Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0021843 (bowel obstruction)
 9,927 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The impact of para-aortic field radiation therapy upon survival was studied among 26 patients with para-aortic nodal metastases from carcinoma of the endometrium. Seventeen of these 26 patients received postoperative radiation therapy to the para-aortic field as a part of their primary therapy. Sixteen of the 17 also received adjuvant hormonal therapy. Nine of 17 patients (53%) are alive without evidence of disease (18-55 months) with a median survival time of 27 months. Of the remaining eight patients, six (35%) died of endometrial cancer at 6-38 months, with a median survival time of 14.5 months. Five of these patients had distant disease. Two of the 17 patients (12%) died of intestinal obstruction felt to be secondary to radiation enteritis, one of whom was disease free. No difference in survival was detected in patients treated with radiation therapy with microscopic versus macroscopic nodal involvement. Of the nine patients who did not receive para-aortic radiation, eight were treated with hormonal therapy (n = 6) or chemotherapy (n = 2). Seven patients died of disease from 5-28 months, with a median survival time of 13 months. One patient is alive at 12 months. Survival in the 17 patients treated with para-aortic radiation was better than the eight patients not treated with para-aortic radiation (p = 0.004). This survival difference remained significant for patients with microscopic but not macroscopic nodal disease. Para-aortic field radiation appears to improve survival, but has a significant complication rate, and should be reserved for patients with histologic evidence of para-aortic metastases.
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PMID:Radiation therapy for surgically proven para-aortic node metastasis in endometrial carcinoma. 152 60

In order to define prognostic factors in colorectal carcinoma, univariate and multivariate analyses were carried out on data from 113 Japanese patients treated in a typical general hospital in Japan. In the univariate analysis, a poor prognosis was seen in those with poorly differentiated adenocarcinoma, in tumors that perforated the visceral peritoneum or that invaded directly other organs or structures (T4), in metastasis to the nodes along the main vascular pedicle (N3), in lymphatic permeation, in blood vessel invasion, in peritoneal dissemination, in Dukes C stage, and in those with lesions presenting with large bowel obstruction. Of these, only lymph node metastasis and peritoneal dissemination had an independent prognostic significance when a multivariate Cox analysis was performed. The significant risk factors related to an obstructing tumor were determined by multivariate logistic regression analysis. The significant variables were patient's age, nodal involvement and peritoneal dissemination. Since lymph node metastasis and peritoneal dissemination proved significant in both multivariate analyses, we propose that the presence of large bowel obstruction is not an independent prognostic factor in patients with colorectal carcinoma. In poor-risk patients who have an obstructing tumor, a staged operation should be attempted for definitive curative surgery.
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PMID:Prognostic factors in Japanese patients with colorectal cancer: the significance of large bowel obstruction--univariate and multivariate analyses. 207 3

Twenty patients with FIGO stage III epithelial ovarian cancer who had undergone maximum cytoreductive surgery (including pelvic and paraaortic lymph node dissection) and combination chemotherapy (4-10 cycles, median 6) were treated with irradiation to the abdomen and pelvis with 30 Gy followed by diaphragmatic/paraaortic and pelvis boost fields to 42 and 51.6 Gy, respectively. Second-look laparotomy was not performed. Seventeen of 20 patients completed the planned course of radiation. In 2 cases, failure to complete treatment was related to acute hematologic toxicity, and 1 patient refused further treatment. Five patients (29%) required treatment breaks ranging from 8 to 16 days (median, 12 days) due to pancytopenia. Actuarial overall survival and relapse-free survival at 3 years for the 17 patients who completed radiation was 69 and 47%, respectively, with follow-up ranging from 19 to 53 months (median: 24, mean: 27.6 months). Seven patients (41%) relapsed within the abdomen alone and 2 patients developed extraabdominal lymph node metastasis as their sole site of failure. The prognostic factors evaluated for correlation with relapse-free survival included histologic subtype, grade, amount of residual disease at the time of surgery, and nodal involvement; only residual tumor at surgery (none vs less than or equal to 2 cm or greater than 2 cm) was found to be statistically significant (P less than 0.01). Three-year overall survival correlated with amount of residual disease following the initial cytoreductive surgery. It was 100% for patients with no residual disease, 66.7% for less than or equal to 2 cm, and 26.7% for those with greater than 2 cm residual disease, respectively. Radiation treatment was well tolerated, with only one patient developing treatment-related bowel obstruction 7 months after radiation therapy. The results of this planned trimodality treatment approach compare favorably with those reported following surgery and chemotherapy, particularly in patients who have been maximally cytoreduced.
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PMID:Radiation therapy in stage III ovarian cancer following surgery and chemotherapy: prognostic factors, patterns of relapse, and toxicity: a preliminary report. 222 72

