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)

A brief discussion of the definition, etiology, epidemiology, classification, and prognosis of the gestational trophoblastic tumor (GTT) is presented. Current therapeutic options are summarized. GTTs arise from fetal tissues and can be divided into three histologic categories, hydatidiform mole, chorioadenoma destruens, and choriocarcinoma. Clinically, it is classified as nonmetastatic, metastatic-low risk, or metastatic-high risk. Diagnosis is based on clinical signs and symptoms, ultrasound and X-ray examinations, and the presence of elevated serum levels of the B-subunit of human chorionic gonadotropin (hCG). Primary therapy for hydatidiform mole is evacuation of the uterine contents. Prophylaxis for metastases with actinomycin D sometimes is performed, but generally is not recommended. For persistent disease that is classified as nonmetastatic or low-risk metastatic, a methotrexate-leucovorin rescue protocol is preferred, with actinomycin D used in patients who show resistance to the regimen. Standard therapy for high-risk metastatic disease involves triple agent therapy with methotrexate, actinomycin D, and chlorambucil, but toxicity is significant. Other alternatives include the modified Bagshawe protocol, a VBC (vinblastine, bleomycin, cisplatin) regimen, cisplatin in combination with vincristine and high-dose methotrexate, and VP16-213 (etoposide) in combination with other agents. Other treatment modalities include radiation and surgery. Use of the most appropriate therapies can maximize the survival of a patient with gestational trophoblastic disease.
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PMID:Treatment of gestational trophoblastic tumors. 608 60

We studied the clinical records of 64 women with malignant trophoblastic disease. Fifty-five patients (68%) were aged 25-50 years. The current pregnancy was preceded by abortion in 24 cases, by molar pregnancy in 23 cases and by normal pregnancy in 17 cases. The most common presenting symptoms were vaginal bleeding, abdominal mass and abdominal pain. Pulmonary lesions were mostly silent, but hemoptysis occurred in seven patients. Metastases were found in 39 patients. Treatment was mainly chemotherapy. Remission for over 12 months occurred in 40 patients, and 21 patients died.
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PMID:Clinical observations of malignant trophoblastic disease. 610 62

Circulating levels of four specific placental proteins, human chorionic gonadotrophin (hCG), Schwangerschafts protein 1 (SP1), placental protein 5 (PP5) and pregnancy-associated plasma protein A (PAPP-A), were measured in 31 patients with hydatidiform mole before treatment. Seven patients subsequently developed clinical choriocarcinoma and three of them had pulmonary metastases. The estimations of hCG, PP5 and PAPP-A levels were found to be of no value in the prediction of malignant sequelae. Levels of SP1 greater than or equal to 16.5 i.u./l were associated with a higher incidence of subsequent malignant disease (P less than 0.05), the risk being at least nine times greater in these patients. The predictive value of high levels of SP1 was 35%, the specificity 45.8% and sensitivity 100%.
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PMID:Prognostic significance of the new placental proteins in trophoblastic disease. 618 12

Beta-2-microglobulin (BMG) is physically linked to the allo-antigenic HLA chain on the cell surface and is accordingly a marker for the HLA antigens. BMG concentrations were measured in serum and cerebrospinal fluid (CSF) samples from 22 patients with choriocarcinoma, 5 with hydatidiform mole and 17 reference subjects in the first trimester of pregnancy. Serum BMG levels were elevated in the patients with choriocarcinoma, particularly when human chorionic gonadotrophin levels were higher than 50 000 U/l (less than 50 000 U/l--1,6 +/- 0,3 mg/l; greater than 50 000 U/l--2,75 +/- 0,72 mg/l; molar pregnancy--1,42 +/- 0,44 mg/l; reference subjects--1,47 +/- 0,15 mg/l) (mean +/- 1 SD). BMG levels in the serum and CSF were not increased when metastases were present in the cranium. None of the patients had evidence of abnormal renal function as determined by serum urea, electrolyte and creatinine levels and the creatinine clearance rate. These results suggest that BMG and HLA antigens are expressed on the trophoblastic cells in choriocarcinoma, or alternatively that the maternal immunocytes produce increased quantities of BMG.
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PMID:Beta-2-microglobulin in trophoblastic disease. 619 98

Choriocarcinoma is known to be sensitive to chemotherapy. Remission rates of 70% are reported for patients with metastatic disease. The Southeastern Regional Trophoblastic Disease Center of Duke University has reviewed its experience with the treatment of cerebral metastases from choriocarcinoma. Fourteen patients were identified as having cerebral metastases from a group of more than 500 patients with gestational trophoblastic disease (GTD) other than primary hydatidiform mole. The remission rate of 50% (7/14) was achieved by vigorous, multiagent chemotherapy and combined cerebral irradiation therapy. This series of patients is reviewed with regard to diagnosis, details of multiagent chemotherapy with cerebral irradiation, complications, and survival. The key factors for successful outcome seem to be early diagnosis and vigorous therapy.
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PMID:Cerebral metastatic choriocarcinoma: intensive therapy and prognosis. 624 7

