BACKGROUND/AIMS: Second-line chemotherapy in patients with advanced pancreatic ductal adenocarcinoma (PDAC) that progresses following gemcitabine-based treatment has not been established. This study aimed to investigate the efficacy and safety of second-line combination chemotherapy with capecitabine and oxaliplatin (XELOX) in these patients. METHODS: Between August 2011 and May 2014, all patients who received at least one cycle of XELOX (capecitabine, 1,000 mg/m² twice daily for 14 days; oxaliplatin, 130 mg/m² on day 1 of a 3-week cycle) combination chemotherapy for unresectable or recurrent PDAC were retrospectively recruited. The response was evaluated every 9 weeks, and the tumor response rate, progression-free survival and overall survival, and adverse events were assessed. RESULTS: Sixty-two patients were included; seven patients (11.3%) had a partial tumor response, and 20 patients (32.3%) had stable disease. The median progression-free and overall survival were 88 days (range, 35.1 to 140.9 days) and 158 days (range, 118.1 to 197.9 days), respectively. Patients who remained stable longer with frontline therapy (≥120 days) exhibited significantly longer progression-free and overall survival. The most common grade 3 to 4 adverse events in patients were vomiting (8.1%) and anorexia (6.5%). There was one treatment-related mortality caused by severe neutropenia and typhlitis. CONCLUSIONS: Second-line XELOX combination chemotherapy demonstrated an acceptable response and survival rate in patients with advanced PDAC who had failed gemcitabine-based chemotherapy.
Adenocarcinoma ; Anorexia ; Capecitabine* ; Carcinoma, Pancreatic Ductal ; Disease-Free Survival ; Drug Therapy ; Drug Therapy, Combination* ; Humans ; Mortality ; Neutropenia ; Pancreatic Ducts ; Pancreatic Neoplasms* ; Retrospective Studies ; Salvage Therapy ; Survival Rate ; Treatment Outcome ; Typhlitis ; Vomiting

A 10-year-old boy with severe aplastic anemia was admitted for allogeneic hematopoietic stem cell transplantation. After conditioning chemotherapy using cyclophosphamide, fludarabine, and antithymocyte immunoglobulin, he presented with fever and abdominal pain on day 0 of stem cell transplantation. After diagnosis of acute appendicitis with minor perforation, appendectomy was performed just after cell infusion. A week after the procedure, he showed two huge liver abscesses in S4 and S6 segments. We used broad spectrum antibiotics along with antifungal agents. Percutaneous drainage was attempted, but no fluid was removed and no microorganisms were isolated. After 7 weeks of antibiotics and antifungal therapy, liver abscesses showed improvement. We report a case of successfully treated appendicitis with liver abscesses in a severely neutropenic patient during allogeneic hematopoietic stem cell transplantation.
Abdominal Pain ; Anemia, Aplastic ; Anti-Bacterial Agents ; Antifungal Agents ; Appendectomy ; Appendicitis ; Child ; Cyclophosphamide ; Diagnosis ; Drainage ; Drug Therapy ; Fever ; Hematopoietic Stem Cell Transplantation ; Humans ; Immunoglobulins ; Liver Abscess ; Male ; Stem Cell Transplantation ; Typhlitis

Typhlitis is a necrotizing colitis that usually occurs in neutropenic patients and develops most often in patients with hematologic malignancies such as leukemia and lymphoma. Typhlitis may proceed to bowel perforation, peritonitis and sepsis, which requires immediate treatment. Irinotecan is a semisynthetic analogue of the natural alkaloid camptothecin which prevents DNA from unwinding by inhibition of topoisomerase I. It is mainly used in colon cancer and small cell lung carcinoma (SCLC), of which the most common adverse effects are gastrointestinal toxicities. To the best of our knowledge, no case of typhlitis after chemotherapy with a standard dose of irinotecan in a solid tumor has been reported in the literature. We, herein, report the first case of typhlitis developed after chemotherapy combining irinotecan and cisplatin in a patient with SCLC.
Camptothecin ; Cisplatin ; Colitis ; Colonic Neoplasms ; DNA ; DNA Topoisomerases, Type I ; Hematologic Neoplasms ; Humans ; Leukemia ; Lymphoma ; Peritonitis ; Sepsis ; Small Cell Lung Carcinoma ; Typhlitis

