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Query: UMLS:C0027627 (metastases)
 103,950 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The article describes a retrospective study of the prognosis for 450 patients with inoperable non-small cell lung cancer discharged during the period 1970 to 1979. 81% of the patients were males. The predominant cell type was squamous cell carcinoma. One out of seven patients was inoperable because of poor cardiorespiratory function, six out of ten because of mediastinal metastases. Median survival was six months and was related both to staging of the tumor and to cell type. The prognosis was worst for patients with adenocarcinoma. Only 8% of the 450 patients were alive after two years. Specific and palliative therapy had a minor effect on median survival. Controlled clinical trials can probably settle whether an extension of the criteria for surgical treatment can improve the prognosis of this large group of patients.
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PMID:[Prognosis of inoperable non-small cell bronchial cancer]. 170 68

Squamous, large cell, and adenocarcinoma, collectively termed non-small cell lung cancer (NSCLC), are diagnosed in approximately 75% of patients with lung cancer in the United States. The treatment of these three tumor cell types is approached in virtually identical fashion because, in contrast to small cell carcinoma of the lung, NSCLC more frequently presents with localized disease at the time of diagnosis and is thus more often amenable to surgical resection but less frequently responds to chemotherapy and irradiation. Cigarette smoking is etiologically related to the development of NSCLC in the great majority of cases. Genetic mutations in dominant oncogenes such as K-ras, loss of genetic material on chromosomes 3p, 11p, and 17p, and deletions or mutations in tumor suppressor genes such as rb and p53 have been documented in NSCLC tumors and tumor cell lines. NSCLC is diagnosed because of symptoms related to the primary tumor or regional or distant metastases, as an incidental finding on chest radiograph, or rarely because of a paraneoplastic syndrome such as hypercalcemia or hypertrophic pulmonary osteoarthropathy. Screening smokers with periodic chest radiographs and sputum cytologic examination has not been shown to reduce mortality. The diagnosis of NSCLC is usually established by fiberoptic bronchoscopy or percutaneous fine-needle aspiration, by biopsy of a regional or distant metastatic site, or at the time of thoracotomy. Pathologically, NSCLC arises in a setting of bronchial mucosal metaplasia and dysplasia that progressively increase over time. Squamous carcinoma more often presents as a central endobronchial lesion, while large cell and adenocarcinoma have a tendency to arise in the lung periphery and invade the pleura. Once the diagnosis is made, the extent of tumor dissemination is determined. Since most NSCLC patients who survive 5 years or longer have undergone surgical resection of their cancers, the focus of the staging process is to determine whether the patient is a candidate for thoracotomy with curative intent. The dominant prognostic factors in NSCLC are extent of tumor dissemination, ambulatory or performance status, and degree of weight loss. Stages I and II NSCLC, which are confined within the pleural reflection, are managed by surgical resection whenever possible, with approximate 5-year survival of 45% and 25%, respectively. Patients with stage IIIa cancers, in which the primary tumor has extended through the pleura or metastasized to ipsilateral or subcarinal lymph nodes, can occasionally be surgically resected but are often managed with definitive thoracic irradiation and have 5-year survival of approximately 15%.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Non-small cell lung cancer. Part II: Treatment. 171 39

In a dose escalation study, CIS-diamminedichloroplatinum II (cisplatin) was combined with a standard dose of external beam irradiation in 15 patients with localized non-small cell lung cancer (NSCLC) and 16 patients with fixed or recurrent localized adenocarcinoma of the rectum. Cisplatin was given 5 days a week during irradiation using an outpatient portable infusion pump system, at doses of 3.2 mg/m2/24 hr in 15 patients, 4.0 mg/m2/24 hr in 13 patients, and 5.0 mg/m2 24 hr in 3 patients. Twelve of 15 patients with NSCLC received 66 Gy in 33 fractions in 6 1/2 weeks; one received 46 Gy followed by a surgical resection; for the other two patients treatment was discontinued after 50 Gy and 64 Gy, respectively, because they developed distant metastases. The 16 patients with rectal carcinoma received a preoperative dose to the pelvis of 45 Gy in 25 fractions in 5 weeks. Of 12 patients who underwent laparotomy, 10 had a surgical resection, 2 with close or positive surgical margins. Four patients who had resections received an intraoperative electron boost. Of the two patients who did not undergo resection at laparotomy, one received an intraoperative electron boost, the other a boost with interstitial iridium-192. Among the four patients with rectal adenocarcinoma who were not candidates for surgery because of advanced local disease, two had further external beam therapy up to 59.4 Gy, and two had no further therapy. Major toxicity was site-specific, with esophagitis predominating in the patients with NSCLC, diarrhea in the patients with rectal carcinoma, and nausea experienced by both. Cisplatin dose and toxicity seemed to be related. The maximum tolerated dose for low-dose continuous infusion cisplatin given 5 days/week in these patients was 3.2 mg/m2/24 hr combined with 66 Gy in patients with NSCLC and 4.0 mg/m2/24 hr combined with 45 Gy in patients with rectal carcinoma.
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PMID:Low-dose continuous infusion cisplatin combined with external beam irradiation for advanced colorectal adenocarcinoma and unresectable non-small cell lung carcinoma. 165 11

