Splenomegaly in FOLFOX-naïve stage IV or recurrent colorectal cancer patients due to chemotherapy-associated hepatotoxicity can be predicted by the aspartate aminotransferase to platelet ratio before chemotherapy.

BACKGROUND: Chemotherapy-associated hepatotoxicity is a common cause of postoperative complications after major hepatectomy. Splenomegaly may indicate portal hypertension due to chemotherapy. To identify chemotherapy-naïve patients with liver damage, the splenic volume (SV) and aspartate aminotransferase to platelet ratio (APR) were investigated. METHODS: Seventy-one patients receiving FOLFIRI, FOLFOX, or FOLFOX plus bevacizumab as first-line chemotherapy were included in this study. The SV measurement was performed by helical computed tomography volumetry, and the SV index (SVI) was calculated during 6 cycles of chemotherapy. The APR was used as an indicator of liver injury and the APR index (APRI) was calculated. RESULTS: The SVI and APRI were significantly higher in the FOLFOX group than in the FOLFIRI group. In the FOLFOX group, the maximum APR during FOLFOX administration was significantly higher in the subjects with SVI ≥ +30% than in those with SVI < +30% (p < 0.01). The incidences of grade 3 or 4 adverse events and grade 2 or greater histopathological sinusoidal injury were significantly higher in the SVI ≥ +30% than in the SVI < +30% group. Interestingly, the SVI was significantly higher in the group with APR ≥ 0.17 before FOLFOX than in the subjects with an APR < 0.17 before FOLFOX (p < 0.05). CONCLUSION: Splenomegaly due to FOLFOX-associated hepatotoxicity can be predicted if the APR before FOLFOX is 0.17 or higher.

[A case of unknown primary cancer responding to chemotherapy selected based on the results of an anticancer drug sensitivity test].

CASE: The patient was a 64-year-old man. In 1998, he underwent proximal gastrectomy for gastric cancer. In September 2007, follow-up CT revealed multiple tumors around the hilum of the spleen, and he was referred to our hospital. On the initial consultation, the marked retention of ascites was noted. The levels of tumor markers such as PIVKA-II and a-fetoprotein were markedly increased. Despite various examinations, the primary focus could not be determined. In November 2007, an exploratory laparotomy was performed, but the primary focus was unclear, so one of the nodules of the major omentum was excisionally biopsied. An anticancer drug sensitivity test showed that the specimen was sensitive to 5-FU and CDDP. Therefore, the combined chemotherapy with 5-FU and CDDP was performed. The patient responded to this therapy. Ascites and tumor markers remarkably decreased, and the performance status improved from 3 to 1. CONCLUSION: These results suggest the usefulness of an anticancer drug sensitivity test in the treatment of cancer in which the primary focus is unclear.

[Treatment of a persistent postoperative chylothorax with octreotide].

Chylothorax is a serious postoperative complication in the field of thoracic surgery. To treat refractory chylothorax, various methods including surgery are employed. In this study, we report a patient with refractory chylothorax in whom treatment with octreotide acetate was successful, although the chylorrhea site could not be determined during additional thoracotomy.