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1. Osei DA, Alvandi F, Brooks JS, Ogilvie CM: PEComa of the Upper Extremity: A Unique Case and Description of an Initial Response to Neoadjuvant Chemotherapy. Sarcoma; 2007;2007:53056
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  • [Title] PEComa of the Upper Extremity: A Unique Case and Description of an Initial Response to Neoadjuvant Chemotherapy.
  • Purpose. Tumors of the perivascular epithelial cell tumor (PEComa), first described in 1992, represent a rare soft tissue neoplasm of varying malignant potential.
  • To date, most malignant cases of PEComa have been resistant to chemotherapy, and as such, an appropriate therapy is not known.
  • Case report. Here we describe the first case of PEComa of the upper extremity.
  • Open biopsy revealed a high-grade malignant lesion, and the patient subsequently underwent both neoadjuvant therapy with doxorubicin, ifosfamide and mensa, and radiation therapy prior to wide surgical resection.
  • After six cycles of chemotherapy, the tumor underwent an 80% reduction in size.
  • Subsequent neoadjuvant radiation therapy of 5000 cGy did not further reduce the size of the tumor.
  • Following limb sparing radical resection, pathology showed 20% necrosis within a high-grade malignant lesion.
  • Twenty one months after beginning treatment, the patient shows no sign of local recurrence, but metastatic disease was confirmed after resection of a lung nodule.
  • Conclusion. Given the favorable albeit partial response seen in this patient, the course of therapy outlined here may represent a good starting point for neoadjuvant treatment in a tumor with a historically bleak prognosis.
  • In addition, the diagnosis of PEComa must now be entertained in the differential diagnosis of upper extremity soft tissue sarcoma.

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  • (PMID = 18274609.001).
  • [ISSN] 1357-714X
  • [Journal-full-title] Sarcoma
  • [ISO-abbreviation] Sarcoma
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] Egypt
  • [Other-IDs] NLM/ PMC2225462
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2. Natarajan M, Paraskumar M, Rajkumar G, Sivaseelam A, Natarajan S: Limb salvage in aggressive and malignant tumours of the fibula. Int Orthop; 2004 Oct;28(5):307-10
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  • [Title] Limb salvage in aggressive and malignant tumours of the fibula.
  • The tumours predominantly involved the upper one third; 16 were of Stage IIB.
  • Neo-adjuvant and adjuvant chemotherapy were given to all patients with osteosarcoma and Ewing's sarcoma.
  • The 5- and 10-year survival rates of patient and limb are reported based on Kaplan-Meier survival analysis.
  • [MeSH-major] Bone Neoplasms / pathology. Bone Neoplasms / surgery. Limb Salvage. Neoplasm Invasiveness / pathology
  • [MeSH-minor] Adolescent. Adult. Child. Chondrosarcoma / mortality. Chondrosarcoma / pathology. Chondrosarcoma / surgery. Disease-Free Survival. Female. Follow-Up Studies. Humans. Male. Neoplasm Staging. Osteosarcoma / mortality. Osteosarcoma / pathology. Osteosarcoma / surgery. Retrospective Studies. Risk Assessment. Sarcoma, Ewing / mortality. Sarcoma, Ewing / pathology. Sarcoma, Ewing / surgery. Survival Analysis. Treatment Outcome

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  • (PMID = 15338200.001).
  • [ISSN] 0341-2695
  • [Journal-full-title] International orthopaedics
  • [ISO-abbreviation] Int Orthop
  • [Language] eng
  • [Publication-type] Comparative Study; Journal Article
  • [Publication-country] Germany
  • [Other-IDs] NLM/ PMC3456982
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3. Grunhagen DJ, de Wilt JH, Graveland WJ, van Geel AN, Eggermont AM: The palliative value of tumor necrosis factor alpha-based isolated limb perfusion in patients with metastatic sarcoma and melanoma. Cancer; 2006 Jan 1;106(1):156-62
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  • [Title] The palliative value of tumor necrosis factor alpha-based isolated limb perfusion in patients with metastatic sarcoma and melanoma.
  • BACKGROUND: Both patients with soft tissue sarcoma (STS) and patients with melanoma have limited treatment possibilities once the tumor has metastasized systemically.
  • In patients with extremity STS or bulky melanoma in-transit metastases, the local tumor burden may be so problematic that, even in patients with systemically metastasized disease, an amputation may be inevitable.
  • Isolated limb perfusion (ILP) has proven to be an excellent, local, limb-saving treatment option in patients with locally advanced extremity tumors.
  • In this study, the authors investigated the palliative value of the ILP procedure to avoid amputation in patients who had Stage IV STS and melanoma.
  • METHODS: From 1991 to 2003, of 339 tumor necrosis factor alpha (TNF)-based ILPs, 51 procedures were performed for either Stage IV STS (n = 37 patients) or Stage IV melanoma (n = 14 patients).
  • All patients underwent an ILP with TNF and melphalan of the upper limb (n = 4 patients) or the lower limb (n = 47 patients) with 26-140 mg melphalan and 2-4 mg TNF.
  • Limb salvage was achieved in 36 of 37 patients, with 1 patient undergoing amputation due to treatment toxicity.
  • All patients with melanoma preserved their limb during a median survival of 7 months.
  • CONCLUSIONS: TNF-based ILP is an excellent procedure that provided tumor control and limb salvage for the short survival of patients with metastasized, very bulky, limb-threatening tumors of the extremity.
  • [MeSH-major] Antineoplastic Agents, Alkylating / therapeutic use. Chemotherapy, Cancer, Regional Perfusion. Melanoma / drug therapy. Melphalan / therapeutic use. Palliative Care. Sarcoma / drug therapy. Tumor Necrosis Factor-alpha / therapeutic use
  • [MeSH-minor] Adolescent. Adult. Aged. Aged, 80 and over. Amputation. Arm. Female. Humans. Leg. Male. Middle Aged. Neoplasm Metastasis. Neoplasm Staging. Recombinant Proteins / administration & dosage. Recombinant Proteins / adverse effects. Recombinant Proteins / therapeutic use

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  • [Copyright] Copyright 2005 American Cancer Society.
  • (PMID = 16323177.001).
  • [ISSN] 0008-543X
  • [Journal-full-title] Cancer
  • [ISO-abbreviation] Cancer
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] United States
  • [Chemical-registry-number] 0 / Antineoplastic Agents, Alkylating; 0 / Recombinant Proteins; 0 / Tumor Necrosis Factor-alpha; Q41OR9510P / Melphalan
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4. Di Filippo F, Giacomini P, Rossi CR, Santinami M, Anzà M, Garinei R, Perri P, Botti C, Di Angelo P, Sofra C, Pasqualoni R, Sperduti I, Cavaliere F, Di Filippo S, Corrias F, Armenti A, Ferraresi V, Ginebri A: Prognostic factors influencing tumor response, locoregional control and survival, in melanoma patients with multiple limb in-transit metastases treated with TNFalpha-based isolated limb perfusion. In Vivo; 2009 Mar-Apr;23(2):347-52
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  • [Title] Prognostic factors influencing tumor response, locoregional control and survival, in melanoma patients with multiple limb in-transit metastases treated with TNFalpha-based isolated limb perfusion.
  • BACKGROUND: In isolated limb perfusion (ILP) with tumor necrosis factor-alpha (TNFalpha) and interferon (IFN)-gamma, pioneered by Lienard and Lejenne in 1988, TNFalpha was empirically employed at a dosage (3-4 mg) ten times higher than the systemic maximum tolerable dose (MTD).
  • Patients with tumors in the upper and lower limbs were submitted to ILP via axillary and iliac vessels, respectively.
  • TNFalpha was injected in the arterial line of an extracorporeal circuit at the pre-established dose, followed by melphalan (13 and 10 mg/l of limb volume for the upper and lower limbs, respectively) 30 minutes later.
  • Upon multivariate analysis, only bulky disease maintained its independent value for tumor response with an odds ratio of 4.07 and a p-value of 0.02.
  • CONCLUSION: TNFalpha-based ILP was proven to be an effective treatment for melanoma patients with in-transit metastases.
  • [MeSH-major] Melanoma / drug therapy. Melanoma / pathology. Tumor Necrosis Factor-alpha / metabolism
  • [MeSH-minor] Adult. Aged. Aged, 80 and over. Extremities. Female. Humans. Male. Maximum Tolerated Dose. Melphalan / pharmacology. Middle Aged. Neoplasm Metastasis. Perfusion. Prognosis. Treatment Outcome

