levoleucovorin and Skin-Neoplasms

Topics: Antineoplastic Combined Chemotherapy Protocols; Bone Neoplasms; Camptothecin; Cisplatin; Combined Modality Therapy; Deoxycytidine; Doxorubicin; Etoposide; Femoral Neoplasms; Gemcitabine; Head and Neck Neoplasms; Humans; Ifosfamide; Irinotecan; Leucovorin; Liver Neoplasms; Lung Neoplasms; Male; Methotrexate; Middle Aged; Neoadjuvant Therapy; Osteosarcoma; Palliative Care; Salvage Therapy; Scalp; Skin Neoplasms; Thoracotomy

Malignant lymphoma of the skin is a type of extranodal lymphoma with a benign prognosis, in which the main organ involved is the skin. Some 80-90% of the cases in Japan show a T-cell phenotype. Mycosis fungoides and Sézary syndrome are common T-cell lymphomas of the skin. The tumor cells of mycosis fungoides, small and medium-sized cells with cerebriform nuclei, are detected in an epidermo-dermo junction. The tumor cells show CD3, CD4 and CLA, (cutaneous lymphocyte associated antigen) positivity. Various forms of topical therapy, such as topical steroid, photochemotherapy (PUVA), and interferons, have been indicated for the good-risk group (stages I A, I B and II A). Electron-beam irradiation, various chemotherapy, such as low-dose etoposide, low-dose MTX and CPT-11 and deoxy coformycin (DCF) plus IFNs, have been indicated for intermediate-risk group (stage II B, III and IV A). BRMs plus low-dose etoposide, electron-beam irradiation and a multiagent combination chemotherapy, such as MACOP-B, M-BACOD or ProMACE-CytaBOM, have been indicated for the high-risk group (stages IV A and IV B). Cutaneous B cell lymphoma (CBCL) can be diagnosed using a molecular biological assay. The tumor cells of CBCL do not express T-cell antigens such as CD2, CD3 and CD43 and show B-cell antigens such as sIg, CD19, CD20 and CD22. Electron-beam irradiation has been indicated for early-stage CBCL (stages I and II). An effective multiagent combination chemotherapy, such as MACOP-B, M-BACOD or ProMACE-CytaBOM, is required for patients with advanced stage CBCL (stages III and IV).

Topics: Antigens, CD; Antigens, Differentiation, T-Lymphocyte; Antigens, Neoplasm; Antineoplastic Combined Chemotherapy Protocols; Biomarkers, Tumor; Bleomycin; Combined Modality Therapy; Cyclophosphamide; Doxorubicin; Electrons; Etoposide; Humans; Interferon-gamma; Leucovorin; Membrane Glycoproteins; Methotrexate; Mycosis Fungoides; Prednisone; PUVA Therapy; Skin Neoplasms; Vincristine

Radiation therapy has a broad range of applications in the management of patients with non-Hodgkin's lymphoma. It has curative potential for patients with Stage I to II low-grade lymphoma (small lymphocytic, follicular small cleaved, and follicular mixed) and has substantial palliative efficacy in patients with more advanced stage low-grade lymphoma. Low-dose whole-body irradiation may be used as palliative therapy even in patients with bone marrow involvement by these lymphomas. In the management of the large cell lymphomas (diffuse large cell, diffuse mixed, and immunoblastic), radiation alone has curative potential in only the most favorable early-stage presentations. However, since radiation can achieve significant responses in these tumors, it should be considered for inclusion in combined-modality programs. Reports that have appeared in the literature as well as results of treatment at Stanford that bear upon these issues are reviewed.

Topics: Antineoplastic Combined Chemotherapy Protocols; Bleomycin; Clinical Trials as Topic; Combined Modality Therapy; Cyclophosphamide; Dexamethasone; Doxorubicin; Follow-Up Studies; Humans; Leucovorin; Lymphoma, Follicular; Lymphoma, Non-Hodgkin; Meningeal Neoplasms; Methotrexate; Mycosis Fungoides; Palliative Care; Prednisone; Radiotherapy Dosage; Skin Neoplasms; Time Factors; Vincristine; Whole-Body Irradiation

