melphalan and Genital-Neoplasms--Female

Isolated pelvic perfusion (IPP) is a method of intra-arterial local-regional treatment using a simplified balloon occlusion technique. It achieved high-dose drug concentration in pelvis with the minimal adverse effects. Recently, this approach was improved with the use of a pressure-suit placed above the level of aortic and caval stop-flow. A better ratio between pelvic and systemic compartments was achieved. This stop-flow technique with low dose TNF-alpha and melphalan has shown promise in palliation of resectability of advanced cancer in patients not amenable to treatment with conventional chemo radiation in a comparable proportion to those obtained with isolated limb perfusions. A randomized study will start soon.

Topics: Animals; Antineoplastic Agents; Cattle; Chemotherapy, Cancer, Regional Perfusion; Clinical Trials, Phase III as Topic; Colorectal Neoplasms; Female; Genital Neoplasms, Female; Humans; Male; Melphalan; Pelvic Neoplasms; Tumor Necrosis Factor-alpha

To report a series of cases of hepatic resection for metastatic gynecologic carcinomas.. We reviewed the records of all patients who underwent hepatic resection for metachronous liver metastases from gynecologic carcinomas at our institution from 1986 to 1996.. Twelve patients were identified with a median age of 60 years (range 30-73 years). The primary sites of carcinoma were as follows: ovary, 7 (58%); cervix, 2 (17%); endometrium, 2 (17%); and fallopian tube, 1 (8%). The median disease-free interval before the diagnosis of liver metastasis was 32 months (range 1-243 months). The types of liver resections were as follows: trisegmentectomy, 4 (33%); lobectomy, 4 (33%); segmentectomy, 3 (25%); and wedge resection, 1 (8%). To remove all visible tumor with adequate margins, additional surgery included the following: resection of a portion of the diaphragm, 5 (42%); wedge resection of the right lung, 3 (25%); resection of a portion of the pericardium, 2 (17%); and adrenalectomy, 1 (8%). One patient (8%) had pulmonary wedge resections of bilateral pulmonary metastases. There was no perioperative mortality. Ten patients (83%) received additional chemotherapy. With a median follow-up of 25 months (range 8-94 months), the median survival time is 27 months. Three patients (25%) have no evidence of tumor recurrence at 8, 17, and 38 months of follow-up. Nine patients (75%) have had tumor recurrence at a median of 12 months from the time of surgery.. Hepatic resection of metachronous metastases from gynecologic carcinomas can be performed safely and may help prolong survival in carefully selected patients.

Topics: Adult; Aged; Antineoplastic Combined Chemotherapy Protocols; Cisplatin; Combined Modality Therapy; Female; Genital Neoplasms, Female; Humans; Liver Neoplasms; Melphalan; Middle Aged

Topics: Carcinoma; Chlorambucil; Cyclophosphamide; Female; Genital Neoplasms, Female; Humans; Hysterectomy; Lymph Node Excision; Melphalan; Ovarian Neoplasms; Progestins; Radiotherapy, High-Energy; Thiotepa; Uterine Cervical Neoplasms; Uterine Neoplasms

Regionally advanced cancer is a common, often unresolved problem. Effective local control with chemotherapy is limited by the toxicity following systemic administration. Chemofiltration (CF) is a form of regional perfusion that enables the administration of cytotoxic drugs into one body area while limiting systemic toxicity. The drug is infused into the artery supplying the involved area. The venous effluent of the same organ is pumped out into a hemofiltration unit at a high flow rate. The drug is then filtered away and the blood returned to systemic circulation.. Forty-one patients underwent 45 CF. Twenty-four patients had CF of the pelvis for advanced rectal carcinoma (10), malignant melanoma (6), and cancers of the uterine cervix (3), ovary (2), vulva (1), endometrium (1), and anus (1). Seventeen patients underwent CF of the liver for metastatic colon (10), breast (4), pancreas (1), ovary (1), and unknown primary (1) cancer. 5-fluorouracil (1 g/m2) and mitomycin-C (30 mg/m2); cisplatinum (200 mg/m2) alone or combined with bleomycin (50 mg/m2) and mitomycin-C (20 mg/m2); or melphalan (1 mg/kg) were the combinations used.. Generally the procedure was well tolerated. Complications included transient leukopenia (18), paralytic ileus (2), hair loss (2), renal failure (1). Two patients died within 40 days following CF. Of 36 evaluable patients, 16 (44%) had partial response, 14 (38%) had stable disease, and 6 (18%) had disease progression. A decrease of at least 30% in carcinoembryonic antigen levels occurred in 12 of 24 patients (50%). Median time to progression was 7 months. Ten of 13 patients (77%) achieved good symptomatic palliation.. The results of CF in our study are not superior to alternative methods of drug delivery to the liver and pelvis. However, considering that previous systemic chemotherapy had failed two-thirds of the patients, some benefit may be attributed to this regional delivery modality. Furthermore, pelvic CF afforded very significant symptomatic relief which was definitely superior to other methods.

Topics: Adult; Aged; Aged, 80 and over; Antineoplastic Combined Chemotherapy Protocols; Bleomycin; Carcinoma, Renal Cell; Chemotherapy, Cancer, Regional Perfusion; Cisplatin; Digestive System Neoplasms; Female; Fluorouracil; Genital Neoplasms, Female; Hemofiltration; Humans; Kidney Neoplasms; Male; Melanoma; Melphalan; Middle Aged; Mitomycin; Prognosis; Survival Rate

The use of intravenous melphalan at higher doses is limited by severe myelosuppression. It was postulated that GM-CSF would permit the use of higher dose melphalan with only moderate myelosuppression easily manageable in an outpatient setting. Therefore, a phase I study of intravenous melphalan utilizing GM-CSF (recombinant granulocyte-macrophage colony-stimulating factor) support was initiated. Intravenous melphalan at doses of 15-45 mg/m2 was administered every 28 days. GM-CSF was utilized at doses of 10-20 micrograms/kg/day subcutaneously Days 2-21 on a 28-day cycle. Twenty-five patients received 53 courses of therapy. The dose-limiting toxicities were severe or life-threatening granulocytopenia and thrombocytopenia. Utilizing 20 micrograms/kg/day GM-CSF, the maximum tolerated dose (MTD) of melphalan is 30 mg/m2 and, with 10 mg/kg/day GM-CSF, the maximum tolerated melphalan dose is only 20 mg/m2. One patient with ovarian cancer achieved a partial response. Because the reported MTD of intravenous melphalan without GM-CSF is 30 mg/m2, GM-CSF has not allowed sufficient escalation of the intravenous melphalan dose for routine outpatient use.

Topics: Adenocarcinoma; Adult; Agranulocytosis; Anemia; Drug Evaluation; Endometrial Neoplasms; Female; Genital Neoplasms, Female; Granulocyte-Macrophage Colony-Stimulating Factor; Humans; Leiomyosarcoma; Melphalan; Ovarian Neoplasms; Recombinant Proteins; Thrombocytopenia

Topics: Antineoplastic Agents; Cyclophosphamide; Dactinomycin; Daunorubicin; Female; Genital Neoplasms, Female; Humans; Melphalan; Methotrexate; Mouth Mucosa