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)

The role of chemotherapy in the control of placental tumors is examined, both as a separate, single treatment, and as a conjuctive treatment. Its usefulness is most evident in the latter form of approach. In cases of the simple mole, its use is not really justified, and it does not appear to be effective in 9 out of 10 cases. In any therapeutic approach, it is not always effective and can be dangerous in the event of the development of chemoresistance. In cases of invasive mole and tumors where a histological diagnosis has not been made, and where a definite unfavorable prognosis is not evident, a twice weekly administration of methotrexate for a 2-month period after the cure has been clinically, radiologically, and biologically confirmed usually heals the formations. Choriocarcinomata and cases where a histology has not been carried out but where a negative prognosis is evident (extrapulmonary metastases, pulmonary metastases, delays in treatment, or the excretion of high levels of human chorionic gonadotropin), chemotherapy is considered justified with vincristine followed by methotrexate or actinomycin D. Surgical intervention to remove residual lesions may be necessary in these cases.
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PMID:[Chemotherapy in placental tumors]. 19 2

The incidence of malignant trophoblastic diseases in the population of Paraguay was low in the 1960-1969 and 1970-1974 periods, as shown by the analysis of unselected hospital admissions as compared to the total population. The Institute of Pathologic Anatomy and the National Tumor Registry in Asuncion, Paraguay, receive material from the entire republic. Cases are reported from all the affiliated centers. During the 10 years from 1960-1970, 227 cases of hydatidiform mole, 21 of choriocarcinoma, and 13 of chorioadenoma destruens were registered. In the 1970-1974 period, 121 hydatiform moles, 10 choriocarcinomas, and 3 chorioadenomas destruens were registered. To determine the incidence of choriocarcinoma and chorioadenoma destruens for Paraguay, the number of cases was divided by the number of total pregnancies, calculated from an analysis of 1965 estimates and related to the fertility rate in each age group. Using the estimated number of total pregnancies per year in Paraguay, there is 1 choriocarcinoma per 43,489 pregnancies and 1 chorioadenoma destruens per 70,252 pregnancies if all the probable pregnancies in the period of fertility are considered. Thus, the incidence of choriocarcinoma and chorioadenoma destruens is 0.229 and 0.142/1000 pregnancies, respectively. This means that 25.22 hydatidiform moles occur for 1 carcinoma or 17.46 hydatidiform moles for 1 chorioadenoma destruens. There were no differences in the calculations for the 1970-1974 period. Vaginal metastases were found in 28.57% of the patients with choriocarcinoma.
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PMID:Malignant trophoblastic disease in paraguay. 22 99

The haemodynamics of the uterine arteries and myometrium were assessed using Doppler ultrasound in forty consecutive patients requiring treatment for invasive mole and choriocarcinoma. The investigations were performed prior to the commencement of chemotherapy and the subjects followed prospectively. The Doppler waveforms from the uterine arteries were analysed using the pulsatility index. It was found that patients with a pulsatility index of 1.1 or less were significantly more likely to develop drug resistance than those with a higher value (P < 0.04). There was no significant association between the pulsatility index and metastatic disease or uterine bleeding. Five out of eight patients who developed drug resistance could have avoided initial inadequate treatment if the Doppler findings were included in the scoring system for selecting chemotherapy for these tumours. It can be concluded that assessment of the uterine arteries using the pulsatility index prior to the treatment of patients with invasive mole and choriocarcinoma is of help in predicting those who will develop drug resistance.
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PMID:Doppler assessment of the uterine circulation and the clinical behaviour of gestational trophoblastic tumours requiring chemotherapy. 132 10

From 1948 to 1985, a total of 630 cases of choriocarcinoma and invasive mole were treated in our hospital. The methods of treatment varied in different periods of time. In the third period (1972-1985), 5 Fu and/or KSM were the main therapeutic agents used in the treatment of 110 cases of choriocarcinoma and 99 cases of invasive mole. Metastases were observed in more than 90% of cases of choriocarcinoma and nearly 1/4 belonged to stage IV. The mortality of choriocarcinoma decreased from 84.3% to 32.7% after treatment and that of invasive mole from 32.4% to 8.1%. 43 of 80 patients treated with chemotherapy alone conceived after recovery, resulting in a total of 50 pregnancies including 31 term deliveries by 28 women. All the children are normal and healthy, the eldest being 11 years old now.
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PMID:Treatment of malignant trophoblastic tumors. An analysis of 209 cases. 165 28

From 1962 through 1989, 5063 patients were referred to the John I. Brewer Trophoblastic Disease Center of the Northwestern University Medical School. Among these were 564 patients treated with chemotherapy for gestational trophoblastic tumors (choriocarcinoma and invasive mole). The overall cure rate was 94%, 100% for 323 patients without evidence of metastases and 85% for 241 patients with metastatic disease. Four factors were determined to significantly influence treatment response: (1) clinicopathologic diagnosis of choriocarcinoma, (2) metastases to sites other than the lung or vagina, (3) number of metastases, and (4) previous failed chemotherapy.
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PMID:Study and treatment of gestational trophoblastic diseases at the John I. Brewer Trophoblastic Disease Center, 1962-1990. 166 98