This study was conducted to evaluate the efficacy and safety of combination chemotherapy with biweekly paclitaxel plus infusional 5-fluorouracil (5-FU) and leucovorin as first-line treatment for patients with advanced gastric cancer.. Eligible patients with histologically confirmed advanced or metastatic gastric cancer were enrolled. The chemotherapeutic regimen consisted of paclitaxel (100 mg/m(2) on day 1) as a 3-hour intravenous infusion, followed sequentially by leucovorin (400 mg/m(2) on day 1) as a 2-hour intravenous infusion, bolus 5-FU (400 mg/m(2) on day 1), and then continuous infusion 5-FU (3000 mg/m(2) on day 1) over 46 hours. Cycles were repeated every 2 weeks.. Sixty patients were enrolled (median age, 52.5 years old). Of these, 65% patients had Eastern Cooperative Oncology Group performance status of grade 2. A median of 8 cycles was administered (range, 4-12). Fifty-five patients were evaluable for response. Two patients achieved a complete response and 28 patients achieved a partial response, producing an overall response rate of 50% by intent-to-treat analysis. The median duration of response was 6.4 months (95% CI, 5.14-7.60 months). Median progression-free survival and median overall survival were 7.7 months (95% CI, 6.5-8.9 months) and 14.3 months (95% CI, 9.4-19.1 months), respectively. Hematologic toxicity was mild; grade 3 neutropenia was noted in only 6.7% of patients. Alopecia was the most common nonhematologic toxicity in 51 patients (71.4%). Grade 3 alopecia occurred in 11 patients (18.3%).. Combination chemotherapy of biweekly paclitaxel followed sequentially by infusion leucovorin, bolus 5-FU, and continuous infusion 5-FU over 46 hours is effective and well tolerated in patients with advanced gastric cancer, especially in patients with poor performance status who cannot tolerate aggressive chemotherapy regimens.

Topics: Adult; Aged; Antineoplastic Combined Chemotherapy Protocols; Carcinoma, Signet Ring Cell; Female; Fluorouracil; Follow-Up Studies; Humans; Leucovorin; Liver Neoplasms; Lymphatic Metastasis; Male; Middle Aged; Neoplasm Recurrence, Local; Paclitaxel; Peritoneal Neoplasms; Skin Neoplasms; Stomach Neoplasms; Survival Rate; Time Factors; Treatment Outcome

Thirty-two patients with nasal NK/T-cell lymphoma and disseminated disease (lung, skin, and bone marrow) were treated with an intensive combined therapy that consisted of three cycles of CMED (cyclophosphamide 2 g/m(2), metothrexate 200 mg/m(2), etoposide 600 mg/m(2), and dexamethasone 80 mg/m(2) with leucovorin rescue administered 24 h after) every 14 d, following high-dose radiotherapy: 55 Gy in 20 sesions to centrofacial region and three cycles more of the same chemotherapy regimen. To ameliorate the presence of severe granulocytopenia, granulocyte colony-stimulating factor, 5 microg/kg, daily for 14 d, begun on d 2 after chemotherapy, was administered. Complete response was achieved in 21 cases (65%); failure or progression was observed in 11 cases (35%). With a median follow-up of 69.1 mo, relapse has not been observed; thus, actuarial curves at 5 yr showed that event-free survival (EFS) is 100% in 21 patients and overall survival (OS) is 65%. Granulocytopenia grade IV was observed in 15% cycles, Nonhematological toxicity was mild and well tolerated. Radiotherapy was well tolerated; only mild mucositis was observed. Nasal NK/T-cell lymphoma is an rare presentation of malignant lymphoma (<1% of all cases) with a worse prognosis; less than 5% patients are alive free of disease at 1 yr. The use of intensive more specific chemotherapy and high dose of local radiotherapy, appear to be an excellent therapeutic approach with improvement in EFS and OS.

Topics: Adult; Aged; Agranulocytosis; Antineoplastic Combined Chemotherapy Protocols; Bone Marrow Neoplasms; Cyclophosphamide; Dexamethasone; Disease-Free Survival; Etoposide; Female; Follow-Up Studies; Granulocyte Colony-Stimulating Factor; Humans; Killer Cells, Natural; Leucovorin; Lung Neoplasms; Lymphoma, T-Cell; Male; Methotrexate; Middle Aged; Nose Neoplasms; Radiotherapy, Adjuvant; Remission Induction; Skin Neoplasms; Treatment Outcome

The objectives of this study were to evaluate the outcome after polychemotherapy for patients with primary cutaneous large-cell lymphomas (PCLL) and to validate the recently proposed immunohistologic classification of cutaneous lymphomas. Among 140 patients with positive skin biopsies included in the LNH87 protocol (for treatment of aggressive lymphomas), 49 patients met the criteria of PCLL. Characteristics were: sex ratio M/F, 2.3; age 18 to 83 years (median, 52), peripheral lymph nodes, n=22; diffuse disease, n=12; median tumor size, 4.5 cm; elevated lactate dehydrogenase, n=9; ECOG: 0/1, n=49. Histology was: follicular center B cell, n=23; B-lymphoblastic, n=1; anaplastic large-cell lymphoma, n=14 (T cell phenotype n=8); CD30- T cell lymphoma, n=11. All patients received polychemotherapy: under 70 years, ACVBP (three to four cycles and consolidation for 6 months) n=25; mBACOD (eight cycles) n=16; over 70 years, C(T)VP (six cycles) n=8. Radiation therapy was not included in the protocol. With a median follow-up of 5 years, 24/49 patients had relapsed, with 20 skin relapses. Event-free (EFS) and overall survival (OS) at 5 years were, respectively, 50 and 77%. Significant adverse prognostic factors were: histology (CD30- T cell lymphoma) and diffuse cutaneous disease (>10% of skin). The presence of nodal involvement was only significant for EFS. When compared to 140 non-cutaneous lymphoma patients included in the same trial and fully matched for the main clinical characteristics, OS was similar. In conclusion, PCLL behaves like other localized B or T cell extranodal lymphomas with the same prognostic factors (LDH, ECOG, age) except for CD30+ PCLL which have a very good prognosis.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Antineoplastic Combined Chemotherapy Protocols; Bleomycin; Case-Control Studies; Cyclophosphamide; Dexamethasone; Doxorubicin; Female; Humans; L-Lactate Dehydrogenase; Leucovorin; Lymphoma, Large B-Cell, Diffuse; Lymphoma, Non-Hodgkin; Male; Methotrexate; Middle Aged; Prednisone; Prognosis; Prospective Studies; Skin Neoplasms; Treatment Outcome; Vincristine; Vindesine

