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A fifty-two-year-old female with advanced rectal cancer underwent low anterior resection and hysterectomy. After local pelvic recurrence, she underwent radiation therapy(50 Gy in total), and then chemotherapy(XELOX+bevacizumab)was started. However, left femoral pain developed after the second course of chemotherapy, and necrotizing fasciitis associated with lower bowel perforation was found. Although bowel perforation is known as a serious side-effect of bevacizumab, its association with fasciitis is rare.

Pseudo-Meigs' syndrome caused by ovarian metastasis from colorectal cancer is extremely rare. The clinical symptoms of pleural effusion and ascites that are characteristics of pseudo-Meigs' syndrome are quite similar to those of terminal-stage colon cancer. Therefore, recognizing the clinical characteristics of pseudo-Meigs' syndrome is important. We investigated the prognosis and clinicopathological factors including age, location of the primary cancer, histology, wall depth, curative degree, synchronous/metachronous, unilateral/bilateral, lymph node metastasis, peritoneal dissemination, serum CEA level, venous invasion, and lymphatic invasion, in 5 cases of pseudo-Meigs' syndrome (PM group) and compared these findings with those of 10 cases with ovarian metastasis from colorectal cancer (control group) without pseudo-Meigs' syndrome. No significant differences were found between the PM group and the control group. The three-year survival rate was 37.5% in the PM group and 10% in the control group (logrank test, p=0.19). In the present study, no significant differences in any of the clinicopathological factors examined in this study were seen between the PM and control groups. However, we found that the surgical resection of ovarian metastasis in patients with pseudo-Meigs' syndrome improved the prognosis, similar to the situation for ovarian metastasis from colorectal cancer.

Clinical path for executing mFOLFOX6 in an outpatient chemotherapy room was settled on for the aim of standardization and common information with medical staffs about mFOLFOX6. The feature of this clinical path is described doses of drugs, results of laboratory examination, criteria for deciding adverse effects, common adverse effects and management, criteria for reduction and suspension of oxaliplatin and 5-fluorouracil. Patients before induction of the clinical path were compared with patients after that about relative dose intensity (RDI), reasons why treatments were suspended and progression-free survival (PFS). Fifty eight patients after induction were significantly higher RDI of oxaliplatin than 108 patients before induction (p=0.04). There were no significant differences about a frequency of suspension due to adverse effects (p=0.18) and PFS (p=0.74). The clinical path that we settled on was considered useful not only for common information with medical staffs but also for standardization.

We examined 155 patients who received a first-line modified FOLFOX6 ( mFOLFOX6) regimen for unresectable or recurrent colorectal cancer regarding oxaliplatin-related allergic reactions and prognosis of patients who developed such allergic reactions. Twenty eight patients (18.1%) developed a total of 44 allergic reactions (2.9%): The first allergic reactions were grade 1 in nine, grade 2 in seventeen, and grade 3 in two. The median number of cycles of mFOLFOX6 until the first allergic reaction was 8.5 (range, 1-25). Compared with non-allergic group patients (n=127), allergic group patients (n=28) had mFOLFOX6 regimen more frequently (p=0.01) and higher rate of introduction to second-line FOLFIRI regimen (p0.01). When analysis was restricted to patients who were given a second-line FOLFIRI regimen, the response rate and disease control rate associated with FOLFIRI treatment did not differ significantly between the two groups. However, the allergic group patients tended to show longer disease-free survival (p=0.16) and showed longer overall survival after the start of second-line treatment (p=0.03). In addition, the allergic group patients showed a longer overall survival after the start of mFOLFOX6 (p=0.03). These results suggest that allergic reactions in the first-line mFOLFOX6 treatment might not be a poor prognostic factor, considering the efficacy of second-line FOLFIRI regimen.

This retrospective study was performed to clarify whether or not ovarian metastasis from colorectal cancer should be classified into peritoneal metastasis. We compared patient background data and prognosis between patients with ovarian metastasis (ovarian group, n=16) and female patients with peritoneal metastasis without involving ovaries (peritoneal group, n=22) treated between 1998 and 2008. The two groups did not significantly differ in terms of other clinicopathological factors evaluated. The median overall survival period was 13.8 months for the ovarian group and 16.7 months for the peritoneal group (p=0.96). The 3-year overall survival rate was 48.6%, 46.9%, and 11.5% for patients with ovarian metastasis only (P2), those with minute peritoneal metastasis without involving ovaries (P1), and those with multiple (numerous) peritoneal metastasis without involving ovaries (P3) (p=0.13), respectively. These results suggest that it is valid to classify ovarian metastasis as peritoneal metastasis. However, further collection of data may be needed to conclude that solitary ovarian lesion(s) would be classified into P2.

This retrospective study was performed to examine the outcomes of patients with liver metastasis of colorectal cancer, who received mFOLFOX6 regimen prior to hepatic metastatectomy. The reasons for introducing mFOLFOX6 prior to hepatectomy were unresectable hepatic lesions in two patients, presence or suspicion of extrahepatic lesions in four patients, and patient's refusal for hepatectomy in one patient. The mean number of cycles of administering mFOLFOX6 was 12.7 (range 10-18), two patients received additional FOLFIRI regimen after mFOLFOX6 treatment. The therapeutic efficacy revealed complete response in two, partial response in two, and stable disease in two by RECIST criteria. Histological examination revealed that six from 15 resected nodules were classified into grade 3. Histological examination of the non-cancerous liver tissue revealed stage I sinusoidal dilation (Rubbia-Brandt's classification) in five and grade 1 steatohepatitis (Brunt's classification) in two who received additional FOLFIRI regimen. Blood loss and duration of surgery of the subjects were identical to those (n=17) who underwent hepatic metastatectomy without preoperative chemotherapy during the same study period. It does not seem easy to determine the optimal timing of hepatic metastatectomy after FOLFOX treatment in clinical practice. However, our results suggest that preoperative FOLFOX treatment may have little adverse impact on the safety of hepatic metastatectomy.