Paclitaxel for elderly patients with advanced NSCLC / 대한내과학회지

BACKGROUND: Combination chemotherapy including platinum is based on treatment of advanced non-small cell lung cancer (NSCLC). But combination chemotherapy is not tolerable in elderly patients. Paclitaxel is one of the most active single chemotherapeutic agent in advanced NSCLC. We evaluated the efficacy and safety of single paclitaxel chemotherapy in elderly with advanced NSCLC. METHODS: From September 2002 to May 2004, a total 24 patients aged 70 years and older with advanced NSCLC were enrolled in this study. Treatment was consisted with paclitaxel 135 mg/m2 intravenously for 3hrs on day 1. Chemotherapy repeated every three weeks until disease progression or severe toxicity developed. RESULTS: Of the 24 patents, only 18 patient can be evaluated and 4 partial remission, 11 stable diseases and 3 progressive diseases were observed. Based on an intent-to-treatment analysis, The overall response rate was 17%. The estimated median survival and median time to progression were 44 weeks and 18 weeks, respectively. The major toxicity were grade 3 or 4 neutropenia (6%). Other toxicity were myalgia, neuropathy, nausea and oral mucositis, but all of them were usually mild (grade 1, 2) and recovered spontaneously. There were no treatment- related deaths. CONCLUSIONS: This single low dose paclitaxel chemotherapy is highly tolarable with activity comparable to that of conventional dose regimens especially in elderly advanced non-small cell lung cancer.

Oxaliplatin and UFT, leucovorin combination chemotherapy in patients with advanced colorectal cancer / 대한내과학회지

BACKGROUND: UFT/oral leucovorin (LV) provided a safer, more convenient oral alternative to bolus i.v. 5-Fluorouracil/LV regimen for advanced colorectal cancer while producing equivalent survival. We evaluated the efficacy and safety of a combination of oxaliplatin and UFT/LV in patients with advanced colorectal cancer. METHODS: From January 1999 to December 2001, a total 28 patient with metastatic or relapsed colorectal cancer were enrolled in this study. Treatment was consisted of oxaliplatin 130 mg/m2 i.v. for 2 hours on day 1, and UFT 300 mg/m2 p.o. and LV 30 mg p.o. on day 1-21. Chemotherapy repeated every three weeks until disease progression. RESULTS: Of the 28 patients, 1 complete response and 10 partial responses were observed. The overall response rate was 39.3%. The estimated median time to progression and survival were 6.0 months and 18.2 months, respectively. Peripheral neuropathy was the most common adverse effect. But, peripheral neuropathy was mild (grade 1, 2) and reversible. From the 129 cycles analyzed, grade 3, 4 adverse effects were observed only 3% included neutropenia (1.5%), and thrombocytopenia (1.5%). There were no treatment-related deaths. CONCLUSION: This combination of oxaliplatin and UFT/oral leucovorin is active and feasible in patients with advanced colorectal cancer. The regimen deserve further evaluation in a phase III prospective study.

A Case of Primary Cardiac Non-Hodgkin's Lymphoma

Although 25 to 36% of systemic lymphoma patients develop cardiac involvement, a primary lymphoma involving only the heart or pericardium is much less common. We detected an intracavitary mass in the right atrium and right ventricle in a 73-year-old man with dyspnea on exertion and generalized edema using transthoracic and transesophageal echocardiography. A thoracotomy was performed due to a possible cardiac tamponade, and a myocardial biopsy showed a malignant non-Hodgkin's lymphoma of the diffuse large B cell type. We report a rare case of a primary cardiac lymphoma detected using a transthoracic and transesophageal echocardiography in patient presenting with a massive pericardial effusion.

Nephrotic Syndrome, Hepatitis and Gastric Involvement in Secondary Syphilis / 대한신장학회잡지

Syphilis, caused by the spirochete Treponema pallidum, is a chronic systemic infectious disease. Nephrotic syndrome, hepatitis, or gastric involvement resulting from secondary syphilis are well-documented complications, but very rare. Moreover, the simultaneous occurrence of these complications in the same patient is extremely rare. This report describes 43-year-old male patient with syphilis presented with features of nephrotic syndrome, acute hepatitis, and gastric involvement. A diagnosis of secondary syphilis was made by skin lesions and serologic tests for syphilis. After a diagnosis of syphilis, we supposed that nephrotic syndrome and hepatitis were the complications of secondary syphilis and performed kidney and liver biopsies. A kidney biopsy revealed membranous nephropathy characterized by subepithelial hump-like electron-dense deposits and effacement of epithelial foot-processes on electron microscopy. A liver biopsy showed a feature of lobular hepatitis with a few granulomas. Esophagogastroduodenoscopy (EGD) showed multiple shallow ulcers with varying degrees of nodular mucosa at gastric antrum. The patient was treated with intramuscular benzathine penicillin G, 2.4 million units. Proteinuria, skin lesion, hepatitis, and EGD finding were resolved rapidly after penicillin therapy. In conclusion, syphilis should be considered in the differential diagnosis of the nephrotic syndrome, hepatitis, and gastric involvement occurring separately or simultaneously.