[Splenomegaly Associated with FOLFOX Therapy]

BACKGROUND

Oxaliplatin is one of the key drugs for the treatment of colorectal cancer, although it is known to cause hepatic sinusoidal injury.

METHOD

Thirty-one patients underwent modified FOLFOX6 therapy from April 2006 and December 2009 at our hospital. Four patients were excluded from this study because they had too many intervals in their therapeutic courses. The size of the spleen and the blood platelet count were analyzed before and after 6 months of FOLFOX therapy. The spleen was measured using CT scan, and the splenic index(SI=length×width×height)was evaluated.

RESULTS

After 6 months of treatment, the mean SI was increased from 229 cm3 to 323 cm3(p<0. 01). At the same time, the mean platelet count was decreased from 26. 9 ×10 / / 4 mm3 to 17. 1×104 mm3(p<0. 01). A negative correlation was found between the ratio of SI and the platelet count after 6 months of treatment to baseline(r=-0. 42, p=0. 030). SI increased by>50% in 12 patients (44. 4%). The platelet count decreased more severely in patients whose SI increased by>50%(p=0. 028).

CONCLUSIONS

Splenomegaly and thrombocytopenia were observed in patients who underwent FOLFOX therapy. These are candidate parameters for evaluating hepatic sinusoidal injury.

[Effect of continuous infusion of 5-fluorouracil and daily low-dose cisplatin for inoperable recurrent cancer of the stomach and colon]

With the use of cisplatin to enhance the effect of 5-FU, a combined approach was designed to treat patients with inoperable recurrent cancer of the stomach (15) and colon (6). This CDDP-5-FU therapy consisted of intermittent infusion of CDDP at a dose of 6 mg/m2 every day and continuous infusion of 5-FU at a daily dose of 200 mg/m2 for 2 weeks with a 2-week interval in between. There were 1CR and 6PR, and the overall response rate was 40.0%. Toxicity was manifested in slight nausea or vomiting in two patients (10.0%), but there was no nephrotoxity. Thrombocytopenia of Grade 4 was found in 1 patient and leucopenia of Grade 3 in another. The efficiency of performance status was in 14 patients (66.7%). Combination of daily low-dose cisplatin and 5-FU is a tolerable treatment for patients with inoperable recurrent stomach and colon cancer. It is suggested that CDDP plays a role as not only an effector but also a modulator in biochemical modulation of 5-FU in this therapy. The infusion schedule is also suitable for chemotherapy of outpatients. Further studies on the appropriate infusion of CDDP and 5-FU are needed.