Over a 20-year period, 168 cases of colorectal cancer were treated in a 50-bed rural hospital by 1 surgeon. The majority of the patients were older than 70 years of age. The stage of disease was comparatively advanced, with 71% of the patients having nodal or distant metastases, 19% with bowel obstruction, and 8% with perforation. The operability and resectability rates were 100% and 96%, respectively. The crude 5-year survival was 50% for the entire series. The 5-year survival after curative operations in which there was no gross residual tumor at the end of the operation was 63%, and the 5-year survival for resection of localized node-negative disease was 81%. The wound infection rate was 2%, and the operative mortality rate was 1% for combined elective and emergency operations. The results of treatment of colorectal cancer in small rural hospitals are infrequently reported, and this series may be compared with the published results from large teaching institutions.
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PMID:Colorectal cancer in a small rural hospital. 230 33

Carcinoid tumour was the most common small bowel tumour found in this series of 179 patients. It occurred in 24% of patients. Forty-six percent of patients were asymptomatic during life, the tumours being found either at autopsy or during other surgical procedures. Of those that were symptomatic, half presented with intestinal obstruction and the rest with long-standing symptoms. An abdominal mass, which occurred in 14% of cases, is an uncommon physical finding since the majority present as small submucosal tumors. Fifty-eight per cent overall and 72% of those having surgery had evidence of regional spread, either by local invasion or in the form of regional nodal involvement. Seven per cent of patients have died of their disease. Excisional surgery should be performed for all cases where feasible, and repeated for recurrent symptoms.
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PMID:Carcinoid of the small intestine. 242 20

The authors studied the computed tomographic (CT) images obtained in 56 patients with pathologically proved biliary cancer and 75 patients with no evidence of biliary disease, attempting to define the normal anatomy of the lymphatic system draining the bile ducts and the prevalence of extrahepatic spread of primary biliary cancer into these retroperitoneal planes. Of 20 patients with gallbladder cancer, 14 (70%) had proved adenopathy and nine (45%) had peritoneal spread at presentation, and another three later developed carcinomatosis. Of 22 patients with proximal cholangiocarcinoma, 16 (73%) had nodal involvement at presentation, four later developed adenopathy, and five had peritoneal dissemination. Distal or diffuse cholangiocarcinomas were less associated with metastatic nodes or peritoneal spread. For all biliary cancers, the nodes most commonly involved were the node of the foramen of Winslow, the superior pancreatoduodenal node, and the posterior pancreatoduodenal chain. Extrahepatic tumor spread produced proximal intestinal obstruction in 13 patients (23%). CT reliably demonstrates lymphatic or other extrahepatic spread of biliary cancers, which may have an important bearing on management decisions.
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PMID:Biliary carcinoma: CT evaluation of extrahepatic spread. 254 24

Two-hundred and eighty-eight patients with predominately stage IIB or IIIB cervical carcinoma underwent pretreatment surgical staging including selective paraaortic lymphadenectomy (SPAL), followed by pelvic irradiation with or without paraaortic irradiation (RT). Four patients were excluded from analysis (two received no RT and two were insufficiently documented). Of the remaining 284 patients, 128 underwent extraperitoneal (EP) SPAL and 156 transperitoneal (TP) SPAL procedures. Age, race, and stage (clinical and surgical), cell type, paraaortic nodal status, and peritoneal cytology findings were similar in both groups. Complications presumed to arise from operative staging were infection, which was similar for both groups, and vascular injury, which was higher in the TP group, although not statistically significant. Complications subsequent to RT fell into two categories: local-pelvic necrosis, vesicovaginal and rectovaginal fistulas, proctitis, etc., and regional-enterovaginal fistula, bowel obstruction, enteritis, bowel perforation, etc. The frequency of local complications was similar for both EP and TP patients. Utilizing univariant analysis, among regional complications, both bowel obstruction and nonobstructive enteric injuries were observed significantly more often in TP patients than in EP patients (11.5% vs 3.9%, P = 0.03, for both types). Multivariant analysis confirmed these observations. This report supports the conclusions that in advanced cervical carcinoma (1) EP- and TP-SPAL are of similar sensitivity in detecting nodal spread, (2) no significant differences in the frequency of surgical complications could be detected between EP- and TP-SPAL groups, and (3) TP-SPAL is associated with a higher frequency of certain postirradiation regional enteric complications.
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PMID:Extraperitoneal versus transperitoneal selective paraaortic lymphadenectomy in the pretreatment surgical staging of advanced cervical carcinoma (a Gynecologic Oncology Group study). 272 50

