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1. Marone U, Caracò C, Chiofalo MG, Botti G, Mozzillo N: Resection in the popliteal fossa for metastatic melanoma. World J Surg Oncol; 2007;5:8
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  • [Title] Resection in the popliteal fossa for metastatic melanoma.
  • BACKGROUND: Traditionally metastatic melanoma of the distal leg and the foot metastasize to the lymph nodes of the groin.
  • CASE PRESENTATION: We report a case of a 36-year old man presented with diagnosis of 2 mm thick, Clark's level II-III, non ulcerated melanoma of the left heel, which developed during the course of the disease popliteal node metastases, after a superficial and deep groin dissection for inguinal node involvement.
  • Five months after popliteal lymph node dissection he developed systemic disease, therefore he received nine cycles of dacarbazine plus fotemustine.
  • To date (56 months after prior surgery and 11 months after chemotherapy) he is alive with no evidence of disease.
  • CONCLUSION: In case of groin metastases from melanoma of distal lower extremities, clinical and ultrasound examination of ipsilateral popliteal fossa is essential.
  • [MeSH-major] Lymph Node Excision. Melanoma / secondary. Melanoma / surgery. Skin Neoplasms / pathology

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  • (PMID = 17239242.001).
  • [ISSN] 1477-7819
  • [Journal-full-title] World journal of surgical oncology
  • [ISO-abbreviation] World J Surg Oncol
  • [Language] eng
  • [Publication-type] Case Reports; Journal Article
  • [Publication-country] England
  • [Other-IDs] NLM/ PMC1784092
  • [General-notes] NLM/ Original DateCompleted: 20070723
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2. Di Filippo F, Rossi CR, Santinami M, Cavaliere F, Garinei R, Anzà M, Perri P, Botti C, Di Angelo P, Pasqualoni R, Di Filippo S: Hyperthermic isolation limb perfusion with TNFalpha in the treatment of in-transit melanoma metastasis. In Vivo; 2006 Nov-Dec;20(6A):739-42
Hazardous Substances Data Bank. MELPHALAN .

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  • [Title] Hyperthermic isolation limb perfusion with TNFalpha in the treatment of in-transit melanoma metastasis.
  • BACKGROUND: Hyperthermic isolation limb perfusion (HILP) with tumor necrosis factor alpha (TNFalpha) and IFNgamma was pioneered by Liénard and Lejeune in 1988.
  • The TNFalpha was empirically employed at a dosage of 3-4 mg, that is ten times the systemic maximum tolerated dose (MTD).
  • PATIENTS AND METHODS: A phase I-II study has previously been conducted in 20 patients with in-transit melanoma metastases using a combination of melphalan and TNFalpha at dosages ranging from 0.5 to 3.3 mg.
  • All the patients were submitted to HILP via axillary and iliac vessels for tumor of upper and lower limb, respectively.
  • TNFalpha was injected in the extracorporal circuit at the pre-established dose, followed after 30 minutes by melphalan (13 and 10 mg/L of limb volume for upper and lower limbs, respectively).
  • RESULTS: A grade 1 and 2 limb toxicity was found in 52.9% and 30.1% of the patients, respectively, 5.5% of patients exhibited a grade 3 and 4, whereas grade 5 limb toxicity was not found.
  • CONCLUSION: Only patients with bulky melanoma disease can benefit from HILP with TNFalpha at a low dose of 1 mg.
  • [MeSH-major] Hyperthermia, Induced. Melanoma / therapy. Skin Neoplasms / therapy. Tumor Necrosis Factor-alpha / administration & dosage
  • [MeSH-minor] Adult. Aged. Aged, 80 and over. Antineoplastic Agents, Alkylating / administration & dosage. Chemotherapy, Cancer, Regional Perfusion. Combined Modality Therapy. Drug Therapy, Combination. Extremities. Female. Humans. Male. Melphalan / administration & dosage. Middle Aged. Neoplasm Staging

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  • (PMID = 17203758.001).
  • [ISSN] 0258-851X
  • [Journal-full-title] In vivo (Athens, Greece)
  • [ISO-abbreviation] In Vivo
  • [Language] eng
  • [Publication-type] Clinical Trial, Phase II; Journal Article
  • [Publication-country] Greece
  • [Chemical-registry-number] 0 / Antineoplastic Agents, Alkylating; 0 / Tumor Necrosis Factor-alpha; Q41OR9510P / Melphalan
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3. Adedoyin OT, Johnson AW, Ojuawo AI, Afolayan EA, Adeniji KA: Malignant melanoma in a black child: predisposing precursors and management. J Natl Med Assoc; 2004 Oct;96(10):1368-73
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  • [Title] Malignant melanoma in a black child: predisposing precursors and management.
  • Malignant melanoma (MM) remains a pediatric rarity world-wide, but perhaps more so in black Africans.
  • Smaller-sized hyperpigmented lesions with irregular, nonlobulated, and frequently hairy surfaces were also discernible over the upper and lower extremities, but the face, anterior trunk, and mucosal surfaces were relatively spared.
  • A diagnosis of MM was confirmed by the subsequent histopathologic findings from the fine-needle aspirate and biopsy specimens.
  • Chemotherapy was initiated but was truncated shortly after by parent-pressured discharge.
  • Despite the rarity of MM in a tropical African setting where management options are few, the current case underscores the need for a high clinical index of diagnostic suspicion, an early pursuit of investigative confirmation, and prophylactic excision in children with the predisposing skin lesions, like congenital giant hairy nevus.
  • [MeSH-major] African Continental Ancestry Group / genetics. Dysplastic Nevus Syndrome / complications. Melanoma / etiology. Skin Neoplasms / complications
  • [MeSH-minor] Causality. Child, Preschool. Female. Humans. Lymph Nodes / pathology. Nigeria. Risk Factors. Skin Pigmentation / genetics

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  • (PMID = 15540891.001).
  • [ISSN] 1943-4693
  • [Journal-full-title] Journal of the National Medical Association
  • [ISO-abbreviation] J Natl Med Assoc
  • [Language] eng
  • [Publication-type] Case Reports; Journal Article
  • [Publication-country] United States
  • [Other-IDs] NLM/ PMC2568537
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4. McMahon N, Cheng TY, Beasley GM, Spasojevic I, Petros W, Augustine CK, Zipfel P, Padussis JC, Sanders G, Tyler DS: Optimizing melphalan pharmacokinetics in regional melanoma therapy: does correcting for ideal body weight alter regional response or toxicity? Ann Surg Oncol; 2009 Apr;16(4):953-61
Hazardous Substances Data Bank. MELPHALAN .

