotherapy for stage III colon cancer, but XELOX may be safer than FOLFOX4.

Topics: Adult; Aged; Antineoplastic Combined Chemotherapy Protocols; Capecitabine; Chemotherapy, Adjuvant; Colorectal Neoplasms; Deoxycytidine; Disease-Free Survival; Female; Fluorouracil; Follow-Up Studies; Foot Dermatoses; Hand Dermatoses; Humans; Leucovorin; Male; Middle Aged; Neoplasm Staging; Neutropenia; Organoplatinum Compounds; Oxaliplatin; Oxaloacetates; Retrospective Studies; Syndrome; Thrombocytopenia

Cholinergic syndrome is an acute adverse reaction associated with irinotecan. Development of cholinergic syndrome can be ameliorated or prevented by administering various anticholinergics, including atropine sulfate or scopolamine butylbromide. Although many of the side effects are transient and non-life-threatening, their onset is painful and can lower a patient's quality of life (QoL). This retrospective study was performed to identify predictive factors of the development of irinotecan-related cholinergic syndrome in order to develop future strategies for improving the QoL of patients undergoing chemotherapy. We enrolled 150 cancer patients who underwent chemotherapy, which included irinotecan, in our outpatient chemotherapy center between October 2014 and January 2017. For regression analysis, variables related to the development of irinotecan-related cholinergic syndrome were extracted from the patient's clinical records. The degree of cholinergic syndrome was classified as follows: grade 0 = not developed; grade 1 = developed but did not require anticholinergic drugs; and grade 2 = developed and required anticholinergic drugs or stopping the chemotherapy due to cholinergic syndrome. Multivariate ordered logistic regression analysis was performed to identify predictive factors for the development of irinotecan-related cholinergic syndrome. Threshold measurements were determined using a receiver operating characteristic analysis (ROC) curve. Significant factors identified for the development of cholinergic syndrome included female sex [odds ratio (OR) 2.183, 95% confidence interval (CI) 1.010-4.717; P = 0.0471] and irinotecan dose (OR 1.014, 95% Cl 1.007-1.021; P = 0.0001). ROC curve analysis of the group likely to develop cholinergic syndrome indicated that the threshold for the irinotecan dose was 175 mg or above (area under the curve = 0.69). In conclusion, female sex and irinotecan dose were identified as significant predictors of the development of cholinergic syndrome.

Topics: Abdominal Pain; Adult; Aged; Aged, 80 and over; Antineoplastic Combined Chemotherapy Protocols; Blood Pressure; Camptothecin; Diarrhea; Female; Fluorouracil; Humans; Irinotecan; Leucovorin; Logistic Models; Male; Middle Aged; Neoplasms; Predictive Value of Tests; Quality of Life; Retrospective Studies; Salivation; Syndrome; Young Adult

Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Colonic Neoplasms; Drug Administration Schedule; Erythema; Fluorouracil; Foot; Hand; Humans; Leucovorin; Lymphatic Metastasis; Male; Organoplatinum Compounds; Oxaliplatin; Pain; Penis; Scrotum; Skin Diseases; Stomatitis; Syndrome

Topics: Antiparkinson Agents; Atrophy; Basal Ganglia; Brain Diseases, Metabolic; Carbidopa; Cerebellum; Demyelinating Diseases; Dystonia; Female; Folic Acid Deficiency; Humans; Leucovorin; Levodopa; Male; Syndrome; Tetrahydrofolates; Treatment Outcome; Vitamin B Complex

The patient was an elderly male who had radical surgery for sigmoid cancer in 2001. Owing to metastasis of his cancer to the left supraclavicular lymph nodes in 2002, the patient was admitted to our hospital for systemic chemotherapy. We started treatment with irinotecan, leucovorin, 5-fluorouracil (IFL). After administering 100 mg/m2 of irinotecan, 250 mg/m2 leucovorin and 600 mg/m2 5-fluorouracil to the patient on day 1, grade 3 leukopenia developed rapidly and grade 4 thrombocytopenia was observed on day 5. We excluded irinotecan from the medication and continued the administration of 5-fluorouracil and leucovorin, but his tumors had not been reduced sufficiently. Based on some examination results, we assumed that the patient had Gilbert's syndrome and that the severe side effects that occurred were due to prolongation of SN38 metabolism. We again administered irinotecan but at reduced dose (25 mg/m2). Four courses of this modified IFL were administered safely and the response was favorable.

Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Camptothecin; Fluorouracil; Gilbert Disease; Glucuronosyltransferase; Humans; Irinotecan; Leucovorin; Male; Mutation; Syndrome; Treatment Outcome

To describe three unrelated children with a distinctive variant of Aicardi-Goutières syndrome (AGS) characterized by microcephaly, severe mental and motor retardation, dyskinesia or spasticity, and occasional seizures.. Neuroimaging showed bilateral calcification of basal ganglia and white matter. CSF glucose, protein, cell count, and interferon alpha were normal. Abnormal CSF findings included extremely high neopterin (293 to 814 nmol/L; normal 12 to 30 nmol/L) and biopterin (226 to 416 nmol/L; normal 15 to 40 nmol/L) combined with lowered 5-methyltetrahydrofolate (23 to 48 nmol/L; normal 64 to 182 nmol/L) concentrations in two patients. The absence of pleocytosis and normal CSF interferon alpha was a characteristic finding compared to the classic AGS syndrome. Genetic and enzymatic tests excluded disorders of tetrahydrobiopterin metabolism, including mutation analysis of GTP cyclohydrolase feed-back regulatory protein. CSF investigations in three patients with classic AGS also showed increased pterins and partially lowered folate levels.. Intrathecal overproduction of pterins is the first biochemical abnormality identified in patients with AGS variants. Long-term substitution with folinic acid (2-4 mg/kg/day) resulted in substantial clinical recovery with normalization of CSF folates and pterins in one patient and clinical improvement in another. The underlying defect remains unknown.

Topics: Basal Ganglia; Brain Diseases; Decalcification, Pathologic; DNA Mutational Analysis; Dyskinesias; Female; Fibroblasts; Folic Acid; Humans; Infant; Infant, Newborn; Intellectual Disability; Intracellular Signaling Peptides and Proteins; Leucovorin; Male; Microcephaly; Muscle Hypertonia; Phenotype; Proteins; Psychomotor Disorders; Pterins; Seizures; Syndrome; Tomography, X-Ray Computed

We compared the effectiveness of 5-FU + l-LV with CDDP + 5-FU as a systemic chemotherapy for unresectable recurrence of colorectal cancer. The protocol we carried out in one group was as follows: (Group 1) 5-FU 2,000 mg mixed with l-LV 100-200 mg in the disposable balloon pump was administered continuously for 1 week. In the other group, (Group 2) we administered CDDP 5 mg/day every 5 days for a week and continuous 5-FU 500 mg/day for 3 weeks in the hospital, and in the outpatient clinic CDDP 5 mg/day every 2 days for a week with UFT-E 300-600 mg/day, orally, everyday. The response rate of Group 1 was 18.8% and that of Group 2 was 19.3%; the median survival time (MST) was 10.8 months for Group 1 and 8.4 months for Group 2. There were no significant differences between the 2 groups regarding these parameters. Hand foot syndrome (HFS) was observed in 43.8% of the patients, and stomatitis in 37.5% of all cases as adverse effect of systemic chemotherapy using 5-FU + l-LV. But the grade of the adverse effect was low and patients could continue with this systemic chemotherapy.

