melphalan and Femoral-Neoplasms

The outcome of localized osteosarcoma has remained constant over the past 30 years. Histological response to preoperative chemotherapy is the best predictor of outcome. Strategies to alter treatment based on histological response have not resulted in increased survival.. Patients with localized osteosarcoma received preoperative chemotherapy with cisplatin, doxorubicin, and methotrexate. Patients whose tumors had a good histological response (≥90% necrosis) continued with the same treatment postoperatively. Patients with poor histological response (<90% necrosis) received three courses of melphalan 100 mg/m(2) on day -4, cyclophosphamide 2,000 mg/m(2) on days -3, and -2 followed by stem cell infusion.. Fifty-two patients were enrolled. Median age was 14 years, and 56% of patients were male. The femur was the most common site. Forty patients underwent limb salvage surgery and amputation was performed in six patients. Forty-eight percent of tumors showed good histological response. Forty patients were evaluable for outcome; 18 patients with poor histologic response received high-dose chemotherapy. The 5-year event-free survival (EFS) and overall survival (OS) for patients treated on the high-dose chemotherapy arm were 28% (95% confidence interval [CI], 10-49) and 48% (95% CI, 23-69), respectively. The 5-year EFS and OS for patients treated on the standard chemotherapy arm were 62% (95% CI, 36-80) and 74% (95% CI, 44-90), respectively. All patients who received high-dose chemotherapy developed grade 3 or higher hematological toxicity. There were no treatment-related deaths.. Postoperative alkylator intensification with high-dose cyclophosphamide and melphalan in patients with localized osteosarcoma with poor histological response failed to improve survival.

Topics: Adolescent; Antineoplastic Combined Chemotherapy Protocols; Bone Neoplasms; Chemotherapy, Adjuvant; Cisplatin; Cyclophosphamide; Doxorubicin; Female; Femoral Neoplasms; Humans; Male; Melphalan; Methotrexate; Osteosarcoma; Stem Cell Transplantation; Treatment Outcome

An 8-year-old miniature dachshund presented with a right femoral muscle mass and anorexia. Cytology of the mass revealed a number of small-sized lymphoid cells containing a pleomorphic-shaped dense nucleus and narrow pale cytoplasm. Histopathology indicated that neoplastic lymphoid cells proliferated in skeletal muscles and replaced the muscular architecture. Immunohistochemical and genetic examinations confirmed the diagnosis of primary skeletal muscle lymphoma classified as the pleomorphic small cell type and T-cell low-grade. Although the dog suffered at least three relapses by combination chemotherapy, the dog survived 713 days after the initial presentation.

Topics: Animals; Antineoplastic Combined Chemotherapy Protocols; Asparaginase; Dacarbazine; Dogs; Female; Femoral Neoplasms; Lymphoma; Melphalan; Muscle Neoplasms; Ovariectomy; Prednisolone; Survivors; Tomography, X-Ray Computed

Complications of bone destruction occur in 10-29% of breast cancer patients with skeletal metastases. Palliative treatment consists of systemic chemotherapy, hormonal treatment, radiotherapy, and/or surgery in the case of (impending) fracture. A case is presented where isolated limb perfusion was applied for this indication.. A 43-year-old woman with extensive femoral metastases of breast cancer with impending fracture was treated with isolated limb perfusion (ILP) with melphalan. Radiotherapy had resulted only in pain reduction, and intramedullary fixation was opted against because stable fixation was considered not feasible due to the location of the metastases. ILP with high-dose melphalan (10-20 times the amount that can be administered systemically) under normothermic (37-38 degrees C) conditions, resulted in partial remission and reossification.. One year after ILP, until her death 2 years later, due to progressive metastases at other sites, the patient was able to bear weight again on her left leg.. In selected patients with symptomatic large bone metastases from breast cancer, and no other treatment options, ILP with melphalan may be used for successful palliation.

Topics: Adult; Antineoplastic Agents, Alkylating; Breast Neoplasms; Chemotherapy, Cancer, Regional Perfusion; Combined Modality Therapy; Drug Administration Schedule; Extremities; Female; Femoral Neoplasms; Fractures, Spontaneous; Humans; Melphalan; Palliative Care

A 54-year-old man was admitted to our hospital for precise examination of pancytopenia in October 1988. He had been cut off his left femur and irradiated because of osteosarcoma in 1954. After 30 years, he was diagnosed as Waldenström's macroglobulinemia. Melphalan had been given 2 mg daily for 19 months until August 1988, when it was discontinued due to pancytopenia. Peripheral blood showed Hb 6.6 g/dl, platelet 40 x 10(3)/microliters, and WBC 2000/microliters with 33% blasts. Bone marrow showed normocellularity with 36% blasts. Although blasts were negative for peroxidase staining, surface marker analysis revealed myeloid (CD 13, CD 33) phenotypes. Chromosome analysis showed 45, XY, -7, inv (3). A CT scan of the liver showed a mass, 10 by 10 cm, compatible with hepatocellular carcinoma. He was treated with very low dose Ara-C without noticeable effect. Hepatic tumor gradually enlarged, and he died of hepatic failure. This is a rare case of quadruplicate malignancies. The chromosomal abnormality suggests that AML was secondary leukemia which might be associated with immunosuppression due to macroglobulinemia and/or melphalan therapy.

Topics: Carcinoma, Hepatocellular; Femoral Neoplasms; Humans; Leukemia, Myeloid, Acute; Liver Neoplasms; Male; Melphalan; Middle Aged; Neoplasms, Multiple Primary; Osteosarcoma; Waldenstrom Macroglobulinemia

Topics: Adolescent; Adult; Aged; Bone Neoplasms; Child; Child, Preschool; Cyclophosphamide; Doxorubicin; Drug Therapy, Combination; Female; Femoral Neoplasms; Follow-Up Studies; Frontal Bone; Humans; Humerus; Ilium; Male; Mandibular Neoplasms; Maxillary Neoplasms; Melphalan; Middle Aged; Neoplasm Metastasis; Osteosarcoma; Radiotherapy, High-Energy; Sacrum; Sphenoid Bone; Tibia; Vincristine

Topics: Diagnosis, Differential; Femoral Fractures; Femoral Neoplasms; Granuloma, Giant Cell; Humans; Jaw Neoplasms; Melphalan; Mouth Neoplasms; Multiple Myeloma; Prednisolone

Topics: Arm; Burns; Chemotherapy, Cancer, Regional Perfusion; Dactinomycin; Edema; Femoral Neoplasms; Foot Diseases; Hemangiosarcoma; Hemoglobinuria; Hemolysis; Hot Temperature; Humans; Leg; Melanoma; Melphalan; Neoplasm Metastasis; Sarcoma; Sarcoma, Ewing; Sarcoma, Kaposi; Time Factors