OBJECTIVE: We evaluated the effects and toxicities of docetaxel-carboplatin combination chemotherapy against recurrent or persistent ovarian cancer who were previously heavily treated with one or more lines of chemotherapy. METHODS: Sixteen patients with a recurrent or persistent ovarian cancer, previously received first or more line chemotherapy, had been treated with docetaxel-carboplatin combination chemotherapy at Kosin Medical Center from December 2001 to May 2003. The docetaxel-carboplatin combination chemotherapy consists of docetaxel 75 mg/m2 and carboplatin 450 mg/m2 given i.v. every 3-4 weeks. The response of patients was evaluated with the tumor marker (serum CA-125) and imaging studies (ultrasonogram, CT, MRI). The toxicities were defined according to the WHO toxicity criteria. RESULTS: The overall response rate was 50% (8/16). Eight patients were evaluable for response by WHO criteria. The response rate by WHO criteria was 37.5% (3/8). In detail, complete response was 12.5%, partial response was 25%, stable disease was 37.5% and progressive disease was 25%. The serologic CA-125 response rate was 50% (8/16), in detail serologic partial response was 50%, and serologic stable disease was 31% and serologic progressive disease was 19%. The median response duration was 10 months (3 to 17 months), the median time to response was 1 month (1/2 to 2 months) and the median time to re-progression was 5 months (3 to 7 months). The most common toxicity was gastrointestinal toxicity and the bone marrow suppression was proved as a most serious side effect. CONCLUSION: The docetaxel-carboplatin chemotherapy as a 2nd or more lines regimen against heavily pre-treated recurrent or persistent ovarian cancer is considerable but was associated significant gastrointestinal and bone marrow side effects. Routine premedication is recommended.
Bone Marrow ; Carboplatin* ; Drug Therapy* ; Drug Therapy, Combination* ; Humans ; Ovarian Neoplasms* ; Premedication

Primary lung lymphoma is an uncommon tumor, which constitutes 0.5% of primary lung cancer, and 3% of extranodal lymphoma. The most frequent radiologic presentation of pulmonary parenchymal lymphoma is single mass or nodule. But we have experienced a case which was radiologically presented as patchy lung infiltration at first, and then progressive multiple reticulonodular infiltrations in lung. A 48-year-old woman was admitted to the hospital because of fever and cough. Chest PA obtained on admission revealed multiple patchy infiltration. Eventually, open lung biopsy was performed and the specimen disclosed extranodal NK/T cell lymphoma, and in bone marrow aspiration, hemophagocytosis was present. We report a case of primary extranodal NK/T cell lung lymphoma presented as patchy lung infiltrations, which was treated with chemotherapy.
Biopsy ; Bone Marrow ; Cough ; Drug Therapy ; Female ; Fever ; Humans ; Lung Neoplasms ; Lung* ; Lymphoma* ; Middle Aged ; Thorax

OBJECTIVE: Topotecan has recently been used as a second-line agent in treatment of advanced ovarian cancer. The aim of the study was to evaluate the response rate and toxicities of topotecan in patients with recurrent epithelial ovarian cancer who had been treated with platinum-containing chemotherapy. METHODS: A retrospective review of all cases of recurrent ovarian cancer treated with topotecan was done. Response was evaluated using the clinical examination, CA-125 level and radiologic reports (CT, MRI) according to RECIST criteria. The toxicities were evaluated according to GOG criteria. RESULTS: Between 1998 and 2004, 57 patients were treated with topotecan for recurrent epithelial ovarian cancer. The response rate in platinum-sensitive group was 30.8% (4/13) and the response rate in platinum-resistant group was 15.9% (7/44). The response rate in topotecan alone therapy group was 8.0% (2/25), and the response rate in topotecan plus platinum combination therapy group was 28.1% (9/32). However, topotecan plus platinum combination therapy did not demonstrate a statistically significant trend toward greater median survival than topotecan alone therapy (19.2 month versus 17.2 month, P=0.82). Neutropenia above grade 3 was noted in 70%, and anemia above grade 3 in 36.8%, and thrombocytopenia above grade 3 in 47.3%. Although most severe toxicities were due to bone marrow suppression, they were adequately managed by supportive care. CONCLUSION: The results suggest that topotecan has moderate activity in the recurrent epithelial ovarian cancer who have failed previous treatment with platinum-containing chemotherapy. The response of topotecan plus platinum combination therapy was better than topotecan alone and the potential of other combination regimen deserves further evaluations.
Anemia ; Bone Marrow ; Drug Therapy* ; Humans ; Neutropenia ; Ovarian Neoplasms* ; Platinum ; Retrospective Studies ; Thrombocytopenia ; Topotecan*