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  • (PMID = 19414425.001).
  • [ISSN] 0258-851X
  • [Journal-full-title] In vivo (Athens, Greece)
  • [ISO-abbreviation] In Vivo
  • [Language] eng
  • [Publication-type] Clinical Trial; Journal Article; Research Support, Non-U.S. Gov't
  • [Publication-country] Greece
  • [Chemical-registry-number] 0 / Tumor Necrosis Factor-alpha; Q41OR9510P / Melphalan
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5. Leit ME, Tomaino MM: Principles of limb salvage surgery of the upper extremity. Hand Clin; 2004 May;20(2):v, 167-79
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  • [Title] Principles of limb salvage surgery of the upper extremity.
  • The goals of limb salvage surgery in the upper extremity are to achieve resection of the tumor and preserve hand function without the risk for local recurrence.
  • Historically, amputation was the treatment of choice for a neoplasm of the hand, wrist, and forearm, but limb-sparing procedures have become feasible largely because of advances in diagnostic imaging, reconstructive microsurgery, and adjuvant radiotherapy and chemotherapy.
  • Because preservation of hand function, even modest levels thereof, is clearly superior to amputation from a functional standpoint, the authors review the principles of limb salvage in this article.
  • [MeSH-major] Bone Neoplasms / surgery. Limb Salvage. Soft Tissue Neoplasms / surgery
  • [MeSH-minor] Bone Transplantation. Fibula / transplantation. Forearm. Giant Cell Tumor of Bone / surgery. Hand. Humans. Prostheses and Implants. Surgical Flaps

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  • (PMID = 15201022.001).
  • [ISSN] 0749-0712
  • [Journal-full-title] Hand clinics
  • [ISO-abbreviation] Hand Clin
  • [Language] eng
  • [Publication-type] Journal Article; Review
  • [Publication-country] United States
  • [Number-of-references] 60
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6. Athwal GS, Chin PY, Adams RA, Morrey BF: Coonrad-Morrey total elbow arthroplasty for tumours of the distal humerus and elbow. J Bone Joint Surg Br; 2005 Oct;87(10):1369-74
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  • [Title] Coonrad-Morrey total elbow arthroplasty for tumours of the distal humerus and elbow.
  • We reviewed 20 patients who had undergone a Coonrad-Morrey total elbow arthroplasty after resection of a primary or metastatic tumour from the elbow or distal humerus between 1980 and 2002.
  • Eighteen patients underwent reconstruction for palliative treatment with restoration of function after intralesional surgery and two after excision of a primary bone tumour.
  • There were no infections or wound complications although 18 patients (90%) had radiotherapy, chemotherapy or both.
  • The rates of complications involving local recurrence of tumour (25%) and nerve injury (25%) are of concern.
  • [MeSH-minor] Aged. Aged, 80 and over. Female. Follow-Up Studies. Fractures, Spontaneous / radiography. Fractures, Spontaneous / surgery. Humans. Male. Middle Aged. Neoplasm Recurrence, Local. Prosthesis Failure. Reoperation. Treatment Outcome

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  • (PMID = 16189310.001).
  • [ISSN] 0301-620X
  • [Journal-full-title] The Journal of bone and joint surgery. British volume
  • [ISO-abbreviation] J Bone Joint Surg Br
  • [Language] eng
  • [Publication-type] Evaluation Studies; Journal Article
  • [Publication-country] England
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7. Bacci G, Ferrari S, Longhi A, Donati D, Manfrini M, Giacomini S, Briccoli A, Forni C, Galletti S: Nonmetastatic osteosarcoma of the extremity with pathologic fracture at presentation: local and systemic control by amputation or limb salvage after preoperative chemotherapy. Acta Orthop Scand; 2003 Aug;74(4):449-54
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  • [Title] Nonmetastatic osteosarcoma of the extremity with pathologic fracture at presentation: local and systemic control by amputation or limb salvage after preoperative chemotherapy.
  • To determine whether a pathologic fracture in osteosarcoma of long bones has prognostic importance, and limb salvage can be safely performed in such cases, we reviewed the surgical treatment and oncologic results in 46 patients with nonmetastatic osteosarcoma of the extremity and pathologic fracture at presentation who had been treated in our Institution with neoadjuvant chemotherapy, between 1983 and 1999.
  • Neoadjuvant chemotherapy was given according to 6 consecutive protocols.
  • Surgery consisted of limb salvage (34 patients), amputation (11 patients) and rotationplasty (1 patient).
  • 28 patients remained continuously disease-free, 17 patients relapsed and 1 died of chemotherapy-related toxicity.
  • Despite the high rate of limb salvage, only 2 local failures occurred, 1 after amputation and 1 after limb salvage.
  • These results are similar to those obtained in 689 contemporary patients having an osteosarcoma without a pathologic fracture treated in our Institution, and using the same protocols for chemotherapy.
  • We conclude that with neoadjuvant chemotherapy, osteosarcoma patients presenting with a pathologic fracture can be surgically treated like those with no fracture, and that limb salvage procedures do not increase the risk of local recurrence or death of these patients.
  • [MeSH-major] Bone Neoplasms / pathology. Bone Neoplasms / therapy. Fractures, Spontaneous / diagnosis. Osteosarcoma / pathology. Osteosarcoma / therapy
  • [MeSH-minor] Adolescent. Adult. Amputation / methods. Chemotherapy, Adjuvant. Chi-Square Distribution. Child. Combined Modality Therapy. Confidence Intervals. Diagnosis, Differential. Female. Follow-Up Studies. Humans. Italy. Limb Salvage / methods. Lower Extremity. Male. Neoplasm Staging. Preoperative Care / methods. Probability. Retrospective Studies. Risk Assessment. Sampling Studies. Treatment Outcome. Upper Extremity

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  • (PMID = 14521297.001).
  • [ISSN] 0001-6470
  • [Journal-full-title] Acta orthopaedica Scandinavica
  • [ISO-abbreviation] Acta Orthop Scand
  • [Language] eng
  • [Publication-type] Comparative Study; Journal Article
  • [Publication-country] Norway
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8. 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
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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).
  • Twenty patients were treated and a complete pathological response of 70% was recorded, with no correlation between tumor response and TNFalpha.
  • 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.
  • We tried to correlate the typed tumor response (CR or not CR) and the TNFalpha dosage < or = 1 mg or > 1 mg, but no statistically significant difference was found between the two groups.
  • The bulky disease was the only prognostic factor able to influence the tumor response.
  • [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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9. Germain MA, Bonvalot S, Rimareix F, Missana CM: [Locally advanced soft-tissue sarcomas. An innovating triad to avoid amputation: isolated limb perfusion, TNFalpha, and free microsurgical flap]. Bull Acad Natl Med; 2010 Jan;194(1):51-65; discussion 65-7
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  • [Title] [Locally advanced soft-tissue sarcomas. An innovating triad to avoid amputation: isolated limb perfusion, TNFalpha, and free microsurgical flap].
  • [Transliterated title] Sauvetage des membres atteints de sarcome localement evolué. La triade innovante: perfusion de membre isole sous CEC, TNFalpha, et transplant microchirurgical.
  • We retrospectively studied the benefits of isolated limb perfusion combined with TNFalpha administration and free flap reconstruction in locally advanced soft-tissue sarcomas of the limbs.
  • Between 2000 and 2008, we treated 37 patients (22 women and 15 men) with locally advanced soft tissue sarcomas.
  • The sarcomas were located in the lower and upper limbs in respectively 26 and 11 cases, and had a mean diameter of 15 cm and 12 cm, respectively.
  • Seventeen patients received neoadjuvant chemotherapy.
  • Sarcoma excision was combined with a complementary procedure in 10 patients (vascular graft or nerve anastomosis).
  • Three major improvements were made in recent years, namely isolated limb perfusion, TNFalpha administration, and free flap reconstruction two months after resection of residual sarcoma.
  • The procedure lasted a median of 7 hours.
  • Tumor excision was stage R0 in 29 cases (clean margins), R1 in 7 cases (microscopic residue), and R2 in one case (macroscopic residue).
  • The limb was preserved in 78% of cases.
  • Thirteen patients developed pulmonary metastases and seven of them died between the first and fifth years of follow-up.
  • Isolated limb perfusion and free flap reconstruction permitted more extensive tumor excision.
  • [MeSH-major] Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Chemotherapy, Cancer, Regional Perfusion. Extremities / surgery. Sarcoma / drug therapy. Sarcoma / surgery. Soft Tissue Neoplasms / drug therapy. Soft Tissue Neoplasms / surgery. Tumor Necrosis Factor-alpha / therapeutic use
  • [MeSH-minor] Adolescent. Adult. Combined Modality Therapy. Female. Follow-Up Studies. Humans. Lung Neoplasms / mortality. Lung Neoplasms / secondary. Male. Middle Aged. Muscle, Skeletal / transplantation. Neoadjuvant Therapy. Neoplasm Recurrence, Local / drug therapy. Neoplasm Recurrence, Local / surgery. Neoplasms, Radiation-Induced / drug therapy. Neoplasms, Radiation-Induced / surgery. Neoplasms, Second Primary / drug therapy. Neoplasms, Second Primary / surgery. Radiotherapy, Adjuvant. Reconstructive Surgical Procedures. Reoperation. Retrospective Studies. Skin Transplantation. Surgical Flaps. Treatment Outcome. Young Adult