The administration of chemotherapy to a patient with persistently elevated titers of hCG without metastases after hydatidiform mole implies a diagnosis of nonmetastatic gestational trophoblastic neoplasia (NMGTN). At present, a diagnosis of NMGTN following evacuation of hydatidiform mole is usually made after a plateau of three values of hCG over 2 weeks (days x, x + 7, x + 14), and patients are given chemotherapy on the basis of such a plateau. The frequency of the diagnosis of NMGTN from four United States Centers is presently 26% and this compares with a frequency of choriocarcinoma of 16% in the prechemotherapy era. Data are presented to demonstrate that a plateau of 3 or 4 weeks may be justified before a diagnosis of NMGTN is made and chemotherapy is given in patients who may be followed up closely.
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PMID:Criteria toward the definition of nonmetastatic gestational trophoblastic disease after hydatidiform mole. 627 94

Of 127 patients with hydatidiform mole in southern Connecticut, 34 (28%) received chemotherapy for persistently elevated human chorionic gonadotropin (hCG) titers. An hCG regression curve was found to be useful if not mandatory for following patients. Excess uterine size, theca lutein cysts, uterine bleeding, and histologic trophoblastic hyperplasia were relative discriminators of the need for chemotherapy. In the absence of metastases, an hCG titer was the only valid discriminator for initiating chemotherapy, provided the patient could be followed consistently and reliably. The indications for initiating chemotherapy are discussed. Early diagnosis and close follow-up were associated with low morbidity. Five of 6 patients with metastatic disease were referred from outside the center.
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PMID:Hydatidiform mole and gestational trophoblastic disease in Southern Connecticut. 628 2

Three hundred fifty-nine patients with gestational trophoblastic disease (choriocarcinoma and invasive mole) received complete treatment at the Brewer Trophoblastic Disease Center of Northwestern University Medical School from 1962 through 1978. Data were gathered as of December 31, 1978, to permit a minimum follow-up of 2 years. An overall remission rate of 92% was achieved: 100% (185/185) for nonmetastatic disease and 83% (144/174) for metastatic disease. All 200 patients with invasive mole and 129 of 159 patients (81%) with choriocarcinoma were cured. Chemotherapy was the main form of treatment, with adjuvant surgery and radiation therapy being used in selected patients. Five factors were determined to significantly influence response to treatment in patients with metastatic disease: 1) clinicopathologic diagnosis of choriocarcinoma versus invasive mole (71 versus 100%, P much less than .0005); 2) pretreatment human chorionic gonadotropin titer greater than 100,000 IU/liter and time greater than 4 months from pregnancy event to treatment (62 versus 93%, P much less than .0005); 3) metastases to sites other than lung and/or vagina (37 versus 92%, P much less than .0005); 4) antecedent term gestation compared with hydatidiform mole, abortion, and ectopic pregnancy (56 versus 79%, P less than .02); and 5) prior unsuccessful chemotherapy compared with no previous treatment (48 versus 83%, P much less than .0005). The value of secondary chemotherapy and adjuvant irradiation was evaluated. Relapse from remission was also studied.
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PMID:Gestational trophoblastic disease: treatment results at the Brewer Trophoblastic Disease Center. 628 7

Alpha HCG, estimated after evacuation of hydatidiform mole, was found to follow the decline of beta-HCG. In patients with low-risk non-metastatic gestational disease the alpha-subunit values also followed the beta-HCG values. This indicates no additional value in following alpha-HCG in such patients. Whether alpha-HCG elevation may portend recurrence in treated high-risk cases of metastatic disease in remission with non-detectable beta-HCG remains unresolved by this study.
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PMID:Alpha subunit in gestational trophoblastic disease. 630 44

The relationship between human chorionic gonadotropin (HCG) titers in urine and the number of discrete metastatic pulmonary nodules was studied in patients with persistent trophoblastic disease, after evacuation of hydatidiform mole, and before starting chemotherapy. A significant difference in HCG titers was found between patients with 0 to 2 nodules and patients with 5 or more nodules. A weak linear relationship was found. The distribution of 57 discrete pulmonary nodules in 13 patients was plotted by lung zones (upper, middle, and lower thirds). Twenty-eight percent of the nodules were in the upper third of the lungs. Two patients had solitary apical nodules. This differs from the characteristic predominantly basilar distribution of blood-borne metastases of other neoplasms. Pulmonary spread may have occurred during curettage of moles, when the patients were recumbent and pulmonary blood flow was redistributed to the upper portions of the lungs.
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PMID:Gestational trophoblastic tumors metastatic to the lung. Radiologic--clinical correlations. 631 59


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