CT-Enteroclysis in the preoperative assessment of the small-bowel involvement in patients with peritoneal carcinomatosis, candidates for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy.

PURPOSE: To assess the performance of CT-Enteroclysis (CTE) in the preoperative evaluation of the small bowel (SB) involvement in patients with peritoneal carcinomatosis (PC), candidates for cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). MATERIAL AND METHODS: In this prospective study, 48 consecutive patients (37 women, 11 men, mean age: 57.02 years) with PC of different primaries, eligible for cytoreductive surgery and HIPEC underwent CTE before surgery. Lesions were gathered according to their location (SB wall or mesentery), distribution (jejunum/ileum, proximal/distal) and lesion size (LS, where LS0 is the absence of disease, LS1 < 1 cm, LS < 1-5 cm, and LS3 > 5 cm in maximal diameter). The preoperative CTE classification was correlated with surgical scoring of PC in the SB. RESULTS: CTE was found to have sensitivity 92%, specificity 96%, PPV 97%, NPV 91%, in assessing PC in the SB/mesentery. CTE exhibited "excellent" agreement with surgical classification of disease extent (overall kappa-weighted coefficient of agreement (κ (w)) was 0.962). Patients (n = 6) found inoperable at surgery manifested extensive plaque-like cover of the SB wall/mesentery on CTE. CONCLUSIONS: CTE may be considered a reliable imaging technique for the preoperative evaluation of the extent and distribution of PC in the SB/mesentery in order to assist surgical planning or to prevent unnecessary surgery.

CT imaging of peritoneal carcinomatosis with surgical correlation: a pictorial review.

Cytoreductive surgery in combination with hyperthermic intraperitoneal chemotherapy has revolutionized the survival and the quality of life in selected patients with peritoneal carcinomatosis. Preoperative CT is important for the selection of patients that may benefit from cytoreductive surgery and is useful for surgical planning. There are several tasks for the radiologist during CT interpretation: to describe cancerous implants on a "site-by-site" basis in the peritoneum, ligaments, mesenteries and visceral surfaces, to analyze patterns of involvement and to estimate the disease burden. Knowledge of the correlation between the CT and the surgical findings enhances the understanding of the disease and facilitates the communication between radiologists and surgeons.

A dose escalation study of docetaxel plus capecitabine in combination with oxaliplatin in patients with advanced solid tumors.

OBJECTIVES: Capecitabine (CAP), Oxaliplatin (OX) and Docetaxel (DOC) have shown considerable activity in a wide range of solid tumors. A phase I study was conducted in order to determine the maximum-tolerated dose (MTD) and dose-limiting toxicities (DLTs) of their combination in patients with advanced solid tumors. PATIENTS AND METHODS: Twenty-one patients were enrolled. The patient's median age was 68 years, 15 were male, and 12 were chemo-naïve. DOC was administered on day 1 as an 1-hour (iv) infusion at a standard dose of 50 mg/m(2). OX was administered on day 1 as a 2-hour (iv) infusion at escalating doses ranging from 70-80 mg/m(2). CAP was administered orally on days 1 to 7 at escalating doses ranging from 2,000-2,750 mg/m(2) given as two daily divided doses. Treatment was repeated every two weeks. RESULTS: Six different dose-levels were examined. At dose-level VI, two of three enrolled patients presented DLTs (one patient diarrhea and asthenia grade 3 and another grade 3 diarrhea), and thus, the recommended MTD for future phase II studies is CAP 2,750 mg/m(2) , DOC 50 mg/m(2) and OX 75 mg/m(2). A total of 121 treatment cycles were administered. Grade 3 neutropenia was observed in six (5%) treatment cycles and grade 3 thrombocytopenia in one (1%). There was no febrile episode. Grade 3 asthenia was observed in three (14%) patients, grade 3 diarrhea in four (19%), grade 3 neuropathy in one (5%), and grade 1/2 hand-foot syndrome in three (14%). Other toxicities were uncommon. There was no treatment related death. Four (29%) PRs and seven (50%) SD were observed among 14 evaluable patients. Responses were seen in patients with renal (n = 1), gastric (n = 2) and pancreatic (n = 1) cancer. CONCLUSIONS: These results demonstrate that CAP, DOC and OX can be safely combined at clinically relevant doses and this regimen merits further evaluation.

Anti-personnel landmine injuries during peace: experience in a European country.

INTRODUCTION: The purpose of this study is to report the incidence of landmine injuries during peacetime in a European country. METHODS: Forty victims of landmine explosions were admitted to Didimoticho General Hospital in Greece, from December 1988 to March 2003. A total of 19 people survived (47.5%) these events; all of the others were dead upon admission to the hospital. All of the victims were men, either suspected smugglers or migrants entering the country illegally, with an average of 30 years (range: 15-56 years). RESULTS: Most victims presented in groups, with multiple traumatic injuries, including lower extremity wounds. The mortality rate in the minefield prior to hospital admission was 52.5%, and the amputation rate for the survivors was 37%. There were no deaths of the patients admitted to the hospital. CONCLUSIONS: Landmines cause high-energy injuries with high mortality and amputation rates. Illegal migrants are the main victims of landmine explosions in Greece.

Large bilateral adrenal metastases in non-small cell lung cancer.

BACKGROUND: The adrenal gland is one of the common sites of metastasis from primary lung cancer. Adrenal metastases are usually unilateral however bilateral adrenal metastases are seen in 10% of all lung cancer patients; of these 2-3% occurs at the initial presentation of non-small cell lung cancer. Secondary tumors can disrupt the structure and function of the adrenal. This can lead to adrenal hemorrhage, which constitutes a life threatening hazard for the patient. CASE PRESENTATION: A 59-year-old male presented with persisting abdominal pain. His initial work-up revealed significant anemia, an invasive process in the right upper lobe of the lung and large masses of heterogeneous texture, with hemorrhagic and necrotic elements in both adrenal glands. A biopsy confirmed it to be a large-cell carcinoma of the lungs. The patient developed severe leukocytosis akin to the paraneoplastic syndrome and died suddenly five days after the administration of chemotherapy. CONCLUSION: Intratumoral hemorrhage is a rare but life threatening complication of adrenal metastases and should be treated as soon as it has been diagnosed. If adrenalectomy is not feasible, combination chemotherapy should be applied as in metastatic disease. For choosing the appropriate chemotherapeutic regimen it is important to accurately achieve the diagnosis.