6 patients with invasive mole and 5 patients with choriocarcinoma were treated from 1983 till 1986. Serum samples were analyzed by simultaneous determining of pregnancy-specific beta-1-glycoprotein (SP-1) using enzyme-linked immunosorbent assay (ELISA) and beta subunit of human chorionic gonadotropin (beta-hCG) using Serono radioimmunoassay kit. In 2 patients with metastatic gestational trophoblastic disease (MGTD) SP-1 peaks were found during chemotherapy. In patients with MGTD with normalized beta-hCG levels a repeated, temporary elevation of isolated SP-1 levels was observed within some months following chemotherapy. After the last isolated peak of SP-1 the pulmonary metastases disappeared. This phenomenon was interpreted as a consequence of the oncolytic process in the affected tissue. In 1 patient with nonmetastatic choriocarcinoma SP-1 ELISA pseudoreaction was found. To recognize these pseudoreactions, a control plate with nonimmunized rabbit IgG was used, simultaneously with SP-1 determinations.
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PMID:Elevated sera levels of SP-1 induced by chemotherapy in patients with metastatic gestational trophoblastic diseases. 169 89

All 1391 patients treated for gestational trophoblastic tumors (invasive mole and choriocarcinoma) at the John I. Brewer Trophoblastic Disease Center of Northwestern University between 1969 (when use of combination chemotherapy for initial treatment of high-risk disease came into general use) and 1988 were evaluated. Univariate and multivariate analyses were used to determine the relative importance of prognostic factors with respect to survival. The overall cure rate was 93% (363/391): 100% for 223 patients with nonmetastatic disease and 83% for 168 patients with metastatic disease. The only patients who died had a clinicopathologic diagnosis of metastatic choriocarcinoma. In addition to presence of metastasis (83% vs 100%, p less than 0.0001) and diagnosis of choriocarcinoma (67% vs 100%, p less than 0.0001), number of metastases (47% if greater than 8 vs 92% if less than or equal to 8, p less than 0.0001), metastases to sites other than the lung or vagina (52% vs 91%, p = 0.0002), and previous failed chemotherapy (46% vs 84%, p = 0.0014) demonstrated independent significant effects on survival in patients with metastatic disease. A Brewer score, based on our multivariate analysis of survival in patients with metastatic disease, provided predictability of outcome (likelihood ratio chi 2 statistic, chi 2 = 49.8) comparable to that with the World Health Organization score (chi 2 = 45.3), both of which, in turn, were better predictors than either the traditional Hammond clinical classification system (chi 2 = 34.4) or the International Federation of Gynecology and Obstetrics stage (chi 2 = 22.9).
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PMID:Prognostic factors in gestational trophoblastic tumors: a proposed new scoring system based on multivariate analysis. 184 5

Gestational trophoblastic tumor is a term applied to invasive mole, choriocarcinoma, and placental-site trophoblastic tumor. The overall cure rate in the treatment of these gestational trophoblastic tumors now exceeds 90%. This high success rate is the result of (1) inherent sensitivity of trophoblastic tumors to chemotherapy, (2) ability to monitor therapy effectively with the use of human chorionic gonadotropin as a tumor marker, and (3) identification of prognostic factors which allows categorization of patients into high- and low-risk groups for selection of treatment. Virtually all patients with nonmetastatic and low-risk metastatic disease can be cured using single-agent methotrexate or Actinomycin-D chemotherapy. Intensive therapy with combination chemotherapy including etoposide, high-dose methotrexate and Actinomycin D and, where indicated, adjuvant radiotherapy and surgery has resulted in cure rates of 80-90% in patients with high-risk metastatic disease. The factors which are most important in determining response to treatment are: (1) clinicopathologic diagnosis of choriocarcinoma, (2) metastases to sites other than the lung or vagina, (3) number of metastases, (4) previous failed chemotherapy, and (5) WHO score greater than or equal to 8.
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PMID:Gestational trophoblastic tumors. 217 31

From Jan. 1979 to Nov. 1987, 38 patients with invasive mole and 5 patients of choriocarcinoma were primarily treated with methotrexate and citrovorum factor (MTX-CF) rescue. Thirty-two patients had non-metastatic disease (stage I) and 11 had metastatic disease (stage IIA in 5 cases, stage IIB in 3 cases and stage IIIA in 3 cases). Complete remission was achieved in 28 (87.5%) of 32 patients with non-metastatic disease and in 9 (81.8%) of 11 patients with metastatic disease. Six patients with MTX-CF resistant tumors subsequently achieved complete remission with intravenous infusion of KSM and/or AT 1258. All patients were followed up periodically, 22 of them have been followed up for over 2 years, the longest duration of follow-up being 7 years. Seven of the 14 patients with preserved uterus became pregnant after recovery. All children grew up normally.
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PMID:[Treatment of gestational trophoblastic neoplasms with methotrexate and citrovorum factor rescue: analysis of 43 cases]. 256 Oct 92

With recent progress in chemotherapy, the prognosis of patients with trophoblastic neoplasia has greatly improved, but the remission rate of patients with choriocarcinoma remains unfavorable. The Committee for Trophoblastic Disease of the Japan Society of Obstetrics and Gynecology reported the results of hospital registration at 77 institutions throughout Japan in 1987. In this report, the survival rates of patients treated during the 7 years from 1974 to 1980 were described as follows. The 5-year survival rate has approached 100% for patients with invasive mole, while the rate for patients with choriocarcinoma is now approaching 80%. As far as choriocarcinoma is concerned, the survival rate depends on the presence of metastases. The 5-years survival rate for patients without metastases has approached 100%, while that for patients with metastases is barely 60%. Patients with poor-prognosis choriocarcinoma present difficult and challenging problems for the clinician. These patients are best treated on the basis of the prognostic scoring system proposed by Bagshawe. The higher the score, the greater the risk of drug resistance developing during traditional therapy. To date, our experience with the MECA regimen would indicate that it is most effective for patients with high-risk trophoblastic neoplasia. We now also recommend that all high-risk patients should receive at least four additional courses of the regimen after a negative hCG titer has been obtained. After complete remission has been achieved, further follow up should be repeated every month for at least three years.
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PMID:[Chemotherapy of high-risk trophoblastic neoplasia]. 282 Mar 10


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