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

An overview of brain metastasis with respect to the pathological, diagnostic, and therapeutic aspects is presented. Management is almost always palliative, with cure being a rare exception. Evaluation of various therapeutic modalities--radiation, chemotherapy, or surgery--has been confounded by a lack of controlled, randomized studies whereby the relative benefit of the respective modalities can be assessed objectively. Despite these limitations, some progress is being made in the identification of those patients for whom therapy is likely to be of benefit. Apart from the use of steroids to control cerebral edema, radiotherapy is currently the most commonly employed therapeutic modality for cerebral metastasis. It is the treatment of choice for multiple intracranial metastases and it affords temporary improvement in neurological symptoms in about 60% of patients. For solitary metastases, combined therapy--surgical excision followed by whole brain radiotherapy--has been shown to result in a better quality and longer duration of survival than either modality alone. Except for patients who are terminally ill, aggressive treatment seems warranted, inasmuch as therapeutic results have been improving steadily over the years. Neither chemotherapy nor immunotherapy has been shown to be of benefit in the management of cerebral metastasis. An exception is choriocarcinoma, which responds well to a combination of radiation therapy and chemotherapy. Although the prognosis for meningeal carcinomatosis is poor, improved survival may be achieved by a combination of chemotherapy and radiotherapy. These are recommended guidelines for surgical intervention, usually followed by radiotherapy: (a) In general, surgical excision is recommended only for patients with relatively superficial, solitary lesions. It is reasonable, however, to consider the excision of a metastatic lesion that is immediately life-threatening or incapacitating, even though one or more other metastatic brain lesions may be present. This may be extended to the removal of multiple metastatic brain tumors if they are surgically accessible. (b) The second consideration is whether the primary tumor can or has been treated or if the primary tumor will permit reasonably long survival. (c) There should not be metastases elsewhere in the body, although their presence should not categorically exclude the patient as a surgical candidate. (d) The patient's general condition should be satisfactory. (e) Operation is recommended if the diagnosis of the intracranial lesion is uncertain. (f) A shunt should be considered for treatment of hydrocephalus secondary to obstruction of the cerebrospinal fluid pathway by tumor or edema. (Neurosurgery, 5: 617--631, 1979).
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PMID:Brain metastasis: current status and recommended guidelines for management. 9 55

Primary intracranila choriocarcinoma, either alone or with malignant teratoma, is a rare tumor. The 22 reported cases of primary intracranila mixed choriocarcinoma and malignant teratoma are reviewed, and a further case is added. This 4 1/2-year-old girl presented with multiple cranial nerve palsies, panhypopituitarism and markedly elevated blood and urine human chorionic gonadotrophin (HCG) titres. After subtotal removal of the suprasellar tumor, supervoltage radiation was given with a remarkably rapid and complete response. She died 14 months after diagnosis with no evidence of local recurrence nor of distant metastases.
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PMID:Primary intracranial mixed choriocarcinoma and malignant teratoma. 9 20

Serial assays of serum progesterone and serum human chorionic gonadotropin (HCG) were performed in eight cases of choriocarcinoma before and during treatment of the disease. Serum progesterone was measured by the competitive protein-binding technique and serum HCG was measured by the hemagglutination inhibition method. Serum HCG gives a better index of response of the tumor to treatment when compared to serum progesterone. In cases where the ovaries are still present serum progesterone does not disappear completely when the disease is eradicated and fluctuates cyclically, thus reflecting ovarian activity. However, in most cases with pulmonary secondaries, serum progesterone was elevated in spite of undetectable serum HCG. With widespread metastases serum progesterone rose to pregnancy levels and remained persistently high. Cerebrospinal fluid progesterone in a case of choriocarcinoma with cerebral metastasis was 5 ng. per milliliter, which was very much higher than in normal pregnant subjects. The findings of serum progesterone in comparison to serum HCG during therapy of choriocarcinoma are discussed.
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PMID:Evaluation of serum progesterone during treatment of malignant trophoblastic disease. 17 Aug 26

Thirty-one patients with nonmetastatic trophoblastic disease (NMTD) and 39 patients with metastatic trophoblastic disease (MTD) of gestational origin were treated primarily with actinomycin D. Complete and sustained remission was achieved with actinomycin D alone in 94% of patients with NMTD and 67% with MTD. In the nonmetastatic group, 93% of patients without choriocarcinoma (non-CCA) achieved remission with actinomycin D, as compared to 100% (only 3 patients) with CCA. in the metastatic group, 76% of patients without CCA achieved remission with actinomycin D, as compared to 56% where CCA was present. Fourteen of the 15 patients who failed to respond completely to actinomycin D alone subsequently responded to methotrexate (10 patients), triple therapy (3 patients), methotrexate plus triple therapy (1 patient), and methotrexate plus vinblastine (1 patient). One patient died with widespread metastases despite intensive chemotherapy with actinomycin D and triple therapy. No serious toxic side effects were encountered even in treated patients with pre-existing laboratory evidence of impaired hepatic function.
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PMID:Actinomycin D as the primary agent for gestational trophoblastic disease. 17 Oct 55