Topics: Antineoplastic Combined Chemotherapy Protocols; Cisplatin; Colorectal Neoplasms; Drug Administration Schedule; Fluorouracil; Foot Dermatoses; Hand Dermatoses; Home Care Services; Humans; Leucovorin; Neoplasm Recurrence, Local; Prognosis; Stomatitis; Syndrome

Topics: Antineoplastic Combined Chemotherapy Protocols; Camptothecin; Cardiovascular Diseases; Colorectal Neoplasms; Fluorouracil; Humans; Irinotecan; Leucovorin; Syndrome; Thrombosis

We describe an unusual case of hepatosplenic T-cell lymphoma in a 61-year-old man who presented with fever, hepatosplenomegaly, anemia, and thrombocytopenia. A spleen biopsy was consistent with T-cell lymphoma. Cytogenetic studies did not reveal chromosome abnormalities. Using the polymerase chain reaction approach, clonality of the T-cell receptor gamma-chain gene rearrangement could be demonstrated, while Southern blot analysis disclosed only a germline configuration of the T-cell receptor beta chain genes. Of interest, an immune-mediated mechanism was demonstrated and was most likely responsible for erythrocyte and platelet destruction; this is, therefore, the first report of gamma T-cell lymphoma in association with Evans' syndrome. Initial steroid treatment was efficacious in limiting autoimmunity but constitutional symptoms did not subside. Chemotherapy (MACOP-B) was successful in obtaining complete clinical remission. Finally, thrombocytopenia in gammadelta T-cell lymphoma patients should be routinely evaluated for platelet autoantibodies.

Topics: Anemia, Hemolytic; Antineoplastic Combined Chemotherapy Protocols; Autoantibodies; Autoimmune Diseases; Biopsy; Bleomycin; Blood Platelets; Bone Marrow; Cyclophosphamide; Doxorubicin; Gene Rearrangement, gamma-Chain T-Cell Antigen Receptor; Hepatomegaly; Humans; Hydrocortisone; Leucovorin; Liver Neoplasms; Lymphoma, T-Cell; Male; Methotrexate; Middle Aged; Prednisone; Receptors, Antigen, T-Cell, gamma-delta; Remission Induction; Splenic Neoplasms; Splenomegaly; Syndrome; Thrombocytopenia; Vincristine

To review and assign attribution for the causes of early deaths on two National Cancer Institute-sponsored cooperative group studies involving irinotecan and bolus fluorouracil (5-FU) and leucovorin (IFL).. The inpatient, outpatient, and research records of patients treated on Cancer and Leukemia Group B protocol C89803 and on North Center Cancer Treatment Group protocol N9741 were reviewed by a panel of five medical oncologists not directly involved with either study. Each death was categorized as treatment-induced, treatment-exacerbated, or treatment-unrelated.. The records of 44 patients who experienced early deaths on C89803 (21 patients) or N9741 (23 patients) were reviewed. Patients treated with irinotecan plus bolus 5-FU/leucovorin had a three-fold higher rate of treatment-induced or treatment-exacerbated death than patients treated on the other arm(s) of the respective studies. For C89803, these rates were 2.5% (16 of 635) for IFL versus 0.8% (five of 628) for bolus weekly 5-FU and leucovorin. For N9741, these rates were 3.5% (10 of 289) for IFL, 1.1% (three of 277) for oxaliplatin plus bolus and infusional 5-FU and leucovorin, and 1.1% (three of 275) for oxaliplatin plus irinotecan. Multiple gastrointestinal toxicities that often occurred together were characterized into a gastrointestinal syndrome. Sudden, unexpected thromboembolic events were characterized as a vascular syndrome. The majority of deaths in both studies were attributable to one or both of these syndromes.. Close clinical monitoring, early recognition of toxicities and toxicity syndromes, aggressive therapeutic intervention, and withholding therapy in the presence of unresolved drug-related toxicities is recommended for patients receiving IFL or other intensive chemotherapy regimens.

