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)

Identification of important prognostic factors with respect to the patient's initial response to therapy was made from a set of 25 covariates available on 281 patients with advanced breast cancer. Since the patients studied were all participants in a randomized clinical trial that involved three different treatment regimens (repeated weekly treatment of a combination of cyclophosphamide, methotrexate, 5-fluorouracil, vincristine, and prednisone; intermittent treatment of the same preceding five drugs given in 5-day courses every 4 weeks; or treatment every 3 weeks with adriamycin as a single agent), the effect of these treatments on the selection of important covariates was assessed. Although some evidence indicated that the set of important covariates differed by treatment, the differences were not strong enough to be of practical importance. Non-Caucasian patients did poorly on all regimens with a response rate of only 31% compared to 62% for Caucasian patients. The covariates of major prognostic importance for Caucasians were: disease-free interval, liver involvement, and performance status. Ambulatory patients with long disease-free intervals and no liver involvement had the best prognosis. After adjustments were made for these three covariates, the remaining covariates (such as menopausal status, bone involvement, number of metastatic sites, and duration of metastatic disease) were not significantly related to response. As reported earlier, the treatment effect was significant, even after adjustments were made for the important covariates.
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PMID:Prognostic factors in the initial response to therapy by patients with advanced breast cancer. 34 98

The incidence of breast cancer in Australia is as high as in most parts of the world. The usual presentation is with a breast lump. Invasive and preinvasive malignant changes may be identified in both duct and lobular epithelia. There are clinical features of malignancy, but histological proof is necessary. Aspiration of cysts and reexamination of clinically benign lumps are acceptable in certain circumstances, but a tissue diagnosis should be made by needle or open biopsy. Earlier diagnosis is possible by radiological screening of asymptomatic patients, but the cost is high. Total excision of the breast (simple mastectomy) is the minimum treatment advisable for infiltrating cancer; If there is a high chance that the draining lymph nodes will contain tumor, they should be treated by surgical excision or radiotherapy. Early chemotherapy does reduce the incidence of systemic metastases after mastectomy, but its precise place in management is not yet clear. The social impact of mastectomy is considerable and deserves more attention than has been paid to it in the past. Clinical trials of treatment should continue, as they are beginning to answer some fundamental questions.
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PMID:What shall we teach our students about breast cancer? A personal view. 34 83

The results obtained with a new hormone therapy using medroxyprogesterone acetate (MAP) in previously untested single and total doses in the treatment of advanced breast cancer are reported. Fifty-two postmenopausal patients were treated with an average total dose of 40 g of MAP for a period of 30 days. Nineteen of 44 patients (43%) had complete or partial remission, while the disease remained unchanged in nine of 44 patients (20%). Disease progression occurred in 12 of 44 patients (27%). Partial or complete remission occurred in 12 of 18 (67%) and four of six (67%) of the patients with dominant osseous and soft tissue metastases respectively. Three of ten (16%) of those with visceral metastases had remission. The average duration of remission was 7 months. Average survival times were 15.5 months for patients with remission, 8 months for those with no change, and 2.5 months for those with disease progression. From a subjective standpoint, pain was reduced significantly or disappeared in 34 of 36 patients (94%); this was also the case with respect to dyspnea (13 of 16 patients [81%]), anorexia (24 of 29 [83%]), asthenia (28 of 35 [80%]), and walking impairment (15 of 24 [63%]). When relapse occurred, patients previously treated with massive doses of MAP received further treatment with higher doses of MAP; four of 22 (18%) of the patients attained partial remission once again. Positive effects were also seen in subjective performance status, body weight, and EKG. We also describe the new clinical and toxicologic features of this treatment.
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PMID:A possible new approach to the treatment of metastatic breast cancer: massive doses of medroxyprogesterone acetate. 35 Mar 87