Autopsy findings in 20 cases of clinical extragonadal germ-cell tumors arising in the anterior mediastinum are presented. The histologic types were: 2 choriocarcinomas, 3 seminomas, 3 malignant teratomas, 3 embryonal carcinomas, and 9 mixed germ-cell tumors. All of the patients were men, and the ages ranged from 14 to 45 years, with a mean of 32.5 years. The mean survival for these patients after diagnosis was 10.9 months. Local recurrence was characteristic of non-seminomatous tumors. In patients with seminoma, local control of the disease was good, but distant metastases were the cause of death. The most frequent sites of metastases were lungs, bones and liver. In all 20 cases, the testes were carefully step-sectioned. Occult tumor was found in only one case of embryonal carcinoma and a well-defined testicular scar with calcification in a patient with choriocarcinoma. Both patients had lower retroperitoneal metastases. These findings support the premise that, in the majority of cases, these tumors had a primary extragonadal origin.
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PMID:Germ-cell tumors of the mediastinum, postmortem findings. 17 71

Serum human chorionic gonadotropin (hCG) was measured by a radioreceptorassay (RRA) and radioimmunoassay (RIA) and serum hCG-beta and hCG-alpha by RIA in 10 patients with intact mole, 3 patients with choriocarcinoma, and 4 patients with hydatidiform mole during treatment. hCG levels by RRA were higher in 5 of 10 molar pregnancies and ranged from 20,900 to 100,000 ng/ml and from 30,000 to 100,000 ng/ml by RIA. hCG levels by RRA and RIA paralleled one another closely during treatment of hydatidiform mole. hCG-alpha was higher than hCG by RRA and RIA and hCG-beta in molar pregnancies, in the uterine venous blood draining a uterine choriocarcinoma, and during chemotherapy of choriocarcinoma. In 2 of 3 choriocarcinoma patients who eventually developed cerebral metastases, hCG-alpha increased while hCG and hCG-beta were declining or negative. hCG-beta was usually lower than hCG or hCG-alpha in all the cases studied. These results demonstrate the production of free alpha and beta subunits in trophoblastic disease. Further, due to the biospecificity, simplicity, and rapidity, the RRA of hCG is a sueful diagnostic aid during treatment of trophoblastic neoplasia until the levels fall to within the sensitivity range of the assay. Finally, the RIA of hCG, hCG-beta, and hCG-alpha, which requires several days, should be performed until they become negative or fall within normal range.
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PMID:Human chorionic gonadotropin and its subunits in hydatidiform mole and choriocarcinoma. 19 42

Thirty-five patients with nometastatic gestational trophoblastic neoplasms and 3 patients with metastatic gestational trophoblastic neoplasms were treated primarily with methotrexate and citrovorum factor rescue. The antecedent pregnancy was molar in all patients. The known histologic diagnosis in 34 patients was hydatdiform mole and choriocarcinoma in 3. Up to March 1977, the duration of remissions ranged from 1 to 21 months. Complete and sustained remission was achieved in 91% of patients with nonmetastatic disease and in 2 of the 3 patients with metastases, without evidence of marrow or hepatic and with substantially reduced epithelial toxicity. Response to treatment and the number of courses required to achieve remission were determined solely on the basis of the human chorionic gonadotropin response as measured by the beta subunit radioimmunoassay.
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PMID:Methotrexate with citrovorum factor rescue for gestational trophoblastic neoplasms. 20 93

The experience of the Southern Regional Trophoblastic Disease Center includes 222 patients who were referred from January 1972 to October 1977. The initial tissue diagnosis was hydatidiform mole in 212 patients and choriocarcinoma in ten. There was spontaneous remission of 142 (69%) of the moles and one of the choriocarcinomas, and 77 patients developed persistent trophoblastic disease. Of these, 58 had no evidence of metastasis, and all achieved remission with single-drug therapy. Nineteen patients developed metastases; 13 were in the "good prognosis" category, and all achieved remission with single-drug therapy. Five (83%) of the six patients with metastases in the "poor prognosis" group achieved remission with triple chemotherapy; one died of her disease.
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PMID:Southern Regional Trophoblastic Disease Center, 1972--1977. 21 50

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

Central nervous system metastases are a common complication of disseminated germ cell tumors of the testis. They occurred in 16% of 242 patients treated and in 25% of the patients who died in our VAB chemotherapy series. Pulmonary metastases preceded or coincided with the development of brain metastases. The frequency of brain metastases differed with the histology of the primary tumor. They occurred in 13% of pure embryonal carcinomas, 18% of mixed tumors containing embryonal or choriocarcinoma elements, and 83% of pure choriocarcinomas. Embryonal carcinoma and choriocarcinoma were the principle histologies found in brain metastases. Characteristically, pure choriocarcinoma deposits in the brain were multiple (8/9) and cerebellar involvement was common (5/9). Pure embryonal carcinoma CNS metastases were typically single (6/8) or very few and cerebellar involvement was not observed. The interval from the diagnosis of malignancy to the diagnosis of brain metastases was longer for embryonal carcinoma than for pure choriocarcinoma (23 mos. vs. 6.5 mos.). Survival following the diagnosis of brain metastases was poor. There was a tendency toward longer survival for histologically pure embryonal carcinoma deposits in the brain than for the pure choriocarcinomas (6.5 mos. vs. 1 mo.).
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PMID:Neurological complications of malignant germ cell tumors of testis: biology of brain metastases (I). 22 44


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