Irreversible Paraplegia Following One Time Prophylactic Intrathecal Chemotherapy in an Adult Patient with Acute Lymphoblastic Leukemia

We present an adult female patient who developed irreversible paraplegia and areflexia four days post intrathecal chemotherapy with methotrexate, cytosine arabinoside and hydrocortisone. On magnetic resonance imaging (MRI) of the lumbar spine, diffuse gadolinium enhancement of the anterior spinal nerve roots (ventral roots) was detected. Methylprednisolone was intravenously administered at a daily dose of 30mg/kg for three days. Despite this treatment, flaccid weakness in the lower extremities and urinary retention persisted. Following consolidation chemotherapy, no improvement in neurologic status was noted. Six months later, a follow-up MRI revealed severe atrophy of the thoracic spinal cord.

Combination Chemotherapy with Mitomycin C, Vinorelbine, and Cisplatin (MVrP) in Patients with Advanced Non-Small Cell Lung Cancer / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: A phase II study was conducted in patients with advanced non-small cell lung cancer (NSCLC) in order to evaluate the efficacy and toxicity of the combination chemotherapy regimen of mitomycin C, vinorelbine, and cisplatin (MVrP). MATERIALS AND METHODS: Between June 1996 and December 2000, fifty-nine patients with unresectable stage IIIB to IV, pathologically documented NSCLC were enrolled in this study. One cycle consisted of mitomycin C 10 mg/m2 i.v. day 1, vinorelbine 30 mg/m2 i.v. days 1 & 15, and cisplatin 80 mg/m2 i.v day 1 and the next cycle consisted of vinorelbine 30 mg/m2 i.v. days 29 & 43, and cisplatin 80 mg/m2 i.v day 29. Each cycle was alternated and treatments were repeated every 8 weeks. RESULTS: We were able to evaluate fifty-three of 59 patients. Objective responses were seen in 22 (41.5%) patients (CR 0%, PR 41.5%). The median duration of response was 13.7 weeks and the median time to progression was 17.7 weeks. The median overall survival was 45.6 weeks. There was a significantly longer survival seen in responders (p=0.041). The toxicities of this regimen were acceptable without treatment related toxic death. CONCLUSION: This study suggests that a combination regimen of mitomycin C, vinorelbine, and cisplatin is relatively effective and well tolerated for the treatment of advanced NSCLC.

Induction Chemotherapy Followed by Concurrent Chemoradiotherapy in Locoregional Esophageal Cancer / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: The object of this study is to evaluate the efficacy and toxicity of induction chemotherapy followed by concomitant chemoradiotherapy in locoregional esophageal cancer. MATERIALS AND METHODS: Between December 1992 and December 1999, 43 patients with locoregional esophageal cancer were enrolled in this phase II trial. Patients were treated with 2-cycles of induction chemotherapy followed by concomitant chemoradiotherapy. F-P chemotherapy consists of 1,000 mg/m2/Day of 5-FU as continuous infusion on day 1~5 and 80 mg/m2 of cisplatin as an intravenous bolus on day 1 and was repeated every 3~4 weeks. All patients received 60 Gy of external beam radiation concomitantly with F-P chemotherapy; intraluminal brachytherapy was added in 12 patients. A total of 4 cycles of chemotherapy were delivered. No further treatment was planned in patients who achieved complete remission after completion of the treatment. RESULTS: Among the 43 patients entered, 35 patients completed the protocol. Of the 35 evaluable patients, 12 patients (34%) achieved complete response and 13 patients (37%) achieved partial response. In 26 of 33 patients, dysphagia was improved. At a median follow-up of 22 months, the 2-year and 5-year survival rates were 39% and 19%, respectively. The median survival duration of the complete responder group was 69 months (4~100 months) and the 2-year survival rate of the complete responder group was 82%. Toxicities were tolerable, comprised of mucositis and cytopenia. CONCLUSION: Induction chemotherapy followed by concurrent chemoradiotherapy in locoregional esophageal cancer is well tolerated and effective.

Acute Phlegmonous Gastritis Diagnosed Early Endoscopically and Treated Successfully with Antibiotics / 대한소화기내시경학회지

Phlegmonous gastritis is a rare disorder caused by suppurative bacterial infection of the gastric wall. The mortality rate remains extremely high and the gastrectomy has been thought to be an effective form of treatment. We report a case of acute phlegmonous gastritis developed in a patient with advanced alcoholic liver cirrhosis, and recovered with early endoscopic diagnosis and antibiotics alone.

BACOD/EISHAP Alternating Combination Chemotherapy for Intermediate and High Grade Non-Hodgkin's Lymphoma / 대한암학회지

PURPOSE: We conducted a phase II study to determine the antitumor activity of BACOD/EISHAP alternating 9-drug chemotherapy in previously untreated patients with intermediate or high grade non-Hodgkin's lymphoma (NHL). MATERIALS AND METHODS: Intermediate or high grade non-Hodgkin's lymphoma patients were treated with BACOD/EISHAP (bleomycin, doxorubicin, cyclophosphamide, vincristine, dexame thasone/etoposide, ifosfamide, high dose cytarabine, cisplatin, dexamethasone) alternating com bination chemotherapy. Stage I and IIA lymphoma patients were excluded. BACOD/EISHAP alternating chemotherapy was given to the eligible patients every 3 weeks/4 weeks respectively. RESULTS: Between April, 1995 and December, 1997, among 25 eligible patients, 19 patients were evaluable for response. Six patients could not be evaluated for response because of follow-up loss within 2 cycles of chemotherapy. Complete response (CR) was achieved in 12 patients (63%) after BACOD/EISHAP alternating combination chemotherapy. With a follow-up period of 41 months (25~57 months), the disease free survival did not reach median (4~47 months) and 3-year disease free survival rate was 75%. Major toxicity was marrow suppression and the incidence of severe leukopenia (WBC<2,000/mm3) and thromobocytopenia (<25,000/mm3) were 15%, 5%, respectively. No treatment-related death was observed. For non-hematologic toxicities, nausea and vomiting were observed in 65% of patients, stomatitis in 25%, peripheral neuropathy in 20%. CONCLUSION: BACOD/EISHAP alternating chemotherapy was feasible with acceptable toxicities. The 63% complete response rate was comparable to other regimens but 75% 3year disease-free survival rate was encouraging. Further evaluation of this regimen is warranted.