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  • (PMID = 20669559.001).
  • [ISSN] 0001-4079
  • [Journal-full-title] Bulletin de l'Académie nationale de médecine
  • [ISO-abbreviation] Bull. Acad. Natl. Med.
  • [Language] fre
  • [Publication-type] English Abstract; Evaluation Studies; Journal Article
  • [Publication-country] Netherlands
  • [Chemical-registry-number] 0 / Tumor Necrosis Factor-alpha
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10. French FP, Murray PM, Perdikis G: Extensive cutaneous metastatic breast carcinoma of the hand and upper extremity: a case report. J Hand Surg Am; 2007 Feb;32(2):252-5
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  • [Title] Extensive cutaneous metastatic breast carcinoma of the hand and upper extremity: a case report.
  • We report a case of a 39-year-old woman with a history of recurrent invasive ductal adenocarcinoma of the breast who had a right modified radical mastectomy, chemotherapy, and radiation therapy before presenting to our institution with extensive cutaneous metastasis to the upper limb including the hand.
  • The presentation, pathogenesis, incidence, prognosis, management, and differential diagnosis of cutaneous metastatic breast carcinoma to the hand and upper limb are discussed.
  • [MeSH-major] Breast Neoplasms / pathology. Carcinoma, Ductal, Breast / pathology. Hand / pathology. Skin Neoplasms / secondary. Upper Extremity / pathology
  • [MeSH-minor] Adult. Amputation. Female. Humans. Lymphatic Metastasis. Neoplasm Recurrence, Local / pathology. Neoplasm Recurrence, Local / therapy

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  • (PMID = 17275603.001).
  • [ISSN] 0363-5023
  • [Journal-full-title] The Journal of hand surgery
  • [ISO-abbreviation] J Hand Surg Am
  • [Language] eng
  • [Publication-type] Case Reports; Journal Article
  • [Publication-country] United States
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11. Murray PM: Soft tissue sarcoma of the upper extremity. Hand Clin; 2004 Aug;20(3):325-33, vii
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  • [Title] Soft tissue sarcoma of the upper extremity.
  • Soft tissue sarcomas of the upper extremities are rare and hand surgeons typically encounter only one or two undiagnosed soft tissue sarcomas during their careers.
  • It is incumbent on the physician to review repeatedly the characteristics of these tumors and remain suspicious, because these lesions typically are misdiagnosed and treatment is delayed.
  • The most common soft tissue sarcomas of the upper extremity are the epithelioid sarcoma, synovial cell sarcoma, and malignant fibrous histiocytoma.
  • Limb salvage surgery is the treatment of choice for soft tissue sarcomas to preserve upper extremity function.
  • Following wide tumor resection, adjuvant therapies such as chemotherapy, external beam radiation therapy, and brachytherapy may lessen local recurrence rates, but their effect on overall survival remains unclear.
  • [MeSH-major] Sarcoma. Soft Tissue Neoplasms
  • [MeSH-minor] Arm. Biopsy. Chemotherapy, Adjuvant. Dermatofibrosarcoma / diagnosis. Dermatofibrosarcoma / surgery. Fibrosarcoma / pathology. Fibrosarcoma / therapy. Histiocytoma, Benign Fibrous / mortality. Histiocytoma, Benign Fibrous / pathology. Humans. Liposarcoma / pathology. Neoplasm Metastasis. Neoplasm Recurrence, Local. Prognosis. Rhabdomyosarcoma / pathology. Rhabdomyosarcoma / therapy. Sarcoma, Clear Cell / diagnosis. Sarcoma, Synovial / diagnosis

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  • (PMID = 15275691.001).
  • [ISSN] 0749-0712
  • [Journal-full-title] Hand clinics
  • [ISO-abbreviation] Hand Clin
  • [Language] eng
  • [Publication-type] Journal Article; Review
  • [Publication-country] United States
  • [Number-of-references] 46
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12. Lejeune FJ, Pujol N, Liénard D, Mosimann F, Raffoul W, Genton A, Guillou L, Landry M, Chassot PG, Chiolero R, Bischof-Delaloye A, Leyvraz S, Mirimanoff RO, Bejkos D, Leyvraz PF: Limb salvage by neoadjuvant isolated perfusion with TNFalpha and melphalan for non-resectable soft tissue sarcoma of the extremities. Eur J Surg Oncol; 2000 Nov;26(7):669-78
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  • [Title] Limb salvage by neoadjuvant isolated perfusion with TNFalpha and melphalan for non-resectable soft tissue sarcoma of the extremities.
  • AIMS: Patients with non-resectable soft tissue sarcomas of the extremities do not live longer if they are treated by amputation or disarticulation.
  • In order to avoid major amputations, we tested isolated limb perfusion (ILP) with tumour necrosis factor alpha (TNF)+melphalan+/-interferon-gamma (IFN) as a pre-operative, neoadjuvant limb salvage treatment.
  • METHODS: Twenty-two patients were included (six men and 16 women; three upper limb and 19 lower limb tumours).
  • Thirteen cases were recurrent or progressive after previous therapy; five tumours had a diameter >/=20 cm, and four were multiple or regionally metastatic.
  • Three patients had a minimal or no response and the tumour progressed in one case.
  • All patients had fever for 24 hours but only one developed a reversible grade 3 distributive shock syndrome with no sequelae.
  • Seventeen patients (77%) underwent limb-sparing resection of the tumour remnants after a median time of 3.4 months: 10 resections were intracompartmental and seven extracompartmental.
  • Adjuvant chemotherapy was given to eight patients and radiotherapy to six.
  • Secondary amputations were performed for recurrence in two patients, resulting in an overall limb salvage rate of 19/22 (86%).
  • The median disease free and overall survival times have been >12.5 and 18.7 months respectively: this is similar to the outcome after primary amputations for similar cases.
  • CONCLUSION: ILP with TNF and chemotherapy is an efficient limb sparing neoadjuvant therapy for a priori non-resectable limb soft tissue sarcomas.
  • [MeSH-major] Antineoplastic Combined Chemotherapy Protocols / administration & dosage. Leg / surgery. Sarcoma / drug therapy. Sarcoma / surgery. Soft Tissue Neoplasms / drug therapy. Soft Tissue Neoplasms / surgery
  • [MeSH-minor] Adult. Aged. Chemotherapy, Adjuvant. Chemotherapy, Cancer, Regional Perfusion. Disease-Free Survival. Doxorubicin / administration & dosage. Female. Humans. Ifosfamide / administration & dosage. Interferon-gamma / administration & dosage. Interferon-gamma / adverse effects. Male. Melphalan / administration & dosage. Melphalan / adverse effects. Middle Aged. Neoadjuvant Therapy. Neoplasm Recurrence, Local / surgery. Radiotherapy, Adjuvant. Salvage Therapy. Survival Analysis. Tumor Necrosis Factor-alpha / administration & dosage. Tumor Necrosis Factor-alpha / adverse effects