The treatment of advanced mycosis fungoides is a therapeutic challenge. A variety of treatment approaches have been used. In our experience, chemotherapy has been most useful. The purpose of this study was to evaluate the effectiveness of the synergy previously demonstrated between methotrexate and fluorouracil in the treatment of advanced mycosis fungoides. Ten patients with mycosis fungoides and Sézary syndrome stages IIa (n = 1), II-b (n = 4), III (n = 1), IVa (n = 2), and IVb (n = 2) were treated with sequential methotrexate followed by fluorouracil and leucovorin rescue. Each patient received several courses of chemotherapy at varying intervals, as required for control of their disease.. The duration of treatment ranged from 3 to 78 months, with an average duration of 33 months. The number of cycles of chemotherapy administered to each patient ranged from five to 45, with an average of 18 infusions per patient. The average survival in patients with tumors was 5.25 years, with a median survival of 6 years. Eight of 10 patients achieved at least 80% clearing and the remaining two achieved at least 60% clearing. Adverse reactions were minimal and included nausea and vomiting, mucositis, and leukopenia in only one patient.. Sequential methotrexate and fluorouracil chemotherapy is an effective and safe treatment for advanced mycosis fungoides and Sézary syndrome. This regimen is extremely well tolerated, with minimal toxic side effects.

Topics: Adult; Aged; Aged, 80 and over; Algorithms; Antineoplastic Combined Chemotherapy Protocols; Fluorouracil; Humans; Infusions, Intravenous; Leucovorin; Methotrexate; Middle Aged; Mycosis Fungoides; Neoplasm Staging; Neoplasms, Multiple Primary; Sezary Syndrome; Skin Neoplasms; Survival Rate

In this study, 30 patients with metastatic breast cancer were treated with 5-Fluorouracil (5-FU) and high-dose Folinic acid, using a new sequential dosing schedule. Our treatment consisted of one day i.v. infusion of 500 mg/m2 of Folinic acid over two hours. One hour after the beginning of Folinic acid infusion, 5-FU (500 mg/m2) was given by i.v. bolus injection. The complete and partial response rates achieved (CR+PR) were 21% in a population of patients pretreated with chemotherapy including 5-FU. Cutaneous and bone metastasis responded best to our treatment. There were no treatment related deaths or withdrawals from the study. The drug related toxicities observed in this study were usually mild to moderate and easily controllable. Thus preliminary results of our study suggest that response rate, quality of life and time to disease progression for the responders improved by this sequential treatment.

Topics: Adult; Aged; Antineoplastic Combined Chemotherapy Protocols; Bone Neoplasms; Breast Neoplasms; Doxorubicin; Drug Administration Schedule; Female; Fluorouracil; Follow-Up Studies; Humans; Leucovorin; Middle Aged; Remission Induction; Skin Neoplasms

Radiation therapy has a broad range of applications in the management of patients with non-Hodgkin's lymphoma. It has curative potential for patients with Stage I to II low-grade lymphoma (small lymphocytic, follicular small cleaved, and follicular mixed) and has substantial palliative efficacy in patients with more advanced stage low-grade lymphoma. Low-dose whole-body irradiation may be used as palliative therapy even in patients with bone marrow involvement by these lymphomas. In the management of the large cell lymphomas (diffuse large cell, diffuse mixed, and immunoblastic), radiation alone has curative potential in only the most favorable early-stage presentations. However, since radiation can achieve significant responses in these tumors, it should be considered for inclusion in combined-modality programs. Reports that have appeared in the literature as well as results of treatment at Stanford that bear upon these issues are reviewed.