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  • [Title] Optimizing melphalan pharmacokinetics in regional melanoma therapy: does correcting for ideal body weight alter regional response or toxicity?
  • BACKGROUND: This study aims to determine what effect correcting melphalan dosing for ideal body weight (IBW) has on toxicity and response in isolated limb infusion (ILI) in patients with advanced extremity melanoma.
  • METHODS: This was an open observational study examining whether correcting the melphalan dose for IBW will influence response and toxicity in patients undergoing ILI for advanced extremity melanoma in 41 patients undergoing 42 procedures (13 without correction for IBW; and 29 with correction for IBW).
  • Melphalan pharmacokinetics, limb toxicity, serologic toxicity, and response at 3 months were compared.
  • RESULTS: The corrected group had a lower estimated limb volume (V (esti)) to melphalan volume at steady state (V (ss)) (P < .0001) ratio as well as lower incidence of grade > or =3 regional toxicity, serologic toxicity, and compartment syndrome (P = .0249, P = .027, P = .02).

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  • (PMID = 19184236.001).
  • [ISSN] 1534-4681
  • [Journal-full-title] Annals of surgical oncology
  • [ISO-abbreviation] Ann. Surg. Oncol.
  • [Language] ENG
  • [Grant] United States / NCI NIH HHS / CA / P30 CA014236; United States / NCI NIH HHS / CA / 5P30 CA 14236-29
  • [Publication-type] Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't
  • [Publication-country] United States
  • [Chemical-registry-number] 0 / Antineoplastic Agents, Alkylating; Q41OR9510P / Melphalan
  • [Other-IDs] NLM/ NIHMS524556; NLM/ PMC3872993
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5. Fraker DL: Management of in-transit melanoma of the extremity with isolated limb perfusion. Curr Treat Options Oncol; 2004 Jun;5(3):173-84
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  • [Title] Management of in-transit melanoma of the extremity with isolated limb perfusion.
  • In-transit metastases for melanoma are a type of stage III regional metastatic disease that are intradermal or subcutaneous nodules growing within lymphatics and not in nodal basins.
  • If the initial diagnosis is a limited number of in-transit metastases (1-3 nodules), the optimal management is simple surgical excision with minimal negative margins and primary closures and appropriate staging to look for any distant metastases.
  • There is no role for wide excision of in-transit lesions as there is for primary melanoma because the entire extremity or that region of the body is at risk for recurrence.
  • Patients who are diagnosed with additional lesions in a short period of time or patients who at initial diagnosis have large numbers of nodules are candidates for isolated limb perfusion (ILP).
  • Once isolation is obtained surgically, the limb is heated to what is considered mild hyperthermia (38.5 degrees -40 degrees C), then chemotherapeutics are administered at very high concentrations for a 60- to 90-minute treatment.
  • The drug recirculates and, at the end of the treatment period, it is flushed from the extremity and the circulation is re-established.
  • The optimal regimen is melphalan dosed per limb volume (10 mg/L limb volume for lower extremities and 13 mg/L limb volume for upper extremities) with mild hyperthermia for 60 minutes.
  • The major toxicities are skin erythema, myopathy, and peripheral neuropathy.
  • There have been several studies adding high-dose tumor necrosis factor to ILP, but there is no clear benefit in the treatment of melanoma.
  • Other new approaches include isolated limb infusion as a percutaneous procedure to avoid the surgical toxicity.
  • [MeSH-major] Chemotherapy, Cancer, Regional Perfusion. Melanoma / drug therapy. Skin Neoplasms / drug therapy
  • [MeSH-minor] Antineoplastic Combined Chemotherapy Protocols. Extremities. Humans. Hyperthermia, Induced. Neoplasm Metastasis. Randomized Controlled Trials as Topic

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  • (PMID = 15115646.001).
  • [ISSN] 1527-2729
  • [Journal-full-title] Current treatment options in oncology
  • [ISO-abbreviation] Curr Treat Options Oncol
  • [Language] eng
  • [Publication-type] Journal Article; Review
  • [Publication-country] United States
  • [Number-of-references] 35
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6. Rossi CR, Lejeune FJ, Pontes L, Foletto M, De Salvo GL, Pilati PL, Mocellin S, Ribeiro M, Lopes M, Lise M: Phase I-II study on isolation antiblastic fotemustine perfusion after dacarbazine chemosensitization for advanced melanoma of the extremities. Melanoma Res; 2003 Jun;13(3):293-7
Hazardous Substances Data Bank. Fotemustine .

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  • [Title] Phase I-II study on isolation antiblastic fotemustine perfusion after dacarbazine chemosensitization for advanced melanoma of the extremities.
  • Isolation limb perfusion (ILP) is the treatment of choice for locally advanced limb melanoma.
  • With melphalan, the referral drug, complete response (CR) is achieved in about 50% of patients, but significant local toxicity occurs in up to 30%.
  • The aim of the present phase I-II study was to challenge fotemustine (F) in ILP after systemic chemosensitization with dacarbazine (DTIC), given its lower toxicity and greater efficacy, as reported in a previous pilot study.
  • Eleven patients with locally advanced limb melanoma were subdivided into triplets, and given F ILP at escalating doses (starting from 25 mg/l) after intravenous administration of 500 mg/m2 DTIC.
  • At drug levels of 12.5, 15.6 and 18.2 mg/l, local toxicity decreased, but only one of eight patients showed CR.
  • At present, F ILP after DTIC chemosensitization should not be recommended for the treatment of locally advanced limb melanoma.
  • [MeSH-major] Antineoplastic Combined Chemotherapy Protocols / adverse effects. Chemotherapy, Cancer, Regional Perfusion. Melanoma / drug therapy. Skin Neoplasms / drug therapy
  • [MeSH-minor] Adult. Aged. Dacarbazine / administration & dosage. Extremities. Female. Humans. Male. Middle Aged. Nitrosourea Compounds / administration & dosage. Organophosphorus Compounds / administration & dosage. Treatment Outcome

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  • (PMID = 12777985.001).
  • [ISSN] 0960-8931
  • [Journal-full-title] Melanoma research
  • [ISO-abbreviation] Melanoma Res.
  • [Language] eng
  • [Publication-type] Clinical Trial; Clinical Trial, Phase I; Clinical Trial, Phase II; Journal Article
  • [Publication-country] England
  • [Chemical-registry-number] 0 / Nitrosourea Compounds; 0 / Organophosphorus Compounds; 7GR28W0FJI / Dacarbazine; GQ7JL9P5I2 / fotemustine
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7. Panagiotou I, Brountzos EN, Bafaloukos D, Stoupis C, Brestas P, Kelekis DA: Malignant melanoma metastatic to the gastrointestinal tract. Melanoma Res; 2002 Apr;12(2):169-73
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  • [Title] Malignant melanoma metastatic to the gastrointestinal tract.
  • A retrospective study of 385 melanoma patients was performed, with the goal of evaluating the clinical characteristics, the role of imaging and the impact of treatment on patients with gastrointestinal (GI) metastases.
  • In 50% the primary lesion was on the lower extremities (P< 0.01), while 61.1% had nodular melanomas (P < 0.01).
  • Eight patients underwent curative surgery, two received no treatment, while the remaining eight patients had chemotherapy or immunochemotherapy.
  • GI tract metastases were more common in patients with nodular melanoma of the lower extremities.
  • Imaging is effective in the diagnosis of GI tract involvement.
  • Melanoma patients with GI tract metastases can benefit from palliation by surgical resection.
  • [MeSH-major] Gastrointestinal Neoplasms / secondary. Melanoma / secondary. Skin Neoplasms / pathology
  • [MeSH-minor] Adolescent. Adult. Aged. Aged, 80 and over. Child. Female. Humans. Male. Middle Aged. Neoplasm Staging. Prognosis. Retrospective Studies. Survival Rate. Tomography, X-Ray Computed

