Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0027627 (metastases)
 103,950 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Isolated axillary and chest wall soft tissue masses are an uncommon presentation of metastatic cancer. The authors present three patients in whom malignant melanomas metastatic to these sites had been misdiagnosed, leading to inappropriate oncologic treatment planning in all three cases. The presumed diagnoses, even after fine-needle aspiration or trucut biopsies, were soft-tissue sarcoma (n = 2) and undifferentiated breast cancer (n = 1). The combination of taking a thorough history and performing proper immunohistochemical analysis of the biopsy material would have suggested the presence of malignant melanoma in all cases. As the disease appeared locoregionally limited in all patients, radical surgical resection with extended lymphadenectomy was performed without significant dysfunction of the upper extremity. One patient agreed to postoperative immunotherapy with interferon-alpha. Two patients are currently alive 17 and 14 months after operation. One patient was found to have systemic recurrence at 5 months, one experienced two isolated local recurrences in a prior operative site that were amenable to reresection and presently has no evidence of disease 12 months after resection, and one patient remains free of disease at 14 months. Clinical presentation, suggested diagnostic workup, and therapeutic implications are discussed to avoid misdiagnoses in this setting of possible clinical presentations of metastatic melanoma.
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PMID:Soft tissue masses of the chest wall and axilla: has metastatic melanoma been considered? 1019 54

Neuroendocrine tumors are not seen frequently. They are most commonly located in the small bowel including the vermiform appendix. Neuroendocrine tumors of pancreatic origin are extremely rare. Symptoms caused by excessive hormone production by large liver metastases often lead to their diagnosis. Preoperative diagnostics include analysis of specific hormones in serum and urine, ultrasound, CT and somatostatin receptor scintigraphy. Liver metastases of neuroendocrine tumors of the pancreas are common at the time of diagnosis. Curative resection should be performed whenever possible, although patients often benefit from debulking procedures, too. Liver metastases can be subjected to surgical resection, embolization, regional chemotherapy or local procedures such as alcohol injection or cryoablation. As an exception, liver transplantation can be considered in selected cases where radical surgery for the primary tumor could be performed and extrahepatic metastases are not present. Supplementary or alternative options include octreotide and/or interferon-alpha administration. In this article, we report on 6 patients suffering from primary neuroendocrine tumors of the pancreas or the ampulla of Vater who were treated at our department over the past 5 years. In addition, we discuss our own experience with this rare condition in the light of the recent literature.
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PMID:Multimodal treatment of neuroendocrine tumors of the pancreas and the ampulla of Vater. 1020 42

Renal cell cancer (RCC) accounts for 2-3% of all malignant tumors in adults. Due to the indolent course of disease and the few signs and symptoms in early stages the majority of patients presents with metastatic disease when diagnosed. The aims of systemic therapy of RCC are therefore palliative. Recent research shows the key role of immune mechanisms in the course of RCC. The therapeutic use of cytokines, mainly interleukin-2 (IL-2) and interferon-alpha (IFN) results in improvement of remission rates. To date it is unknown to what extent multiple cycles of chemo-immunotherapy alter the life quality (LQ) of patients with metastatic RCC. We monitored life quality during therapy in a three-armed protocol with interferon-alpha 2a, interleukin-2, 5-fluorouracil (5-FU), isotretinoin (ISO) and vinblastin (VBL). Life quality was impaired by two factors: response to chemo-immunotherapy and therapy side effects. A steep decrease of LQ-scores was seen in week 1 of therapy, LQ improved then for patients with stable disease (SD) and partial remission (PR) but not for those with progressive disease (PD).
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PMID:Life quality of patients with metastatic renal cell carcinoma and chemo-immunotherapy--a pilot study. 1036 44

In recent months, we have witnessed a 'paradigm shift' in the management of intermediate-thickness melanoma. The collective experience of the recent past confirms the validity of the 'sentinel' lymph node as being the initial draining site from a specific area of skin. Furthermore, the sentinel lymph node has been confirmed as the most likely site in the regional lymph node basin to harbor occult metastatic disease. Identification of sentinel lymph nodes by visual inspection and intraoperative gamma probe detection after the peritumoral injection of Lymphazurin blue dye and technetium sulfur colloid is a reliable new technique. Staging accuracy also has improved, allowing the precise identification of patients who benefit from avoiding the morbidity of radical lymphadenectomy. The importance of accurate staging has been heightened by data demonstrating effective adjuvant therapy with recombinant interferon-alpha 2B. Precisely defining patient subsets who benefit from adjuvant high-dose interferon-alpha 2B is the current focus of clinical trials designed to maximize the enhanced staging accuracy of the novel approach of sentinel lymph node biopsy.
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PMID:Lymphatic mapping and sentinel lymph node biopsy in the staging of melanoma. 1042 6

