melphalan and Choriocarcinoma

Although cytotoxic immunosuppressive agents play an unquestionably useful role in treating many neoplastic and non-neoplastic disorders, there is accumulating evidence that the toxicity associated with their use is considerable. The therapeutic successes obtained with antitumor agents have led to increases in the life span of cancer patients, but have also provided the opportunity for this toxicity to become manifest. A search of the available literature was carried out, with emphasis on cases in which a malignancy developed in patients following chemotherapy for either neoplastic or non-neoplastic (e.g., renal transplantation, psoriasis) conditions; particular focus was given to the incidence of acute myelogenous leukemia in various groups of Hodgkin's disease and multiple myeloma patients. That patients with nonmalignant conditions treated with cytotoxic immunosuppressive agents are also at increased risk of developing a malignancy raises the possibility that these agents may have oncogenic potential. Therefore, one may be faced with the paradox that the patients benefiting most from chemotherapy may be at highest risk of suffering its consequences.

Topics: Alkylating Agents; Animals; Antineoplastic Agents; Azathioprine; Burkitt Lymphoma; Choriocarcinoma; Cyclophosphamide; Dactinomycin; Female; Hodgkin Disease; Humans; Immunosuppressive Agents; Kidney Neoplasms; Leukemia, Myeloid, Acute; Lymphoma; Mechlorethamine; Melphalan; Mercaptopurine; Methotrexate; Mice; Multiple Myeloma; Neoplasms; Prednisone; Pregnancy; Procarbazine; Time Factors; Vincristine

Topics: Abdominal Neoplasms; Alkylating Agents; Animals; Antimetabolites; Antineoplastic Agents; Carcinoma, Basal Cell; Choriocarcinoma; Cyclophosphamide; Dactinomycin; Dysgerminoma; Female; Fluorouracil; Head; Head and Neck Neoplasms; Hodgkin Disease; Humans; Injections, Intra-Arterial; Leg; Melanoma; Melphalan; Methotrexate; Neoplasm Metastasis; Neoplasm Recurrence, Local; Neoplasms; Nitrogen Mustard Compounds; Pregnancy; Sarcoma; Sarcoma, Ewing; Skin Neoplasms; Vinblastine; Wilms Tumor

Although (11)C-methionine (MET)-PET has been used to diagnose intracranial germ cell tumors (GCTs) arising in the basal ganglia, whether this imaging technique is useful in assessing treatment response and residual tumor is still unclear. The authors report 3 cases of basal ganglia GCTs in which the residual MET uptake at the end of treatment did not develop into a relapse, even without additional treatment. Case 1 is a 22-year-old man who had a second relapse of a left basal ganglia germinoma with diffuse dissemination on the walls of both of his lateral ventricles. MET-PET revealed high MET accumulation around tumors and their surroundings (maximum standardized uptake value [SUVmax] 3.3). After all treatments, MET-PET demonstrated mild tracer accumulation in both basal ganglia (SUVmax 2.2). Progression-free survival was 56 months from the second relapse without any further treatment. Case 2 is a 17-year-old boy with a left basal ganglia germinoma that showed increased MET uptake (SUVmax 4.2). After treatment, MET-PET revealed residual MET uptake (SUVmax 2.4) along the left posterior limb of the internal capsule. Progression-free survival was 52 months from the start of treatment. Case 3 is a 7-year-old boy with a left basal ganglia choriocarcinoma with increased tumor MET uptake (SUVmax 2.5). A minor enhanced mass remained on MRI after treatment with residual MET accumulation (SUVmax 1.4). Progression-free survival was 44 months. Treatment strategies based on MET uptake on PET should be carefully designed in patients with basal ganglia GCTs to avoid overtreatment and complications.

Topics: Adolescent; Antineoplastic Combined Chemotherapy Protocols; Basal Ganglia; Carbon Radioisotopes; Child; Choriocarcinoma; Combined Modality Therapy; Cranial Irradiation; Craniotomy; Cyclophosphamide; Disease-Free Survival; Etoposide; False Positive Reactions; Germinoma; Hematopoietic Stem Cell Transplantation; Humans; Ifosfamide; Lateral Ventricles; Male; Melphalan; Methionine; Neoplasm Recurrence, Local; Neoplasm, Residual; Organoplatinum Compounds; Positron-Emission Tomography; Radiopharmaceuticals; Radiotherapy, Adjuvant; Remission Induction; Supratentorial Neoplasms; Tissue Distribution; Young Adult

A patient with gestational trophoblastic disease failed to respond to all standard multiple-agent chemotherapy and had progressive uterine disease. Total hysterectomy also proved ineffective. We therefore administered high-dose cyclophosphamide, etoposide, and melphalan with autologous bone marrow support. Severe marrow suppression followed but a complete remission was achieved and the patient remains free of disease 3 years after the completion of therapy. This result seems to confirm the value of using high-dose multiagent therapy to optimize the dose-effect of therapy regimens on drug-refractory gestational trophoblastic disease.

