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 specificity and sensitivity of malignancy marker determinations in cerebrospinal fluid (CSF) are often insufficient. Even at the subclinical stage of the disease the marker should be present. The effect of therapy should be monitored and relapses noted. Thus high standards of methodology are required. There are many substances that may indicate a malignant process in the central nervous system. However, there are many pitfalls in their determination. Malignant cells may occur in CSF via processes involving leptomeningeal structures such as metastases and leukaemia, but primary brain tumours seldom show cells in CSF. Human chorionic gonadotrophin and alpha-fetoprotein determinations assist in the early detection of cerebral germ cell tumours and of relapses, even in the subclinical stage. Desmosterol may aid in the diagnosis of medulloblastomas and malignant gliomas and in monitoring therapy. Putrescine levels are elevated in CSF of patients with medulloblastoma and correlate with the clinical state, and serial analyses may reveal relapses. Fibronectin, when determined in CSF at the time of diagnosis, appears to be of great significance for the prognosis of acute lymphoblastic leukaemia. Ferritin and beta-2-microglobulin may help in some well-defined conditions. Brain-specific proteins and antibodies to them are non-specific markers whereas tumour-specific antigens and growth factors may be more significant.
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PMID:Malignancy markers in the cerebrospinal fluid. 305 81

Seven patients with extraneural metastases from medulloblastoma were treated with a combination of cytoxan, adriamycin, and vincristine (CAV). None of the patients had evidence of active neural axis disease. All patients with bone metastases responded with a reduction in bone pain and improvement on the radionuclide bone scan. One patient presenting with lymph node metastases showed initial reduction in the size of the palpable nodes. In this group, the median time to the development of extraneural metastasis was 18 months from the time of original diagnosis of central nervous system medulloblastoma. The median duration of response to CAV, after extraneural metastasis, was 17 months (4-65 months). Four of seven patients died of disease-related causes, one patient presumed well was lost to follow-up, and two of seven are still without evidence of active disease at 37 and 65 months. The combination of CAV is well tolerated and provides reasonably good palliation for extraneural medulloblastoma.
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PMID:Treatment of extraneural metastatic medulloblastoma with a combination of cyclophosphamide, adriamycin, and vincristine. 320 Mar 78

In this paper, 374 cases of intracranial tumor were studied retrospectively. The incidence of glioma (45.6%) was the highest, next was meningioma (19%) and pituitary tumor (12.3%). Astrocytoma comprised 73.5% of glioma. 75% of medulloblastoma and 54% of ependymoma occurred under 20 years of age, whereas 71.8% of meningioma, 44% of astrocytoma and 47.4% of metastatic tumor occurred between 21 to 50. The ratio of male and female was 1.69:1 except 0.8:1 of meningioma. 73.8% of all the lesions was located above the tentorium of cerebellum, the rest under it. Ninety one cases were followed. The 5 year survival rate was 25.3% (23/91). According to Kernohan's classification, the authors believe that astrocytoma can be divided into four grades, which is of great use in clinical diagnosis and prognosis. The other gliomas are only divided into benign and malignant. The results of surgery are related to tumor type and differentiation. Pituitary adenoma, meningioma, neurilemmoma and astrocytoma grades I and II have a good result by operation, while medulloblastoma, astrocytoma grades III and IV and metastatic cancer have a higher mortality.
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PMID:[Clinicopathologic study of 374 cases of intracranial tumors]. 344 63

Estimates of the gain in survival, if all local failures were eliminated, indicate that many more patients could be cured provided the efficacy of treatment of the primary and regional disease were substantially improved. The expected gain in survival is assumed to be the gain in local control, less the loss due to distant metastases and intercurrent disease among the new local control subjects. The observed incidence of DM among local failure patients may be higher than among local control patients; this excess in incidence of DM is assumed to result from metastases established secondary to the persistent or recurring tumor. A powerful argument that higher local control rates would result in more cured patients is the high incidence of long-term survivors after salvage surgery for local failures. Examples of higher survival associated with more effective local therapy are presented from the literature for medulloblastoma, ependymoma, carcinoma of the oral cavity-oropharynx, carcinoma of the urinary bladder, carcinoma of the prostate and carcinoma of the rectum. For Stage I-II cancer of the breast, the reduction of an already low local failure rate by combining surgery and radiation has a very small impact. For tumors, such as, early stage breast cancer, where the possible decrease in local failure is small and the loss due to DM is high, a demonstrable gain in survival is not likely. The potential increase in number of survivors among the U.S. cancer population, if the primary-regional disease were regularly treated successfully, indicates large gains for patients with cancer of the uterine cervix, oral cavity-oropharynx, ovary, colo-rectum, non-oat cell cancer of lung, prostate cancer, and bladder cancer. These provide powerful bases for aggressive investigation of new approaches to improvement of local-regional therapies.
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PMID:Impact of improved local control on survival. 351 48

We analyze a series of 44 medulloblastomas in patients aged 20 and older, listed in the Connecticut Tumor Registry. Average age was 34.1 years. Incidence was 0.058 per 100,000 per year. Headache and ataxia were the most frequent presenting complaints. Findings at diagnosis most often were papilloedema, cranial nerve palsies, and cerebellar dysfunction. Treatments included operation (15%), radiation (7%), and operation plus radiation (60%). Probability of survival at one year was 0.62; at five years, 0.26. Survival with operation and radiation was superior to survival with other courses of treatment. Extracranial metastases to the spinal cord, the bones, and the pleura occurred in 27% of cases. For the first two years from diagnosis, survival in this series was significantly better than survival in the contemporary series of children with medulloblastoma. At five years and ten years, survival in adults and children was comparable.
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PMID:Adult occurrence of medulloblastoma. 361

