title: Isolated limb perfusion with melphalan for femoral metastases of breast cancer: case report.
abstract: OBJECTIVE
  Complications of bone destruction occur in 10-29% of breast cancer patients with skeletal metastases. Palliative treatment consists of systemic chemotherapy, hormonal treatment, radiotherapy, and/or surgery in the case of (impending) fracture. A case is presented where isolated limb perfusion was applied for this indication.
  
  
  METHODS
  A 43-year-old woman with extensive femoral metastases of breast cancer with impending fracture was treated with isolated limb perfusion (ILP) with melphalan. Radiotherapy had resulted only in pain reduction, and intramedullary fixation was opted against because stable fixation was considered not feasible due to the location of the metastases. ILP with high-dose melphalan (10-20 times the amount that can be administered systemically) under normothermic (37-38 degrees C) conditions, resulted in partial remission and reossification.
  
  
  RESULTS
  One year after ILP, until her death 2 years later, due to progressive metastases at other sites, the patient was able to bear weight again on her left leg.
  
  
  CONCLUSIONS
  In selected patients with symptomatic large bone metastases from breast cancer, and no other treatment options, ILP with melphalan may be used for successful palliation.
authors.affiliation: Department of Surgery, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands. e.noorda@nki.nl
authors.forename: E M
authors.initials: EM
authors.lastname: Noorda
authors.forename: B C
authors.initials: BC
authors.lastname: Vrouenraets
authors.forename: O E
authors.initials: OE
authors.lastname: Nieweg
authors.forename: H M
authors.initials: HM
authors.lastname: Pinedo
authors.forename: B B R
authors.initials: BB
authors.lastname: Kroon
mesh_terms: D000328:Adult; D018906:Antineoplastic Agents, Alkylating / Q000008:administration & dosage*; D001943:Breast Neoplasms / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery; D010478:Chemotherapy, Cancer, Regional Perfusion; D003131:Combined Modality Therapy; D004334:Drug Administration Schedule; D005121:Extremities; D005260:Female; D005266:Femoral Neoplasms / Q000188:drug therapy* / Q000556:secondary*; D005598:Fractures, Spontaneous / Q000188:drug therapy; D006801:Humans; D008558:Melphalan / Q000008:administration & dosage*; D010166:Palliative Care
chemical_list: D018906:Antineoplastic Agents, Alkylating; D008558:Melphalan