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  • [Copyright] Copyright 2000 Harcourt Publishers Ltd.
  • (PMID = 11078614.001).
  • [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] Clinical Trial; Journal Article
  • [Publication-country] ENGLAND
  • [Chemical-registry-number] 0 / Tumor Necrosis Factor-alpha; 80168379AG / Doxorubicin; 82115-62-6 / Interferon-gamma; Q41OR9510P / Melphalan; UM20QQM95Y / Ifosfamide
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13. Grünhagen DJ, de Wilt JH, Verhoef C, van Geel AN, Eggermont AM: TNF-based isolated limb perfusion in unresectable extremity desmoid tumours. Eur J Surg Oncol; 2005 Oct;31(8):912-6
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  • [Title] TNF-based isolated limb perfusion in unresectable extremity desmoid tumours.
  • BACKGROUND: Desmoid tumours are soft tissue sarcomas with local aggressive behaviour and a high rate of local recurrence after treatment.
  • Although they do not tend to metastasise systemically, the local aggressiveness can lead to situations in which limb-preserving surgery cannot be performed without severe disability.
  • As isolated limb perfusion (ILP) with TNF and melphalan has proven to be extremely effective in the treatment of soft tissue sarcoma, we studied its potential in locally advanced extremity desmoid tumours.
  • Local surgical therapy with preservation of limb function was impossible in all patients due to large or multifocal tumours, multiple recurrences or extensive previous treatment.
  • Perfusions were performed with 4-3mg TNF and 10-13 mg/l limb volume melphalan form leg and arm perfusions, respectively.
  • Local control was obtained after 10/12 ILPs and in the other two patients through repeat ILP and systemic chemotherapy, thus leading to an overall local control rate of 100%.
  • CONCLUSION: ILP is a very effective treatment option in the multimodality treatment of limb desmoid tumours.
  • [MeSH-major] Antineoplastic Agents / administration & dosage. Antineoplastic Agents, Alkylating / administration & dosage. Chemotherapy, Cancer, Regional Perfusion. Dermoid Cyst / drug therapy. Lower Extremity / pathology. Melphalan / administration & dosage. Soft Tissue Neoplasms / drug therapy. Tumor Necrosis Factor-alpha / administration & dosage. Upper Extremity / pathology
  • [MeSH-minor] Adolescent. Adult. Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Disease Progression. Female. Humans. Limb Salvage. Male. Middle Aged. Neoplasm Recurrence, Local / drug therapy. Prospective Studies. Remission Induction. Treatment Outcome

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  • (PMID = 16098709.001).
  • [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 / Tumor Necrosis Factor-alpha; Q41OR9510P / Melphalan
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14. Noorda EM, Vrouenraets BC, Nieweg OE, Kroon BB: Isolated limb perfusion in regional melanoma. Surg Oncol Clin N Am; 2006 Apr;15(2):373-84
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  • [Title] Isolated limb perfusion in regional melanoma.
  • Randomized studies are needed to further establish the role of perfusion as an adjuvant treatment for resectable recurrences of melanoma.
  • Unresectable limb melanoma is the primary indication for perfusion.
  • Better response rates tend to be seen when TNF-a is used in patients who have a high tumor load.
  • The long-term health-related quality of life of survivors of melanoma who underwent treatment with perfusion is comparable to that of their healthy peers in the general Dutch population.
  • [MeSH-major] Chemotherapy, Cancer, Regional Perfusion. Lower Extremity. Melanoma / drug therapy. Perfusion. Skin Neoplasms / drug therapy. Upper Extremity
  • [MeSH-minor] Chemotherapy, Adjuvant. Humans. Neoplasm Recurrence, Local / drug therapy. Neoplasm Recurrence, Local / prevention & control. Neoplasm Staging

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  • (PMID = 16632221.001).
  • [ISSN] 1055-3207
  • [Journal-full-title] Surgical oncology clinics of North America
  • [ISO-abbreviation] Surg. Oncol. Clin. N. Am.
  • [Language] eng
  • [Publication-type] Journal Article; Review
  • [Publication-country] United States
  • [Number-of-references] 50
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15. Noriyuki T, Shimatani K, Shintaku S, Uchida T, Asahara T, Nishi T, Nishimura S, Nishino R, Okamoto N, Sanefuji H: [Local advanced lung cancer invaded thoracic vertebral bodies with unruptured cerebral aneurysm]. Kyobu Geka; 2003 Mar;56(3):183-9
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  • A 57-year-old man presented with the chief complaint of left shoulder pain in June 2001, and paridrosis of left upper trunk and left upper limb in July 2001.
  • Head magnetic resonance imaging (MRI) showed 8 mm sized unrupture aneurysm of left middle cerebral artery, and chest computed tomography (CT) showed the lung tumor invaded thoracic vertebral bodies.
  • The prevented clipping of unrupture aneurysm was performed at 11th September 2001, and left upper lobectomy, hemivertebrectomy and reconstruction of thoracic vertebral body (Th 3-5) with Modul' ICS at 12th October 2001.
  • After the radiotherapy (50 Gy), chemotherapy (gemcitabine and vinorelbine) was performed.
  • But the radiation pneumonia was occurred and chemotherapy was intermitted.
  • The prevented clipping of unrupture cerebral aneurysm and the reconstruction of thoracic vertebral body (Th 3-5) with Modul' ICS were useful for the radical operation of the local advanced lung cancer.
  • [MeSH-minor] Humans. Male. Middle Aged. Neoplasm Invasiveness. Thoracic Surgical Procedures / methods

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  • (PMID = 12649907.001).
  • [ISSN] 0021-5252
  • [Journal-full-title] Kyobu geka. The Japanese journal of thoracic surgery
  • [ISO-abbreviation] Kyobu Geka
  • [Language] jpn
  • [Publication-type] Case Reports; English Abstract; Journal Article
  • [Publication-country] Japan
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16. Bien E, Stachowicz-Stencel T, Balcerska A, Godzinski J, Kazanowska B, Perek-Polnik M, Madziara W, Rybczynska A, Kurylak A, Zalewska-Szewczyk B, Peregud-Pogorzelski J: Angiosarcoma in children - still uncontrollable oncological problem. The report of the Polish Paediatric Rare Tumours Study. Eur J Cancer Care (Engl); 2009 Jul;18(4):411-20
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  • The report of the Polish Paediatric Rare Tumours StudyAngiosarcoma is a rare, highly malignant vascular neoplasm with little data available on its clinical course and management in children.
  • Ten children with angiosarcoma (M/F: 6/4; aged 2, 3-16 years) registered in Polish Paediatric Rare Tumours and Soft Tissue Sarcomas Studies between 1992 and 2006.
  • Primary tumour exceeded 5 cm in seven patients and affected mainly deep tissues (heart-2, head/neck, bladder, brain, liver and upper limb - one patient each).
  • All patients received supplementing chemotherapy with no response in four.
  • Three of five secondary tumour resections proved complete.
  • Relapsed patients received chemotherapy +/- radiotherapy and surgery (three).
  • The response to chemotherapy is poor and the large number of metastatic recurrences suggests a need for systemic therapy modifications.
  • [MeSH-major] Hemangiosarcoma / pathology. Hemangiosarcoma / therapy. Sarcoma / pathology. Sarcoma / therapy
  • [MeSH-minor] Adolescent. Antineoplastic Agents / therapeutic use. Child. Child, Preschool. Disease Progression. Humans. Male. Poland / epidemiology. Prognosis. Radiotherapy. Recurrence. Retrospective Studies. Survival Rate

