A pilot study of chronomodulated infusional 5-fluorouracil chemoradiation for pancreatic cancer.

BACKGROUND: Dose limiting acute toxicity from chemoradiation for pancreatic cancer occurs in 15% -20% of patients treated with post-operative adjuvant therapy. Reported here is a pilot study using chronomodulated infusional 5-fluorouracil (5-FU) chemoradiation (CIC) for pancreatic cancer, a treatment designed to reduce normal tissue toxicity and maintain efficacy, with specific evaluation of acute and late morbidity, patterns of disease progression, and survival. PATIENTS AND METHODS: Twenty-three patients with adenocarcinoma of the pancreas were treated with 5-FU CIC between January 1997 and September 1999. The median age was 64, and there were 9 males and 14 females. Six patients were considered unresectable and seventeen others were treated post-operatively. The median external beam irradiation dose was 50.4 Gy. 5-FU infusion was given five days per week (300 mg/m2/d) and the median total dose was 8.4 g/m2. The chronomodulated 5-FU infusion consists of a low basal infusion rate for 16 hours followed by an eight-hour escalating-deescalating infusion peaking at 10 p.m. All patients were followed from the time of initial diagnosis until last follow-up or death; the median follow-up was 16 months. RESULTS: No RTOG grade 3 or 4 hematologic toxicity occurred. Twelve of seventeen patients treated postoperatively have been controlled locally, and seven patients have no evidence of disease. The median survival is 28 months and one-year actuarial survival is 88% in the group of resected patients. The 6 patients treated for unresectable disease have a median survival of 13 months. CONCLUSIONS: Acute toxicity of 5-FU CIC appears to be less frequent and less severe than that reported with flat infusional or bolus 5-FU based chemoradiation used for adjuvant post-operative therapy for pancreatic cancer. This method may warrant further examination, as it may be attractive for the elderly or those who cannot tolerate the toxicity associated with standard post-operative treatment protocols.

Third ventricular lesion masquerading as suprasellar disease.

We discuss the case of a patient who presented with a bitemporal visual field disturbance thought to arise from chiasmatic compression secondary to a suprasellar mass. The patient was ultimately diagnosed with medulloblastoma with diffuse intraventricular disease. Careful review of magnetic resonance (MR) findings in this case demonstrate the apparent suprasellar mass to be within the suprachiasmatic recess of the third ventricle. The role of MR imaging in distinguishing between suprasellar disease involving the third ventricle and primary third ventricular lesions is discussed.

p53 mutations in gastric and colorectal cancers in Texas Hispanics versus Anglos.

Gastric cancer is more than twice as common in Hispanics as in Anglos in Texas, while colorectal cancer is almost twice as common in Anglos as Hispanics. To test the hypothesis that mutations in the p53 tumour suppressor gene are involved in these differences, we examined 131 gastric and 138 colorectal cancers from Hispanic and Anglo patients from South Texas and Mexico using immunohistochemistry (IHC) as a screening assay for p53 mutations. The fraction of p53 positive cases was not significantly different in gastric cancers from Hispanics compared to Anglos (43% versus 61%, respectively, p = 0.13) or in colorectal cancer (57% versus 58%, respectively, p = 1.0), suggesting that p53 mutations are not involved in causing the different incidences of these cancers in these populations. In addition, the types of p53 mutations arising in gastric tumours from Hispanic patients were consistent with those reported in gastric tumours in other populations. Sequencing of mutations in five gastric cancers revealed two G:C to A:T transitions, two A:T to G:C transitions and one complex deletion. In contrast with findings in studies in other tumour types, neither stage nor survival was associated with p53 positive staining by IHC in either gastric or colorectal tumours in this study. Positive p53 immunostaining was associated with the diffuse histological subtype in gastric carcinoma (p = 0.05) and high histological grade in colorectal carcinoma (p = 0.04).

Recurrent non-0:1 Vibrio cholerae bacteremia in a patient with multiple myeloma.

BACKGROUND: Episodes of bacteremia with non-0:1 Vibrio cholerae are rarely reported, even though the organism is endemic along the Gulf Coast of the United States. Recurrent episodes of bacteremia with non-0:1 V. cholerae are described even more rarely. A patient is reported who had multiple myeloma and experienced two episodes of bacteremia with non-0:1 V. cholerae. METHODS: Hospital records and the medical literature were reviewed, and the organism was serotyped by the Alabama State Laboratory. RESULTS: The patient had no prodromal illnesses or diarrhea with either episode of bacteremia. Treatment with empiric antibiotic therapy resulted in successful resolution of his bacteremia, which is fatal in almost 50% of reported cases in patients with malignant neoplasms. CONCLUSIONS: This is the first reported case of non-0:1 V. cholerae bacteremia occurring in a patient with multiple myeloma. Both his initial episode and a second episode of bacteremia responded to broad-spectrum antibiotics, which are used as empiric therapy for patients with hematologic malignancies and fever. Emphasis is placed on the paucity of clinical manifestations and the need for empiric therapy for non-0:1 V. cholerae infection in patients with hematologic malignancies.