levoleucovorin and Thoracic-Neoplasms

Acute renal failure induced by methotrexate (MTX) can be lethal because renal excretion of the drug can be delayed. Pre-existing renal impairment, abstention, or underdosage of folinic acid and inadequate hydration facilitate toxicity. The prolonged high serum levels of MTX result in severe mucositis and pancytopenia, but strategies useful to accelerate MTX removal have not been universally accepted. We report a case of a 13-year-old girl with osteosarcoma who was treated with high-dose MTX because of thoracic tumor recurrence. No side effects were observed after 2 cycles of high-dose MTX; however, after the third cycle there was a delayed MTX elimination followed by clinical toxicity. Forty hours post-MTX infusion the serum level of MTX was 5.39 x 10(-4) mol/L. Treatment was based on symptomatic measures, such as maintenance of an abundant and alkaline diuresis and parenteral administration of folinic acid. Concomitantly, plasma exchange was employed to accelerate MTX removal and reduce its toxicity. After 24 days, she was discharged from the hospital, and her renal function recovered gradually.

Topics: Acute Kidney Injury; Adolescent; Antimetabolites, Antineoplastic; Diuresis; Female; Femoral Neoplasms; Humans; Leucovorin; Methotrexate; Osteosarcoma; Plasma Exchange; Thoracic 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

Topics: Antineoplastic Agents; Carcinoma, Squamous Cell; Catheterization; Chemotherapy, Cancer, Regional Perfusion; Extremities; Female; Fluorouracil; Follow-Up Studies; Head; Head and Neck Neoplasms; Humans; Injections, Intra-Arterial; Leucovorin; Liver Neoplasms; Male; Mechlorethamine; Methotrexate; Neoplasms; Pelvic Neoplasms; Thoracic Neoplasms

Topics: Adenocarcinoma; Arteries; Brain Neoplasms; Carcinoma, Hepatocellular; Carcinoma, Squamous Cell; Catheterization; Chloramphenicol; Facial Neoplasms; Fever; Fluorouracil; Head and Neck Neoplasms; Humans; Infections; Infusions, Parenteral; Leucovorin; Liver Neoplasms; Lymphoma, Large B-Cell, Diffuse; Male; Methotrexate; Neoplasm Metastasis; Palliative Care; Penicillins; Stomach Neoplasms; Thoracic Neoplasms