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  • (PMID = 19490008.001).
  • [ISSN] 1365-2354
  • [Journal-full-title] European journal of cancer care
  • [ISO-abbreviation] Eur J Cancer Care (Engl)
  • [Language] eng
  • [Publication-type] Journal Article; Multicenter Study
  • [Publication-country] England
  • [Chemical-registry-number] 0 / Antineoplastic Agents
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17. Hornick JL, Jaffe ES, Fletcher CD: Extranodal histiocytic sarcoma: clinicopathologic analysis of 14 cases of a rare epithelioid malignancy. Am J Surg Pathol; 2004 Sep;28(9):1133-44
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  • Histiocytic sarcoma is a rare malignant neoplasm that occurs in lymph nodes, skin, and the gastrointestinal tract.
  • Seven tumors arose in soft tissue (6 lower limb; 1 upper limb), 5 in the gastrointestinal tract (1 involving both stomach and colon, 1 ileum, 2 rectum, 1 anus), 1 in the nasal cavity, and 1 in the lung.
  • Binucleated cells were common, and 6 cases contained tumor giant cells.
  • Six patients were treated with postoperative radiation and 7 with chemotherapy (CHOP or ProMACE-MOPP).
  • Two tumors recurred locally, and 5 patients developed distant spread: 3 to lymph nodes, 1 to lung, and 1 to bone.
  • At the last follow-up, 2 patients have died of disseminated disease, 4 and 5 months following initial diagnosis.
  • Histiocytic sarcoma may arise primarily in soft tissue and shows reproducible histologic features, including abundant eosinophilic cytoplasm and a prominent inflammatory infiltrate.
  • Tumor size may be a prognostic factor.

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  • (PMID = 15316312.001).
  • [ISSN] 0147-5185
  • [Journal-full-title] The American journal of surgical pathology
  • [ISO-abbreviation] Am. J. Surg. Pathol.
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] United States
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18. 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.
  • 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.
  • [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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19. Wasner G, Hilpert F, Schattschneider J, Binder A, Pfisterer J, Baron R: Docetaxel-induced nail changes--a neurogenic mechanism: a case report. J Neurooncol; 2002 Jun;58(2):167-74
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  • Docetaxel is a new taxoid widely used in chemotherapy for advanced breast cancer and other solid malignancies.
  • We report a patient with a complete peripheral palsy of the right arm due to advanced breast cancer with diffuse tumor infiltration of the brachial plexus.
  • Treatment with docetaxel led to onycholysis at all extremities except the paretic hand.
  • In summary, a severe denervation of small and large fibers of the right upper limb was revealed.
  • [MeSH-major] Arm. Breast Neoplasms / complications. Breast Neoplasms / drug therapy. Nail Diseases / chemically induced. Paclitaxel / adverse effects. Paclitaxel / analogs & derivatives. Paralysis / etiology. Taxoids
  • [MeSH-minor] Afferent Pathways / physiopathology. Brachial Plexus / pathology. Efferent Pathways / physiopathology. Female. Humans. Middle Aged. Motor Neurons / physiology. Neoplasm Invasiveness. Neural Conduction. Neurologic Examination. Neurons, Afferent / physiology. Parasympathetic Nervous System / physiopathology. Sensory Thresholds. Skin / innervation. Sympathetic Nervous System / physiopathology. Vibration

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  • (PMID = 12164689.001).
  • [ISSN] 0167-594X
  • [Journal-full-title] Journal of neuro-oncology
  • [ISO-abbreviation] J. Neurooncol.
  • [Language] eng
  • [Publication-type] Case Reports; Journal Article; Research Support, Non-U.S. Gov't
  • [Publication-country] United States
  • [Chemical-registry-number] 0 / Taxoids; 15H5577CQD / docetaxel; P88XT4IS4D / Paclitaxel
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20. Eyesan SU, Obalum DC, Onovo DO, Ketiku KK, Abdulkareem FB: Indications for ablative surgery in extremity musculoskeletal tumours. Nig Q J Hosp Med; 2009 Sep-Dec;19(4):206-9
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  • BACKGROUND: Surgical options for treatment of extremity musculoskeletal tumours include excision [limb sparing] surgery or amputation [limb ablation].
  • Ablative surgery is for advanced extremity musculoskeletal tumours when limb salvage surgery is not feasible.
  • Data such as age, gender, presenting complaints, anatomic location of the tumour, clinical stage, type of ablative surgery and adjuvant treatment offered, histologic type of tumour, and treatment outcome were documented.
  • RESULTS: Nineteen patients had ablative surgery as a mode of treatment.
  • Seven patients [6 males and 1 female] refused ablative surgery and voluntarily discontinued treatment.
  • Most tumours were located in the lower limb and all patients that had ablative treatment presented with stage 3 or 4 disease.
  • Osteogenic sarcoma was the most common diagnosis, accounting for 4 cases [21.1%].
  • Six patients [31.6%] with non-malignant tumours had ablative surgery due to either late presentation or inaccurate preoperative diagnosis.
  • Adjuvant chemotherapy was prescribed for all patients.
  • The recurrence and survival rates could not be determined for each tumour as the patients were lost to follow-up soon after surgery with average post operative follow up of 5.5 months.
  • [MeSH-major] Amputation / methods. Bone Neoplasms / surgery. Lower Extremity / surgery. Neoplasms, Bone Tissue / surgery. Upper Extremity / surgery
  • [MeSH-minor] Adolescent. Adult. Aged. Chemotherapy, Adjuvant. Child. Child, Preschool. Female. Follow-Up Studies. Hospitals, Special. Humans. Male. Middle Aged. Neoplasm Staging. Nigeria. Orthopedics. Prospective Studies. Radiotherapy, Adjuvant. Treatment Outcome. Young Adult

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  • (PMID = 20836332.001).
  • [ISSN] 0189-2657
  • [Journal-full-title] Nigerian quarterly journal of hospital medicine
  • [ISO-abbreviation] Nig Q J Hosp Med
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] Nigeria
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21. Bonvalot S, Rimareix F, Causeret S, Le Péchoux C, Boulet B, Terrier P, Le Cesne A, Muret J: Hyperthermic isolated limb perfusion in locally advanced soft tissue sarcoma and progressive desmoid-type fibromatosis with TNF 1 mg and melphalan (T1-M HILP) is safe and efficient. Ann Surg Oncol; 2009 Dec;16(12):3350-7
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  • [Title] Hyperthermic isolated limb perfusion in locally advanced soft tissue sarcoma and progressive desmoid-type fibromatosis with TNF 1 mg and melphalan (T1-M HILP) is safe and efficient.
  • BACKGROUND: In a prior randomized phase II trial comparing hyperthermic isolated limb perfusion (HILP) with four different doses of tumor necrosis factor alpha (TNF-alpha), no dose effect was detected for response, but systemic toxicity was far lower with low-dose TNF-alpha.
  • The objective of the present study was to confirm these data on a larger sample size of locally advanced or recurrent extremity soft tissue sarcomas with low-dose TNF-alpha.
  • The remnant tumor was resected 2 months later.
  • The site/size were: 30 patients/57 mm and 70 patients/86 mm for the upper and lower limbs, respectively.
  • Tumor grades (FNCLCC) were 1 (23 patients), 2 (34 patients), and 3 (43 patients).
  • Fifty-one patients had received systemic chemotherapy before HILP.
  • Age, sex, tumor size, recurrence, uni- or multifocality, grade, preoperative chemotherapy, and a previously irradiated field were not predictive of response or local toxicity.
  • [MeSH-major] Antineoplastic Agents, Alkylating / administration & dosage. Chemotherapy, Cancer, Regional Perfusion. Extremities / pathology. Fibromatosis, Aggressive / therapy. Hyperthermia, Induced. Melphalan / administration & dosage. Sarcoma / therapy. Tumor Necrosis Factor-alpha / administration & dosage
  • [MeSH-minor] Adolescent. Adult. Aged. Drug Therapy, Combination. Female. Follow-Up Studies. Humans. Male. Middle Aged. Neoplasm Staging. Prognosis. Prospective Studies. Survival Rate. Young Adult