Topics: Antineoplastic Combined Chemotherapy Protocols; Camptothecin; Cause of Death; Fluorouracil; Gastrointestinal Diseases; Guidelines as Topic; Irinotecan; Leucovorin; Mortality; Randomized Controlled Trials as Topic; Risk Factors; Syndrome; Time Factors; Vascular Diseases

The aim of this study was to examine in detail the incidence and severity of hand-foot syndrome in advanced colorectal cancer patients receiving 5-fluorouracil (5-FU) and leucovorin (L-LV) chemotherapy. 70 advanced colorectal cancer patients (pts) were given weekly 24 h continuous 5-FU (2600 mg/m2) infusion plus L-LV (100 mg/m2 i.v., 50 mg orally). The toxicity, in particular HFS, was analysed, correlated to the main pts characteristics and compared to the other observed side-effects. HFS occurred in 36/70 pts (51%): grade 1 in 16 pts, grade 2 in 16 pts, grade 3 in 3 pts and grade 4 in 1 pt. It occurred after a median number of nine courses. In one case, chemotherapy was interrupted for this toxicity, and in another 5 pts drug reduction and/or treatment delay were undertaken. Changes in the therapeutic programme because of diarrhoea or mucositis were more frequent, even though these toxicities were generally mild in our series of pts. HFS was significantly correlated to previous exposure to chemotherapy (P = 0.00003). HFS was a frequent side-effect of high-dose, short-term continuous 5-FU infusion, but the impact on quality of life of pts and on the correct delivery of the planned chemotherapy was limited.

Topics: Adult; Aged; Antidotes; Antimetabolites, Antineoplastic; Antineoplastic Combined Chemotherapy Protocols; Colorectal Neoplasms; Drug Administration Schedule; Drug Eruptions; Female; Fluorouracil; Foot Dermatoses; Hand Dermatoses; Humans; Infusions, Intravenous; Leucovorin; Male; Middle Aged; Syndrome

Topics: Antimetabolites, Antineoplastic; Antineoplastic Combined Chemotherapy Protocols; Erythema; Female; Fluorouracil; Humans; Injections, Intravenous; Leucovorin; Middle Aged; Paresthesia; Syndrome

Topics: Adult; Female; Humans; Leucovorin; Malaria, Falciparum; Male; Pyrimethamine; Splenomegaly; Syndrome

Topics: Adenocarcinoma; Angina Pectoris; Electrocardiography; Female; Fluorouracil; Heart; Heart Diseases; Humans; Hypotension; Intestinal Neoplasms; Intestine, Small; Leucovorin; Middle Aged; Syndrome; Tachycardia; Ventricular Function, Left

The mechanism of the transient encephalopathy induced by high dose systemic administration of methotrexate (HDMTX) is unknown. Metabolic and vascular hypothesis have been formulated but convincing evidence is lacking. We report the first case of vascular disturbances (thinness of cortical arteries on angiography, reversible fall down of cerebral flow and increase of carotid resistance) in a young Algerian patient treated for an osteogenic osteosarcoma. This observation might lead to the exploration by non invasive and easily repeatable techniques of the cerebral vascular dynamic in patients submitted to HDMTX and thus contributed to the elucidation of the mechanism and to the prevention of these neurological side effect.

Topics: Adolescent; Antineoplastic Combined Chemotherapy Protocols; Bone Neoplasms; Cerebral Arteries; Cerebrovascular Circulation; Cisplatin; Cyclophosphamide; Doxorubicin; Female; Humans; Leucovorin; Methotrexate; Osteosarcoma; Seizures; Syndrome

An unusual neurological syndrome occurred in 4 of 158 patients treated for osteogenic sarcoma with combination chemotherapy. There was an abrupt onset of focal cerebral deficits approximately ten days after chemotherapy with vincristine and high-dose methotrexate plus citrovorum factor rescue. The syndrome was short lived and always occurred early in the course of treatment. Prolonged neurological deficits remained in 2 patients. When similar chemotherapy was reinstituted in the 4 patients, no further neurological complications ensued. Possible causes include a leukoencephalopathy related to methotrexate or an embolic cerebral vasculopathy related to necrotic tumor microemboli emanating from the lungs.

Topics: Adolescent; Adult; Bone Neoplasms; Brain Diseases; Drug Therapy, Combination; Female; Femoral Neoplasms; Humans; Humerus; Leucovorin; Male; Methotrexate; Neoplasm Metastasis; Osteosarcoma; Pelvic Bones; Syndrome; Vincristine