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  • (PMID = 11930114.001).
  • [ISSN] 0960-8931
  • [Journal-full-title] Melanoma research
  • [ISO-abbreviation] Melanoma Res.
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] England
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8. Barbour AP, Thomas J, Suffolk J, Beller E, Smithers BM: Isolated limb infusion for malignant melanoma: predictors of response and outcome. Ann Surg Oncol; 2009 Dec;16(12):3463-72
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  • [Title] Isolated limb infusion for malignant melanoma: predictors of response and outcome.
  • PURPOSE: Isolated limb infusion (ILI) is an alternative to isolated limb perfusion (ILP) for the treatment of unresectable limb melanoma recurrence.
  • The aims of this study were to determine the response rates of unresectable local and/or in-transit melanoma of the upper or lower limb to ILI and to identify factors predictive of survival.
  • METHODOLOGY: A prospective database identified 74 patients (35 male and 39 female) with local and/or in-transit melanoma recurrence without metastatic disease who underwent hyperthermic ILI with melphalan at a single institution between January 1996 and December 2008.
  • Median maximum temperature achieved was 38.1 degrees C and median tourniquet time was 32.5 min.
  • Wieberdink III/IV complications occurred following 7/74 (10%) ILI and were associated with higher limb volumes and higher total melphalan dose.
  • Univariable analyses found that limb volume >8.0 l and maximum limb temperature >38.5 degrees C were the only independent factors predictive for a CR following ILI.
  • Multivariate analyses identified CR and positive lymph nodes as the only independent prognostic factors for melanoma-specific survival.
  • [MeSH-major] Chemotherapy, Cancer, Regional Perfusion. Extremities / pathology. Lymph Nodes / pathology. Melanoma / drug therapy. Neoplasm Recurrence, Local / drug therapy. Skin Neoplasms / drug therapy
  • [MeSH-minor] Adult. Aged. Aged, 80 and over. Female. Humans. Hyperthermia, Induced. Lymphatic Metastasis. Male. Middle Aged. Neoplasm Staging. Prognosis. Prospective Studies. Survival Rate. Treatment Outcome

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  • (PMID = 19830498.001).
  • [ISSN] 1534-4681
  • [Journal-full-title] Annals of surgical oncology
  • [ISO-abbreviation] Ann. Surg. Oncol.
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] United States
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9. Aguilar M, de Troya M, Martin L, Benítez N, González M: A cost analysis of photodynamic therapy with methyl aminolevulinate and imiquimod compared with conventional surgery for the treatment of superficial basal cell carcinoma and Bowen's disease of the lower extremities. J Eur Acad Dermatol Venereol; 2010 Dec;24(12):1431-6
Hazardous Substances Data Bank. Imiquimod .

  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] A cost analysis of photodynamic therapy with methyl aminolevulinate and imiquimod compared with conventional surgery for the treatment of superficial basal cell carcinoma and Bowen's disease of the lower extremities.
  • Surgery is often the first choice of treatment and the modality with the lowest failure rate.
  • However, non-invasive procedures, such as topical methyl aminolevulinate photodynamic therapy (MAL-PDT) and imiquimod, are increasingly demanded by dermatologists and patients, because of their generally favourable efficacy and adverse effects profile and their excellent cosmetic outcome.
  • OBJECTIVE: To assess the cost of MAL-PDT and of treatment with imiquimod for primary non-melanoma superficial cutaneous carcinomas compared with conventional surgery, thereby calculating the total medical cost, and the direct and indirect costs.
  • The mean cost and mean cost per complete clinical response were calculated for each therapeutic option.
  • CONCLUSIONS: Although surgery proved to be more effective treatment, our results suggest that its average cost is greater than that of non-invasive therapy for the treatment of non-melanoma superficial cutaneous carcinomas on the lower limbs, at least after the first 2 years of follow-up.
  • [MeSH-major] Aminolevulinic Acid / analogs & derivatives. Aminoquinolines / therapeutic use. Bowen's Disease / drug therapy. Carcinoma, Basal Cell / drug therapy. Photochemotherapy / economics. Skin Neoplasms / drug therapy

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  • [Copyright] © 2010 The Authors. Journal compilation © 2010 European Academy of Dermatology and Venereology.
  • (PMID = 20456549.001).
  • [ISSN] 1468-3083
  • [Journal-full-title] Journal of the European Academy of Dermatology and Venereology : JEADV
  • [ISO-abbreviation] J Eur Acad Dermatol Venereol
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] Netherlands
  • [Chemical-registry-number] 0 / Aminoquinolines; 0 / methyl 5-aminolevulinate; 88755TAZ87 / Aminolevulinic Acid; 99011-02-6 / imiquimod
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10. Ferrari A, Bono A, Baldi M, Collini P, Casanova M, Pennacchioli E, Terenziani M, Marcon I, Santinami M, Bartoli C: Does melanoma behave differently in younger children than in adults? A retrospective study of 33 cases of childhood melanoma from a single institution. Pediatrics; 2005 Mar;115(3):649-54
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  • [Title] Does melanoma behave differently in younger children than in adults? A retrospective study of 33 cases of childhood melanoma from a single institution.
  • OBJECTIVE: To ascertain whether childhood melanoma presents any peculiar clinical features or differences in prognosis with respect to adults, we retrospectively analyzed the data from 33 patients who were up to 14 years of age and treated for cutaneous melanoma at the Istituto Nazionale Tumori, Milan, over a 25-year period.
  • Lower extremities were the most common primary sites.
  • Histologically, 9 cases were classified as nodular type, and median thickness was 2.5 mm.
  • Nine children had nodal involvement at diagnosis, 2 in-transit metastases, and 1 distant spread.
  • Surgery was the mainstay of treatment; 9 patients underwent lymph node dissection, 3 received chemotherapy, and 2 received radiotherapy.
  • CONCLUSION: By comparison with adult cases, childhood melanoma can have a higher percentage of atypical clinical features (amelanotic and raised lesions), nodular histotype, and thick lesions.
  • Although we have no data to support any suggestion of biological differences between young children and adolescents or adults, our findings give the impression that melanoma behaves differently in the younger age group.
  • [MeSH-major] Melanoma. Skin Neoplasms
  • [MeSH-minor] Adolescent. Adult. Age Factors. Analysis of Variance. Child. Child, Preschool. Combined Modality Therapy. Disease-Free Survival. Female. Follow-Up Studies. Humans. Male. Prognosis. Recurrence. Retrospective Studies. Survival Analysis. Treatment Outcome

