Aim-FOLFUGEM 1 (leucovorin 400 mg/m2 combined with 5-flurorouracil (FU) bolu s 400 mg/m2 then 5-FU 2-3 g/m2/46 hours and gemcitabine 1000 mg/m2 in 30 min) in patients with locally advanced and metastatic pancreatic ad...Aim-FOLFUGEM 1 (leucovorin 400 mg/m2 combined with 5-flurorouracil (FU) bolu s 400 mg/m2 then 5-FU 2-3 g/m2/46 hours and gemcitabine 1000 mg/m2 in 30 min) in patients with locally advanced and metastatic pancreatic adenocarcinoma appeared to be toxic (neutropenia and alopecia). The aims of this phase II multicent ric study were to evaluate the response rate, clinical benefit and tolerance of a new scheme of combined leucovorin, 5-FU and gemcitabine (FOLFUGEM 2). Patients and methods-FOLFUGEM 2 associated leucovorin 400 mg/m2 in 2 hours followed by 5-FU 1000 mg/m2 in 22 hours, then gemcitabine 800 mg/m2 (10 mg/m2/min) with cycles every 14 days. Gemcitabine dose could be increased (1000 then 1250 mg/m2) when NCI/CTC toxicity was ≤grade 2. Results-Fifty-eight patients were included (locally-advanced tumor: N=I3 and metastatic: N=45). Among the 39 patients with measurable disease, 11 had partial response (28.2%, 95%confidence interval: 14-42%) and 11 had stable disease (28.2%). On an intent-to-treat analysis,the objective response rate was 19% (95%confidence interval: 9-29%). Clinical benefit rate was 46%. Median progression-free survival and median overall survival were 3.1 and 7.2 months, respectively. There were 13%grade 3-4 neutropenia and 36%complete alopecia. Conclusion FOLFUGEM 2 schema has an antitumoral effect in advanced pancreatic cancer and has an acceptable toxicity which appears to be less than that of FOLFUGEM1.展开更多
We report the case of a 32-year-old Indian man with symptoms suggesting Zollinger-Ellison syndrome including abdominal pain, esaphagitis, duodenal stenosis that did not improve with antisecretory medication, elevated ...We report the case of a 32-year-old Indian man with symptoms suggesting Zollinger-Ellison syndrome including abdominal pain, esaphagitis, duodenal stenosis that did not improve with antisecretory medication, elevated fasting gastrin serum levels that increased after intravenous secretin injections, elevated chromogranin A serum levels and tumoral aspect of pancreatic uncus on CT scan examination. A pancreaticoduodenectomy was performed. Histological examination of the resected specimen showed that there was no endocrine tumour of the pancreas or the duodenum, but identified marked lesions of follicular and caseous tuberculosis. The final diagnosis retained pseudo Zollinger-Ellison syndrome due to gastric outlet obstruction caused by duodenal stenosis of a tuberculosis origin.展开更多
Aims of the study To evaluate the diagnosis, treatment and outcome of patients with pancreatic metastases. Patients and methods We retrospectively reviewed the records of patients with pancreatic metastasis managed in...Aims of the study To evaluate the diagnosis, treatment and outcome of patients with pancreatic metastases. Patients and methods We retrospectively reviewed the records of patients with pancreatic metastasis managed in the Paris area between 1990 and 2000. Results The series analyzed included 22 patients, 10 men and 12 women, mean age 61 years (range: 35-76). The primary tumors were renal cell carcinoma (N = 10), colorectal cancer (N = 4), lung cancer (N = 4), breast cancer (N = 2), cutaneous melanoma (N = 1) and ileal carcinoid (N = 1). The mean interval between primary treatment and presentation was 73.5 months (range: 2-151). Diagnosis was established because of clinical symptoms (N = 15) or during surveillance (N = 7). Computed tomography (N = 19) and endoscopie ultrasound (EUS) (N= 18) mainly showed solitary and hypodense/or hypoechoic masses. Histological diagnosis was obtained before surgery by EUS guided fine needle aspiration(N =6), ultra sound guided biopsy (N = 3) or duodenoscopy (N = 3). Among 10 patients with primary renal cell carcinoma, 7 were treated by surgery. Median global survival was 33 months. Median survival was 61 months in the event of surgical treatment and 20 months in the other patients (ns). Mean survival depended on the type of primary tumor, 61 months for renal cell carcinoma and 33 for colorectal cancer (P = 0.06). Conclusions Most pancreatic metastases develop from renal cell carcinoma and can occur several years after nephrectomy. Histological diagnosis is often obtained before surgery. Surgical resection must be discussed as it can allow long term survival.展开更多
