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Remarkable response to fluorouracil, leucovorin, oxaliplatin, and irinotecan therapy in urothelial cancer of the renal pelvis: a case report

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ABSTRACT

Background: No standard chemotherapy regimen for advanced urothelial cancer has been established, except for cisplatin-based regimens. We report the case of a patient with double primary cancer, urothelial carcinoma of the upper urinary tract and colorectal cancer, who underwent oxaliplatin-based chemotherapies.

Case presentation: A 56-year-old Japanese man presented to our hospital with the diagnosis of a left renal pelvic tumor and rectal cancer. Several examinations including ureteroscopic biopsy and computed tomography-guided biopsy were performed; however, the diagnosis of renal pelvic cancer could not be made. Because the rectal cancer had been growing during the course of examination, he underwent five cycles of neoadjuvant chemotherapy with fluorouracil, leucovorin, oxaliplatin, and irinotecan. The volumes of both the rectal cancer and renal pelvic tumor drastically decreased. He then underwent pelvic evisceration with colostomy and ureterocutaneostomy. The histological diagnosis of the renal pelvic tumor was urothelial carcinoma. He is free of disease at 12 months after the treatment.

Conclusions: To the best of our knowledge, this is the first report describing a remarkable response to fluorouracil, leucovorin, oxaliplatin, and irinotecan therapy for renal pelvic cancer. We suggest fluorouracil, leucovorin, oxaliplatin, and irinotecan is an effective therapy for patients with advanced urothelial cancer.

No MeSH data available.


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a, b Abdominal computed tomography scan demonstrating the volume of renal pelvic tumor before treatment (a), and the decrease in volume after two cycles of fluorouracil, leucovorin, oxaliplatin, and irinotecan (b). c, d The rectal cancer before treatment (c), and decrease in tumor volume after two rounds of fluorouracil, leucovorin, oxaliplatin, and irinotecan (d). Red arrows indicate the sites of the tumor
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Fig1: a, b Abdominal computed tomography scan demonstrating the volume of renal pelvic tumor before treatment (a), and the decrease in volume after two cycles of fluorouracil, leucovorin, oxaliplatin, and irinotecan (b). c, d The rectal cancer before treatment (c), and decrease in tumor volume after two rounds of fluorouracil, leucovorin, oxaliplatin, and irinotecan (d). Red arrows indicate the sites of the tumor

Mentions: A 56-year-old Japanese man with a diagnosis of a left renal pelvic tumor and rectal cancer was referred to our hospital. He had been smoking cigarettes for 36 years. He had been healthy all his life and his family history was unremarkable. His chief complaints were bloody stools and proctodynia for several months. On admission, his vital signs were normal. An abdominal examination revealed distension; a rectal examination showed bloody stool and narrowing of his anus. The findings on other examinations were completely unremarkable. Laboratory examination revealed anemia and an inflammatory response (hemoglobin level of 100 g/L, white blood cell count of 12.5×109/L, neutrophil count of 10.8×109/L, and lymphocyte count of 1.3×109/L); the other findings were normal. His level of carcinoembryonic antigen (CEA) was normal. Contrast-enhanced abdominal computed tomography (CT) showed a huge mass in his rectum and a left renal pelvic tumor. Histological examination of a sample obtained during colonoscopy revealed adenocarcinoma of the rectum. Several examinations including ureteroscopic and CT-guided biopsies were performed; however, the diagnosis of renal pelvic cancer could not be made. Because the rectal cancer was growing during our evaluations of the patient, we started to administer two cycles of neoadjuvant chemotherapy with fluorouracil, leucovorin, oxaliplatin, and irinotecan (FOLFOXIRI). The volumes of the rectal cancer and renal pelvic tumor decreased drastically at the end of the two cycles of chemotherapy (Fig. 1). He received a total of five cycles of FOLFOXIRI. The renal pelvic tumor reduced by 50% as measured across the maximum diameter (from 64 mm to 32 mm). During the administration of chemotherapy, laboratory examination revealed neutropenia (white blood cell count of 1.7×109/L with 0.46×109/L neutrophils). Febrile neutropenia was observed at the end of the first round of chemotherapy; however, no other severe adverse events were observed after that. Subsequently, laparoscopic total nephroureterectomy on the left side was performed following pelvic evisceration with colostomy and ureterocutaneostomy on the right side. On histological examination, the rectal cancer and renal pelvic tumor were diagnosed as adenocarcinoma (pT2N0M0) and UC (pT3N0M0) with high grade, respectively, as presented in Fig. 2. There has been no disease progression at 12 months after treatment.Fig. 1