We undertook a retrospective study of all lung cancer patients diagnosed between 1978 to 1982 and seen at the University of California San Diego affiliated hospitals. There were 390 evaluable patients; the vast majority were men. Overall median survival was 8 months and was similar for all histologic types. Completely asymptomatic patients had a median survival of 20.1 months while symptomatic patients had a median survival of 5-8 months. Retrospective application of the new clinical staging system for lung cancer increased the survival distinction between clinical Stage I and Stage II disease. Median survival for small cell carcinoma of the lung was 10 months: 16.6 months for disease limited to the chest, and 5.8 months for metastatic disease. Median survival for Stage III nonsmall cell lung cancer patients was only 5 months. Only those asymptomatic patients with small lesions which were detected incidentally or by screening chest x-ray had any likelihood of long-term, disease-free survival with more than 60% alive two years after diagnosis. This study suggests that screening and early detection programs in existence during the period of observation were not effective in detecting early disease, and that no therapy of advanced diseases [Stages II through IV] was sufficiently efficacious to be considered standard.
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PMID:Recent outcomes for patients with carcinoma of the lung. 184 43

ESTRO members were surveyed by questionnaires regarding the management of three cases of advanced cancer and the organisation of cancer care in their centre. There were 278 replies from within Europe from a total of 21 countries and 231 centres. The cases were a 64-year-old man with brain metastases from a small cell carcinoma of the lung, a 64-year-old woman with bone metastases from carcinoma of the breast on tamoxifen and a 59-year-old man with a squamous cell carcinoma (NSCLC) of the bronchus and positive mediastinal lymph nodes. Over 90% of respondents replied that they would give radiotherapy in each of these cases. The median total doses were 30 Gy for the brain metastases, 30 Gy for the bony metastases and 56 Gy for the case of NSCLC. There was variation as to the perceived prognosis and appropriate aims of therapy, particularly for the case of NSCLC. The total dose and number of fractions of radiotherapy could be related to the perceived aims and expectations of treatment, e.g. those aiming to extend life gave significantly higher total doses of radiotherapy (p = 0.0001) and those aiming to relieve symptoms gave significantly lower total doses (p = 0.0001). Treatment for this case was described as "radical" by 53% of respondents and as "palliative" by 47% and the prognosis was estimated to be less than 12 months by 41% and 1-2 years by 44%. Those describing treatment as radical and estimating longer survival gave higher doses and more fractions than those treating palliatively.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Treatment strategies for advanced and metastatic cancer in Europe. 194 7

A technetium-labeled monoclonal antibody was administered to 52 patients with non-small cell lung carcinoma, either to stage the mediastinum preoperatively or to detect distant metastases. Results from planar and tomographic imaging are compared to CT and histologic confirmation. Differences in detection rates and predictive values between imaging modalities are discussed. The authors conclude that imaging with a technetium-labeled monoclonal antibody is safe and accurate and may be useful for staging patients with either operable or inoperable non-small cell lung cancer.
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PMID:Staging non-small cell carcinoma of the lung using technetium-99m-labeled monoclonal antibodies. 196 76

In a phase I study, epirubicin was administered as an intravenous bolus at an initial dose of 105 mg/m2 in untreated patients with advanced tumours considered resistant to antineoplastic treatment. A 15 mg/m2 dose escalation was done every 3 patients if toxicity was below grade 3 or every 6 patients if at least 1 patient had grade 3 toxicity. 18 patients entered the study. The dose was (mg/m2): 105 (3 patients), 120 (3), 135 (3), 150 (6) and 165 (3). The maximally tolerated dose was 165 mg/m2. The dose-limiting toxicity was neutropenia. Other side-effects were nausea/vomiting (78%) and alopecia (100%). 4 patients stopped treatment because of a decrease in left ventricular ejection function, without clinical signs of cardiotoxicity. A complete response was observed in a patient with abdominal metastases from unknown origin at 105 mg/m2 and a partial response in 2 out of 7 patients with non-operable non-small cell lung cancer, at 135 and 150 mg/m2, respectively. The recommended dose for phase II trial is 135-150 mg/m2.
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PMID:High-dose epirubicin for untreated patients with advanced tumours: a phase I study. 196 44