The clinical assessment of patients with Stages I and II breast cancer is outlined in Figure 1. A chest x-ray film and serum alkaline phosphatase are the only routine studies indicated. If the serum alkaline phosphatase is abnormal in the presence of otherwise normal liver function studies, a bone scan, liver scan, and CEA should be obtained. Areas of increased radioactivity on bone scan are always evaluated by additional radiographs and in some cases tomograms. The majority of focal areas of increased radioactivity will demonstrate radiographic evidence of benign bone lesions, predominantly degenerative joint disease. Only those focal areas of increased radioactivity that are normal on x-ray film or show radiographic evidence of metastases are considered to be positive for metastatic disease. The results of the liver scan are correlated with the level of CEA. Focal areas of decreased radioactivity associated with a CEA greater than 5 ng per ml are considered to be metastases. In the absence of elevation of the CEA, focal areas of increased radioactivity should be biopsied prior to any further considerations as to definitive therapy. The clinical assessment of patients with Stage III disease is outlined in Figure 2. Patients with this stage of disease have a much greater chance of having clinically occult metastases of sufficient size to be detected by chest x-ray film, serum alkaline phosphatase, and bone scan. If the serum alkaline phosphatase is abnormal, a liver scan and CEA are obtained in an effort to detect liver metastases. The same sequence of events is then followed as suggested for patients with Stages I and II disease. Several new techniques of detecting occult metastases are being evaluated. Biomarkers are the subject of another article in this volume. The use of computerized axial tomography is also being evaluated as a means of detecting lung, liver, and mediastinal metastases. The results of these initial clinical trials should be carefully followed.
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PMID:Preoperative assessment of the patient with breast cancer. 35 93

In animal tumor systems, all three major treatment modalities, surgery, radiotherapy, and chemotherapy, may increase the incidence of metastases in the presence of circulating viable tumor cells. In breast cancer patients, selected studies can be found which report an increased incidence of metastases after surgery, radiotherapy, or chemotherapy, but these effects appear to exert little influence on overall survival. Caution is advised in using systemic therapy prior to effective primary tumor cytoreductive treatment. Clinical trials in advanced local disease should be done to test this concern. Minimal surgery, loco-regional radiotherapy, and effective adjuvant systemic therapy may result in the improved survival of patients with breast cancer with minimal functional or cosmetic impairment.
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PMID:Effect of primary treatment modality on the metastatic pattern of mammary carcinoma. 35 82

Using a standard heterologous assay in which lymphokines alter guinea pig peritoneal macrophage migration, it was found that regional lymph node cells (RLNCs) from patients with primary breast cancer elaborate soluble factors which variably affect such migration. Variation of migration resulted when soluble factors employed were obtained from different nodes in the same patient as well as from nodes from different patients. Some nodes from a patient elaborated migration inhibition factors (MIF) and other migration enhancing factors (MEF). The findings are in keeping with others obtained by us relative to the variation in lymphocyte transformation and thymidine uptake by RLNCs and further emphasize that all RLNs in patients with breast cancer are not biologically similar. They lend support to our previous hypothesis that the reason why some RLNs contain metastases and others do not is more likely due to biological differences than because of anatomical happenstance, i.e., transport of tumor cells to some nodes and not to others.
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PMID:Variation of macrophage migration by a factor from regional lymph node cells of breast cancer patients. 36 51

Breast cancer is the most common malignancy of women in the United States, affecting one out of every 13 women at some time in their lives. Although only 10% of patients have demonstrable distant metastases at the time of diagnosis, a majority will eventually die of disseminated disease. Chemotherapy was formerly considered to be the treatment of last resort in patients with breast cancer, reserved for those who had failed surgery, radiotherapy and hormonal manipulation. However, combination chemotherapy has now been shown to be highly effective. The most active drug combinations produce objective tumour regression in about 60% of patients with advanced disease. Parallel to the development of effective chemotherapy, there has been a renewal of interest in hormonal therapy. The ability to predict whether or not a patient will respond to hormonal therapy has been improved significantly by the clinical application of the oestrogen receptor assay. The selection of a specific treatment for the patients with advanced breast cancer must be individualised. It should take into account a number of prognostic variables, including: sites of metastatic involvement; total extent of disease; disease free interval; menopausal status; and the presence or absence of oestrogen receptor in tumour tissue. The final decision regarding treatment should then be based not only on the probability of response, but also on the anticipated degree of toxicity. Current efforts to improve the management of advanced breast cancer include the development of more effective drug regimens and the combination of chemotherapy with hormonal manipulation. For instance, it would appear that in premenopausal patients, the combination of chemotherapy with oophorectomy may yield results that are superior to those achieved with either treatment alone. The most promising development in the management of early breast cancer has been the use of chemotherapy as an adjuvant treatment in patients with operable disease.
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PMID:Drug treatment of breast cancer. 36 1