Systemic immunotherapy, notably with interleukin-2 (IL-2) and interferon-alpha (IFNalpha), has yielded a response rate of 10 % to 30 % in metastatic renal cell carcinoma. However, systemic immunotherapy is limited by severe side effects, and long-lasting response is rare. Tumor palliation and quality-of-life are important end points for evaluating the clinical benefits of immunotherapy. Experimental and clinical treatment models have proved that local IL-2 application is less toxic than systemic treatment and is therapeutically effective. Here we report long-term experience with inhalation IL-2 therapy in 188 patients who had progressive pulmonary metastatic renal cell carcinoma. High-dose inhalation of IL-2 was used with low-dose systemic IL-2 or IFNalpha. Maximal toxicity over the total treatment time was mild, and the low incidence of WHO grade 3 toxicity (24 %) allowed social activities and performance of social roles. Comedication for systemic side effects was required only in half of the patients. Inhaled IL-2 prevented progress of pulmonary metastases in 68 % of patients for a median period of 9.8 months. Median survival was 12.4 months compared with the expected 5.3 months and quality-of-life did not differ substantially from pretreatment status. Local treatment can be applied alone or in combination with systemic therapy and can increase therapeutic efficacy.
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PMID:[Treatment of pulmonary metastases from kidney cell carcinoma with inhalational interleukin-2. 10-year experience Hamburger Unicenter]. 1050 5

A 61-year-old man presented with gross hematuria. He underwent left radical nephrectomy under a diagnosis of left renal cell carcinoma without distant metastasis, but bilateral multiple pulmonary metastases appeared 2.5 months after the operation. Though the metastases responded well to combination therapy of interferon-alpha and a 1:4 mixture of tegafur and uracil (UFT), the side effects of liver dysfunction and leukoencephalopathy-like symptoms due to UFT appeared 7 months after the beginning of the chemotherapy. These side effects were improved after the cessation of UFT administration.
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PMID:[A case of pulmonary metastasis from renal cell carcinoma with complete response to interferon-alpha and tegafur/uracil (UFT) but possibly UFT-induced liver dysfunction and leukoencephalopathy-like symptoms]. 1054 Jul 8

The VIPoma syndrome is rare. It is usually caused by a neuroendocrine tumor located in the pancreas. Somatostatin analogs and interferon-a can be helpful in the symptomatic control of the disease, but the efficacy of chemotherapy in metastatic disease is limited. We report the case of a 32-yr-old patient who had a primary intestinal VIPoma with peritoneal carcinomatosis and hepatic metastases. Somatostatin analogs and conventional chemotherapy regimens were not effective on VIPoma syndrome and tumor progression. The combination of 5- fluorouracil and interferon-alpha was associated with a major clinical improvement and tumor regression. Further investigations should evaluate the place of such a combination as a first line treatment for patients with metastatic neuroendocrine tumors.
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PMID:Metastatic jejunal VIPoma: beneficial effect of combination therapy with interferon-alpha and 5-fluorouracil. 1063

In order to evaluate the natural history, prognostic parameters and treatment modalities for metastatic uveal melanoma, a review of the clinical data from the current literature was performed based on a Medline database search. Uveal melanoma represents approximately 5% of all melanomas. It is a distinct clinico-pathological entity, differing in many aspects from cutaneous melanoma. The clinical course is unpredictable and metastatic disease can develop very late after a long disease-free interval. Uveal melanoma metastasizes haematogenously, predominantly to the liver. The most Important prognostic parameters for primary uveal melanoma are tumour diameter, the patient's age and gender, histological features and tumour location. Systemic chemotherapy that is effective in cutaneous melanoma has failed to show activity in uveal melanoma. So far only the BOLD chemotherapy regimen (dacarbazine, lomustine, vincristine and bleomycin) combined with interferon-alpha has been shown to produce an objective tumour response in approximately 20% of previously untreated patients. For metastatic disease localized to the liver, intra-arterial application of fotemustine or carboplatin or chemoembolization with cisplatin have shown useful activity, resulting in a response in up to 40% of patients. Selected patients may benefit from palliative surgery. Immunotherapy with interleukin-2 or interferon-alpha has not shown consistent activity in metastatic uveal melanoma. In conclusion, patients with uveal melanoma metastatic to the liver should undergo one of the local treatment options. Carefully selected patients with extrahepatic disease or patients failing local treatment may benefit from systemic therapy using the BOLD regimen combined with interferon.
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PMID:Uveal melanoma: natural history and treatment options for metastatic disease. 1066 68