PURPOSE: To evaluate antitumor response, time to progression, and toxicities of oxaliplatin, 5- fluorouracil (5-FU), and leucovorin (LV) continuous infusion in patients with metastatic colorectal cancer who progressed during or after treatment with a 5-FU-containing regimen. MATERIALS AND METHODS: Forty-eight patients with metastatic colorectal cancer, who progressed while receiving or after discontinuing palliative chemotherapy with 5- FU-based regimen, were enrolled in this study. Treatment consisted of oxaliplatin (85 mg/m2 on day 1) as a 2-hour infusion followed by bolus 5-FU (400 mg/m2 on day 1), and 5-FU 48-hour infusion 2.4~3 g/m2 concurrently with LV 48-hour infusion 150 mg/m2, without mixing. Cycles were repeated at 2-week intervals. The dose of 5-FU was modified, depending on the hematologic toxicity profile. RESULTS: The objective response rate was 28% for 43 assessable patients (95% confidence interval, 14% to 42%), including one complete remission (2%). Seventeen additional patients (39%) had stable disease, and fourteen (33%) progressed. The median time to progression was 5.9 months and the median overall survival was 13.2 months from the start of the chemotherapy. From the 297 cycles analyzed, hematologic toxicities per course were: leukopenia; grade I 26.6%, grade II 3.4%, and grade III 0.3%, thrombocytopenia; grade I 10.8%, grade II 3.0%, grade III 1.0%, and grade IV 0.3%. The most frequent nonhematologic adverse reactions were nausea/vomiting and peripheral neuropathy, which were rated as WHO grade II in 13 patients (49%) and 11 patients (22%), respectively. CONCLUSION: This phase II study of oxaliplatin, 5-FU, and LV continuous infusion showed enhanced antitumor activity in patients with 5-FU-pretreated metastatic colorectal cancer. Overall toxicity was acceptable; neurotoxicity and bone marrow suppression constituted the dose-limiting side effects.
Bone Marrow ; Colorectal Neoplasms* ; Drug Therapy ; Fluorouracil* ; Humans ; Leucovorin* ; Leukopenia ; Peripheral Nervous System Diseases ; Thrombocytopenia

Gastric cancer is a major cause of cancer-related mortality. At the time of diagnosis, majority of the patients usually have unresectable or metastatic disease. The most common sites of metastases are the liver and the peritoneum, but in the advanced stages, there may be metastases to any region of the body. Bone marrow is an important metastatic site for solid tumors, and the prognosis in such cases is poor. In gastric cancer cases, bone marrow metastasis is usually observed in younger patients and in those with poorly differentiated tumors. Prognosis is worsened owing to the poor histomorphology as well as the occurrence of pancytopenia. The effect of standard chemotherapy is unknown, as survival is limited to a few weeks. This report aimed to evaluate 5 gastric cancer patients with bone marrow metastases to emphasize the importance of this condition.
Bone Marrow* ; Diagnosis ; Drug Therapy ; Humans ; Liver ; Mortality ; Neoplasm Metastasis* ; Pancytopenia ; Peritoneum ; Prognosis ; Stomach Neoplasms

