Mitomycin-based hepatic arterial infusion chemotherapy for solitary ampullary cancer liver metastasis: an unusual treatment for an uncommon disease.

Ampullary carcinoma is an uncommon gastrointestinal disease. Its natural history is often characterized by the occurrence of liver metastases. Among patients who undergo pancreatoduodenectomy, those presenting with lymph nodes involvement are more prone to early distant disease relapse. In this report, a patient previously diagnosed with ampullary carcinoma had been treated with curative surgery. After subsequent adjuvant gemcitabine, the patient developed significant myelotoxicity and suffered from a single liver metastasis a few months later. A hepatic intra-arterial mitomycin plus fluorouracil-based chemotherapy was administered in order to avoid any serious systemic toxicity. The treatment was well tolerated and no serious side effects occurred. Extra-hepatic cancer relapse, involving intra-thoracic and abdominal lymph nodes, was observed not long after the initial intra-hepatic almost complete response. In conclusion, the locoregional chemotherapy administration was effective in overcoming any systemic toxicities and showed activity against the liver metastasis but it did not prevent extra-hepatic cancer dissemination.

Primary thromboprophylaxis in not surgically treated intra-luminal gastrointestinal cancer (ILGC) treated with first-line chemotherapy: A single institution preliminary safety report.

Occurrence of venous thromboembolism in cancer patients (patients) undergoing chemotherapy is a remarkable concern for the oncologist. In addition, careful attention has to be paid to the possible major bleeding when patients carrying gastrointestinal cancer need antithrombotic therapies. To date some Cancer Associated Thrombosis (CAT) risk scores as Khorana and PROTECHT score have been developed to identify the cancer population at high-risk for venous thromboembolism (VTE). Consensus guidelines recommend to consider also low molecular weight heparin (LMWH) for primary thromboprophylaxis in high-risk patients. This is a report on a retrospective case series of 15 intra-luminal not surgically treated gastrointestinal cancer patients deemed high risk for VTE. The patients had a Khorana or PROTECHT score of 2 points or more (at least ≥ 2 points). They were undergoing first line chemotherapy in the absence of endoscopic signs of cancer spontaneous bleeding. A prophylactic dose of LMWH was administered just before starting the chemotherapy session and until 48 hours after its completion. The authors mainly aimed to report occurrence of clinically perceptible gastrointestinal bleeding events. Fifteen patients were administered LMWH - median age: 59 (range: 42-79); gender: male 12 (80%); tumor type: stomach - 13 patients (86%); gastro-esophageal junction: 2 patients (14%). Duration of heparin treatment: the total treatment duration was 228 days; mean 15.2 days (range: 5-45); nadroparin: mean 14.7 days (range: 5-45); enoxaparin: mean 10.1 days (range: 5-20); parnaparin: a total of 5 days. None of the patients experienced perceptible gastrointestinal bleeding. Short-term LMWH thromboprophylaxis appeared to be safe for this series of patients.

Mitomycin C plus capecitabine (mixe) in anthracycline- and taxane-pretreated metastatic breast cancer. A multicenter phase II study.

BACKGROUND: Capecitabine is considered the treatment of choice for anthracycline- and taxane-pretreated metastatic breast cancer. Mitomycin C seems to improve the activity of capecitabine by up-regulation of thymidine phosphorylase. PATIENTS AND METHODS: Fifty-five women with metastatic breast cancer previously treated with anthracyclinetaxane were treated with mitomycin C 10 mg/m2 on day 1 every six weeks and capecitabine 1000 mg/m2 on days 2-15 every three weeks. RESULTS: An overall response rate of 38% was found, consisting of 3 (5%) complete responses (CR) and 18 (33%) partial responses (PR); 8 patients (14%) had a stable disease (SD) for more than 4 months. The combination was well-tolerated, with the main toxicities being neutropenia, diarrhea and fatigue; other toxicities were of mild to moderate intensity without impairment in the quality of life of the patients. CONCLUSION: Capecitabine is confirmed as the drug of choice in the treatment of anthracycline- and taxane-pretreated metastatic breast cancer and its combination with mitomycin appears to improve its efficacy.

Disseminated Mycobacterium tuberculosis following renal transplant with alemtuzumab induction.

Mycobacterium tuberculosis presents unique challenges in the peritransplant period. Here, we describe a case of disseminated tuberculosis following renal transplantation with alemtuzumab induction immunosuppression in a patient with remotely treated pulmonary tuberculosis and ongoing risk factors for re-infection. We also review the available literature regarding the prevalence of tuberculosis infection following solid organ transplant and management of high-risk patients, including the role for isoniazid preventative therapy.

The value of attenuation correction by hybrid SPECT/CT imaging on infarct size quantification in male patients with previous inferior myocardial infarct.

BACKGROUND: Attenuation correction (AC) has been shown to improve the accuracy of myocardial perfusion single photon emission computed tomography (SPECT) for the detection and evaluation of patients with coronary artery disease. Attenuation artifacts, because of diaphragmatic attenuation, frequently affect the evaluation of the inferior wall, especially in male patients. PURPOSE: The aim of this study was to evaluate the value of AC for the assessment of infarct size in coronary artery disease patients after inferior myocardial infarction. MATERIALS AND METHODS: Gated-SPECT with Tc-labeled compounds with AC by hybrid SPECT/computed tomography (CT) was performed in 56 male patients with documented previous inferior myocardial infarction. Both corrected and uncorrected SPECT images were processed after motion and scatter correction by ordered-subset expectation maximization iterative reconstruction. When needed, a manual realignment between SPECT and computed tomography (CT) sections was performed. Uncorrected and corrected SPECT images were analyzed for perfusion using a 5-point segmental scoring scale from 0 (normal) to 4 (absent). Summed stress score (SSS), summed rest score (SRS), and summed difference score (SDS) of the inferior left ventricle wall (inferoseptal, inferior, infero-apical and infero-lateral segments) were determined and compared with the regional wall motion score as determined by uncorrected gated-SPECT. RESULTS: The SSS, SRS, SDS for attenuation-uncorrected and attenuation-corrected studies were 14.02 ± 7.9, 9.51 ± 7, 4.5 ± 3.2 and 9.39 ± 7.1, 5.6 ± 6.1, 3.8 ± 2.8, respectively. Differences were statistically significant (P<0.0001) for SSS and SRS but not for SDS. The regional summed rest score of the inferior wall (SRS of inferior segments) showed a better correlation with the regional summed wall motion score of the same segments: R²=0.50 in comparison to uncorrected SRS, R²=0.46. CONCLUSION: The combination of diaphragmatic attenuation and inferior myocardial infarction determines an artifactual overestimation of infarct size of inferior infarcts. The AC regional perfusion score (SRS) correlates with the regional wall motion score of the inferior wall. AC does not affect the detection and size of residual ischemia (SDS).