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  • (PMID = 19830495.001).
  • [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
  • [Chemical-registry-number] 0 / Antineoplastic Agents, Alkylating; 0 / Tumor Necrosis Factor-alpha; Q41OR9510P / Melphalan
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22. Huang WR, Li R, Jing Y, Zhang YZ, Wu XX, Gao CJ, Bo J, Yu L, Wang QS, Da WM: [Salvage therapy with proteasome inhibitor bortezomib for relapsed and refractory multiple myeloma]. Zhongguo Shi Yan Xue Ye Xue Za Zhi; 2006 Dec;14(6):1146-50
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  • [Title] [Salvage therapy with proteasome inhibitor bortezomib for relapsed and refractory multiple myeloma].
  • This observation is to study the clinical treatment effect of bortezomib in one relapsed multiple myeloma (MM) patient and one primary refractory MM patient.
  • And the disease became further aggressive with 4 courses of chemical therapy regimen including methylprednisolone, Arsenic trioxide, dexamethasone, cyclophosphamide, mitoxantrone, VM-26.
  • Bone destruction became severe, and there was a plasmacytoma about 5 x 6 cm on the patient's right upper chest wall.
  • Therefore, the patient received therapy of bortezomib combined with doxrubicin, dexamethasone and thalidomide (VADT).
  • After one course of therapy with this VADT regimen, IgA in blood plasma decreased from 54 g/L to 6.6 g/L, and abnormal plasma cells in bone marrow decreased from 40% to 0.6%, and plasmacytoma on the patient's right upper chest wall almost absorbed.
  • But there was no obvious clinical effect after the second course of therapy of VADT, and the disease status became progressive again.
  • The second patient was MM patient with a light chain kappa type, III B stage.
  • There was no any effect after two courses of VAD therapy and one course of MOFP therapy.
  • The patient acquired near complete remission after one course of treatment with VADT.
  • And this patient got complete remission after three consecutive VADT therapy.
  • All the side effects could be tolerated and became disappeared after contraposing treatment and stopping the bortezomib regimen therapy.
  • The second patient complicated with severe subacute left hemiplegia after the bortezomib dose had been increased to 1.45 mg/m2 at the third time of the first VADT course and the complication became worst at the following day.
  • The upper limb muscle strength was only 1 grade and the lower limb muscle strength was 2 grade.
  • Then the condition improved with the support therapy and gradually recovered after two weeks.
  • Therefore, bortezomib is an effective target drug for therapy in refractory multiple myeloma, and more attentions to the side effects should be paid in order to deal with those side effects in time.

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  • (PMID = 17204182.001).
  • [ISSN] 1009-2137
  • [Journal-full-title] Zhongguo shi yan xue ye xue za zhi
  • [ISO-abbreviation] Zhongguo Shi Yan Xue Ye Xue Za Zhi
  • [Language] CHI
  • [Publication-type] Case Reports; English Abstract; Journal Article
  • [Publication-country] China
  • [Chemical-registry-number] 0 / Antineoplastic Agents; 0 / Boronic Acids; 0 / Protease Inhibitors; 0 / Pyrazines; 69G8BD63PP / Bortezomib
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23. Asuquo ME, Ngim O, Ebughe G, Bassey EE: Skin cancers amongst four Nigerian albinos. Int J Dermatol; 2009 Jun;48(6):636-8
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  • The sites of the lesions included the head [squamous cell carcinoma (SCC) in two patients and basal cell carcinoma (BCC) in one patient] and the upper limb (melanoma).
  • All tumors were excised; in addition, patients with SCC and melanoma received adjuvant chemotherapy.
  • Two patients, one woman with SCC and the patient with melanoma, showed residual tumor because of inadequate excision.
  • [MeSH-minor] Adult. Female. Humans. Male. Neoplasm Recurrence, Local / epidemiology. Nigeria / epidemiology. Risk Factors. Sunlight / adverse effects. Young Adult

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  • (PMID = 19538377.001).
  • [ISSN] 1365-4632
  • [Journal-full-title] International journal of dermatology
  • [ISO-abbreviation] Int. J. Dermatol.
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] United States
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24. Gebhard S, Coindre JM, Michels JJ, Terrier P, Bertrand G, Trassard M, Taylor S, Château MC, Marquès B, Picot V, Guillou L: Pleomorphic liposarcoma: clinicopathologic, immunohistochemical, and follow-up analysis of 63 cases: a study from the French Federation of Cancer Centers Sarcoma Group. Am J Surg Pathol; 2002 May;26(5):601-16
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  • Tumor size ranged from 2 to 23 cm (median 10 cm).
  • Tumor locations included lower extremity (36.5%), especially the thigh (28.5%), limb girdles (17.5%), upper extremity (16%), thoracoabdominal wall (9.5%), and internal trunk (20.5%).
  • Tumor necrosis was observed in 51 (81%) cases, vascular invasion in three, and mitotic counts ranged from 3 to 124 per 10 high power fields (median 25).
  • Treatment procedures in 51 patients consisted of simple tumorectomy (16) and wide excision (33).
  • Five and 31 patients received neoadjuvant and adjuvant chemotherapy and/or radiation therapy, respectively.
  • Seventeen patients (35%) died of disease, of whom none was metastatic at diagnosis.
  • Patient age > or =60 years, truncal tumor location, deep situation, tumor size >5 cm, vascular invasion, and incomplete tumor excision were significant adverse prognostic factors.
  • Tumor grade and histology did not affect patient outcome.
  • In conclusion, pleomorphic liposarcoma is a rare, often deep-seated and limb-based aggressive and metastasizing neoplasm of late adulthood.
  • It shows a wide range of morphologic appearances, but tumor grade and histology have no effect on patient outcome.
  • [MeSH-major] Liposarcoma / pathology. Soft Tissue Neoplasms / pathology
  • [MeSH-minor] Adolescent. Adult. Aged. Aged, 80 and over. Biomarkers, Tumor / analysis. Disease-Free Survival. Female. Humans. Immunohistochemistry. Male. Middle Aged. Neoplasm Proteins / analysis. Survival Rate. Treatment Outcome

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  • (PMID = 11979090.001).
  • [ISSN] 0147-5185
  • [Journal-full-title] The American journal of surgical pathology
  • [ISO-abbreviation] Am. J. Surg. Pathol.
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] United States
  • [Chemical-registry-number] 0 / Biomarkers, Tumor; 0 / Neoplasm Proteins
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25. Lan XL, Zhang YX, He Y, Sun X, An R, Gao ZR, Cao GX: [Feasibility of apoptosis-imaging agent 99mTc-HYNIC-annexin V in early assessment of chemotherapeutic effect on tumor models]. Zhonghua Zhong Liu Za Zhi; 2008 Oct;30(10):737-40
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  • [Title] [Feasibility of apoptosis-imaging agent 99mTc-HYNIC-annexin V in early assessment of chemotherapeutic effect on tumor models].
  • Normal Kunming mice received inoculation of Ehrlich ascites cells into the right upper limb.
  • After the tumor reached 1 cm in diameter, the mice were randomly divided into saline treatment group as control and cyclophosphamide (150 mg/kg injected intraperitoneally) treatment group.
  • 99mTc-HYNIC-annexin V was injected intravenously at 1 h and 24 h after treatment.
  • Region of interest technique (ROI) from the SPECT images taken at different time was used to get the ratio of tumor/limb in each group.
  • RESULTS: After treatment with saline, only little amount of the radiolabeled tracer could be seen in the tumor and showed weak image of the tumor.
  • But after 24 h of treatment with cyclophosphamide, clear image on the tumor could be seen.
  • 24 h after the treatment of cyclophosphamide, the ratio of tumor/limb was (6.27 +/- 0.24) which was much higher than that at 24 h after treatment with saline (2.36 +/- 0.18) and that at 1 h after cyclophosphamide treatment (4.00 +/- 0.38).
  • At 24 h after cyclophosphamide treatment, TUNEL staining showed a significantly higher rate of apoptotic cells in the mice.
  • CONCLUSION: 99mTc-HYNIC-annexin V can be used as an apoptosis-imaging agent to detect and evaluate the early curative effect after chemotherapy.
  • The effective detection of apoptotic response in tumor with 99mTc-HYNIC-annexin V requires a 24 h interval after chemotherapy.
  • [MeSH-major] Annexin A5. Apoptosis. Carcinoma, Ehrlich Tumor / radionuclide imaging. Cyclophosphamide / therapeutic use. Organotechnetium Compounds
  • [MeSH-minor] Animals. Antineoplastic Agents, Alkylating / therapeutic use. Male. Mice. Neoplasm Transplantation. Radiopharmaceuticals / pharmacokinetics. Random Allocation. Tissue Distribution. Tomography, Emission-Computed, Single-Photon