Between May 1974 and March 1983, 44 children with histologically verified cerebellar medulloblastoma were seen for post-operative cranial-spinal irradiation following attempted total tumor removal. Six patients were excluded from review because they received all or part of their treatment at another institution (3 patients) or did not complete the planned course of irradiation (3 patients). All of the 38 remaining patients were treated by a previously described technique on a 4 MeV Linear Accelerator with 55 Gy delivered to the primary tumor site. Prior to December 1978, 19 consecutive children (Group A) had spinal prophylactic doses of 30-40 Gy and brain prophylactic doses of 40-50 Gy. After the date, 25 Gy was given to the cranial-spinal axis of 19 consecutive children (Group B). This lower dose was arbitrarily selected with the hope of reducing morbidity in treated survivors and achieving the same tumor control. Risk factors that define good and poor prognosis were evaluated for each group, and there were no differences noted. Myelography and CSF cytology were not routinely performed. Follow-up for the 38 patients ranges from 20 months to 124 months. For the low risk patients, survival (12/15 or 80%) was independent of cranial-spinal radiation dose (Group A 6/8, Group B 6/7). For the high risk patients survival was poor (9/23 or 39%), not dependent on cranial-spinal radiation dose (Group A 5/11, Group B 4/12), and associated with failure at the primary site (10/14), often with CSF seeding (8/10). The other 4 failures include 2 who had moved outside the United States (details of failure are unknown), 1 with supratentorial, CSF seeding and distant metastases, and 1 with distant metastasis only. There were no isolated spinal failures. This pilot study shows that the prophylactic radiation dose to the cranial-spinal axis can be decreased to 25 Gy without jeopardizing control rate and survival in patients with medulloblastoma.
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PMID:Long-term results of a pilot study of low dose cranial-spinal irradiation for cerebellar medulloblastoma. 366 70

We conducted a Phase II study of combination therapy with vincristine and cyclophosphamide in the treatment of patients with recurrent or metastatic medulloblastoma. Fourteen patients were treated with vincristine 2 mg/m2 (2.0-mg maximal dose) by intravenous bolus on Day 1 and cyclophosphamide 1 g/m2 by intravenous infusion on Days 1 and 2, with cycles repeated every 4 weeks. All 4 patients with extraneural disease (biopsy-proven bony metastases) responded (duration of responses 2+, 6+, 8, and 16+ months) and 4 of 8 evaluable patients with neuraxis disease responded (duration of response 2, 2+, 2+, and 21+ months). Toxicity was limited to neutropenia without any episodes of infection. These therapeutic results compare favorably with other reports of therapy for recurrent medulloblastoma and support the inclusion of vincristine and cyclophosphamide in randomized adjuvant therapy trials of patients with medulloblastoma.
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PMID:Efficacy of vincristine and cyclophosphamide in the therapy of recurrent medulloblastoma. 370 92

Prognostic factors were evaluated in 30 children with primitive neuroectodermal tumors of the posterior fossa (classical medulloblastoma or differentiated medulloblastoma). The preoperative TNM (Tumor, Node, Metastasis) staging system has been applied to estimate prognosis of patients with central nervous system tumors, but this system was not applicable in assessing the postoperative status of the tumor. To fill this need, a postoperative staging system was developed known as MAPS (Metastasis, Age, Pathology, Surgery), and in this report its efficacy is compared with that of the TNM system. The predictive values of MAPS staging in these 30 children were better than those obtained using the TNM method (MAPS r2 = -0.90; TNM r2 = 0.73; P less than 0.05).
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PMID:A new staging method versus TNM staging in children with posterior fossa primitive neuroectodermal tumor (medulloblastoma). 379 Dec 81

Between 1970 and 1985, 29 patients were postoperatively irradiated for medulloblastoma. Eight out of them received only a local irradiation and 21 a complete CNS irradiation. The posterior fossa was saturated up to a dose of 45 to 49 Gy in nine patients and 50 to 55 Gy in twelve patients. The patients treated by complete CNS irradiation show a three-year survival rate of 47% and a five-year survival rate of 40%. A nonsignificant increase of the three-year survival rate is found in patients whose posterior fossa was exposed to a higher radiation dose. Eleven recurrences were observed, and the posterior fossa was involved in seven out of these cases. Four recurrences confined to the spine were found after a dose of 20 to 30 Gy. Remote metastases, preferentially with a skeletal site, were formed in three out of 29 cases.
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PMID:[Radiotherapy of medulloblastoma]. 381 Apr 72

Since 1975, intracranial subarachnoid metastases of medulloblastoma have been detected in seven of 23 initial contrast-enhanced computed tomographic (CT) scans in children with proven medulloblastoma. Furthermore, four of the seven cases with subarachnoid seeding were diagnosed after the introduction of high-resolution contrast-enhanced CT. Only three cases of seeding had been detected in the previous 17 low-resolution cases studied with CT. Thus, it is quite likely that the incidence of subarachnoid metastases may be substantially more than the overall figure of 30% indicated by this series. This may have an impact on the treatment of these patients, since the frequent appearance of metastases may indicate the need for more vigorous chemotherapeutic regimens. One should be aware of the possibility of early intracranial subarachnoid seeding and that it can be demonstrated by contrast-enhanced CT. This is particularly true when using high-resolution scanners in conjunction with 5 mm sections through the posterior fossa.
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PMID:Early CT detection of intracranial seeding from medulloblastoma. 391 8


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