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  • [CommentIn] Pediatrics. 2005 Mar;115(3):802-3 [15741391.001]
  • (PMID = 15741367.001).
  • [ISSN] 1098-4275
  • [Journal-full-title] Pediatrics
  • [ISO-abbreviation] Pediatrics
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] United States
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11. Bonenkamp JJ, Thompson JF, de Wilt JH, Doubrovsky A, de Faria Lima R, Kam PC: Isolated limb infusion with fotemustine after dacarbazine chemosensitisation for inoperable loco-regional melanoma recurrence. Eur J Surg Oncol; 2004 Dec;30(10):1107-12
Hazardous Substances Data Bank. Fotemustine .

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  • [Title] Isolated limb infusion with fotemustine after dacarbazine chemosensitisation for inoperable loco-regional melanoma recurrence.
  • BACKGROUND: Isolated limb infusion (ILI) is a simple yet effective alternative to conventional isolated limb perfusion for the treatment of advanced melanoma of the extremities.
  • PATIENTS AND METHODS: The study group comprised 13 patients with very advanced limb disease who had failed to achieve a satisfactory response to one or more ILIs with melphalan, and in whom amputation was the only other realistic treatment option.
  • Limb salvage was achieved in five of 12 assessable patients (42%).
  • Limb toxicity peaked 9 days after ILI; two patients experienced Wieberdink grade IV (severe) toxicity and four patients had grade V toxicity (requiring early amputation).
  • CONCLUSIONS: ILI with fotemustine after DTIC chemosensitisation can be successful when gross limb disease has not been controlled by one or more ILIs with melphalan.
  • However, it cannot be recommended as a routine method of treatment for advanced melanoma of the extremities because of the high incidence of severe limb toxicity.
  • [MeSH-major] Antineoplastic Agents / therapeutic use. Antineoplastic Agents, Alkylating / therapeutic use. Chemotherapy, Cancer, Regional Perfusion. Dacarbazine / therapeutic use. Lower Extremity. Melanoma / drug therapy. Neoplasm Recurrence, Local / drug therapy. Nitrosourea Compounds / therapeutic use. Organophosphorus Compounds / therapeutic use. Skin Neoplasms / drug therapy
  • [MeSH-minor] Aged. Aged, 80 and over. Amputation. Follow-Up Studies. Humans. Limb Salvage. Middle Aged. Neoplasm Staging. Remission Induction. Salvage Therapy. Treatment Outcome

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  • (PMID = 15522559.001).
  • [ISSN] 0748-7983
  • [Journal-full-title] European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology
  • [ISO-abbreviation] Eur J Surg Oncol
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] England
  • [Chemical-registry-number] 0 / Antineoplastic Agents; 0 / Antineoplastic Agents, Alkylating; 0 / Nitrosourea Compounds; 0 / Organophosphorus Compounds; 7GR28W0FJI / Dacarbazine; GQ7JL9P5I2 / fotemustine
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12. Zogakis TG, Bartlett DL, Libutti SK, Liewehr DJ, Steinberg SM, Fraker DL, Alexander HR: Factors affecting survival after complete response to isolated limb perfusion in patients with in-transit melanoma. Ann Surg Oncol; 2001 Dec;8(10):771-8
Hazardous Substances Data Bank. MELPHALAN .

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  • [Title] Factors affecting survival after complete response to isolated limb perfusion in patients with in-transit melanoma.
  • BACKGROUND: Isolated limb perfusion (ILP) results in complete response (CR) rates of 60% to 90% in patients with regionally advanced melanoma.
  • Survival after a CR may be influenced by various factors, particularly out-of-field disease in iliac lymph nodes (ILN) identified during lower-extremity ILP.
  • We examined clinical and pathological parameters, including ILN status and outcome, for patients with in-transit melanoma who had a CR to ILP.
  • METHODS: From May 1992 to July 1997, 50 patients (16 men and 34 women; median age, 57 years) with stage IIIA or IIIAB melanoma had a CR to a 90-minute hyperthermic iliac ILP with melphalan (10 mg/L limb volume, n = 20) or melphalan and tumor necrosis factor (4-6 mg+/-200 microg interferon; n = 30).
  • By univariate analysis, there was a trend for improved outcome with female sex and stage IIIA (vs. IIIAB) at initial diagnosis was associated with improved survival after a CR to ILP (P = .056 and .012, respectively).
  • The probability of overall in-field recurrence was 70% after 4 years, and there was no difference between those with or without positive ILNs; median time to in-field recurrence was 13 and 19 months, respectively (P = .62).
  • Of note, Cox models identified that the risk of death was significantly greater in those with a history of prior systemic therapy (hazard ratio: 2.67 [95% confidence interval, 1.17-6.11]; P = .02) and those with an in-transit lesion size > or =1.4 cm2 (hazard ratio, 3.12 [95% confidence interval, 1.30-7.5]; P = .011).
  • In addition, patients who have a CR after ILP and have a history of prior treatment or larger lesions should be considered for adjuvant systemic therapy.
  • [MeSH-major] Antineoplastic Combined Chemotherapy Protocols / administration & dosage. Melanoma / drug therapy. Skin Neoplasms / drug therapy
  • [MeSH-minor] Adult. Aged. Chemotherapy, Cancer, Regional Perfusion / methods. Disease-Free Survival. Extremities / blood supply. Female. Humans. Hyperthermia, Induced / methods. Interferons / administration & dosage. Lymphatic Metastasis. Male. Melphalan / administration & dosage. Middle Aged. Neoplasm Staging. Tumor Necrosis Factor-alpha / administration & dosage

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  • (PMID = 11776490.001).
  • [ISSN] 1068-9265
  • [Journal-full-title] Annals of surgical oncology
  • [ISO-abbreviation] Ann. Surg. Oncol.
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] United States
  • [Chemical-registry-number] 0 / Tumor Necrosis Factor-alpha; 9008-11-1 / Interferons; Q41OR9510P / Melphalan
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13. Lindnér P, Doubrovsky A, Kam PC, Thompson JF: Prognostic factors after isolated limb infusion with cytotoxic agents for melanoma. Ann Surg Oncol; 2002 Mar;9(2):127-36
Hazardous Substances Data Bank. MELPHALAN .