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  • (PMID = 19173800.001).
  • [ISSN] 0253-3766
  • [Journal-full-title] Zhonghua zhong liu za zhi [Chinese journal of oncology]
  • [ISO-abbreviation] Zhonghua Zhong Liu Za Zhi
  • [Language] chi
  • [Publication-type] English Abstract; Evaluation Studies; Journal Article; Research Support, Non-U.S. Gov't
  • [Publication-country] China
  • [Chemical-registry-number] 0 / Annexin A5; 0 / Antineoplastic Agents, Alkylating; 0 / Organotechnetium Compounds; 0 / Radiopharmaceuticals; 0 / technetium Tc 99m HYNIC annexin V; 8N3DW7272P / Cyclophosphamide
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26. Santini M, Vicidomini G, Di Marino MP, Baldi A: Solitary muscle metastasis from lung carcinoma. J Cardiovasc Surg (Torino); 2001 Oct;42(5):701-2
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  • Limb muscle metastasis from lung cancer is extremely rare.
  • We present a case of a 71-year-old man who presented with a solitary metastasis to his right lower limb two months after right upper lobectomy for lung cancer (stage: T2N0M0).
  • Twenty-four months after surgical excision and chemotherapy he is alive without signs of neoplastic disease.
  • [MeSH-minor] Aged. Antineoplastic Agents / therapeutic use. Cisplatin / therapeutic use. Humans. Male. Neoplasm Metastasis

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  • (PMID = 11562606.001).
  • [ISSN] 0021-9509
  • [Journal-full-title] The Journal of cardiovascular surgery
  • [ISO-abbreviation] J Cardiovasc Surg (Torino)
  • [Language] eng
  • [Publication-type] Case Reports; Journal Article
  • [Publication-country] Italy
  • [Chemical-registry-number] 0 / Antineoplastic Agents; Q20Q21Q62J / Cisplatin
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27. Orbach D, Glorion C, Mary P, Freneaux P, Brisse H, Helfre S, Schleiermacher G, Pacquement H: [Malignant tumours of the locomotor apparatus in children: an "intermediate" prognosis]. Rev Prat; 2007 May 31;57(10):1080-6
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  • [Transliterated title] Les tumeurs malignes de l'appareil locomoteur en pédiatrie: un pronostic "intermédiaire".
  • Malignant tumours of the locomotor apparatus in children mainly comprise bone tumours such as osteosarcoma or Ewing's sarcoma and soft tissue sarcomas such as rhabdomyosarcoma.
  • The diagnosis must be considered in any case of progressively worsening limb pain at a fixed site, possibly associated with a soft tissue mass.
  • Standard radiological examinations, Doppler ultrasound, then MRI confirm the diagnosis of a solid tumour, allow staging and may sometimes suggest the invasive nature of the tumour.
  • The biopsy provides a precise histological diagnosis.
  • A frozen section is usually necessary to confirm this diagnosis using the currently available genetic biology tools.
  • Treatment must be adapted to the known prognostic factors, mainly tumour operability, initial size, histological type, response to neoadjuvant chemotherapy and initial staging.
  • Treatment must comprise neoadjuvant chemotherapy followed by local treatment combining radical surgery with reconstruction if necessary and sometimes external beam radiotherapy.
  • This treatment must be completed by postoperative adjuvant chemotherapy resulting in an average total duration of treatment between 6 and 12 months.
  • Long-term follow-up is designed to ensure absence of disease recurrence, attentive orthopaedic follow-up and absence of late sequelae related to anticancer therapy.
  • [MeSH-major] Bone Neoplasms / therapy. Lower Extremity / pathology. Muscle Neoplasms / therapy. Soft Tissue Neoplasms / therapy. Upper Extremity / pathology
  • [MeSH-minor] Biopsy. Chemotherapy, Adjuvant. Child. Diagnostic Imaging. Follow-Up Studies. Humans. Neoadjuvant Therapy. Neoplasm Invasiveness. Neoplasm Recurrence, Local / pathology. Neoplasm Staging. Osteosarcoma / therapy. Prognosis. Radiotherapy, Adjuvant. Rhabdomyosarcoma / therapy. Sarcoma / therapy. Sarcoma, Ewing / therapy. Treatment Outcome

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  • (PMID = 17844801.001).
  • [ISSN] 0035-2640
  • [Journal-full-title] La Revue du praticien
  • [ISO-abbreviation] Rev Prat
  • [Language] fre
  • [Publication-type] English Abstract; Journal Article
  • [Publication-country] France
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28. Aloia TA, Grubbs E, Onaitis M, Mosca PJ, Cheng TY, Seigler H, Tyler DS: Predictors of outcome after hyperthermic isolated limb perfusion: role of tumor response. Arch Surg; 2005 Nov;140(11):1115-20
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  • [Title] Predictors of outcome after hyperthermic isolated limb perfusion: role of tumor response.
  • HYPOTHESIS: Analysis of multiple clinical and pathological factors in patients undergoing therapeutic hyperthermic isolated limb perfusion for extremity melanoma can identify variables with prognostic significance.
  • DESIGN: Retrospective review of a prospectively collected limb perfusion database with a median follow-up interval of 32.2 months.
  • PATIENTS: We report a series of 59 consecutive therapeutic hyperthermic isolated limb perfusion treatments (14 upper extremity and 45 lower extremity) in 54 patients with melanoma from January 1, 1995, through December 31, 2002, using a standard melphalan dosing protocol.
  • At the time of perfusion, 31 cases had fewer than 10 lesions, with none greater than 3 cm in diameter.
  • Thirty-three (56%) of the 59 perfusion treatments resulted in a persistent complete response of at least 6 months' duration.
  • Those patients achieving a complete response to therapy had a survival advantage (P = .03).
  • CONCLUSION: In patients undergoing therapeutic hyperthermic isolated limb perfusion for in-transit melanoma, the ability to achieve a complete response following treatment, independent of regional nodal status, was the strongest predictor of long-term survival.
  • [MeSH-major] Chemotherapy, Cancer, Regional Perfusion / methods. Hyperthermia, Induced. Melanoma / drug therapy
  • [MeSH-minor] Aged. Chi-Square Distribution. Extremities. Female. Humans. Male. Middle Aged. Neoplasm Metastasis. Neoplasm Recurrence, Local. Prognosis. Retrospective Studies. Survival Rate. Treatment Outcome

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  • (PMID = 16301451.001).
  • [ISSN] 0004-0010
  • [Journal-full-title] Archives of surgery (Chicago, Ill. : 1960)
  • [ISO-abbreviation] Arch Surg
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] United States
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29. 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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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [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.
  • 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.
  • 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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30. Poulsen M, Rischin D, Walpole E, Harvey J, Mackintosh J, Ainslie J, Hamilton C, Keller J, Tripcony L, Trans-Tasman Radiation Oncology Group: High-risk Merkel cell carcinoma of the skin treated with synchronous carboplatin/etoposide and radiation: a Trans-Tasman Radiation Oncology Group Study--TROG 96:07. J Clin Oncol; 2003 Dec 1;21(23):4371-6
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  • PURPOSE: The effectiveness of synchronous carboplatin, etoposide, and radiation therapy was prospectively assessed in a group of patients with high-risk Merkel cell carcinoma (MCC) of the skin.
  • PATIENTS AND METHODS: Patients were eligible if they had disease localized to the primary site and nodes, and were required to have at least one of the following high risk features: recurrence after initial therapy, involved nodes, primary tumor size greater than 1 cm, gross residual disease after surgery, or occult primary with nodes.
  • Radiation was delivered to the primary site and nodes to a dose of 50 Gy in 25 fractions over 5 weeks and synchronous carboplatin (area under the curve, 4.5) and intravenous etoposide 80 mg/m2 days 1 to 3 was given in weeks 1, 4, 7, and 10.
  • The sites involved were head and neck (22 patients), occult primary (13 patients), upper limb (eight patients), lower limb (eight patients), and trunk (two patients).
  • There were no treatment related deaths.
  • Tumor site and the presence of nodes were factors that were predictive for local control and survival.
  • CONCLUSION: High levels of locoregional control and survival have been achieved with the addition of chemotherapy to radiation treatment for high-risk MCC of the skin.
  • [MeSH-major] Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Carcinoma, Merkel Cell / drug therapy. Carcinoma, Merkel Cell / radiotherapy. Skin Neoplasms / drug therapy. Skin Neoplasms / radiotherapy
  • [MeSH-minor] Adult. Aged. Aged, 80 and over. Carboplatin / administration & dosage. Combined Modality Therapy. Etoposide / administration & dosage. Female. Humans. Male. Middle Aged. Neoplasm Recurrence, Local / drug therapy. Neoplasm Recurrence, Local / radiotherapy. Prospective Studies. Radiation Oncology. Risk Factors. Societies, Medical. Survival Rate