Two anatomic subsets of patients with stage IIIa non-small cell cancer of the lung are candidates for definitive surgical treatment. The first group includes patients with T1, T2, or T3 primary tumors and regional lymph node metastases confined to the ipsilateral mediastinal and subcarinal lymph nodes (N2 disease). There is controversy over the selection of this group of patients for surgery; some physicians do not believe that resection is an option if there is any evidence of mediastinal lymph node involvement. The second group is composed of patients with limited, circumscribed extrapulmonary extension of the primary tumor and lymph node metastasis, if present, limited to the hilar and peribronchial nodes (T3 N0-1 M0 disease). Peripheral tumors invading the chest wall, tumors originating in the superior sulcus of the lung, and those with limited involvement of the pericardium or the main bronchus are included. A five-year cumulative survival rate of 28 percent was documented for 198 consecutive patients undergoing complete resection for stage IIIa non-small cell lung cancer, 21 percent for the T1-3 N2 group, and 39 percent for the T3 N0-N1 patients. Cell type was not a statistically significant variable for survival; however, a superior outcome was observed for patients with squamous cell carcinoma in every TNM category. The results support surgical treatment as a valid option for selected patients with extrapulmonary extension of the disease.
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PMID:Expanded possibilities for surgical treatment of lung cancer. Survival in stage IIIa disease. 215 77

Twenty previously untreated patients with histologically or cytologically proven non-small cell lung cancer (NSCLC) were treated with ifosfamide in combination with cisplatin and etoposide. Patients received ifosfamide 4 g/m2 with mesna uroprotection on day 1 and cisplatin 25 mg/m2 and etoposide 100 mg/m2 on days 1 through 3. Courses were repeated every 28 days. Premedication with prochlorperazine, dexamethasone, and high-dose metoclopramide was given to prevent nausea, and lorazepam was added on days 2 and 3 only. Seventeen male and three female patients (median age, 57 years) have been treated. Two patients had stage IIIb disease, and 18 had hematogenous metastases. Eighteen patients are evaluable for response and toxicity, and it is too early to evaluate two patients. Early in the study, two patients died of toxicity and have been classified as nonresponders. One patient achieved complete response (21+ weeks), and seven patients achieved partial response (median, 30+ weeks; range, 5 to 38+), for an overall response rate of 44.5%. The median survival of the group has not been reached, and 14 patients are alive 5 to 38+ weeks from the start of treatment. The median nadir granulocyte count was 0.275 x 10(9)/L (range, 0 to 2.283 x 10(9)/L), and there were six episodes (involving 5 patients) of neutropenia-associated fever, one of which resulted in death. The median nadir platelet count was 120 x 10(9)/L (range, 13 to 385 x 10(9)/L), but no patient experienced bleeding or required platelet transfusions. Five patients required RBC transfusions. Only eight patients had grade 2 gastrointestinal toxicity, and one patient had microscopic hematuria; there was no CNS toxicity.
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PMID:A phase II study of ifosfamide, cisplatin, etoposide in patients with advanced non-small cell lung cancer: a preliminary report. 215 85

The p53 gene initially was thought to be an oncogene, but recent evidence suggests that wild-type p53 can function as a tumor suppressor gene in lung, colon, and breast cancer as well as less common malignancies. This study reports the first identification of intronic point mutations as a mechanism for inactivation of the p53 tumor suppressor gene. Abnormally sized p53 mRNAs found in a small cell and a non-small cell lung cancer cell line were characterized by sequence analysis of cDNA/PCR products, the RNase protection assay and immunoprecipitation. These mRNAs were found to represent aberrant splicing leading to the production of abnormal or no p53 protein. Sequence analysis of genomic DNA revealed that a point mutation at the splice acceptor site in the third intron or the splice donor site in the seventh intron accounts for the abnormal mRNA splicing. In one patient the same intronic point mutation was found in the tumor cell line derived from a bone marrow metastasis and in multiple liver metastases but not in normal DNA, indicating that it occurred as a somatic event before the development of these metastases. These findings further support the role of inactivation of the p53 gene in the pathogenesis of lung cancer and indicate the role of intronic point mutation in this process.
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PMID:Identification of intronic point mutations as an alternative mechanism for p53 inactivation in lung cancer. 216 47


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