melphalan and Vascular-Diseases

Isolated limb perfusion is the preferred treatment option for locally advanced melanoma and sarcoma confined to a limb. This treatment results in high response rates with a satisfying duration of response in both tumours. A drawback of isolated limb perfusion, however, is the invasive and complex character of the procedure.Isolated limb infusion has been designed as a minimally invasive alternative to isolated limb perfusion. Treatment results of this simple technique, reported by various centres worldwide, show comparable response rates for melanoma and sarcoma. Therefore isolated limb infusion may replace isolated limb perfusion in the future as the preferred treatment option for these locally advanced limb tumours.

Topics: Animals; Chemotherapy, Cancer, Regional Perfusion; Extremities; Humans; Melanoma; Melphalan; Prognosis; Sarcoma; Vascular Diseases

Isolated limb perfusion (ILP) with tumor necrosis factor alpha (TNF-alpha) and melphalan, followed by delayed surgical resection and adjuvant external-beam radiotherapy is a limb salvage treatment strategy for locally advanced soft tissue sarcomas. The long-term vascular side effects of this combined procedure were evaluated.. Thirty-two patients were treated for a locally advanced sarcoma of the upper (n = 5) or lower limb (n = 27). All patients underwent a noninvasive vascular work-up.. Five patients underwent a leg amputation, in two cases due to critical leg ischemia 10 years after ILP. With a median follow-up of 88 (range, 17-159) months, none of the patients with a salvaged lower leg (n = 22) experienced peripheral arterial occlusive disease. Ankle-brachial index (ABI) measurements in the involved leg (median, 1.02; range, .50-1.20) showed a significant decrease compared with the contralateral leg (median, 1.09; range, .91-1.36, P = .001). Pulsatility index (PI) was decreased in the treated leg in 17 of 22 patients at the femoral level (median, 6.30; range, 2.1-23.9 vs. median, 7.35; range, 4.8-21.9; P = .011) and in 19 of 20 patients at popliteal level (median, 8.35; range, 0-21.4 vs. median, 10.95; range, 8.0-32.6; P < .0005). In patients with follow-up of >5 years, there was more often a decrease in ABI (P = .024) and PI at femoral level (P = .011).. ILP followed by resection and external-beam radiotherapy can lead to major late vascular morbidity that requires amputation. Objective measurements show a time-related decrease of ABI and femoral PI in the treated extremity.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Amputation, Surgical; Antineoplastic Combined Chemotherapy Protocols; Chemotherapy, Cancer, Regional Perfusion; Extremities; Female; Humans; Ischemia; Limb Salvage; Male; Melphalan; Middle Aged; Radiotherapy, Adjuvant; Sarcoma; Soft Tissue Neoplasms; Tumor Necrosis Factor-alpha; Vascular Diseases

A 63-year-old patient had experienced bilateral spontaneous periorbital hemorrhage for one year. After hospitalization because of recurring hemoptysis, biopsies of skin and colon revealed systemic ALlambda amyloidosis. In addition, the heart and lungs appeared to be involved. Monoclonal gammopathy was excluded by a normal plasma cell count and a polyclonal expression pattern in a bone marrow sample and by radiographic examination. The patient was treated with a relatively non-aggressive regimen of melphalan and prednisolone monthly with careful hematologic monitoring. This approach led to a significant improvement in relevant parameters. Recent advances in diagnosis, monitoring and therapy have made it easier to manage patients with amyloidosis with their poor prognosis.

Topics: Amyloidosis; Drug Combinations; Eye Hemorrhage; Facial Dermatoses; Humans; Male; Melphalan; Middle Aged; Prednisolone; Treatment Outcome; Vascular Diseases

Topics: Adult; Amyloidosis; Antibody Formation; Antigen-Antibody Complex; Azathioprine; Chloramphenicol; Cysteine; Heart Diseases; Humans; Intestinal Obstruction; Malabsorption Syndromes; Male; Melphalan; Penicillamine; Prednisone; Time Factors; Vascular Diseases

Topics: Aged; Carcinoma, Squamous Cell; Female; Humans; Lung Neoplasms; Melphalan; Middle Aged; Pulmonary Artery; Pulmonary Fibrosis; Pulmonary Veins; Recurrence; Vascular Diseases

Topics: Adolescent; Adult; Aged; Anemia; Cardiomyopathies; Chemotherapy, Cancer, Regional Perfusion; Child; Cyclophosphamide; Electrocardiography; Humans; Leg; Leukopenia; Melphalan; Middle Aged; Neoplasms; Tachycardia; Thiotepa; Vascular Diseases

Topics: Blood Protein Disorders; Blood Protein Electrophoresis; Cyclophosphamide; Drug Therapy; gamma-Globulins; Geriatrics; Hospitals, General; Humans; Leukemia; Leukemia, Lymphoid; Lymphocytes; Melphalan; Multiple Myeloma; Myeloma Proteins; Neoplasms; Vascular Diseases; Waldenstrom Macroglobulinemia