The gastrointestinal tract is one of the major sites for complications after solid organ and hematopoietic stem cell transplantation, and gastrointestinal complications are the principle cause of morbidity and death. The major gastrointestinal complications after transplantation include mucositis, typhlitis, infectious enterocolitis by virus, bacteria or fungus, pseudomembranous colitis, gastric ulcer, graft-versus-host disease, pneumatosis cystoides intestinalis, thrombotic microangiopathy and post-transplantation lymphoproliferative disease. Symptoms and signs of gastrointestinal complications following transplantation are often non-specific and present with varying severity. Moreover, the suppressed immune state often prohibits invasive studies including endoscopy and blurs the serologic and hematologic results. Therefore, it is hard to reach accurate diagnoses even after thorough investigations. Almost all immunosuppressive drugs can lead to gastrointestinal complications and we need proper strategies to minimize their side effects. On the one hand, we can expect better organ and patient survival through the judicious use of a broad range of immunosuppressive drugs; on the other hand, we should try to not ruin survival through proper precautions and early treatment of gastrointestinal complications following successful transplantation.
Bacteria ; Endoscopy ; Enterocolitis ; Enterocolitis, Pseudomembranous ; Fungi ; Gastrointestinal Diseases ; Gastrointestinal Tract ; Graft vs Host Disease ; Hand ; Hematopoietic Stem Cell Transplantation ; Humans ; Immunosuppression ; Mucositis ; Pneumatosis Cystoides Intestinalis ; Stomach Ulcer ; Thrombotic Microangiopathies ; Transplants ; Typhlitis ; Viruses

Catheter related and perianal problems are common surgical complications encountered during the treatment of pediatric malignancies. However acute surgical abdominal emergencies are rare. The aim of this study is to review acute surgical abdominal complications that occur during the treatment of childhood malignancies. Out of a total of 1,222 patients who were newly diagnosed with malignant disease, between January 2003 and May 2008, there were 10 patients who required surgery because of acute abdominal emergencies. Their medical records were reviewed retrospectively. Hematologic malignancies were present in 7 patients (4 leukemia, 2 lymphoma, 1 Langerhans cell histiocytosis) and solid tumors in 3 patients (1 adrenocortical carcinoma, 1 desmoplastic small round cell tumor, 1 rhabdomyosarcoma). Seven patients had intestinal obstruction, two had gastrointestinal perforation and one, typhlitis. Intestinal obstructions were treated with resection of the involved segment with (N=2) or without (N=3) enterostomy. Two patients had enterostomy alone when resection could not be performed. Intestinal perforation was treated with primary repair. Typhlitis of the ascending colon was treated with ileostomy. Right hemicolectomy was necessary the next day because of the rapidly progressing sepsis. Three patients are now alive on chemotherapy and one patient was lost to followed-up. Among six patients who died, five died of their original disease progression and one of uncontrolled sepsis after intestinal perforation. Although rare, acute surgical abdominal complications can occur in childhood malignancies. Rapid and accurate diagnosis and appropriate operation are required for effective treatment of the complications.
Abdomen ; Adrenocortical Carcinoma ; Catheters ; Child ; Colon, Ascending ; Desmoplastic Small Round Cell Tumor ; Disease Progression ; Emergencies ; Enterostomy ; Hematologic Neoplasms ; Humans ; Ileostomy ; Intestinal Obstruction ; Intestinal Perforation ; Leukemia ; Lymphoma ; Medical Records ; Retrospective Studies ; Sepsis ; Typhlitis

PURPOSE: Neutropenic enterocolitis is an acute, life-threatening inflammation of the small and large bowel, often seen in children with malignancies during periods of prolonged or severe neutropenia. The optimal management for typhlitis in pediatric oncology patients has been debateful between operative and nonoperative approaches. The purpose of this study was to review the outcome of medical management of patients who were diagnosed as typhlitis. METHODS: The records of 207 pediatric cancer patients who were diagnosed and treated at the pediatric department of Yeungnam University Hospital for cancer between August, 2002 and July, 2007 were reviewed. RESULTS: Among 207 patients, 12 (5.7%) children aged 9 to 14 years, were diagnosed clinically to have typhlitis. Clinical symptoms and signs of patients were fever, abdominal pain and tenderness, diarrhea, vomiting and rebound tenderness. Bowel-wall thickening (> 4mm) was seen on CT or ultrasonography. All patients were treated with antibiotics combinations of teicoplanin, carbapenem, aminoglycoside, or other third generation cephalosporin and metronidazole or clindamycin. Eight patients were treated with additional antifungal agents. Other supportive management included bowel rest, total parenteral nutrition, and G-CSF administration. All patients recovered completely and did not need any surgical management. CONCLUSION: Early diagnosis and aggressive supportive treatment appears to be important for complete recovery and survival of typhlitis.
Abdominal Pain ; Aged ; Anti-Bacterial Agents ; Antifungal Agents ; Child ; Clindamycin ; Diarrhea ; Early Diagnosis ; Enterocolitis ; Enterocolitis, Neutropenic ; Fever ; Granulocyte Colony-Stimulating Factor ; Humans ; Inflammation ; Metronidazole ; Neutropenia ; Parenteral Nutrition, Total ; Teicoplanin ; Typhlitis ; Vomiting