Topics: Antineoplastic Combined Chemotherapy Protocols; Bleomycin; Clinical Trials as Topic; Combined Modality Therapy; Cyclophosphamide; Dexamethasone; Doxorubicin; Follow-Up Studies; Humans; Leucovorin; Lymphoma, Follicular; Lymphoma, Non-Hodgkin; Meningeal Neoplasms; Methotrexate; Mycosis Fungoides; Palliative Care; Prednisone; Radiotherapy Dosage; Skin Neoplasms; Time Factors; Vincristine; Whole-Body Irradiation

Twenty-eight patients with advanced malignant melanoma were treated with high dose methotrexate (HDMTX) and folinic acid (FA) rescue. Nineteen patients were treated with 6-hour infusions and 10 patients with 24-hour infusions. One patient in the 6-hour infusion group showed a partial response. In the 24-hour infusion group there were no responses but there was a significant increase in renal toxicity. It is concluded that HDMTX and FA rescue are not useful agents in the treatment of advanced malignant melanoma.

Topics: Adult; Clinical Trials as Topic; Female; Humans; Infusions, Parenteral; Leucovorin; Male; Melanoma; Methotrexate; Middle Aged; Skin Neoplasms

Cutaneous metastases from colorectal cancer are extremely rare and generally appear several years after diagnosis or resection of the primary colorectal tumor. Although cutaneous metastasis is unusual, it often indicates a poor prognosis.. We treated a 62-year-old woman with multiple cutaneous metastatic nodules on the chest, back, and armpit 7 months after resection of ascending colon cancer.. The patient was diagnosed with cutaneous metastasis of ascending colon cancer with BRAF V600E mutation.. After 6 cycles of fluorouracil, leucovorin, oxaliplatin, cetuximab, and emurafenib, most of the metastatic lesions had begun to shrink, and no new metastases were observed. Serum tests showed that the levels of several tumor markers were decreased.. The patient responded well to treatment and survived for 6.5 months after presentation with skin metastasis.. Cutaneous metastasis of colorectal cancer with BRAF V600E mutation is a rare but important phenomenon that should not be ignored. Cutaneous metastasis of colorectal cancer frequently indicates advanced disease and poor prognosis. The SWOG 1406 program is one of the treatment options, but this needs further exploration.

Topics: Adenocarcinoma; Antineoplastic Combined Chemotherapy Protocols; Camptothecin; Colorectal Neoplasms; Fatal Outcome; Female; Fluorouracil; Humans; Leucovorin; Middle Aged; Proto-Oncogene Proteins B-raf; Skin Neoplasms

The synchronous diagnosis of two or more primary malignancies in a patient is overall rare. This is a case report of a 70-year-old female with a history of skin squamous cell carcinoma presenting with occult hematochezia. Colonoscopy and biopsy results confirmed a microsatellite stable (MMS) adenocarcinoma in the ascending colon, and subsequent computed tomography (CT) scans identified a 3.2 cm right colonic mass and a 5.0 cm mass in the pancreatic body. Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) confirmed the presence of pancreatic ductal adenocarcinoma (PDAC). The patient underwent neo-adjuvant FOLFIRINOX (folinic acid, fluorouracil, irinotecan and oxaliplatin) chemotherapy prior to the simultaneous distal pancreatectomy and right hemicolectomy for both pancreatic and colonic tumors. The pathology diagnoses included moderately differentiated pancreatic ductal carcinoma (PDAC) with histiocyte-like features (tumor stage: ypT3N1M0) and moderately differentiated colonic adenocarcinoma, intestinal type (tumor stage: ypT3N0M0). To the best of our knowledge, this is the first documented case of synchronous primary colonic adenocarcinoma and PDAC in the English literature.

Topics: Adenocarcinoma; Aged; Antineoplastic Agents; Antineoplastic Combined Chemotherapy Protocols; Carcinoma, Pancreatic Ductal; Carcinoma, Squamous Cell; Colonic Neoplasms; Female; Fluorouracil; Humans; Irinotecan; Leucovorin; Neoplasms, Multiple Primary; Oxaliplatin; Pancreatic Neoplasms; Skin Neoplasms

A 64-year-old woman presented to our hospital with subcutaneous tumors in the right thoracic region. After undergoing a thorough medical evaluation, she was diagnosed with multiple skin metastases arising from cancer of the descending colon. Surgical resection of the primary lesion was performed and FOLFIRI (5-fluorouracil, levofolinate calcium, irinotecan) and cetuximab chemotherapy for the metastases was initiated. The patient subsequently entered remission and did not experience any major side effects. This case report details an effective therapy for colon cancer with multiple skin metastases and presents a discussion of the expression profiles of epidermal growth factor receptor in both the primary and metastatic lesions.

