pituitrin and Esophageal-Neoplasms

BACKGROUND Cisplatin/5-fluorouracil therapy is the standard therapy for unresectable and recurrent esophageal cancer. Cisplatin-based chemotherapy often causes adverse effects, such as nausea, vomiting, and renal dysfunction, which may necessitate dose modification or treatment prolongation. Therefore, novel combination therapies are urgently needed to improve the efficacy and overcome drug toxicity in this setting. CASE REPORT A 77-year-old man with advanced esophageal cancer received cisplatin/5-fluorouracil therapy as neoadjuvant chemotherapy. On day 8 of administration, the patient had lightheadedness, diaphoresis, and nausea and became unconscious and developed severe hyponatremia. We diagnosed the patient with cisplatin-induced syndrome of inadequate antidiuretic hormone secretion (SIADH). Subsequently, water restriction was started, and treatment with a salt-added diet and 3% hypertonic saline infusion was initiated. The hyponatremia improved and the patient was discharged on day 16 of administration. Therefore, neoadjuvant chemotherapy was discontinued, and surgical treatment was performed. However, the tumor recurred and chemotherapy was required. The patient developed severe hyponatremia while receiving neoadjuvant chemotherapy; hence, folinic acid, fluorouracil, and oxaliplatin therapy (FOLFOX) were administered as an alternative treatment. The patient completed the FOLFOX therapy without developing SIADH. CONCLUSIONS The cisplatin/5-fluorouracil therapy is currently the standard chemotherapy regimen for esophageal cancer. However, SIADH is a known adverse effect when using cisplatin. In patients with esophageal cancer, oxaliplatin appears to have a lower risk of SIADH than cisplatin, suggesting that oxaliplatin can be a therapeutic option for patients with esophageal cancer who are at high risk of SIADH.

Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Cisplatin; Esophageal Neoplasms; Fluorouracil; Humans; Inappropriate ADH Syndrome; Leucovorin; Male; Neoadjuvant Therapy; Neoplasm Recurrence, Local; Oxaliplatin; Vasopressins

Genome-wide association studies (GWAS) have discovered numerous genetic susceptibility loci including a cluster of alcohol dehydrogenase (ADH) gene family for esophageal squamous-cell carcinoma (ESCC). However, the underlying mechanism has not fully been elucidated. In this study, we integrated the GWAS data, gene-drinking interaction, expression quantitative trait locus (eQTL) analysis and biochemical experiments to clarify the specific mechanism of the polymorphisms in ADH loci. By imputation and eQTL analysis, we identified rs1154402C>G in intron 1 of ADH5 substantially associated with the expression levels of ADH1A. Association analysis showed that the rs1154402[G] allele was significantly associated with ESCC risk in drinkers (OR = 1.44, 95% CI = 1.20-1.73; P = 7.74 × 10

Topics: Esophageal Neoplasms; Esophageal Squamous Cell Carcinoma; Gene Expression Regulation, Neoplastic; Genetic Predisposition to Disease; Genome-Wide Association Study; Genotype; Humans; Neurophysins; Polymorphism, Single Nucleotide; Protein Precursors; Vasopressins

A 66-year-old man was referred to our hospital with esophageal tumor. He was diagnosed with esophageal small cell carcinoma by endoscopic biopsy. He had a low serum sodium level at admission and was diagnosed syndrome of inappropriate secretion of antidiuretic hormone (SIADH). His CT scan revealed esophageal wall thickness and swelling of thoracic and abdominal lymph nodes. He was classified as Stage IV a (cT3cN4cM0). He received systemic chemotherapy with CDDP and CPT-11. After three courses of chemotherapy, his tumor disappeared on CT scan and endoscopy. He was diagnosed as in complete remission and his SIADH recovered. The patient was then discharged and visited our outpatient clinic. Seven months after diagnosis, a tumor recurrence was indicated by CT scan and endoscopy. He received radiation therapy, and chemotherapy of paclitaxel, followed by CBDCA+VP-16. He is presently alive sixteen months after diagnosis.