Five-year overall survival after radical nephrectomy in pT3N0M0 renal cell carcinoma is 35-50%. In light of immunotherapy, which has shown some activity in advanced diseases with increasing efficacy in limited metastatic invasion, we decided to explore the theoretical advantage of adjuvant immunotherapy in radically resected stage pT3N0M0 renal cell carcinoma. We studied several factors including tumor size, nuclear grade, mean nuclear area and expression of p53 protein to find out which factor is concerned with disease progression. A total of 10 patients with pT3N0M0 RCC who received radical nephrectomy from February 1992 to April 1999 were randomly assigned to receive treatment with either interferon-alpha alone or interferon-alpha plus vinblastine. Eight patients with pT3N0M0 RCC who received only radical nephrectomy from January 1984 to February 1993 were analyzed and the results were compared with the first group. Six out of 10 (60%) patients in the adjuvant immunotherapy group are alive with no evidence of disease. Metastases were documented in 4 patients (40%) with a median interval to progression of 17.5 months. All of them died of tumor. In the surgery only group, 5 out of 8 patients (62.5%) are still alive with no evidence of disease. Two patients (25%) developed distant metastases and both of them died of tumor. The median progression interval was 11 months. There were no statistical differences in time to progression and survival rate between the two groups. In the univariate analysis using a log-rank test, the expression of p53 protein seemed to be associated with shorter survival (p = 0.0591). However, in the multivariate analysis using Cox's proportional hazard model, no parameter had significant independent prognostic value. We concluded that adjuvant immunotherapy did not improve the survival of patients with pT3N0M0 RCC. Furthermore, we failed to find significant prognostic factors in patients with pT3N0M0 RCC.
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PMID:The role of adjuvant immunotherapy after radical nephrectomy and prognostic factors in pT3N0M0 renal cell carcinoma. 1069 24

In patients with metastatic renal cell carcinoma response rates of 7-26% have been achieved with immunotherapy. A high response rate of 48% in 35 patients has been reported for treatment with the combination of interferon-alpha (IFN-alpha), interleukin-2 (IL-2) and 5-fluorouracil (5-FU) (Atzpodien et al (1993a) Eur J Cancer29A: S6-8). We conducted a multicentre phase II study to confirm these results. Metastatic renal cell carcinoma patients were treated as outpatients with an 8-week treatment cycle. Recombinant human IL-2 20 MU m(-2) was administered subcutaneously (s.c.) three times a week (t.i.w) in weeks 1 and 4 and 5 MU m(-2) t.i.w. in weeks 2 and 3. Recombinant human IFN-alpha 2a 6 MU m(-2) was administered s.c. once in weeks 1 and 4 and t.i.w. in weeks 2 and 3, and 9 MU m(-2) t.i.w. in weeks 5-8. 5-FU (750 mg m(-2)) was given as a bolus injection intravenous once a week in weeks 5-8. The treatment cycle was repeated once in case of response or minor response. Fifty-two patients entered the study. All had undergone a nephrectomy and had progressive metastatic disease. The median WHO-performance status was 1, the median number of metastatic sites was 2 (range 1-5) and the median time between the diagnosis of the primary tumour and the start of treatment was 12.9 months (range 1-153). Among the 51 patients, including four patients with early progressive disease, who were evaluable for response, the response rate was 11.8% (95% confidence interval (CI) 2.9-20.7%), with no complete responses. Median duration of response was 8.3 (range 3.8-22.4+) months. Median survival was 16.5 (range 1.8-30.5+) months. Grade 3/4 toxicity (WHO) occurred in 29/52 (55.8%) of the patients in cycle 1 and in 6/16 (37.5%) of the patients in cycle 2. It consisted mainly of anorexia, fatigue, nausea, fever and leucocytopenia. We cannot confirm the high response rate in patients with metastatic renal cell carcinoma treated with the combination of IFN-alpha, IL-2 and 5-FU, as described by Atzpodien et al.
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PMID:Immunochemotherapy with interleukin-2, interferon-alpha and 5-fluorouracil for progressive metastatic renal cell carcinoma: a multicenter phase II study. Dutch Immunotherapy Working Party. 1073 44


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