Topics: Adenocarcinoma; Antibodies, Monoclonal, Humanized; Antineoplastic Agents; Antineoplastic Combined Chemotherapy Protocols; Camptothecin; Cetuximab; Colonic Neoplasms; Fatal Outcome; Female; Fluorouracil; Humans; Leucovorin; Middle Aged; Skin Neoplasms

Oxaliplatin is an anticancer agent only approved for treatment of colorectal cancer, but that has shown some activity in metastatic breast cancer in phase II studies. Herein, we examine the off-label use of oxaliplatin in unselected patients with metastatic breast cancer.. A retrospective review was performed of all patients with metastatic breast cancer treated with oxaliplatin at our hospital between February 2003 and November 2009. Data concerning patterns of use, safety and activity were collected from patient charts.. The cohort comprised 30 female patients with a median age of 49 (range, 34-68 years) and a median of two involved organs (range, 1-4). All patients had been pretreated for metastatic breast cancer (median number of previous lines: 3; range:1-6). Oxaliplatin was only given in association either with fluorouracil and folinic acid (n=23) or with gemcitabine (n=7). The most commonly used dose was 100 mg/m(2) given every other week or every 3 weeks. As of December 15, 2009, the median duration of treatment was 4 (range, 0.75-11) months. Most of the discontinuations occured due to disease progression (n=11) and adverse effects or worsening condition (n=8). Twelve (40%) patients presented side-effects related to oxaliplatin use including hematotoxicity (n=8), gastrointestinal disorders (n=4) and neuropathies (n=2). Among patients evaluable for antitumoral activity (n=15), one patient achieved a complete response and one patient demonstrated a partial response. Most of the patients (57%) continued to be treated by chemotherapy after oxaliplatin. Median overall survival for the evaluable patients was 10 (range, 1-51) months.. In our population of heavily pretreated women with metastatic breast cancer, off-label use of oxaliplatin was of little worth. This off-label treatment was not the last therapeutic option for most of these patients.

Topics: Adult; Aged; Antineoplastic Combined Chemotherapy Protocols; Bone Neoplasms; Brain Neoplasms; Breast Neoplasms; Carcinoma, Ductal, Breast; Carcinoma, Lobular; Cohort Studies; Deoxycytidine; Female; Fluorouracil; Gemcitabine; Humans; Leucovorin; Lung Neoplasms; Lymphatic Metastasis; Middle Aged; Neoplasm Staging; Off-Label Use; Organoplatinum Compounds; Oxaliplatin; Retrospective Studies; Skin Neoplasms; Survival Rate; Treatment Outcome

Carcinoma of the large intestine is a common and relatively well known neoplastic malignancy of the digestive tract. In a very few cases its spread seems unpredictable and can cause a distant metastasis to head and neck region.. A 58 years old patient was admitted to the ENT Department because of an exulcerated tumour mass of the left mental and buccal region. 9 months earlier he underwent anterior resection of rectum due to carcinoma. Histopatological examination of specimen from the facial skin lesion revealed adenocarcinoma cells. Radiological findings suggested isolated character of lesion. The patient was treated by surgery and chemotherapy. Wide excision of tumour mass with partial mandibulectomy was performed and the tissue defect reconstructed with a pectoralis major musculocutaneous flap. A postoperative chemiotherapy with FA and 5-FU followed the surgical procedure. Regardless of the first promising results of the oncological treatment the patient died eight months later.. We present this case report as an example of an unusual and rare secondary malignancy of head and neck, emphasizing the interdisciplinary character of oncological treatment and the role of oncological vigilance on every step of diagnosis.

Topics: Adenocarcinoma; Antineoplastic Combined Chemotherapy Protocols; Chemotherapy, Adjuvant; Facial Neoplasms; Fatal Outcome; Fluorouracil; Humans; Leucovorin; Male; Middle Aged; Radiotherapy, Adjuvant; Rectal Neoplasms; Skin Neoplasms

There are different types of skin changes associated with internal malignancy. One type is the skin involvement as a result of cutaneous metastasis from an internal tumor. The skin is an uncommon site for distant metastasis; when it is present the most common sources are breast, lung, and colon. Metastasis generally occurs after an internal malignancy had been discovered and signifies disseminated disease with a poor prognosis. We report an exuberant and rare case of cutaneous metastasis from gastric adenocarcinoma as the first sign of this serious visceral cancer.

Topics: Antineoplastic Combined Chemotherapy Protocols; Cachexia; Carcinoma, Signet Ring Cell; Etoposide; Fluorouracil; Humans; Leucovorin; Lung Neoplasms; Male; Middle Aged; Skin Neoplasms; Spinal Neoplasms; Stomach Neoplasms; Treatment Failure

A metastatic malignancy of the umbilicus is commonly termed Sister Mary Joseph nodule (SMJN). It is a rare occurrence but may represent the first sign of a visceral malignancy and therefore should prompt a thorough search for the primary tumor. Typically, the most common origin of an umbilical metastasis is an adenocarcinoma from a gastrointestinal or gynecologic primary malignancy. The presence of SMJN carries a poor prognosis with the average survival time at the appearance of an umbilical metastasis being 10 months. We report a case of a 66-year-old man who was referred for evaluation of an enlarging umbilical lesion. Histopathology revealed adenocarcinoma. After a full metastatic workup, the tumor of origin was identified as adenocarcinoma of the sigmoid colon. Benign tumors of the umbilicus are uncommon. This case report serves to emphasize the importance of obtaining a histologic diagnosis when any new lesion presents in the umbilical region.