Seventy patients with breast cancer (stage IIIb--IV) were randomized by an "envelope" method into 2 groups, each including 35 persons. Patients of the first group were injected vincristin, 5-fluoruracil, methotrexate (once a week), cyclophosphane (3 times a week) and prednisolone daily during 3 weeks. The duration of the course of treatment was 4 weeks. The therapy course was repeated with an interval of 1--2 months. Patients of the second group in addition to the analogous treatment were subjected to ovariectomy with subsequent continuous administration of prednisolone, testosterone-propionate or synoestrol. An objective effect was noted in 24 patients of the first group (71.4%), the complete remission being gained in 4 of them. An average duration of the remission--7.6 months. An objective effect was noted in 31 patients of the second group (88.5%), the complete remission--in 4 of them. An average duration of the remission--10.7 months. Primary mammary tumors and metastases in regional lymph nodes proved to be mostly susceptible to the conducted therapy. Lung and pleural metastases were found to be less susceptible. No grave complications due to this kind of treatment were noted.
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PMID:[Combined drug treatment of far-advanced forms of breast cancer]. 36 97

Seventy-eight advanced breast cancer patients with hormone-resistant disease or visceral metastases were randomized to receive either of two low dose regimens consisting of cyclophosphamide (C), methotrexate (M), 5-fluorouracil (F), and Adriamycin (A) as their initial chemotherapy. One group was treated with CAMF, and the other with CMF until progression, followed by A (CMF leads to A). C was given at 50 mg/m2, po, days 1-14; M at 20 mg/m2, F at 300 mg/m2, and A at 20 mg/m2, iv, days 1 and 8 of each 28-day cycle. The response rates for CAMF vs. CMF did not differ significantly (complete and partial responses-62% vs. 49%; stabilizations-23% vs. 31%). Responses by site of metasis, median times to progression and median survivals were similar for both groups. Poor and good risk partial responders had similar survivals. Twelve percent of CMF patients treated with Adriamycin at the time of progression had partial responses with an associated improved survival. Since CMF is as effective as CAMF, but has less toxicity, low dose therapy with CMF is more acceptable than CAMF as an initial chemotherapy regimen for metastatic breast cancer. Adriamycin may be reserved for subsequent regression induction.
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PMID:Low dose chemotherapy of metastatic breast cancer with cyclophosphamide, adriamycin, methotrexate, 5-fluorouracil (CAMF) versus sequential cyclophosphamide, methotrexate, 5-fluorouracil (CMF) and adriamycin. 36 74

A totally satisfying concept of treatment is not easy to formulate from the complex and often conflicting results of local therapeutic interventions for breast cancer. It seems evident that clinically occult cancer is often beyond the pale of both resection and irradiation at primary treatment, particularly when cancer is found in regional lymph nodes. Despite all combinations of local treatment, the ultimate risk of failure correlates more closely with the stage of the disease at the time of treatment than with the particular form of treatment. Thus the extent of disease must be considered the major, perhaps the ultimate determinant of prognosis. Because, under controlled conditions, several therapeutic alternatives have appeared to provide virtually identical end results in terms of survival and ultimate dissemination of the disease, the adequacy of control within the field of treatment may, in fact, be the most meaningful end result of local treatment. The experience that has accumulated with treatment of breast cancer supports the thesis that removal of the breast accomplishes all that can be achieved in terms of curing the disease, and wider treatment with surgery or irradiation serves only to improve the prospects for local control. Halsted demonstrated this principle with his radical mastectomy and it still seems to be the case. This fact provides further impetus for detecting and treating cancer while it is still localized to the breast. With these generalizations in mind some empirical observations can be added. An anatomic fact is that multiple microscopic foci of cancer that are not evident clinically are often present in the mammary parenchyma. Undisturbed, at least some, and perhaps eventually all, of these foci of cancer progress to become clinical cancers. Thorough removal of the entire breast (the entire mammary parenchyma) eliminates this particular hazard and, one may presume, terminates the disease if it is still limited to the breast. Removal of the underlying pectoralis major muscle provides additional margin around the tissues primarily involved, but sacrific of the muscle is apparently needless unless it is directly invaded by cancer. Microscopic metastases are also often present in regional lymph nodes without being clinically detectable and, left untreated, have the capacity to enlarge and become clinically apparent. Routine wide removal of regional lymph nodes improves the control of cancer at these sites when metastases are present, but whether it improves the chances for cure is doubtful. The fact is that approximately 25 per cent of patients with axillary metastases enjoy prolonged survival free of recurrence, some remaining well even after thirty years (Adair et al., 1974). Whether they would survive as well without removal of the metastases is uncertain. Desease-free survival is highest if metastases are removed while still microscopic, but this phenomenon may simply reflect treatment at an earlier phase in the evolution of the disease...
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PMID:Cancer of the breast. Staging methods, primary treatment options and end results. 37 50


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