Typhlitis is one of the most ominous complications in immunocompromised patients. Neutropenic enterocolitis or typhlitis is a clinical syndrome characterized by fever, diarrhea and abdominal pain that occurs in neutropenic patients. It has been reported as a complication of childhood leukemia, but is now known to occur in adults with solid malignancies, acquired immunodeficiency syndrome (AIDS) or bone marrow transplantation (BMT). The association of typhlitis and propylthiouracil has not been previously reported. We report a case of a 42-year-old female patient with typhlitis due to propylthiouracil patient with hyperthyroidism.
Abdominal Pain ; Acquired Immunodeficiency Syndrome ; Adult ; Bone Marrow Transplantation ; Diarrhea ; Enterocolitis, Neutropenic ; Female ; Fever ; Humans ; Hyperthyroidism* ; Immunocompromised Host ; Leukemia ; Propylthiouracil* ; Typhlitis*

Neutropenic enterocolitis is an acute life-threatening, necrotizing inflammation of cecum and terminal ileum often seen in leukemia and lymphoma during periods of prolonged or severe neutropenia. It has been also referred to as necrotizing enterocolitis, ileocecal syndrome, or typhlitis (from the Greek word typhlon meaning cecum). The pathophysiology of the neutropenic enterocolitis is unknown but is believed to be multifactorial. The clinical symptoms of neutropenic enterocolitis are nonspecific including fever, abdominal pain (often right lower quadrant), abdominal distension, diarrhea, bloody stools, nausea, and vomiting. So acute appendicitis is should be included in the differential diagnosis. The early signs and symptoms are nonspecific and it may rapidly lead to intestinal perforation. The definite management of neutropenic enterocolitis is contrversial. but the prognosis is likely to be good with early diagnosis and proper management. We report one case of neutropenic enterocolitis in acute myelogenous leukemia with literature review.
Abdominal Pain ; Appendicitis ; Cecum ; Diagnosis, Differential ; Diarrhea ; Early Diagnosis ; Enterocolitis, Necrotizing ; Enterocolitis, Neutropenic* ; Fever ; Ileum ; Inflammation ; Intestinal Perforation ; Leukemia ; Leukemia, Myeloid, Acute* ; Lymphoma ; Nausea ; Neutropenia ; Prognosis ; Typhlitis ; Vomiting

PURPOSE: Acute appendicitis and typhlitis are difficult problems in acute myeloid leukemia (AML) patients. Whereas the treatment of typhlitis is primarily conservative, acute appendicitis is managed by surgery. The difficulty lies in distinguishing between the two becauae they both present similar conditions, and before surgery or autopsy, differentiation of these disease is nearly impossible. Careful evaluation is necessary before considering surgical treatment. In order to determinate proper treatment, we have reviewed our experiences with the right lower quadrant (RLQ) abdominal pain in patients with AML. METHODS: From July 1990 to December 2001, at St. Mary's hospital, Seoul, Korea, the records of AML patients that were consulted to the surgical department for RLQ abdominal pain were reviewed. Thirty patients were consulted and 12 out of the 30 patients underwent surgery. RESULTS: The average age of the patients who underwent operation was 33.9, with 9 males and 3 females. Six patients were in complete remission, and the other 6 were in the active state. RLQ pain was the first symptom of AML in four patients. All 12 patients had RLQ pain and 10 had rebound tenderness. In three patients, the white blood cell (WBC) count was less than 1, 000/mm3. Appendectomy was performed in five patients, appendectomy with drainage was performed in five, and laparoscopic appendectomy was performed in two patients. The final diagnosis was periappendicial abscess in four cases, leukemic cell infiltration in three cases, adenocarcinoma in one case, and typhlitis in three patients. Four patients developed wound infection and one patient died due to sepsis 7 days after the operation. For the patients who were treated medically, the average age was 36, with 11 males and 7 females. Seven patients were in the active state, three patients were in CR, four patients were in the refractory state, and two patients were in relapse. Six patients died within one month because of sepsis or pneumonia. CONCLUSION: Surgery is safe and is the sole method that can improve the survival rate in patients with AML and RLQ abdominal pain. Furthermore, complications related to surgery may be reduced through the laparoscopic surgery.
Abdominal Pain ; Abscess ; Adenocarcinoma ; Appendectomy ; Appendicitis ; Autopsy ; Diagnosis ; Drainage ; Female ; Humans ; Korea ; Laparoscopy ; Leukemia ; Leukemia, Myeloid, Acute* ; Leukocytes ; Male ; Pneumonia ; Recurrence ; Seoul ; Sepsis ; Survival Rate ; Typhlitis ; Wound Infection

The cecal perforation is very rare in pediatrics. Our center has experienced a 7-year-old girl with idiopathic perforated cecitis. The surgeon couldn't differentiate perforated cecitis from perforated appendicitis because of anatomical location, incidence and ambiguous radiologic result when this patient was admitted to our clinic due to RLQ pain.
Appendicitis* ; Child ; Female ; Humans ; Incidence ; Pediatrics ; Typhlitis*