Topics: Adenocarcinoma; Aged; Antineoplastic Combined Chemotherapy Protocols; Colonic Neoplasms; Combined Modality Therapy; Diagnosis, Differential; Fluorouracil; Humans; Leucovorin; Male; Organoplatinum Compounds; Skin Neoplasms; Umbilicus

Gastric adenocarcinoma is a high-lethality tumour and has a great tendency to recur. Liver and peritoneum are the places where the metastases are most frequently localised. We introduce the case of a woman diagnosed with gastric adenocarcinoma who showed isolated skin metastasis. There were an important number of recurrences (always in the skin). She was treated with radical surgery and later treated with different cytostatic schedules. The patient died 13 years after metastasis were diagnosed. With this case we wanted to pay attention to the role of the biologic prognostic factors of gastric carcinoma. The molecular biology of these tumours can explain the different evolution of the disease. Biologic prognostic factors can separate gastric carcinoma into different kinds of disease.

Topics: Antineoplastic Combined Chemotherapy Protocols; Carcinoma, Signet Ring Cell; Cisplatin; Cobalt Radioisotopes; Combined Modality Therapy; Etoposide; Fatal Outcome; Female; Fluorouracil; Gastroenterostomy; Humans; Leucovorin; Middle Aged; Radioisotope Teletherapy; Shoulder; Skin Neoplasms; Stomach Neoplasms; Stomach Ulcer; Survivors

For preservation of integrity of appearance and function in a 57-year-old male with a squamous cell carcinoma of his left big toe who had refused amputation, intra-arterial infusion with methotrexate was used.. To evaluate the effectiveness of arterial infusion with methotrexate in this uncommon big toe cancer.. Left external iliac arterial catheterization and infusion with methotrexate (50 mg) were used every 24 hours plus simultaneous intramuscular injection of 6 mg of leucovorin every 6 hours for 8 days.. At 7 years and 3 months after therapy, the patient was in sustained complete remission with a functionally normal left foot.. This case study suggests that intra-arterial infusion chemotherapy is a simple and effective method for big toe squamous cell carcinoma with the unique advantage of preservation of organ and function. It can be considered as an effective alternative treatment.

Topics: Antimetabolites, Antineoplastic; Carcinoma, Squamous Cell; Hallux; Humans; Infusions, Intra-Arterial; Injections, Intramuscular; Leucovorin; Male; Methotrexate; Middle Aged; Skin Neoplasms

Topics: Antibodies, Monoclonal; Antibodies, Monoclonal, Murine-Derived; Antigens, CD20; Antigens, Neoplasm; Antineoplastic Combined Chemotherapy Protocols; Bleomycin; Cyclophosphamide; Doxorubicin; Drug Resistance, Neoplasm; Etoposide; Humans; Leucovorin; Lymphoma, Large B-Cell, Diffuse; Male; Methotrexate; Middle Aged; Mitoxantrone; Orchiectomy; Prednisone; Recurrence; Remission Induction; Rituximab; Skin Neoplasms; Testis; Vincristine

Topics: Antineoplastic Combined Chemotherapy Protocols; Bleomycin; Cell Transformation, Neoplastic; Cyclophosphamide; Diabetes Mellitus; Doxorubicin; Humans; Hypertriglyceridemia; Insulin Resistance; Leucovorin; Lipodystrophy; Magnetic Resonance Imaging; Male; Methotrexate; Middle Aged; Mycosis Fungoides; Parotid Diseases; Parotid Gland; Prednisone; Skin Neoplasms; Vincristine

A left radical mastectomy was performed on a 53-year-old woman, diagnosed with left inflammatory breast cancer, after local arterial chemotherapy with cyclophosphamide (CPA), doxorubicin and 5-fluorouracil (5-FU). Adjuvant therapy was added with irradiation and ECF. Four months after the operation, a red eruption was detected on the left upper chest wall. The lesion was diagnosed by skin biopsy as a recurrent breast cancer with carcinoma erysipeloides. Tumor marker levels suggested the recurrent cancer was ECF resistant, so we changed the chemotherapy regime to a single dose of TXT. Although tumor marker levels and the skin eruptions improved at the beginning of the therapy, pleuritis carcinomatosa was found. We changed the regime again to a continuous dose of 5'-DFUR and LV for day 1 to 7. With this regime the clinical symptoms improved, and 2 courses of this modified FL therapy were carried out. After the therapy, the tumor seemed resistant to this modified FL therapy. Therefore, we tried a sequential therapy with TXT and the modified FL, which induced an improvement in clinical symptoms. Two years later, the patient died from the breast cancer. Therefore, we conclude that the sequential therapy may be beneficial in managing untreatable carcinoma erysipeloides of recurrent breast cancer.

