Gemcitabine in elderly patients with advanced pancreatic cancer

AIM:To assess feasibility,tolerability and efficacy of gemcitabine-based chemotherapy in patients≥75 years old with advanced pancreatic cancer.METHODS:All consecutive patients≥75 years old with advanced pancreatic adenocarcinoma were included in this retrospective study.Necessary criteria to receive chemotherapy were:performance status 0-2,adequate biological parameters and no serious comorbidities.Other patients received best supportive care(BSC).RESULTS:Thirty-eight patients(53%women,median age 78 years,range 75-84)with pancreatic cancer(metastatic:n=20,locally advanced:n=18)were studied.Among them,30(79%)were able to receivechemotherapy[median number:9 infusions(1-45)].Six patients(23%)had at least one episode of grade 3 neutropenia and one patient developed a grade 3 hemolytic-uremic syndrome.No toxic death occurred.Three patients(11%)had a partial tumor response,13(46%)had a stable disease and 12(43%)had a tumor progression.Median survival was 9.1 mo(metastatic:6.9 mo,locally advanced:11.4 mo).CONCLUSION:Tolerance and efficacy of gemcitabinebased chemotherapy is acceptable in elderly patients in good condition,with similar results to younger patients.

Hepatic veins as a site of clot formation following liver resection

Pulmonary embolism occurs more frequently after hepatectomy than previously thought but is infrequently associated with peripheral deep vein thrombosis. In this paper, we report 2 cases of postoperative hepatic vein thrombosis after liver resection. Both patients had undergone major hepatectomy of a non-cirrhotic liver largely exposing the middle hepatic vein. Clots were incidentally found in the middle hepatic vein 4 and 17 d after surgery despite routine systemic thrombo-prophylaxis with low molecular weight heparin. Coagulation of the transition plan in a context of mutation of the prothrombin gene and inflammation induced biloma were the likely predisposing conditions. Clots disappeared following curative anticoagulation. We conclude that thrombosis of hepatic veins may occur after liver resection and is a potential source of pulmonary embolism.

Detection of liver micrometastases from colorectal origin by perfusion CT in a rat model

BACKGROUND: Some patients with colorectal carcinoma have liver metastases(LMs) which cannot be detected by conventional imaging. This study aimed to assess whether hepatic perfusion changes induced by micrometastases can be detected by perfusion computed tomography(CT).METHODS: LMs were produced in rats by injecting carcinoma cells into the portal vein. Perfusion CT was performed at microscopic(day 10), interval(day 17), and macroscopic stage(day 34). Perfusion parameters were computed using a dualinput one-compartmental model.RESULTS: Micro and macro LMs presented a mean diameter of 0.5 and 2.6 mm, respectively. Compared to controls, LMs at interval(1.1 mm) and macroscopic stage induced significant perfusion changes: a decrease of 42%(P=0.004) and 41%(P=0.029) in hepatic transit time and an increase of 292%(P=0.073) and 240%(P=0.001) in portal delay, respectively.CONCLUSIONS: LMs with a mean diameter between 1.1 and2.6 mm induced significant hepatic perfusion changes, detected by CT. Such detection may help to select patients and propose chemotherapy at the time of primary tumor resection.