There are no reports of cholangiocarcinoma complicating post radiotherapy cholangitis. We report the case of a 40 year old patient who had undergone thoracoabdominal radiotherapy for Hodgkin’s disease, 22 years ago. ...There are no reports of cholangiocarcinoma complicating post radiotherapy cholangitis. We report the case of a 40 year old patient who had undergone thoracoabdominal radiotherapy for Hodgkin’s disease, 22 years ago. This radiotherapy was complicated, many years later, by chronic pancreatitis and cholangitis. Recurrent angiocholangitis led us to schedule a biliodigestive anastomosis. During surgery, cholangiocarcinoma was discovered. The patient died from his carcinoma some months later.展开更多
文摘Aim-FOLFUGEM 1 (leucovorin 400 mg/m2 combined with 5-flurorouracil (FU) bolu s 400 mg/m2 then 5-FU 2-3 g/m2/46 hours and gemcitabine 1000 mg/m2 in 30 min) in patients with locally advanced and metastatic pancreatic adenocarcinoma appeared to be toxic (neutropenia and alopecia). The aims of this phase II multicent ric study were to evaluate the response rate, clinical benefit and tolerance of a new scheme of combined leucovorin, 5-FU and gemcitabine (FOLFUGEM 2). Patients and methods-FOLFUGEM 2 associated leucovorin 400 mg/m2 in 2 hours followed by 5-FU 1000 mg/m2 in 22 hours, then gemcitabine 800 mg/m2 (10 mg/m2/min) with cycles every 14 days. Gemcitabine dose could be increased (1000 then 1250 mg/m2) when NCI/CTC toxicity was ≤grade 2. Results-Fifty-eight patients were included (locally-advanced tumor: N=I3 and metastatic: N=45). Among the 39 patients with measurable disease, 11 had partial response (28.2%, 95%confidence interval: 14-42%) and 11 had stable disease (28.2%). On an intent-to-treat analysis,the objective response rate was 19% (95%confidence interval: 9-29%). Clinical benefit rate was 46%. Median progression-free survival and median overall survival were 3.1 and 7.2 months, respectively. There were 13%grade 3-4 neutropenia and 36%complete alopecia. Conclusion FOLFUGEM 2 schema has an antitumoral effect in advanced pancreatic cancer and has an acceptable toxicity which appears to be less than that of FOLFUGEM1.
文摘We report the case of a 32-year-old Indian man with symptoms suggesting Zollinger-Ellison syndrome including abdominal pain, esaphagitis, duodenal stenosis that did not improve with antisecretory medication, elevated fasting gastrin serum levels that increased after intravenous secretin injections, elevated chromogranin A serum levels and tumoral aspect of pancreatic uncus on CT scan examination. A pancreaticoduodenectomy was performed. Histological examination of the resected specimen showed that there was no endocrine tumour of the pancreas or the duodenum, but identified marked lesions of follicular and caseous tuberculosis. The final diagnosis retained pseudo Zollinger-Ellison syndrome due to gastric outlet obstruction caused by duodenal stenosis of a tuberculosis origin.
文摘Aims of the study To evaluate the diagnosis, treatment and outcome of patients with pancreatic metastases. Patients and methods We retrospectively reviewed the records of patients with pancreatic metastasis managed in the Paris area between 1990 and 2000. Results The series analyzed included 22 patients, 10 men and 12 women, mean age 61 years (range: 35-76). The primary tumors were renal cell carcinoma (N = 10), colorectal cancer (N = 4), lung cancer (N = 4), breast cancer (N = 2), cutaneous melanoma (N = 1) and ileal carcinoid (N = 1). The mean interval between primary treatment and presentation was 73.5 months (range: 2-151). Diagnosis was established because of clinical symptoms (N = 15) or during surveillance (N = 7). Computed tomography (N = 19) and endoscopie ultrasound (EUS) (N= 18) mainly showed solitary and hypodense/or hypoechoic masses. Histological diagnosis was obtained before surgery by EUS guided fine needle aspiration(N =6), ultra sound guided biopsy (N = 3) or duodenoscopy (N = 3). Among 10 patients with primary renal cell carcinoma, 7 were treated by surgery. Median global survival was 33 months. Median survival was 61 months in the event of surgical treatment and 20 months in the other patients (ns). Mean survival depended on the type of primary tumor, 61 months for renal cell carcinoma and 33 for colorectal cancer (P = 0.06). Conclusions Most pancreatic metastases develop from renal cell carcinoma and can occur several years after nephrectomy. Histological diagnosis is often obtained before surgery. Surgical resection must be discussed as it can allow long term survival.
文摘There are no reports of cholangiocarcinoma complicating post radiotherapy cholangitis. We report the case of a 40 year old patient who had undergone thoracoabdominal radiotherapy for Hodgkin’s disease, 22 years ago. This radiotherapy was complicated, many years later, by chronic pancreatitis and cholangitis. Recurrent angiocholangitis led us to schedule a biliodigestive anastomosis. During surgery, cholangiocarcinoma was discovered. The patient died from his carcinoma some months later.