Topics: Antineoplastic Agents, Phytogenic; Antineoplastic Combined Chemotherapy Protocols; Breast Neoplasms; Carcinoma; Cyclophosphamide; Docetaxel; Doxorubicin; Drug Administration Schedule; Female; Floxuridine; Fluorouracil; Humans; Injections, Intra-Arterial; Leucovorin; Mastectomy; Middle Aged; Neoplasm Recurrence, Local; Paclitaxel; Skin Neoplasms; Taxoids

We report here a 20-year-old man presenting with primary nasal NK/T-cell lymphoma which showed an aggressive clinical course spreading to the spleen and skin despite various treatments. Eight months after high dose chemotherapy followed by autologous peripheral blood stem cell transplantation, acute appendicitis with perforation occurred and the patient underwent appendectomy. The histopathological diagnosis was NK/T-cell lymphoma of the appendix. Lymphoma of the appendix is extremely rare and the majority of appendiceal lymphomas are of B-cell origin. This is the first report of involvement of appendix by nasal NK/T-cell lymphoma.

Topics: Adult; Antineoplastic Combined Chemotherapy Protocols; Appendectomy; Appendiceal Neoplasms; Appendicitis; Bleomycin; Cisplatin; Combined Modality Therapy; Cyclophosphamide; Cytarabine; Doxorubicin; Epstein-Barr Virus Infections; Etoposide; Humans; Intestinal Perforation; Killer Cells, Natural; Leucovorin; Lymphoma, T-Cell; Male; Methotrexate; Methylprednisolone; Nitrosourea Compounds; Nose Neoplasms; Prednisone; Skin Neoplasms; Splenic Neoplasms; Tumor Virus Infections; Vincristine

We describe a 61-year-old man with a multiple neurologic complication of Merkel cell carcinoma, a rare skin cancer. An enhancing brain mass, and cytologically proven leptomeningeal disease produced a succession of symptoms including seizures, bilateral radiculopathies, myoclonus, a cauda equina syndrome and altered mental status. Aggressive treatment prolonged his survival marginally.

Topics: Antineoplastic Combined Chemotherapy Protocols; Brain Neoplasms; Carcinoma, Merkel Cell; Cytarabine; Fatal Outcome; Humans; Leucovorin; Magnetic Resonance Imaging; Male; Meningeal Neoplasms; Methotrexate; Middle Aged; Nervous System Diseases; Skin Neoplasms

Topics: Antineoplastic Combined Chemotherapy Protocols; Bleomycin; Cyclophosphamide; Dexamethasone; Doxorubicin; Female; Humans; Leucovorin; Lymphoma, Non-Hodgkin; Methotrexate; Middle Aged; Oculomotor Nerve Diseases; Prednisone; Skin Neoplasms; Vincristine

A case of cutaneous B-cell lymphoma successfully treated by MACOP-B therapy is described. The patient was a 43-year-old man with reddish tumors measuring 3 to 7 cm in diameter on the right cheek and the post-auricles. Histopathologically, massive infiltrations of medium-sized atypical lymphoid cells were found in the reticular dermis and subcutis. A clear zone beneath the epidermis was also detected. The atypical lymphoid cells were positive for CD19, CD20, CD22 and HLA-DR but negative for CD3, CD4, CD5, CD10, CD43, CD45RO and CDw75. The patient was treated successfully with the MACOP-B protocol from March of 1990 to May of 1990. Since April of 1990, he has been free of disease.

Topics: Adult; Antineoplastic Combined Chemotherapy Protocols; B-Lymphocyte Subsets; Bleomycin; Cyclophosphamide; Doxorubicin; Humans; Immunoenzyme Techniques; Leucovorin; Lymphocytes, Tumor-Infiltrating; Lymphoma, B-Cell; Male; Methotrexate; Prednisone; Remission Induction; Skin Neoplasms; Vincristine

Malignant lymphoma of the skin is a type of extranodal lymphoma, in which the main organ involved is the skin, and 80-90% of cases in Japan show a T-cell phenotype. Mycosis fungoides (MF) and Sézary syndrome (SS) are common T-cell lymphomas of the skin with a benign prognosis. Therefore, various forms of topical therapy, such as topical steroid, photochemotherapy (PUVA) and interferons, have been indicated for the low-risk group (stages I A, I B and II A), whereas electron-beam irradiation, retinoid plus interferon (IFN), photopheresis and deoxycoformycin (DCF) plus IFN have been indicated for intermediate-risk group (stages II B and III). The cutaneous involvement of B-cell lymphoma has been considered an unmistakable sign of progression and dissemination of lymphoid disease, and is thus associated with a poor prognosis. However, some primary cutaneous B-cell lymphomas (CBCLs) show a benign prognosis, and electron-beam irradiation has been indicated for early-stage CBCL (stages I and II). However, the prognosis of high-risk group CTCL (stage IV) and cutaneous B-cell lymphoma (CBCL) (stages III and IV) is poor. Therefore, an effective multiagent combination chemotherapy, such as MACOP-B, M-BACOD or ProMACE-Cyta BOM is required for patients with advanced-stage CTCL and CBCL. With regard to age at the time of the first medical examination, patients with CTCL or CBCL at an advanced stage have a tendency to be older. Therefore, a mild but effective therapy, such as DCF plus IFN is recommendable.

