Primary osteogenic sarcoma arising from the dura mater: case report.

A 42-year-old woman who sought treatment for left drop foot was found to have a right frontoparietal parasagittal mass. Gross total resection of the tumor was performed and pathologic analysis revealed high grade osteoblastic osteosarcoma. The patient received adjuvant chemotherapy and continues to do well with no evidence of metastases or local recurrence 3 years after initial presentation.

Acquired activated protein C resistance is common in cancer patients and is associated with venous thromboembolism.

PURPOSE: Cancer patients have an increased risk for venous thromboembolism. Because activated protein C resistance is a common risk factor for venous thromboembolism, we prospectively evaluated the activated protein C sensitivity ratio and factor V Leiden mutation in cancer patients with and without venous thromboembolism. SUBJECTS AND METHODS: We studied 55 consecutive cancer patients with deep vein thrombosis, 58 cancer patients with no history of venous thromboembolism, 54 patients with venous thromboembolism without malignancy, and 56 healthy controls. The presence of factor V Leiden mutation was determined by polymerase chain reaction and allele specific restriction digestion. The activated protein C sensitivity ratio was expressed as the ratio of activated partial thromboplastin times measured in the presence and absence of activated protein C; a ratio <2.0 in patients who did not have factor V Leiden was considered to indicate acquired activated protein C resistance. RESULTS: The prevalence of factor V Leiden mutation in cancer patients with thromboembolism (1 of 55, 2%) did not differ significantly from those in cancer patients without thromboembolism (4 of 58, 7%) or normal controls (2 of 56, 4%), but was significantly lower than that of patients with thromboembolism without cancer (18 of 54, 33%, P <0.001). The prevalence of acquired activated protein C resistance was significantly greater in cancer patients with thromboembolism (29 of 54, 54%, P = 0.001) compared with the other groups: 9 of 54 (17%) in cancer patients without thromboembolism, 7 of 36 (19%) in patients with thromboembolism without cancer, and none of the normal controls. CONCLUSION: Although factor V Leiden is not a major risk factor for thrombosis in cancer patients, acquired activated protein C resistance is common and may contribute to the thrombotic tendency in these patients.

5-Fluorouracil and low-dose leucovorin in metastatic colorectal cancer: a pilot study.

A total of 56 consecutive patients with metastatic colorectal cancer received treatment with 5-fluorouracil (5-FU) given at 425 mg/m2 by rapid intravenous infusion, immediately preceded by leucovorin (LV) given at 20 mg/m2, with cycles being repeated every 4 weeks. Of 48 evaluable patients undergoing this treatment, a tumor response was observed in 16 (33%); a complete response, in 2 (4%); and a partial response, in 14 (29%). The median survival was 8.5 months for all patients and 16.5 months for responders. An improvement in symptoms was seen in 9 (26%) of 34 symptomatic patients. In all 15 (27%) of 44 evaluable patients showed an improvement in performance status. The most significant toxicity attributable to the treatment was mucositis of grade 3 or 4, seen in 27% of the patients. Altogether, 2 patients (3.5%) were hospitalized for treatment-related toxicity. We conclude that the combination of 5-FU and low-dose LV is active in advanced colorectal cancer and is associated with acceptable toxicity.

[Cisplatin-based chemotherapy for advanced basal and squamous cell carcinomas].

The majority of basal cell (BCC) and squamous cell (SCC) carcinomas of the skin are curable by surgery and/or radiation. However, additional therapy is required when the tumor is locally advanced, or has metastasized. 4 men and 4 women (mean age 70, range 49-86) with advanced BCC and/or SCC were treated with cisplatin-based chemotherapy. The disease was local in 4, local with regional lymph node involvement in 2, involved regional lymph nodes in 1 and was local with distant metastases in 1 patient. All were treated with a combination of cisplatin and 5'-fluorouracil. 2 were treated in addition with a combination of cyclophosphamide, doxorubicin, and cisplatin (CAP). Complete pathological response was seen in 2/8 and partial response in 4/8 with an overall response rate of 75%. There was tumor progression in 2. Survival of patients who responded was from 3-47 months (mean 12). The 2 who did not respond to chemotherapy died within 1 and 3 months of treatment. Significant side-effects in 6 included myelotoxicity and transient renal toxicity. We conclude that chemotherapy is effective in advanced BCC and SCC of the skin and may have curative potential when combined with local therapy.

Treatment of gastric adenocarcinoma with the combination of etoposide, adriamycin and cisplatin (EAP): comparison between two schedules.

The results of two schedules of the combination of etoposide, doxorubicin, and cisplatin (EAP) in gastric cancer are reported. EAP-1 was administered as originally reported and consisted of i.v. doxorubicin (adriamycin) 20 mg/m2 on days 1 and 7, i.v. cisplatin 40 mg/m2 on days 2 and 8 and i.v. etoposide (VP-16) 120 mg/m2 (100 mg/m2 in patients aged 60-65) on days 4-6. EAP-2 consisted of i.v. adriamycin 40 mg/m2 on day 1, i.v. cisplatin 80 mg/m2 (total dose per cycle) given in 3 divided doses on days 1-3 and i.v. VP-16 100 mg/m2 on days 1-3. Cycles of the two regimens were repeated on day 22. Drug doses were reduced in patients over 65 years of age. Twenty patients were treated with EAP-1 and 43 with EAP-2. Forty-five of the 63 patients included in this study had advanced gastric carcinoma, 16 had radically resected stage III disease, and 2 had metastatic signet ring cell carcinoma of unknown primary origin. Thirty-eight patients with advanced gastric adenocarcinoma were evaluable for response. The response rate for EAP-1 (6/13, 46%) was similar to that of EAP-2 (13/25, 52%). The median duration of response was 8 months for EAP-1 and 6.5 months for EAP-2. Myelotoxicity of EAP-1 was much more severe than that of EAP-2. Hospitalization due to granulocytopenic fever was required in 15/78 (19%) EAP-1 versus 20/215 (9%) EAP-2 courses. Toxic deaths occurred in 3/20 treated with EAP-1 and in 1/45 treated with EAP-2. The difference in toxicity between the two regimens could not be attributed to differences in patients' characteristics or to dose intensity. We conclude that the modified EAP regimen (EAP-2) is effective in the treatment of gastric cancer and is less toxic than the original EAP.