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  • (PMID = 14645427.001).
  • [ISSN] 0732-183X
  • [Journal-full-title] Journal of clinical oncology : official journal of the American Society of Clinical Oncology
  • [ISO-abbreviation] J. Clin. Oncol.
  • [Language] eng
  • [Publication-type] Clinical Trial; Journal Article
  • [Publication-country] United States
  • [Chemical-registry-number] 6PLQ3CP4P3 / Etoposide; BG3F62OND5 / Carboplatin
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31. Goubier JN, Teboul F, Oberlin C: [Desmoid tumors and brachial plexus]. Chir Main; 2003 Aug;22(4):203-6

  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • The aim of our paper is to assess the functional results and specific difficulties encountered in the treatment of desmoid tumors located near the brachial plexus.
  • Seven patients with a desmoid tumor in this region were followed for at least 2 years (average 59 months).
  • Three patient had postoperatively chemotherapy and 1 patient had radiation therapy.
  • At review, none of the 7 patients had had to undergo upper limb amputation and the mean functional results were good or excellent in 6 patients (mean MSTS = 72.8).
  • The margins of desmoid tumor resection have to be wide to avoid local recurrence.
  • However, nerves and blood vessels have to be preserved in order to maintain upper limb function and there may well be a need for adjuvant therapy.
  • [MeSH-major] Brachial Plexus. Fibromatosis, Aggressive / surgery. Soft Tissue Neoplasms / surgery
  • [MeSH-minor] Adult. Aged. Female. Humans. Male. Middle Aged. Neoplasm Recurrence, Local / epidemiology

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  • (PMID = 14611074.001).
  • [ISSN] 1297-3203
  • [Journal-full-title] Chirurgie de la main
  • [ISO-abbreviation] Chir Main
  • [Language] fre
  • [Publication-type] English Abstract; Journal Article; Review
  • [Publication-country] France
  • [Number-of-references] 10
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32. Sugimoto K, Nakahara I, Nishikawa M: Bilateral metachronous germinoma of the basal ganglia occurring long after total removal of a mature pineal teratoma: case report. Neurosurgery; 2002 Mar;50(3):613-6; discussion 616-7
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  • OBJECTIVE AND IMPORTANCE: We report the extremely rare occurrence of a second germ cell tumor at a different site and with different histological types long after total removal of a mature pineal teratoma.
  • Neuroradiological studies revealed a tumor in the pineal region.
  • The tumor was totally removed.
  • Histologically, the tumor proved to be a mature teratoma.
  • The patient received no adjuvant therapy and was followed in the outpatient clinic.
  • Three years later, he was readmitted with transient left upper limb weakness and vomiting.
  • Neuroradiological studies showed a tumor in the bilateral basal ganglia.
  • INTERVENTION: The second tumor, which was located in the right basal ganglion, was partially removed for biopsy.
  • Histologically, the tumor proved to be a germinoma.
  • The patient received three cycles of combination chemotherapy consisting of carboplatin and etoposide with radiotherapy.
  • After the second course of chemotherapy, magnetic resonance imaging studies revealed no evidence of the tumor.
  • CONCLUSION: The second tumor was considered to be a de novo metachronous neoplasm rather than a recurrence of the original mature teratoma.
  • We think that if primordial germ cell groups exist along the midline of the brain, more than two primordial germ cell groups could give rise to metachronous neoplasms at different sites and with different histological types.
  • [MeSH-minor] Antineoplastic Agents / administration & dosage. Antineoplastic Agents, Phytogenic / administration & dosage. Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Carboplatin / administration & dosage. Child. Combined Modality Therapy. Etoposide / administration & dosage. Humans. Magnetic Resonance Imaging. Male

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  • (PMID = 11841731.001).
  • [ISSN] 0148-396X
  • [Journal-full-title] Neurosurgery
  • [ISO-abbreviation] Neurosurgery
  • [Language] eng
  • [Publication-type] Case Reports; Journal Article; Review
  • [Publication-country] United States
  • [Chemical-registry-number] 0 / Antineoplastic Agents; 0 / Antineoplastic Agents, Phytogenic; 6PLQ3CP4P3 / Etoposide; BG3F62OND5 / Carboplatin
  • [Number-of-references] 11
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33. Temple CL, Ross DC, Magi E, DiFrancesco LM, Kurien E, Temple WJ: Preoperative chemoradiation and flap reconstruction provide high local control and low wound complication rates for patients undergoing limb salvage surgery for upper extremity tumors. J Surg Oncol; 2007 Feb 1;95(2):135-41
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Preoperative chemoradiation and flap reconstruction provide high local control and low wound complication rates for patients undergoing limb salvage surgery for upper extremity tumors.
  • BACKGROUND AND OBJECTIVES: Neoadjuvant protocols in the management of upper extremity sarcoma have improved local control rates but have been associated with high complication rates.
  • We present a refinement of the Eilber protocol using judicious preoperative chemoradiation, limb salvage surgery, and flap coverage to achieve high local control rates with acceptable wound healing complications.
  • METHODS: Patients presenting with upper extremity neoplasms from 1986 to 2002 were treated with a modified Eilber protocol, consisting of 3 days of adriamycin (30 mg/day) and sequential radiotherapy (300 cGy/day for 10 days).
  • Limb salvage surgery with flap coverage where needed was performed 4-8 weeks later.
  • RESULTS: Fifty-three consecutive patients with upper extremity tumors were treated and followed for a mean of 6.1 years.
  • Limb salvage was achieved in all patients.
  • Major complications occurred in 11%, were all flap related (partial flap loss, venous congestion), and went on to heal promptly with treatment.
  • CONCLUSION: This modified Eilber protocol achieved 96% local control for upper extremity tumors with a wound complication rate of 11%.
  • [MeSH-major] Limb Salvage. Reconstructive Surgical Procedures. Sarcoma / surgery. Soft Tissue Neoplasms / surgery. Surgical Flaps
  • [MeSH-minor] Adolescent. Adult. Aged. Antibiotics, Antineoplastic / administration & dosage. Combined Modality Therapy. Doxorubicin / administration & dosage. Drug Administration Schedule. Follow-Up Studies. Humans. Middle Aged. Neoadjuvant Therapy. Neoplasm Recurrence, Local / mortality. Preoperative Care. Prospective Studies. Radiotherapy Dosage. Upper Extremity

  • MedlinePlus Health Information. consumer health - Plastic and Cosmetic Surgery.
  • MedlinePlus Health Information. consumer health - Soft Tissue Sarcoma.
  • ClinicalTrials.gov. clinical trials - ClinicalTrials.gov .
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  • [Copyright] (c) 2007 Wiley-Liss, Inc.
  • (PMID = 17262730.001).
  • [ISSN] 0022-4790
  • [Journal-full-title] Journal of surgical oncology
  • [ISO-abbreviation] J Surg Oncol
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] United States
  • [Chemical-registry-number] 0 / Antibiotics, Antineoplastic; 80168379AG / Doxorubicin
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