OBJECTIVE: We evaluated the effects and toxicities and cost effectiveness of iv etoposide-carboplatin- cyclophosphamide (ECC) combination chemotherapy against persistent or recurrent ovarian cancer who were previously heavily treated with one or more lines of chemotherapy which included platinum-paclitaxel- cyclophosphamide-topotecan based regimens. METHODS: Fifteen patients with a persistent or recurrent ovarian cancer, previously received first or more line chemotherapy, had been treated with ECC combination chemotherapy at Konsin Medical Center from September 2000 to October 2002. The ECC (iv etoposide-carboplatin-cyclophosphamide) combination chemotherapy consists of 100 mg/m2 etoposide iv and 500 mg/m2 cyclophosphamide iv in first day and 100 mg/m2 etoposide iv, 450 mg/m2 carboplatin iv in second day and 100 mg/m2 etoposide iv in third (and 4th-5th day if necessary) every 3-4 weeks. The response of patients was evaluated with the tumor marker (serum CA-125) and imaging studies (ultrasonogram, CT, MRI). The toxicities were defined according to the WHO toxicity criteria. RESULTS: The overall response rate by WHO criteria is 47%. In detail, partial response is 47%, Stable disease is 40% and progressive disease is 13%. The serologic CA-125 response rate is 64%, in detail serologic partial response is 64%, and serologic stable disease is 22% and serologic progressive disease is 14%. The median response duration is 9 months (4 to 12 months), the median time to response is 1 month (2 weeks to 2 months) and the median time to progression is 9 month (4 to 12 months). The most common side effect is nausea and vomiting and the bone marrow suppression is proved as a most serious side effect (grade 3 or more-13%). CONCLUSION: The iv etoposide-carboplatin-cyclophosphamide chemotherapy as a 2nd or more lines regimen against persistent or recurrent ovarian cancer is considerable.
Bone Marrow ; Carboplatin* ; Cost-Benefit Analysis ; Cyclophosphamide* ; Drug Therapy* ; Drug Therapy, Combination* ; Etoposide* ; Humans ; Nausea ; Ovarian Neoplasms* ; Vomiting

BACKGROUND: Bone marrow transplantation (BMT) or peripheral blood stem cell transplantation (PBSCT) following high dose chemotherapy has been an important therapeutic option for patients with hematologic malignancies or some solid tumors. The number of progenitor cells in the collection products has been used to determine the optimum time to stop the collections and to predict the hematopoietic engraftment after transplantation. In this study, we investigated the relationship between end-product cell counts measured by different methods and the influence of the infused cell dose on the engraftment rate. METHODS: Twenty five patients receiving autologous PBSCT and 25 patients receiving allogeneic BMT were studied. The number of total nucleated cells (TNC), of mononuclear cells (MNC), of CD34+ cells, and of CFU-GM (colony-forming unit-granulocyte monocyte) colonies were measured in each collection product. The number of days required to achieve an absolute neutrophil count (ANC) of 0.5x109/L with TNC count of 1.0x109/L and platelet count of 20x109/L without transfusions was taken as an arbitrary measure of the engraftment rate. RESLUTS: A close correlation between CD34+ cells/kg and CFU-GM/kg was observed in both collection products (p<0.05). However, MNC/kg also showed significant correlations with CD34+ cells/kg and CFU-GM/kg in allogeneic bone marrow collection products (p<0.05). The CFU-GM amount in the PBSC products was greater than that in the bone marrow collection products (p<0.05). Time to engraftment was a median of 14 (range 9-50) days in autologous PBSCT group, but 29 (range 17-57) days in allogeneic BMT group. In autologous PBSCT, infused CD34+ cells/kg and CFU-GM/kg correlated significantly with ANC recovery (p<0.05). CONCLUSIONS: The number of CD34+ cells was correlated with that of CFU-GM in the collection products, and the infused cell doses showed positive relation to the engraftment rate in autologous PBSCT. These findings suggest that measurement of CD34+ cell counts alone would be a sufficient parameter to predict the engraftment rate in autologous PBSCT.
Bone Marrow Transplantation* ; Bone Marrow* ; Cell Count ; Drug Therapy ; Granulocyte-Macrophage Progenitor Cells ; Hematologic Neoplasms ; Humans ; Neutrophils ; Peripheral Blood Stem Cell Transplantation* ; Platelet Count ; Stem Cells*