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  • [Title] Prognostic factors after isolated limb infusion with cytotoxic agents for melanoma.
  • BACKGROUND: Isolated limb perfusion (ILP) with cytotoxic agents is a remarkably effective but complex technique used to treat locally recurrent and metastatic melanoma confined to a limb.
  • Isolated limb infusion (ILI), essentially a low-flow ILP performed without oxygenation via percutaneous catheters, has been developed as a simpler alternative.
  • RESULTS: The overall response rate in the treated limb was 85% (complete response [CR] rate 41%, partial response rate 44%).
  • CR rate and survival time decreased with increasing disease stage.
  • On multivariate analysis, factors associated with an improved outcome were a lower stage of disease, a final limb temperature >37.8 degrees C, and a tourniquet time >40 minutes.
  • [MeSH-major] Antineoplastic Agents, Alkylating / administration & dosage. Chemotherapy, Cancer, Regional Perfusion / methods. Extremities. Melanoma / drug therapy. Melanoma / secondary. Melphalan / administration & dosage. Neoplasm Recurrence, Local / drug therapy. Skin Neoplasms / drug therapy

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  • (PMID = 11888868.001).
  • [ISSN] 1068-9265
  • [Journal-full-title] Annals of surgical oncology
  • [ISO-abbreviation] Ann. Surg. Oncol.
  • [Language] eng
  • [Publication-type] Journal Article; Research Support, Non-U.S. Gov't
  • [Publication-country] United States
  • [Chemical-registry-number] 0 / Antineoplastic Agents, Alkylating; Q41OR9510P / Melphalan
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14. Tominaga R, Nakano T, Shibata S, Siraishi K, Nagae S, Nakayama J, Yasui H: Systemic effects of hyperthermic isolated lower limb perfusion with carboplatin and interferon-beta. Artif Organs; 2001 Jan;25(1):36-41
Hazardous Substances Data Bank. CARBOPLATIN .

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  • [Title] Systemic effects of hyperthermic isolated lower limb perfusion with carboplatin and interferon-beta.
  • The changes in systemic circulation during hyperthermic isolated lower limb perfusion with carboplatin and interferon-beta were investigated in 19 patients with malignant melanoma.
  • The cardiac output (CO) increased significantly (p < 0.01) from 3.81 +/- 0.22 L/min before the procedure to 5.30 +/- 0.49 L/min 1 h after hyperthermic perfusion.
  • However, the serum CPK level increased markedly on the first postoperative day, and persisted for 1 week, thus suggesting that some muscle damage occurred during the procedure.
  • From these data, we concluded that hyperthermic isolated limb perfusion with interferon-beta is a relatively safe therapeutic method for malignant melanoma of the extremities.
  • However, care should be taken in patients with ischemic heart disease who may suffer a heart attack due to the rapid increase in cardiac work during the procedure.
  • [MeSH-major] Antineoplastic Combined Chemotherapy Protocols / administration & dosage. Body Temperature. Chemotherapy, Cancer, Regional Perfusion. Hemodynamics. Hyperthermia, Induced. Leg. Melanoma / drug therapy. Skin Neoplasms / drug therapy

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  • (PMID = 11167557.001).
  • [ISSN] 0160-564X
  • [Journal-full-title] Artificial organs
  • [ISO-abbreviation] Artif Organs
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] United States
  • [Chemical-registry-number] 77238-31-4 / Interferon-beta; BG3F62OND5 / Carboplatin; EC 2.7.3.2 / Creatine Kinase
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15. Rossi CR, Foletto M, Mocellin S, Pilati PL, Campana L, Rubello D, Lise M: TNF-based limb perfusion for cutaneous melanoma in transit metastases: suggestions for modification of the perfusional schedule. J Exp Clin Cancer Res; 2003 Dec;22(4 Suppl):103-7
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  • [Title] TNF-based limb perfusion for cutaneous melanoma in transit metastases: suggestions for modification of the perfusional schedule.
  • Isolated limb perfusion (ILP) is currently considered the standard treatment for melanoma patients with extensive in-transit disease, and L-PAM, combined or not with TNF, represents the most active drug.
  • We here report on our clinical experience with TNF-based limb perfusion.
  • Thirty-seven stage III patients underwent TNF-based limb perfusion, 22 with bulky disease, 15 with recurrences after perfusion with L-PAM.
  • Our results showed that it is possible to modify the perfusion schedule, without compromising the response rate but with lower cost and toxicity.
  • [MeSH-major] Chemotherapy, Cancer, Regional Perfusion. Melanoma / drug therapy. Skin Neoplasms / drug therapy. Tumor Necrosis Factor-alpha / administration & dosage
  • [MeSH-minor] Adult. Aged. Aged, 80 and over. Antineoplastic Agents, Alkylating / therapeutic use. Dose-Response Relationship, Drug. Extremities / pathology. Female. Humans. Hyperthermia, Induced. Male. Melphalan / therapeutic use. Middle Aged. Neoplasm Recurrence, Local / drug therapy. Time Factors. Treatment Outcome

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  • [ErratumIn] J Exp Clin Cancer Res. 2006 Sep;25(3):preceding table of contents. Ribello, D [corrected to Rubello, D]
  • (PMID = 16767915.001).
  • [ISSN] 0392-9078
  • [Journal-full-title] Journal of experimental & clinical cancer research : CR
  • [ISO-abbreviation] J. Exp. Clin. Cancer Res.
  • [Language] eng
  • [Publication-type] Clinical Trial, Phase I; Clinical Trial, Phase II; Journal Article; Multicenter Study
  • [Publication-country] Italy
  • [Chemical-registry-number] 0 / Antineoplastic Agents, Alkylating; 0 / Tumor Necrosis Factor-alpha; Q41OR9510P / Melphalan
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16. Kroon HM, Moncrieff M, Kam PC, Thompson JF: Factors predictive of acute regional toxicity after isolated limb infusion with melphalan and actinomycin D in melanoma patients. Ann Surg Oncol; 2009 May;16(5):1184-92
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Factors predictive of acute regional toxicity after isolated limb infusion with melphalan and actinomycin D in melanoma patients.
  • INTRODUCTION: Isolated limb infusion (ILI) with cytotoxic drugs is a low-flow isolated limb perfusion (ILP) performed via percutaneous catheters without oxygenation to treat metastatic melanoma confined to a limb.
  • Previously we have shown that more significant limb toxicity is not associated with a higher response rate or improved patient outcome.
  • METHODS: From our prospective database 185 patients with advanced metastatic melanoma of the limb treated with a single ILI between 1992 and 2007 were identified.
  • Drug circulation time was 20-30 min under mild hyperthermic conditions (38-39 degrees C).
  • Limb toxicity was assessed using the Wieberdink scale.
  • No patient developed grade V toxicity (requiring amputation).
  • On univariate analysis high peak and high final melphalan concentrations were found to be predictive factors for grade III/IV limb toxicity as well as the area under the curve of the melphalan concentration.
  • Surprisingly, a greater rise in the CO(2) level during the procedure was associated with lower toxicity in the univariate analysis.
  • In the multivariate analysis high final melphalan concentration and shorter tourniquet time were independent predictive risk factors for developing grade III/IV limb toxicity.
  • CONCLUSIONS: ILI is a safe alternative to the more invasive and laborious ILP technique to treat melanoma confined to a limb.
  • Based on the predictive factors found in this series, altering melphalan dose and tourniquet time may allow further reductions in post-ILI toxicity without compromising effectiveness.
  • [MeSH-major] Antineoplastic Combined Chemotherapy Protocols / adverse effects. Chemotherapy, Cancer, Regional Perfusion / adverse effects. Melanoma / drug therapy. Skin Neoplasms / drug therapy
  • [MeSH-minor] Adult. Aged. Aged, 80 and over. Dactinomycin / administration & dosage. Dactinomycin / adverse effects. Extremities. Female. Humans. Hyperthermia, Induced. Male. Melphalan / administration & dosage. Melphalan / adverse effects. Middle Aged