Topics: Antineoplastic Combined Chemotherapy Protocols; Bleomycin; Chemotherapy, Adjuvant; Combined Modality Therapy; Cyclophosphamide; Doxorubicin; Humans; Leucovorin; Lymphoma, B-Cell; Lymphoma, T-Cell; Methotrexate; Prednisolone; Prednisone; PUVA Therapy; Skin Neoplasms; Vincristine

A 60-year-old female presented with a one-year history of multiple enlarging tender subcutaneous nodules. Initial biopsy demonstrated a poorly differentiated adenocarcinoma. Mammography showed multiple nodular breast lesions. After the patient failed to respond to tamoxifen, a second biopsy demonstrated a metastatic carcinoid tumor. Further search revealed a single small pulmonary nodule, which on aspiration biopsy proved to be a carcinoid tumor. The patient failed to respond to treatment with streptozotocin and 5'-fluorouracil. Therapy with leucovorin calcium and 5'-fluorouracil then produced a partial response.

Topics: Antineoplastic Combined Chemotherapy Protocols; Carcinoid Tumor; Female; Fluorouracil; Humans; Leucovorin; Lung Neoplasms; Middle Aged; Skin Neoplasms

Lymphomatoid granulomatosis is an uncommon disorder with features of vasculitis and lymphoma. Treatment has usually consisted of steroids and, occasionally, single cytotoxic drugs, but prognosis remains poor. The authors report a patient with life-threatening disease treated successfully with combination chemotherapy consisting of methotrexate, doxorubicin, cyclophosphamide, vincristine, prednisone, and bleomycin (MACOP-B) who achieved complete remission and remains disease-free over 3 years from diagnosis. Justification for an aggressive therapeutic approach to this disease is presented.

Topics: Antineoplastic Combined Chemotherapy Protocols; Bleomycin; Cyclophosphamide; Doxorubicin; Female; Humans; Leucovorin; Lung Neoplasms; Lymphomatoid Granulomatosis; Methotrexate; Middle Aged; Neoplasms, Multiple Primary; Prednisone; Remission Induction; Skin Neoplasms; Vincristine

Seven patients with advanced cutaneous T-cell lymphomas were treated with a combination chemotherapy regimen of vincristine, doxorubicin (Adriamycin), bleomycin, methotrexate, leucovorin factor, 5-FU, and hydrocortisone. All patients had an objective response but only one had a complete clinical remission. Our results are compared to other regimens reported in the literature.

Topics: Adult; Aged; Antineoplastic Agents; Bleomycin; Doxorubicin; Drug Therapy, Combination; Female; Fluorouracil; Humans; Hydrocortisone; Leucovorin; Lymph Nodes; Lymphoma; Male; Methotrexate; Middle Aged; Skin Neoplasms; T-Lymphocytes; Vincristine

High-dose methotrexate was given to 28 patients with advanced malignant melanoma who had previously failed to respond to two chemotherapy protocols. There were five instances of serious, but not fatal, toxicity. One patient has had an objective response and seven patients have had stabilization of disease with an average duration of 4 months.

Topics: Adult; Aged; Female; Humans; Intestinal Neoplasms; Leucovorin; Leukopenia; Male; Melanoma; Methotrexate; Middle Aged; Skin Neoplasms

Biopsy specimens from a 21-year-old man showed mycosis fungoides involving the skin and lungs. Usually such a case represents a fulminant and fatal course of the disease. This patient had a complete remission of his pulmonary disease following sequential therapy with cyclophosphamide, vincristine sulfate, methotrexate, leucovorin calcium, and cytarabine (COMLA).

Topics: Adult; Cyclophosphamide; Cytarabine; Drug Therapy, Combination; Humans; Leucovorin; Lung Neoplasms; Male; Methotrexate; Mycosis Fungoides; Remission, Spontaneous; Skin Neoplasms; Vincristine

Surgical techniques for the selective administration of anti-cancer drugs is presented. These isolated-perfusion or intra-arterial infusion procedures have achieved significant palliation for many patients with advanced cancer. When used in conjunction with surgical excision of certain early skin cancers, such as aggressive forms of malignant melanoma of the extremities, improved cure rates may be achieved.

Topics: Adenocarcinoma; Aged; Antineoplastic Agents; Carcinoma, Squamous Cell; Chemotherapy, Cancer, Regional Perfusion; Drug Therapy, Combination; Extremities; Female; Head and Neck Neoplasms; Humans; Injections, Intra-Arterial; Leucovorin; Male; Melanoma; Methotrexate; Middle Aged; Neoplasm Recurrence, Local; Sarcoma; Sarcoma, Kaposi; Skin Neoplasms