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)

Twenty patients with osteosarcoma and pathologic fractures were treated with a chemotherapeutic regimen consisting of cis-diamminedichloroplatinum-II (CDP), Adriamycin (ADR) (doxorubicin) and high-dose methotrexate with citrovorum factor "rescue" (MTX-CF). Before the introduction of the regimen, the primary tumor in two patients was treated by immediate amputation and in 13 with preoperative intra-arterial CDP. Among these 13 patients, responses (healing) were observed in 11 (one required the addition of radiation therapy). In three patients, the responses were so dramatic that, at their request, surgery was deferred and treatment exclusively with chemotherapy was instituted. Based on this experience, treatment exclusively with chemotherapy was also administered to an additional five patients who were admitted without pathologic fractures. In the course of such treatment, pathologic fractures also developed; notwithstanding, chemotherapy was maintained and healing also occurred. One of the 20 patients had pulmonary metastases at diagnosis; these were resected after treatment and pathologic examination revealed no evidence of viable tumor. The remaining 19 patients were free of pulmonary metastases but these later developed in seven patients. These data were compared to a historical control series in which 16 of 21 patients with pathologic fractures developed pulmonary metastases. Three of the chemotherapy treated patients died of nonosteosarcoma related causes (leukemia, generalized varicella, and a metabolic complication). Overall, survival was improved in the chemotherapy treated patients as compared to the historical control series: 10 of 20 versus 6 of 21, respectively. Pathologic fractures in osteosarcoma may heal under treatment with chemotherapy, which also has a favorable impact on the eradication of pulmonary metastases and survival.
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PMID:Pathologic fracture in osteosarcoma. Impact of chemotherapy on primary tumor and survival. 349 61

The most important factor to consider in deciding between treatment options in the management of metastatic bone disease is the level of the patient's dysfunction and pain. Severe dysfunction or pain demands a treatment that predictably leads to a quick resumption of the painless activities of daily living. A treatment that predictably will restore function in months may seem reasonable in patients with a normal remaining life span, but is untenable if those months represent a high percentage of remaining life span, as they do in metastatic disease afflicted patients. The treating physician needs also to understand the basis for the patient's dysfunction. A destroyed joint will not return to painless function even if the metastasis responsible is totally eliminated. A bone that has lost its structural integrity, even though not grossly fractured, will not support weight bearing for months even if the metastasis is eliminated. Control of the metastatic tumor does not always equate with return to function. Treatment options in the management of metastatic bone disease are not mutually exclusive. In many patients treatment options are combined. Surgical stabilization may best return the patient's function while he is being treated postoperatively with radiotherapy or chemotherapy for good neoplasm control. Neoplasm control should not be such an overriding concern that function is not addressed. Function can almost always be returned to the patient, but neoplasm "cure" is rarely achieved in this group of patients. It is a reasonable goal to avoid allowing bone metastasis to progress to pathological fracture. Routine periodic examinations and bone scans should commonly alert the treating physician to the presence of metastatic bone disease well before fracture occurs. Pathological fracture narrows the range of treatment options, mitigates against full functional restoration, demands a rehabilitation hiatus, and acutely frightens the patient who does not have time to participate fully in treatment decisions. An impending pathological fracture can be treated with surgery, radiotherapy, chemotherapy, or hormonal manipulation. The options are basically operative or nonoperative. Lesions that predictably will fracture short term, involve joints, or will cause catastrophic consequences if fracture occurs should be strongly considered for surgical stabilization. Other factors to consider are the location of the metastasis, the primary tumor, and the expected response to nonoperative therapy. The patient becomes a surgical candidate for the above reasons and not because of any estimated life span.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Surgical stabilization of pathological neoplastic fractures. 351 30

A series of clinical and pathological studies were performed on 74 cartilaginous bone tumors including osteochondromas, multiple cartilaginous exostoses, chondromas, chondromatoses, benign chondroblastomas and chondrosarcomas. Resection was adequate for the osteochondromas, and no recurrence was observed. Out of 14 multiple cartilaginous exostoses, three, all in flat bones showed malignant change. The predominant sites of chondroma were the finger and toe bones, and curettage and bone graft was adequate treatment. Neither recurrence nor malignant change was observed. Two cases of chondromatosis, one of Ollier's disease and one of Maffucci's syndrome, were included in our series. Leg length discrepancy and pathologic fracture were common problems in chondromatosis. Moreover, malignant change was suspected in a hemangioma of the Maffucci's syndrome patient. Benign chondroblastoma was treated by curettage and bone graft, with no recurrence. In our series, 4 primary and 3 secondary chondrosarcomas were observed. Metastasis was seen in only one case. Because of the discrepancy between the biological behavior and histological findings of cartilaginous bone tumors, the malignancy of tumors should be evaluated by clinical signs and symptoms as well as by histological findings.
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PMID:Follow-up study of cartilaginous bone tumors. 352 17

During the past ten to 20 years, there have been many advances in the understanding of the way in which skeletal metastases develop and great strides in the methods of detection, particularly with the development of the gamma camera and axial or whole-body skeletal scintigraphy. Skeletal metastases may present with pain, hypercalcemia, large lytic lesions, pathologic fracture, spinal cord or cauda equina compression, or spinal instability. Much has been learned about the management of skeletal metastases, and many of these developments have occurred in Great Britain.
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PMID:Skeletal metastases. 375 60