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  • [CommentIn] Ann Surg Oncol. 2009 May;16(5):1095-7 [19189189.001]
  • (PMID = 19224289.001).
  • [ISSN] 1534-4681
  • [Journal-full-title] Annals of surgical oncology
  • [ISO-abbreviation] Ann. Surg. Oncol.
  • [Language] eng
  • [Publication-type] Journal Article; Research Support, Non-U.S. Gov't
  • [Publication-country] United States
  • [Chemical-registry-number] 1CC1JFE158 / Dactinomycin; Q41OR9510P / Melphalan
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17. Pilati P, Mocellin S, Miotto D, Fittà C, Casara D, Ori C, Scalerta R, Nitti D, Lise M, Rossi CR: Hypoxic antiblastic stop-flow limb perfusion: clinical outcome and pharmacokinetic findings of a novel treatment for in transit melanoma metastases. Oncol Rep; 2004 Oct;12(4):895-901
Hazardous Substances Data Bank. MELPHALAN .

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  • [Title] Hypoxic antiblastic stop-flow limb perfusion: clinical outcome and pharmacokinetic findings of a novel treatment for in transit melanoma metastases.
  • Hypoxic antiblastic stop-flow perfusion (SFP) has recently been proposed as a therapeutic option for patients with locally advanced tumors.
  • We report on the clinical and pharmacological results of our prospective study of limb SFP for the treatment of in transit melanoma metastases.
  • Twenty-three patients with limb-sited melanoma metastases were treated with melphalan (10 mg/l) based pelvic (n=11, group A) or femoral (n=12, group B) SFP under hypoxic conditions.
  • Tumor response rate (complete + partial response) and time to local disease progression were significantly different in group A and B (9% vs 58% and 7 vs 13 months, respectively).
  • The pharmacokinetic study showed that pelvic SFP was associated with a higher leakage rate and a lower area under the curve ratio than femoral SFP (44% vs 31% and 5.6 vs 9.8, respectively).
  • Limb SFP is a feasible and relatively simple procedure.
  • Toxicity and tumor response rates strictly depend upon drug leakage control.
  • Further efforts should be made to exploit the potential anti-tumor activity of this novel locoregional drug delivery system.
  • [MeSH-major] Anoxia. Antineoplastic Agents / pharmacokinetics. Chemotherapy, Cancer, Regional Perfusion. Melanoma / drug therapy. Melphalan / pharmacokinetics. Skin Neoplasms / drug therapy
  • [MeSH-minor] Aged. Disease-Free Survival. Extremities / pathology. Female. Humans. Male. Middle Aged. Prospective Studies. Treatment Outcome

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  • (PMID = 15375519.001).
  • [ISSN] 1021-335X
  • [Journal-full-title] Oncology reports
  • [ISO-abbreviation] Oncol. Rep.
  • [Language] eng
  • [Publication-type] Comparative Study; Journal Article
  • [Publication-country] Greece
  • [Chemical-registry-number] 0 / Antineoplastic Agents; Q41OR9510P / Melphalan
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18. Guadagni S, Santinami M, Patuzzo R, Pilati PL, Miotto D, Deraco M, Rossi CR, Fiorentini G, Di Filippo F, Valenti M, Amicucci G: Hypoxic pelvic and limb perfusion with melphalan and mitomycin C for recurrent limb melanoma: a pilot study. Melanoma Res; 2003 Feb;13(1):51-8
Hazardous Substances Data Bank. MITOMYCIN C .

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  • [Title] Hypoxic pelvic and limb perfusion with melphalan and mitomycin C for recurrent limb melanoma: a pilot study.
  • Hypoxic pelvic and limb perfusion by means of a balloon occlusion technique was evaluated in patients with recurrent melanoma of the lower limbs who were non-responders to isolated hyperthermic limb perfusion or who were not eligible for this procedure.
  • A pilot study was performed in 17 patients, who underwent hypoxic pelvic and limb perfusion with 50 mg/m(2) of melphalan or 50 mg/m(2) of melphalan and 25 mg/m(2) of mitomycin C.
  • Each procedure was followed by haemofiltration.
  • The response rate and time to disease progression were the primary endpoints, with overall survival as the secondary endpoint.
  • After one course of treatment, the objective response rate was 47% (95% confidence interval 22.5-71.5%), the median time to disease progression was 10 months (range 2-40 months), and the 3 year overall survival was 20%.
  • Hypoxic pelvic and limb perfusion seems to be a safe and effective treatment for patients with unresectable recurrent limb melanoma who are not eligible for isolated hyperthermic limb perfusion.
  • Further studies are necessary to establish whether the response rates can be improved by using different drug regimens.
  • [MeSH-major] Anoxia. Antineoplastic Combined Chemotherapy Protocols / administration & dosage. Chemotherapy, Cancer, Regional Perfusion. Melanoma / drug therapy. Neoplasm Recurrence, Local / drug therapy. Skin Neoplasms / drug therapy
  • [MeSH-minor] Adult. Aged. Disease Progression. Extremities / pathology. Female. Humans. Male. Maximum Tolerated Dose. Melphalan / administration & dosage. Middle Aged. Mitomycin / administration & dosage. Pilot Projects. Survival Rate. Time Factors

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  • (PMID = 12569285.001).
  • [ISSN] 0960-8931
  • [Journal-full-title] Melanoma research
  • [ISO-abbreviation] Melanoma Res.
  • [Language] eng
  • [Publication-type] Clinical Trial; Controlled Clinical Trial; Journal Article
  • [Publication-country] England
  • [Chemical-registry-number] 50SG953SK6 / Mitomycin; Q41OR9510P / Melphalan
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19. Moncrieff MD, Kroon HM, Kam PC, Stalley PD, Scolyer RA, Thompson JF: Isolated limb infusion for advanced soft tissue sarcoma of the extremity. Ann Surg Oncol; 2008 Oct;15(10):2749-56
Hazardous Substances Data Bank. DACTINOMYCIN .