Topics: Adult; Antineoplastic Combined Chemotherapy Protocols; Bone Marrow Transplantation; Choriocarcinoma; Combined Modality Therapy; Cyclophosphamide; Dose-Response Relationship, Drug; Etoposide; Female; Humans; Hysterectomy; Melphalan; Pregnancy; Transplantation, Autologous; Trophoblastic Tumor, Placental Site; Uterine Neoplasms

The patient was a 26-year-old male. He was admitted to our hospital with a chief complaint of hemoptysis, cough and left scrotal mass on May 9,1984. Chest X-ray film, LAG and CT revealed multiple lung, lymph node and cerebral metastases. Based on a diagnosis of testicular neoplasm, orchiectomy was performed on May 14,1984. PVB chemotherapy (Cis-diamminedichloro-platinum, Vinblastine and Pepleomycin) was administered. Because he got worse, however, he was treated with another combination chemotherapy, consisting of Methotrexate (MTX, 100 mg/m2 intravenous push (i.v.), 200 mg/m2 12-h infusion, day 1. The dose of MTX was increased with each course. Maximum dose of MTX was 900 mg/m2/day), Vincristine (1.0 mg/m2 i.v. day 1.) Actinomycin D (10 micrograms/kg i.v. days 3.4.5), Cyclophosphamide (600 mg/m2 i.v. day 3.), Adriamycin (30 mg/m2 i.v. day 8.) and Melphalan (6 mg/m2 p.o. day 8.). After 6 courses of this regimen, distant metastases disappeared or were reduced to under one tenth, and complete remission was obtained without severe side effects. The patient was in good health on March 30, 1985.

Topics: Adult; Antineoplastic Combined Chemotherapy Protocols; Brain Neoplasms; Choriocarcinoma; Cyclophosphamide; Dactinomycin; Doxorubicin; Drug Administration Schedule; Humans; Lung Neoplasms; Male; Melphalan; Methotrexate; Testicular Neoplasms; Vincristine

Topics: Adult; Antineoplastic Agents; Choriocarcinoma; Colchicine; Dactinomycin; Daunorubicin; Female; Flavonoids; Humans; Lung Neoplasms; Melphalan; Mercaptopurine; Methotrexate; Middle Aged; Mitomycins; Neoplasm Metastasis; Olivomycins; Pneumonectomy; Pregnancy; Uterine Neoplasms; Vinblastine

Topics: Adult; Antibiotics, Antineoplastic; Chlorambucil; Choriocarcinoma; Cyclophosphamide; Dactinomycin; Dysgerminoma; Humans; Male; Melphalan; Methotrexate; Plicamycin; Prognosis; Teratoma; Testicular Neoplasms

Topics: Antineoplastic Agents; Asparaginase; Burkitt Lymphoma; Choriocarcinoma; Cyclophosphamide; Cytarabine; Dactinomycin; Daunorubicin; Female; Leukemia, Lymphoid; Leukemia, Myeloid, Acute; Melphalan; Mercaptopurine; Methotrexate; Prednisone; Pregnancy; Vincristine; Wilms Tumor

Topics: Antimetabolites; Antineoplastic Agents; Breast Neoplasms; Carcinoma; Chlorambucil; Choriocarcinoma; Cyclophosphamide; Female; Fluorouracil; Hodgkin Disease; Humans; Hydrazines; Intestinal Neoplasms; Melphalan; Methotrexate; Multiple Myeloma; Ovarian Neoplasms; Pregnancy; Thiotepa; Vinblastine

Topics: Antibiotics, Antineoplastic; Antineoplastic Agents; Chlorambucil; Choriocarcinoma; Cyclophosphamide; Dactinomycin; Drug Synergism; Dysgerminoma; Humans; Male; Melphalan; Methotrexate; Olivomycins; Teratoma; Testicular Neoplasms

Topics: Choriocarcinoma; Cyclophosphamide; Dysgerminoma; Female; Humans; Male; Melphalan; Methotrexate; Neoplasms, Germ Cell and Embryonal; Ovarian Neoplasms; Pregnancy; Teratoma; Testicular Neoplasms; Vincristine

Topics: Adolescent; Adult; Choriocarcinoma; Dysgerminoma; Female; Humans; Male; Melphalan; Methotrexate; Middle Aged; Neoplasm Metastasis; Ovarian Neoplasms; Pregnancy; Teratoma; Testicular Neoplasms; Vincristine

Topics: Choriocarcinoma; Dysgerminoma; Female; Humans; Male; Melphalan; Neoplasms; Ovarian Neoplasms; Pregnancy; Teratoma; Testicular Neoplasms