A total of 45 patients have received surgical treatment for distant metastases in 41 follicular and four papillary carcinomas. Fifty-four metastatic lesions were removed. In the majority of cases (n = 25, 46%), surgical intervention was indicated on the basis of oncologic data (reduced administration of radioiodine). Sixteen patients (30%) underwent surgery to relieve pain, and 13 other patients (24%) had surgical treatment of pathologic fracture. At the time of surgery, 29 patients (64%) had only one resectable metastasis, while 16 patients (36%) had further nonresectable metastases (six in the bone, 10 in the bones and lungs). In the course of 53 operations, metastases were resected from bone in 46 cases, from the lungs and greater omentum in two cases, and from the skin, suprarenal gland, pleura, and intra-abdominal lymph node in one case each. A total of 25 metastases (17 bone, eight soft tissue) could be removed by resection. In 16 patients, the resulting bone defect was filled with bone cement after resection of the metastases. Osteosynthesis was necessary in another six cases, while seven required the implantation of an endoprosthesis. Thirty-eight patients died between 1 and 136 months after surgical treatment. Twenty-six (58%) died of their primary disease after an average 49.3 months, seven (15%) died with their carcinomas of other causes after an average of 12 months, and five (11%) died intercurrently after an average of 16 months. Seven patients (15%) are still alive after 12 to 264 months (average, 99.3 months); four of them are without recurrence and three have metastases. Five of these patients exhibit normal activity, while the activity of the other two is limited by the progress of the carcinoma or as a result of surgical treatment. The estimated cumulative survival rate (Kaplan-Meier) was 44.8 +/- 11.2% for 5 years and 32.7 +/- 11.0% for 10 years after removal of a solitary metastasis. Analysis of these patients shows that the surgical removal of resectable metastases can be a valuable complement to nuclear medical therapy. The complicated surgical treatment of metastases is justified by the favorable effect it has on prognosis and on the patient's quality of life.
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PMID:Surgical treatment of distant metastases in differentiated thyroid cancer: indication and results. 378 64

Review of patients with pathologic fracture of the humerus disclosed that closed treatment resulted in a high incidence of pain, disability, and failure to heal. The most common cause of pathologic fracture of the humerus is breast cancer. A review of records of 103 patients with persistent disease after initial treatment for breast cancer revealed that 19 had humeral metastases (18.5%); of those with humeral metastases, two patients (10%) had pathologic fractures. Prophylactic internal fixation of humeral metastases is not routinely recommended, but operative treatment for pathologic fracture of the humerus is generally superior to nonoperative methods of fracture management.
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PMID:Pathologic fracture of the humerus. 395 87

Clinical records and radiographs of 203 female patients with 516 metastatic breast lesions located in the proximal femur were examined retrospectively to determine: the dimensions of those lesions that were at risk of fracture; and the relationship of other variables (bone pain, body habitus, age, and radiation treatment) with the occurrence of a pathologic fracture. Twenty-three patients sustained 26 pathologic fractures. Their average age, height, and weight were not significantly different from the 180 patients without fractures. Similarly, moderate to severe bone pain was experienced by a great majority of the total patient population, yet only 11% sustained fractures. Fifty-six patients received radiation treatment of a femoral metastasis. Ten of these patients subsequently sustained fractures. Radiation treatment relieved bone pain but did not have any consistent curative effect on the lesion itself. Finally, the authors were unable to identify either a specific percent involvement of the bone or a critical diameter for metastases that fractured because: 296 (57%) of the 516 metastases were permeative lesions and unmeasurable; 14 (54%) of the 26 pathologic fractures observed occurred through unmeasurable lesions; and the 12 measurable lesions that fractured had the same range of percent involvement as the 208 measurable lesions that did not fracture. Breast metastases at risk of fracture cannot be identified by measurements obtained from standard radiographs alone.
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PMID:Metastatic breast cancer in the femur. A search for the lesion at risk of fracture. 395 91

Fifty-four patients with metastatic bone disease were followed prospectively to assess the risk of pathologic fracture during rehabilitation. Sixteen fractures were observed in 12 patients. Only one fracture occurred while the patient was undergoing rehabilitation, and this was a fourth lumbar vertebral compression that did not affect the clinical course of the patient. Patients in the fracture group were generally younger, female, and in a more advanced stage of disease with lytic metastases and a previous occurrence of pathologic fracture.
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PMID:Pathologic fracture risk in rehabilitation of patients with bony metastases. 396 25

Malignant change at the site of a chronic osteomyelitis, a rare condition, is reported in a 45-year-old man, along with a review of the literature. This patient with a 30-year history of chronic osteomyelitis of the right femur and an intermittently discharging sinus had a large abscess in the lower thigh. The abscess was drained, and an ulcer developed at the mouth of the sinus tract. Soon afterward, he sustained a pathologic fracture through the lower femur. Biopsy specimens of the ulcer showed a well-differentiated squamous carcinoma. An amputation was performed at the level of the proximal 10 cm of the femur. The patient remains well 18 months later with no clinical or radiologic evidence of metastases. Changes in character of a previously innocuous osteomyelitis sinus tract should arouse suspicion of neoplastic transformation. Biopsy of various depths of the sinus tract, including the bone marrow, is essential. Early amputation for squamous cell carcinoma is indicated and offers a good prognosis.
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PMID:Squamous cell carcinoma in chronic osteomyelitis. Report of a case and review of the literature. 402 59

A survey of the surgical treatment of 31 patients with metastases in the long bones is presented. Early diagnosis is essential to prevent pathological fractures in patients with a malignancy. Localized bone pain and an abnormal isotope bone scan or X-ray are the most reliable clues to diagnosis. Should a pathological fracture occur, reduction and internal fixation are indicated to keep the patient active and reduce pain. This was performed in 29 of the cases reported here. Fixation prior to fracture was carried out in six patients. The advantage of this strategy is that it reduces both operative risks and duration of hospitalization. Furthermore, it creates a more favourable situation with regard to preoperative diagnostic appraisal and choice of approach to improve the mechanical qualities of the bone involved, thus preserving function and activity.
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PMID:Surgical treatment of pathological fractures caused by bone metastases. 405 77


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