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  • [Title] Isolated limb infusion for advanced soft tissue sarcoma of the extremity.
  • BACKGROUND: Isolated limb infusion (ILI) is a minimally invasive technique for delivering high-dose regional chemotherapy.
  • We report our experience with ILI for the treatment of soft tissue sarcoma (STS).
  • METHODS: From our prospective database, 21 patients with STS of the limb treated with ILI between 1994 and 2007 were identified.
  • In all patients, a high-dose cytotoxic drug combination was used.
  • Eighteen patients (86%) had lower limb tumors.
  • The procedure was well tolerated.
  • Fourteen patients (67%) received ILI before definitive surgery.
  • CR and malignant fibrous histiocytoma tumor subtype were associated with a lower local recurrence rate.
  • A lower initial skin temperature (median 35.8 degrees C) was associated with a CR (P = .033).
  • Patients who had a steep increase in intramuscular temperature during the procedure were more likely to have a CR (P = .055).
  • Ultimately, the overall limb salvage rate was 76%.
  • CONCLUSION: The outcomes after ILI are comparable to those achieved by conventional isolated limb perfusion.
  • ILI is a minimally invasive alternative to isolated limb perfusion for patients with advanced STS of the extremity.
  • [MeSH-major] Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Chemotherapy, Cancer, Regional Perfusion. Extremities / pathology. Neoplasm Recurrence, Local / drug therapy. Sarcoma / drug therapy
  • [MeSH-minor] Adolescent. Adult. Aged. Aged, 80 and over. Cohort Studies. Dactinomycin / administration & dosage. Female. Humans. Male. Melphalan / administration & dosage. Middle Aged. Neoadjuvant Therapy. Neoplasm Staging. Prognosis. Prospective Studies. Survival Rate

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  • (PMID = 18648882.001).
  • [ISSN] 1534-4681
  • [Journal-full-title] Annals of surgical oncology
  • [ISO-abbreviation] Ann. Surg. Oncol.
  • [Language] eng
  • [Publication-type] Journal Article; Research Support, Non-U.S. Gov't
  • [Publication-country] United States
  • [Chemical-registry-number] 1CC1JFE158 / Dactinomycin; Q41OR9510P / Melphalan
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20. van Ginkel RJ, Limburg PC, Piers DA, Koops HS, Hoekstra HJ: Value of continuous leakage monitoring with radioactive iodine-131-labeled human serum albumin during hyperthermic isolated limb perfusion with tumor necrosis factor-alpha and melphalan. Ann Surg Oncol; 2002 May;9(4):355-63
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Value of continuous leakage monitoring with radioactive iodine-131-labeled human serum albumin during hyperthermic isolated limb perfusion with tumor necrosis factor-alpha and melphalan.
  • BACKGROUND: The aim of this study was to analyze the value of continuous leakage monitoring with radioactive iodine-131-labeled human serum albumin (RISA) in patients treated with hyperthermic isolated limb perfusion with tumor necrosis factor-alpha (TNF alpha) and melphalan.
  • METHODS: Forty-eight patients with melanoma (n = 14) or soft tissue sarcoma (n = 34) of an extremity underwent 51 perfusions.
  • The area under the curve for TNF alpha in the perfusion circuit, indicating the exposure of the perfused limb to TNF alpha, was 18.7% lower in the >2% leakage group.
  • The area under the curve for systemic TNF alpha, indicating the exposure of the patient to TNF alpha, was 18.1 times higher in the >2% leakage group, resulting in a significant decrease in leukocyte and platelet count, hyperbilirubinemia, hypocholesterolemia, and proteinemia.
  • CONCLUSIONS: A good correlation between RISA leakage measurement and TNF alpha exposure during and after hyperthermic isolated limb perfusion with TNF alpha and melphalan was demonstrated.
  • If leakage exceeds the 2% limit during perfusion, less exposure of the tumor-bearing limb to TNF alpha, increased exposure of the patient systemic circulation to TNF alpha, and more systemic side effects can be expected.
  • [MeSH-major] Antineoplastic Agents, Alkylating. Chemotherapy, Cancer, Regional Perfusion / methods. Hypothermia, Induced. Iodine Radioisotopes. Melanoma / drug therapy. Melphalan / therapeutic use. Monitoring, Physiologic / methods. Organotechnetium Compounds. Radiopharmaceuticals. Sarcoma / drug therapy. Serum Albumin. Skin Neoplasms / drug therapy. Soft Tissue Neoplasms / drug therapy. Tumor Necrosis Factor-alpha / therapeutic use
  • [MeSH-minor] Adult. Aged. Aged, 80 and over. Area Under Curve. Extremities. Female. Humans. Male. Middle Aged. Treatment Outcome

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  • (PMID = 11986187.001).
  • [ISSN] 1068-9265
  • [Journal-full-title] Annals of surgical oncology
  • [ISO-abbreviation] Ann. Surg. Oncol.
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] United States
  • [Chemical-registry-number] 0 / Antineoplastic Agents, Alkylating; 0 / Iodine Radioisotopes; 0 / Organotechnetium Compounds; 0 / Radiopharmaceuticals; 0 / Serum Albumin; 0 / Tumor Necrosis Factor-alpha; 0 / technetium Tc 99m serum albumin; Q41OR9510P / Melphalan
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21. Cornett WR, McCall LM, Petersen RP, Ross MI, Briele HA, Noyes RD, Sussman JJ, Kraybill WG, Kane JM 3rd, Alexander HR, Lee JE, Mansfield PF, Pingpank JF, Winchester DJ, White RL Jr, Chadaram V, Herndon JE 2nd, Fraker DL, Tyler DS, American College of Surgeons Oncology Group Trial Z0020: Randomized multicenter trial of hyperthermic isolated limb perfusion with melphalan alone compared with melphalan plus tumor necrosis factor: American College of Surgeons Oncology Group Trial Z0020. J Clin Oncol; 2006 Sep 1;24(25):4196-201
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Randomized multicenter trial of hyperthermic isolated limb perfusion with melphalan alone compared with melphalan plus tumor necrosis factor: American College of Surgeons Oncology Group Trial Z0020.
  • PURPOSE: To determine in a randomized prospective multi-institutional trial whether the addition of tumor necrosis factor alpha (TNF-alpha) to a melphalan-based hyperthermic isolated limb perfusion (HILP) treatment would improve the complete response rate for locally advanced extremity melanoma.
  • PATIENTS AND METHODS: Patients with locally advanced extremity melanoma were randomly assigned to receive melphalan or melphalan plus TNF-alpha during standard HILP.
  • Patient randomization was stratified according to disease/treatment status and regional nodal disease status.
  • There were two toxicity-related lower extremity amputations in the melphalan-plus-TNF-alpha arm, and one disease progression-related upper extremity amputation in the melphalan-alone arm.
  • There was no treatment-related mortality in either arm of the study.
  • Sixty-four percent of patients (36 of 58) in the melphalan-alone arm and 69% of patients (40 of 58) in the melphalan-plus-TNF-alpha arm showed a response to treatment at 3 months, with a complete response rate of 25% (14 of 58 patients) in the melphalan-alone arm and 26% (15 of 58 patients) in the melphalan-plus-TNF-alpha arm (P = .435 and P = .890, respectively).
  • CONCLUSION: In locally advanced extremity melanoma treated with HILP, the addition of TNF-alpha to melphalan did not demonstrate a significant enhancement of short-term response rates over melphalan alone by the 3-month follow-up, and TNF-alpha plus melphalan was associated with a higher complication rate.
  • [MeSH-major] Antineoplastic Agents, Alkylating / administration & dosage. Chemotherapy, Cancer, Regional Perfusion. Extremities. Hyperthermia, Induced. Melanoma / drug therapy. Melphalan / administration & dosage. Skin Neoplasms / drug therapy. Tumor Necrosis Factor-alpha / administration & dosage
  • [MeSH-minor] Adult. Aged. Female. Humans. Male. Middle Aged. Patient Selection. Treatment Outcome. United States

