Chemohormone therapy of metastatic melanoma with megestrol acetate plus dacarbazine, carmustine, and cisplatin
BACKGROUND:Chemotherapy with dacarbazine, carmustine, and cisplatin produces a modest objective response rate in melanoma. Megestrol acetate may ameliorate cachexia, abrogate drug resistance, and increase survival time in melanoma. METHODS:Nineteen patients with metastatic melanoma (16 evaluable) treated with dacarbazine (220 mg/m2/day for 3 days, intravenously [IV]), cisplatin (25 mg/m2/day for 3 days IV) every 3 weeks, and carmustine (150 mg/m2 IV single dose every 6 weeks) together with megestrol acetate (160 mg/day by mouth continuously) starting 2 days before chemotherapy. RESULTS:This regimen was well tolerated and resulted in a mean net weight gain of 1.45 kg. A 47% objective response rate was observed in all patients, including visceral sites of response, with a 39+ week median duration of response and median survival time of 16.7+ months in all evaluable patients. CONCLUSIONS:In this small Phase II study, the authors showed that megestrol acetate may contribute to a high objective response rate and prolonged median survival when used with a chemotherapy regimen of dacarbazine, carmustine, and cisplatin.
Cecal volvulus: the CT whirl sign [Case Report]
Cecal volvulus is a rare, but potentially fatal, cause of intestinal obstruction. As computed tomographic (CT) scanning is often the initial diagnostic test in patients with acute abdominal pain, we reiterate the importance of the "whirl sign" in diagnosing intestinal volvulus. We report the first description of the CT diagnosis of cecal volvulus.