Local control is the important prognostic factor in cancer treatment because local control decrease the relative risk of metastatic spread and increse distant metastasis free survival. IORT is the modality which could increase local control without incressing complication, combined with curative operation. Eventhough we could achieve significant deacreased local failure by IORT and curative resection, it should not be committed as a main treatment modality without proving acceptable complications. Therapeutic Radiology Department of Yeungnam University Medical Center have tried 58 IORT from June 15, 1988, and performed 53 IORT in patients with gastric cancer. No local failure has been reporte? by regular follow up so far. Nine cases(17%) of treatment related complifaiton were reported including intestinal obstrution, hemorrhage, sepsis, and bone marrow depression. These complications could be comparable to Jo's 25.2% (chemotherapy + operation), Kim's 18% (chemotherapy only in inoperable patients), because our treatment regimen is consisted of IORT (1500 cGy), external irradiation(--4500 cGy) and extensive chemotherapy (FAM, 5FU+MMC, BACOP). Our data encouraged us to re-inforce further IORT in stomach cancer treatment.
Academic Medical Centers ; Bone Marrow ; Depression ; Drug Therapy ; Follow-Up Studies ; Hemorrhage ; Humans ; Neoplasm Metastasis ; Radiation Oncology ; Sepsis ; Stomach Neoplasms*

BACKGROUND: Abnormalities of chromosome 3q21-26 in patients with hematologic malignancies have been suggested to be associated with normal or elevated platelet counts and abnormal megakaryopoiesis. However, the relationship and pathogenic mechanisms are not yet clear. Therefore, we have attempted to clarify the relation of the chromosome 3q abnormalities with dysmegakaryopoiesis in 23 leukemia patients. METHODS: We reviewed retrospectively bone marrow studies, cytogenetic analyses and clinical records of 229 patients with leukemia (AML, ALL or CML in blastic crisis) between 1995 and 1999 with the emphasis on thrombocytopenia, chromosome 3q abnormalities, and dysmegakaryopoiesis in bone marrow. RESULTS: Among 229 leukemia patients, 9 patients (3.9%) had chromosome 3q abnormalities, 11 (4.8%) had dysmegakaryopoiesis and 13 (5.7%) showed normal to increased platelet counts. The platelet count of 9 patients with chromosome 3q abnormalities ranged from 7x109/L to 1623x109/L and 6 of them had decreased numbers of platelets and megakaryocytes, and two patients had dysmegakaryopoiesis. Among them, three patients had an increased number of megakaryocytes with dysmegakaryopoiesis and showed t (2; 3)(q31; q25) or inv (3)(q21q26). They showed a good response to standard chemotherapy. 8 of 10 patients, but neither thrombocytopenia nor chromosome 3q abnormalities, had normal or an increased number of megakaryocytes. CONCLUSIONS: No major prognostic influence was found due to the presence of large numbers of dysplastic megakaryocytes and normal to increased platelet counts in acute leukemia and seemingly were not uniquely associated with changes involving chromosome 3q and abnormalities of 3q21 and 3q26 associated with dysplastic megakaryocytes.
Bone Marrow ; Chromosome Aberrations* ; Cytogenetic Analysis ; Drug Therapy ; Hematologic Neoplasms ; Humans ; Leukemia* ; Megakaryocytes ; Platelet Count ; Retrospective Studies ; Thrombocytopenia

PURPOSE: Patients with advanced ovarian carcinoma and refractory to platinum based chemotherapy have a very poor prognosis and effective salvage regimens are needed. This study was conducted in order to determine the maximum tolerated dose (MTD) and dose limiting toxicity of combination with paclitaxel and ifosfamide. MATERIALS AND METHODS: After premedication, patients received paclitaxel (110~225 mg/m2) as a 24 hour IV infusion on day 1. Ifosfamide (1,000~1,500 mg/m2) was given as a 12 hour IV infusion with standard dose of mesna on day 2~6. All patients received G-CSF (granulocyte colony stimulating factor) on day 6~15. RESULTS: 12 patients with advanced ovarian cancer entered this trial. Toxicity included bone marrow suppression, neuromuscular toxicity, urothelial toxicity, gastrointestinal toxicity, which occurred in 84.6%, 65.3%, 30.7%, 88.4% of cycles. CONCLUSION: Neuromuscular toxicity was dose limiting toxicity. Maximum tolerated dose in com bination with paclitaxel and ifosfamide was 175 mg/m2 of paclitaxel and 1,500 mg/m2 of ifosfamide.
Bone Marrow ; Drug Therapy ; Granulocyte Colony-Stimulating Factor ; Humans ; Ifosfamide* ; Maximum Tolerated Dose ; Mesna ; Ovarian Neoplasms* ; Paclitaxel* ; Platinum ; Premedication ; Prognosis