The authors studied treatment complications, recurrence patterns, and survival in 18 patients with histologically proved metastases to the paraaortic lymph nodes from invasive cervical carcinoma treated with extended-field irradiation. Complications following treatment developed in five of 10 patients who underwent transperitoneal nodal biopsy or dissection and in two of eight patients in whom an extraperitoneal approach was used (overall complication rate of 39%); however, only one had a gastrointestinal complication (small bowel obstruction after transperitoneal nodal biopsy and irradiation). Fourteen patients had persistent or recurrent disease within the abdominal or pelvic cavity; only one had distant metastases without recurrence in the abdomen or pelvis. Two of the 14 patients had a recurrence in the surgical scar following extraperitoneal nodal biopsy, possibly due to placement of the scar outside the radiation field. After a minimum follow-up of 48 months, only three of 18 patients (17%) were alive and well.
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PMID:Cervical carcinoma: treatment results and complications of extended-field irradiation. 274 May 13

Forty-seven patients with endometrial cancer, surgical Stage I through IV, received adjuvant whole abdomino-pelvic irradiation with a nodal and vaginal boost between August 1981 through December 1986. The median age was 66.5 years (range 37-86 years). Twenty-two patients were Stages I-II, 14 Stage III, and eleven patients Stage IV. Thirty-four patients (79%) had positive peritoneal cytology, 29 patients (62%) had deep myometrial involvement, 27 patients (58%) had high grade lesions, 18 patients (40%) had either serous-papillary or adenosquamous histologic variants, and ten patients (22%) had residual disease of up to 2 cm. remaining after operation, mostly in the form of nodal disease. Twenty-four patients (51%) had two or more life time laparotomies. Mean follow-up was 40.5 mo. (range 17-85 mo.). The 5-year actuarial survival was 68% and the 5-year relapse-free survival (RFS) was 77%. The 5 year relapse-free survival for Stages I/II, III, and IV were 85%, 78%, and 53%, respectively. The 5 year relapse-free survival for grades 1/2 was 100% and for grades 3/4 was 60%. (p value of 0.0017). Acute toxicity has been modest, and particularly evident in thinner patients (weight below 115 lbs.). Chronic toxicity of significance has been limited to one patient with a conservatively managed bowel obstruction. These results are very encouraging and suggest benefit to the use of more aggressive adjuvant irradiation.
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PMID:Postoperative whole abdomino-pelvic irradiation for patients with high risk endometrial cancer. 275 61

Between June 1979 and March 1985, 77 patients received whole abdominal radiation as the sole postoperative treatment for gynecologic malignancy. With an open-field technique of irradiation, a median of 3,000 cGy was delivered to the entire abdominal contents with partial liver and kidney shielding; the total dose to the pelvis after boosts was 5,100 cGy, and that to the sub-diaphragmatic and para-aortic nodal regions was 4,200 cGy. The primary sites of malignancy were the endometrium in 41 patients, ovary in 25, uterus in 5, fallopian tube in 4, and cervix in 2. Seven patients (9%), all older than 60 years, experienced acute gastrointestinal toxicity that interrupted treatment, only one of whom failed to complete the prescribed course as a result. Hematologic toxicity was sufficient to interrupt therapy in 21 patients (27%), 1 of whom failed to complete therapy as a result. Hematologic toxicity was not increased in elderly patients. All patients were followed up for a minimum of 30 months (median, 43 months) or until death. Six patients experienced a treatment-related bowel obstruction (two of whom had concomitant progressive intra-abdominal disease); the 3-year actuarial risk for a treatment-related bowel obstruction was 9%. This risk was significantly increased by high-dose boosting for residual disease. Only one instance of clinical radiation pneumonitis occurred, and no cases of clinical hepatitis were noted; however, subclinical evidence of pulmonary and hepatic radiation effect was frequent. Whole abdominal irradiation as described has modest toxicity for patients with gynecologic cancer who are at high risk for intra-abdominal failure.
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PMID:Toxicity of open-field whole abdominal irradiation as primary postoperative treatment in gynecologic malignancy. 292 Nov 44


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