Upper gastrointestinal complications associated with gemcitabine-concurrent proton radiotherapy for inoperable pancreatic cancer.

BACKGROUND: Little is known about acute upper gastrointestinal (GI) complications associated with gemcitabine-concurrent proton radiotherapy (GPT) for inoperable pancreatic cancer. We investigated acute GI complications following GPT in patients with inoperable pancreatic cancer using small-bowel endoscopy. METHODS: This prospective single center observational study was conducted at the Hyogo Ion Beam Medical Center from January 2010 to January 2012. Ninety-one patients who had clinically and medically inoperable pancreatic cancer treated by GPT were analyzed. Endoscopic examinations were performed before and after GPT to clarify the incidence rates of radiation-induced ulcers, GI hemorrhage, and GI perforation associated with GPT. RESULTS: Post-treatment endoscopic examinations revealed that 45 (49.4 %) patients had radiation-induced ulcers in the stomach and duodenum. Of those, many ulcerative lesions were found in the lower stomach (51 %) and horizontal part of the duodenum (39 %), regardless of the primary tumor site in the pancreas. Neither GI hemorrhage, nor perforation, was found in post-treatment endoscopy examinations. CONCLUSION: Approximately half of the patients treated with GPT for inoperable pancreatic cancer exhibited radiation-induced ulcers in the stomach and duodenum.

Therapeutic effects of mosapride citrate and lansoprazole for prevention of aspiration pneumonia in patients receiving gastrostomy feeding.

BACKGROUND: Aspiration pneumonia is an emerging problem in patients receiving gastrostomy feeding. This study is designed to clarify the therapeutic effects of mosapride citrate and lansoprazole for prevention of aspiration pneumonia in patients receiving gastrostomy feeding. METHODS: The study subjects were 119 patients with dysphasia who required gastrostomy feeding. They were randomly assigned to the control (without medication), lansoprazole (15 mg, 1/day), and mosapride (5 mg, 3/day) groups. The number of days with fever (≥37.8 °C), vomiting, and antibiotics administration, as well as the occurrence of pneumonia were investigated during the 6-month observation period. RESULTS: The incidence of pneumonia during the observation period was significantly lower in the mosapride group as compared to the control (7/38 vs. 16/40, p = 0.038) and lansoprazole (vs. 20/41, p = 0.005) groups. The mosapride group also showed a significant decrease in days with fever and antibiotics administration as compared to the other groups. Multivariate analysis revealed that the presence of hiatal hernia was a significant risk factor and administration of mosapride was a significant preventive factor for pneumonia. CONCLUSION: Mosapride has a preventive effect on occurrence of pneumonia in patients receiving gastrostomy feeding.

[Cisplatin administration for outpatients with short hydration of less than four hours].

BACKGROUND: The administration of cisplatin (CDDP)-containing regimens for outpatients has been popularized with the development of supportive care such as antiemetics. Currently, the number of chemotherapies available for outpatients has increased for many kinds of cancer, and administration with a shorter duration is desirable even in CDDP-containing regimens. METHODS: Between January 2008 and October 2011, we retrospectively evaluated 22 outpatients who received B 50mg/m² of cisplatin with a short hydration of within 4 hours. We instructed the patients to drink water(1, 000mL/day) on days 2 and 3 instead of receiving a drip infusion. The first course of chemotherapy was usually introduced on admission, and subsequent courses were administered in outpatient clinics. RESULTS: Thirteen cases of lung cancer, eight with gastric cancer, and one with esophageal cancer, were retrospectively evaluated. Thirteen CDDP+S-1 regimens, four CDDP+gemcitabine regimens, and five other types of regimens were administered. The median dose of CDDP was 60mg/m² (range, 50-75mg/m²), the median amount of drip infusion was 1, 600 mL (range, 1, 350-2, 000mL), and the median duration of drip infusion was 4 hours (range 3-4 hours). The decision to use antiemetics and diuretics was made on a case-by-case basis. The average creatinine level before the initiation of a CDDP-containing regimen was 0. 778±0. 212mg/dL, and the lebel four weeks after completion of the regimen was 0. 847±0. 200mg/dL. Among these 22 patients, 20 completed cisplatin-containing regimens. However, cisplatin was reduced in one patient due to renal dysfunction, and the cisplatin regimen was interrupted in one patient due to intolerable nausea and vomiting. CONCLUSIONS: CDDP administration at doses of 50-60mg/m² for outpatients was suggested to be safe with optimal patient selection, a total duration of administration of less than four hours, and with 2, 000 mL of hydration on day 1 and without drip infusion from day 2.

Medroxyprogesterone acetate for refractory emesis in cisplatin-treated patients.

Chemotherapy-induced nausea and vomiting (CINV) is one of the most distressing side effects in systemic chemotherapies. Recently, several effective agents have been developed to prevent CINV, and CINV can be prevented in 70%-80% of patients receiving chemotherapies. Conversely, 20%-30% of patients still suffer from CINV despite recommended optimal antiemetic preventions. Refractory emesis is defined as emesis occuring despite the use of antiemetic prophylaxis during the previous cycle of chemotherapy. Salvage treatments for refractory emesis are necessary, but there are few effective treatments at present. We consider medroxyprogesterone acetate to be a potentially promising agent for refractory emesis. We encountered three cases in which medroxyprogesterone acetate was extremely effective for refractory emesis induced by cisplatin-containing chemotherapy.