Curative resection of leiomyosarcoma of the descending colon with metachronous liver metastasis: A case report

BACKGROUND Leiomyosarcoma(LMS)has a poor prognosis and rarely originates from the colon.If resection is possible,surgery is the first treatment most commonly considered.Unfortunately,no standard treatment exists for hepatic metastasis of LMS;although,several treatments,such as chemotherapy,radiotherapy,and surgery,have been used.Subsequently,the management of liver metastases remains controversial.CASE SUMMARY We present a rare case of metachronous liver metastasis in a patient with LMS originating from the descending colon.A 38-year-old man initially reported abdominal pain and diarrhea over the previous two months.Colonoscopy revealed a 4-cm diameter mass in the descending colon,40 cm from the anal verge.Computed tomography revealed intussusception of the descending colon due to the 4-cm mass.The patient underwent a left hemicolectomy.Immunohistochemical analysis of the tumor revealed that it was positive for smooth muscle actin and desmin,and negative for cluster of differentiation 34(CD34),CD117,and discovered on gastrointestinal stromal tumor(GIST)-1,which are characteristic of gastrointestinal LMS.A single liver metastasis developed 11 mo postoperatively;the patient subsequently underwent curative resection thereof.The patient remained disease-free after six cycles of adjuvant chemotherapy(doxorubicin and ifosfamide),and 40 and 52 mo after liver resection and primary surgery,respectively.Similar cases were obtained from a search of Embase,PubMed,MEDLINE,and Google Scholar.CONCLUSION Early diagnosis and surgical resection may be the only potential curative options for liver metastasis of gastrointestinal LMS.

Weekly docetaxel and gemcitabine in previously treated metastatic esophageal squamous cell carcinoma

AIM: To assess the efficacy and safety of weekly docetaxel plus a fixed-dose rate(FDR) of gemcitabine in metastatic esophageal squamous cell carcinoma(SCC).METHODS: A multi-center, open-label, prospective phase Ⅱ study was designed.Thirty-three esophageal SCC patients with documented progression after fluoropyrimidine/platinum-based first-line chemotherapy were enrolled and treated with docetaxel 35 mg/m2 and gemcitabine 1000 mg/m2 iv at a FDR(10 mg/m2 per minute) on days 1 and 8.Treatment was repeatedevery twenty-one days until disease progression, unacceptable toxicity, or consent withdrawal.The primary endpoint was response rate(RR), and secondary endpoints were safety, progression-free survival(PFS) and overall survival(OS).RESULTS: Combination of weekly docetaxel and FDR gemcitabine was well tolerated: the most common treatment-related adverse events were anemia(97%), fatigue(64%) and neutropenia(55%).One patient with multiple lung and lymph node metastases died of respiratory failure after receiving four cycles of chemotherapy, and the possibility of drug-induced pneumonitis could not be completely excluded.Disease control(objective response plus stable disease) in the ITT population was achieved in 88% of patients, and the overall RR was 30%(95%CI: 15%-46%).The median PFS and OS were 4.0(95%CI: 3.4-4.6) and 8.8 mo(95%CI: 7.8-9.8 mo), respectively.CONCLUSION: A combination of weekly docetaxel and FDR gemcitabine showed promising antitumor activity and tolerability in previously treated, metastatic esophageal SCC.

减量FOLFIRINOX方案挽救性治疗吉西他滨抵抗的晚期胰腺癌:一项Ⅱ期研究

背景与目的奥沙利铂、伊立替康、氟尿嘧啶和亚叶酸的联合化疗方案(FOLFIRINOX)极大提高了晚期胰腺癌患者的生存期。然而,FOLFIRINOX方案作为吉西他滨失败后二线治疗的疗效尚未进行前瞻性的检测。我们研究了减量FOLFIRINOX方案治疗吉西他滨抵抗的晚期胰腺癌患者的可行性和安全性。方法在14家医院进行了这一多中心II期前瞻、开放标签的单臂研究。经组织学确诊为胰腺浸润性导管腺癌、有可测量或可评价的病灶、东部肿瘤协作组体能状况评分0或1分、器官功能良好、年龄19岁或以上的患者符合入组条件。减量FOLFIRINOX方案的组成:奥沙利铂65 mg/m2、伊立替康135 mg/m2和亚叶酸400 mg/m2,第1天静脉注射;5?氟尿嘧啶2000 mg/m2,第1–2天持续静脉输注46 h;每2周重复。主要终点为FOLIFLIOX治疗起始后的无进展生存期。次要终点为客观缓解率、疾病控制率、总生存期、安全性和耐受性。采用Kaplan?Meier法评估了总生存期和无进展生存期。结果我们招募了来自14个中心的39例患者。客观缓解率为10.3%,疾病控制率为64.1%。6个月和1年总生存率分别为59.0%和15.4%。中位无进展生存期和总生存期分别为3.8个月[95%置信区间(confidence interval,CI)=1.5–6.0个月]和8.5个月(95%CI=5.6–11.4个月)。3或4级不良事件为中性粒细胞减少(41%)、恶心(10.3%)、食欲减退(10.3%)、贫血(7.7%)、黏膜炎(7.7%)、肺炎/胸膜融合(5.1%)和乏力(5.1%)。发生1例由感染性休克引起的治疗相关死亡。结论减量FOLFIRINOX方案有望作为二线方案治疗吉西他滨抵抗的胰腺癌。

Attenuated FOLFIRINOX in the salvage treatment of gemcitabine-refractory advanced pancreatic cancer: a phase II study

Background:Combination therapy with oxaliplatin,irinotecan,fluorouracil,and leucovorin(FOLFIRINOX)chemotherapy drastically improves survival of advanced pancreatic cancer patients.However,the efficacy of FOLFIRINOX as a second-line treatment after gemcitabine failure has not been tested prospectively.We investigated the feasibility and safety of attenuated FOLFIRINOX in patients with gemcitabine-refractory advanced pancreatic cancer.Methods:A multicenter phase II prospective open-label,single-arm study was conducted at 14 hospitals.Patients with histologically proven invasive ductal pancreatic adenocarcinoma,a measurable or evaluable lesion,Eastern Cooperative Oncology Group performance status 0 or 1,adequate organ function,and aged 19 years or older were eligible.Attenuated FOLFIRINOX consisted of oxaliplatin 65 mg/m2,irinotecan 135 mg/m2,and leucovorin 400 mg/m2 injected intravenously on day 1 and 5-fluorouracil 2000 mg/m2 continuously infused intravenously over 46 h on days 1-2,repeated every 2 weeks.The primary endpoint was progression-free survival from the initiation of FOLFIRINOX.Secondary endpoints were the objective response rate,disease control rate,overall survival,safety,and tolerability.We estimated overall survival and progression-free survival using the Kaplan-Meier methods.Results:We enrolled 39 patients from 14 institutions.The objective response rate was 10.3%,while the disease control rate was 64.1%.The 6-month and 1-year overall survival rates were 59.0%and 15.4%,respectively.Median progression-free survival and overall survival were 3.8 months(95%confidence interval[CI]1.5-6.0 months)and 8.5 months(95%CI 5.6-11.4 months),respectively.Grade 3 or 4 adverse events were neutropenia(41.0%),nausea(10.3%),anorexia(10.3%),anemia(7.7%),mucositis(7.7%),pneumonia/pleural effusion(5.1%),and fatigue(5.1%).One treatment-related death attributable to septic shock occurred.Conclusion:Attenuated FOLFIRINOX may be promising as a second-line therapy for gemcitabine-refractory pancre-atic cancer.