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  • [CommentIn] J Clin Oncol. 2007 Mar 20;25(9):1149; author reply 1149-51 [17369585.001]
  • [CommentIn] J Clin Oncol. 2007 Apr 10;25(11):1449-50; author reply 1450-1 [17416870.001]
  • (PMID = 16943537.001).
  • [ISSN] 1527-7755
  • [Journal-full-title] Journal of clinical oncology : official journal of the American Society of Clinical Oncology
  • [ISO-abbreviation] J. Clin. Oncol.
  • [Language] eng
  • [Grant] United States / NCI NIH HHS / CA / U10 CA076001
  • [Publication-type] Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, N.I.H., Extramural
  • [Publication-country] United States
  • [Chemical-registry-number] 0 / Antineoplastic Agents, Alkylating; 0 / Tumor Necrosis Factor-alpha; Q41OR9510P / Melphalan
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22. Casara D, Rubello D, Pilati P, Scalerta R, Foletto M, Rossi CR: Optimized procedure of real-time systemic leakage monitoring during isolated limb perfusion using a hand held gamma probe and 99mTc-HSA. Nucl Med Commun; 2004 Jan;25(1):61-6
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  • [Title] Optimized procedure of real-time systemic leakage monitoring during isolated limb perfusion using a hand held gamma probe and 99mTc-HSA.
  • Isolated limb perfusion (ILP) therapy using a combination of tumour necrosis factor alpha (TNF) and cytostatic agents in hyperthermic conditions has proven to be effective in treating cancers limited to limbs or to a single organ such as the liver.
  • A critical step for ILP is the accurate and real-time monitoring of that TNF toxic effects become relevant when overcoming the 10% limit of the 'effective' therapeutic dose administered during ILP.
  • The most diffuse procedure for systemic leakage monitoring is based on the utilization of human soluble serum albumin (HSA) labelled with 131I and an external scintillation detector.
  • In order to overcome some drawbacks connected with the properties of 131I, we developed a new procedure based on the utilization of HSA labelled with 99mTc in combination with a hand held gamma probe used as a detector.
  • Our procedure consists of the following steps:.
  • (2) a hand held gamma probe is placed over the pre-cordial area in a zone pre-marked on the patient's skin during a simulation test;.
  • (4) during the simulation test the maximum count-rate zone detected on the pre-cordial area is marked on patient's skin;.
  • (5) a 60 min time-activity curve corresponding to the circulating 99mTc-HSA radioactivity effective decay is calculated and fitted; and (6) this time-activity curve is used to compensate for the leakage systemic counting observed during ILP.
  • It is concluded that the proposed procedure, based on the combination of 99mTc-HSA as the radiotracer and a hand held gamma probe as the detector, appears to be technically simple and accurate enough in the real-time monitoring of perfusion leakage in ILP cancer therapy.
  • Moreover, using 99mTc-HSA as the radiotracer, the risk of radioactive contamination is significantly lower in comparison with 131I-HSA.
  • [MeSH-major] Chemotherapy, Cancer, Regional Perfusion / methods. Drug Therapy, Computer-Assisted / methods. Extravasation of Diagnostic and Therapeutic Materials / radionuclide imaging. Melanoma / radionuclide imaging. Sarcoma / radionuclide imaging. Technetium Tc 99m Aggregated Albumin. Tumor Necrosis Factor-alpha / administration & dosage
  • [MeSH-minor] Antineoplastic Agents / therapeutic use. Extremities. Gamma Cameras. Humans. Radioisotope Dilution Technique. Radiopharmaceuticals / pharmacokinetics. Skin Neoplasms / drug therapy. Skin Neoplasms / metabolism. Skin Neoplasms / radionuclide imaging. Treatment Outcome

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  • (PMID = 15061266.001).
  • [ISSN] 0143-3636
  • [Journal-full-title] Nuclear medicine communications
  • [ISO-abbreviation] Nucl Med Commun
  • [Language] eng
  • [Publication-type] Clinical Trial; Comparative Study; Journal Article
  • [Publication-country] England
  • [Chemical-registry-number] 0 / Antineoplastic Agents; 0 / Radiopharmaceuticals; 0 / Technetium Tc 99m Aggregated Albumin; 0 / Tumor Necrosis Factor-alpha
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23. Thieu KP, Rosenbach M, Xu X, Kist JM: Neutrophilic dermatosis complicating lenalidomide therapy. J Am Acad Dermatol; 2009 Oct;61(4):709-10
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Neutrophilic dermatosis complicating lenalidomide therapy.
  • Lenalidomide, a derivative of thalidomide, is an immunomodulatory agent introduced in 2004 for the treatment of multiple myeloma in combination with dexamethasone.
  • It is also indicated for the treatment of myelodysplastic syndrome and is currently under investigative use for metastatic melanoma.
  • We present a case of neutrophilic dermatosis involving predominantly the lower extremities in a patient receiving lenalidomide therapy for multiple myeloma.
  • [MeSH-major] Antineoplastic Agents / adverse effects. Multiple Myeloma / drug therapy. Sweet Syndrome / chemically induced. Thalidomide / analogs & derivatives
  • [MeSH-minor] Biopsy. Female. Humans. Middle Aged. Skin / pathology

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  • (PMID = 19577327.001).
  • [ISSN] 1097-6787
  • [Journal-full-title] Journal of the American Academy of Dermatology
  • [ISO-abbreviation] J. Am. Acad. Dermatol.
  • [Language] eng
  • [Publication-type] Case Reports; Journal Article
  • [Publication-country] United States
  • [Chemical-registry-number] 0 / Antineoplastic Agents; 4Z8R6ORS6L / Thalidomide; F0P408N6V4 / lenalidomide
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