Remarkable response to fluorouracil, leucovorin, oxaliplatin, and irinotecan therapy in urothelial cancer of the renal pelvis: a case report
a, b Abdominal computed tomography scan demonstrating the volume of renal pelvic tumor before treatment (a), and the decrease in volume after two cycles of fluorouracil, leucovorin, oxaliplatin, and irinotecan (b). c, d The rectal cancer before treatment (c), and decrease in tumor volume after two rounds of fluorouracil, leucovorin, oxaliplatin, and irinotecan (d). Red arrows indicate the sites of the tumor
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC5385593&req=5

Fig1: a, b Abdominal computed tomography scan demonstrating the volume of renal pelvic tumor before treatment (a), and the decrease in volume after two cycles of fluorouracil, leucovorin, oxaliplatin, and irinotecan (b). c, d The rectal cancer before treatment (c), and decrease in tumor volume after two rounds of fluorouracil, leucovorin, oxaliplatin, and irinotecan (d). Red arrows indicate the sites of the tumor
Mentions: A 56-year-old Japanese man with a diagnosis of a left renal pelvic tumor and rectal cancer was referred to our hospital. He had been smoking cigarettes for 36 years. He had been healthy all his life and his family history was unremarkable. His chief complaints were bloody stools and proctodynia for several months. On admission, his vital signs were normal. An abdominal examination revealed distension; a rectal examination showed bloody stool and narrowing of his anus. The findings on other examinations were completely unremarkable. Laboratory examination revealed anemia and an inflammatory response (hemoglobin level of 100 g/L, white blood cell count of 12.5×109/L, neutrophil count of 10.8×109/L, and lymphocyte count of 1.3×109/L); the other findings were normal. His level of carcinoembryonic antigen (CEA) was normal. Contrast-enhanced abdominal computed tomography (CT) showed a huge mass in his rectum and a left renal pelvic tumor. Histological examination of a sample obtained during colonoscopy revealed adenocarcinoma of the rectum. Several examinations including ureteroscopic and CT-guided biopsies were performed; however, the diagnosis of renal pelvic cancer could not be made. Because the rectal cancer was growing during our evaluations of the patient, we started to administer two cycles of neoadjuvant chemotherapy with fluorouracil, leucovorin, oxaliplatin, and irinotecan (FOLFOXIRI). The volumes of the rectal cancer and renal pelvic tumor decreased drastically at the end of the two cycles of chemotherapy (Fig. 1). He received a total of five cycles of FOLFOXIRI. The renal pelvic tumor reduced by 50% as measured across the maximum diameter (from 64 mm to 32 mm). During the administration of chemotherapy, laboratory examination revealed neutropenia (white blood cell count of 1.7×109/L with 0.46×109/L neutrophils). Febrile neutropenia was observed at the end of the first round of chemotherapy; however, no other severe adverse events were observed after that. Subsequently, laparoscopic total nephroureterectomy on the left side was performed following pelvic evisceration with colostomy and ureterocutaneostomy on the right side. On histological examination, the rectal cancer and renal pelvic tumor were diagnosed as adenocarcinoma (pT2N0M0) and UC (pT3N0M0) with high grade, respectively, as presented in Fig. 2. There has been no disease progression at 12 months after treatment.Fig. 1

View Article: PubMed Central - PubMed

ABSTRACT

Background: No standard chemotherapy regimen for advanced urothelial cancer has been established, except for cisplatin-based regimens. We report the case of a patient with double primary cancer, urothelial carcinoma of the upper urinary tract and colorectal cancer, who underwent oxaliplatin-based chemotherapies.

Case presentation: A 56-year-old Japanese man presented to our hospital with the diagnosis of a left renal pelvic tumor and rectal cancer. Several examinations including ureteroscopic biopsy and computed tomography-guided biopsy were performed; however, the diagnosis of renal pelvic cancer could not be made. Because the rectal cancer had been growing during the course of examination, he underwent five cycles of neoadjuvant chemotherapy with fluorouracil, leucovorin, oxaliplatin, and irinotecan. The volumes of both the rectal cancer and renal pelvic tumor drastically decreased. He then underwent pelvic evisceration with colostomy and ureterocutaneostomy. The histological diagnosis of the renal pelvic tumor was urothelial carcinoma. He is free of disease at 12 months after the treatment.

Conclusions: To the best of our knowledge, this is the first report describing a remarkable response to fluorouracil, leucovorin, oxaliplatin, and irinotecan therapy for renal pelvic cancer. We suggest fluorouracil, leucovorin, oxaliplatin, and irinotecan is an effective therapy for patients with advanced urothelial cancer.

No MeSH data available.


Related in: MedlinePlus