Topics: Aged; Biopsy; Carcinoma, Small Cell; Combined Modality Therapy; Esophageal Neoplasms; Humans; Inappropriate ADH Syndrome; Male; Tomography, X-Ray Computed; Vasopressins

Topics: Atrial Natriuretic Factor; Endothelins; Esophageal Neoplasms; Gastrectomy; Humans; Peptides; Postoperative Period; Stomach Neoplasms; Vasopressins

The purpose of this study is to analyze the causes of elevation of plasma antidiuretic hormone (ADH) level during surgery and the relationship between urinary volume and plasma ADH level by measuring plasma ADH level of patients undergoing operation for esophageal cancer. The results obtained were as follows: The plasma ADH level was 4.0 pg/ml before surgery, 59 pg/ml after skin incision, 190 pg/ml after thoracotomy, and 276 pg/ml after vagotomy (right esophageal branch). Elevation of the plasma ADH level was partially suppressed by epidural analgesia combined with GOF anesthesia. The main factors that elevate plasma ADH level during surgery were pain at the skin incision, the manipulation of the pleura and vagotomy. The plasma ADH level was high (114 pg/ml) just after surgery and decreased to a normal level (4.3 pg/ml) in the morning of the 2nd postoperative day. Urinary volume was 74 ml/h before surgery, 95 ml/h just after surgery and 40 ml/h in the morning of the 1st postoperative day, and then, continued to gradual increase. There was no correlation between urinary volume and plasma ADH level during surgery until the 1st postoperative day. Elevation of plasma ADH level was not a primary factor of oliguiria during and just after surgery.

Topics: Aged; Esophageal Neoplasms; Female; Humans; Intraoperative Period; Male; Middle Aged; Osmolar Concentration; Pulmonary Wedge Pressure; Sodium; Vasopressins; Water-Electrolyte Balance

Twenty-six patients with the syndrome of inappropriate secretion of antidiuretic hormone were reviewed. The underlying diseases were bronchogenic carcinoma (12 cases); myxoedema (five cases); diseases of the nervous system (five cases); bronchopneumonia, carcinoma of the oesophagus, acute intermittent porphria and chlorpropamide therapy (each one case). Serum sodium levels ranged between 104 and 125 mEq per litre. Eighteen patients presented neurological manifestations, which in 14 were considered to be due to hyponatraemia. Neurological signs included disorders of consciousness (stage I and II coma), extrapyramidal signs, asterixis and epileptic seizures. An hyponatraemic coma was the first manifestation of the syndrome in five cases. In all cases where the EEG was recorded it showed non-specific signs of metabolic coma. The fundi never showed signs of intracranial hypertension. Blood urea and creatinine levels were invariably low in the euthyroid patients; these values were normal or elevated in patients with myxoedema and hyponatraemia. Hypokalaemia was frequent, and hypocalcaemia constant. In eleven cases an excess of water intake revealed the clinical syndrome: six patients were excessive beer drinkers and five had received extensive intravenous infusions. In one case the deleterious effect of diuretics was evident, and in another, the syndrome became evident during radiotherapy of an oesophageal tumour. Treatment of the syndrome was successful in all cases. A review of the literature concerning the various pathogenic mechanisms corresponding to the different underlying diseases is presented. The concept of aberrant hormonal production by a tumour is illustrated by an electron microscopic study.

Topics: Adult; Aged; Carcinoma, Bronchogenic; Cerebrovascular Disorders; Esophageal Neoplasms; Female; Hormones, Ectopic; Humans; Hyponatremia; Hypothyroidism; Lung Neoplasms; Male; Middle Aged; Myxedema; Neurologic Manifestations; Vasopressins; Water Intoxication

Topics: Adult; Aged; Carcinoma, Bronchogenic; Carcinoma, Small Cell; Carcinoma, Squamous Cell; Diuresis; Esophageal Neoplasms; Female; Humans; Lung Neoplasms; Male; Middle Aged; Neurophysins; Protein Binding; Radioimmunoassay; Syndrome; Tongue Neoplasms; Vasopressins

Topics: Acid-Base Equilibrium; Adult; Aged; Blood Pressure Determination; Catheterization; Electrocardiography; Esophageal Neoplasms; Female; Hematocrit; Hodgkin Disease; Humans; Hypertension, Portal; Liver Cirrhosis; Liver Diseases; Lysine; Male; Methods; Middle Aged; Phenylalanine; Portal System; Respiratory Function Tests; Umbilical Veins; Valsalva Maneuver; Vasopressins; Venous Pressure