Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0027627 (metastases)
 103,950 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A cerebral demyelinating disease developed in 3 patients during adjuvant therapy with 5-fluorouracil and levamisole for adenocarcinoma of the colon. None of the patients had evidence of metastatic disease or prior neurological disease. The duration of chemotherapy before onset of neurological symptoms ranged from 15 to 19 weeks. The total dose of 5-fluorouracil was 9.7 to 15.7 gm. The total dose of levamisole was 2.7 to 3.75 gm. Two patients presented with a subacute (2-3 weeks) progressive decline in mental status and ataxia. The third patient had two unexplained episodes of loss of consciousness. In each, magnetic resonance imaging with gadolinium demonstrated prominent multifocal enhancing white matter lesions. Cerebral biopsy was performed stereotaxically in 2 patients. The morphological features were those of active demyelinating disease. The myelin loss was associated with numerous dispersed as well as vasocentric macrophages, sparing of axons, and perivascular lymphocytic inflammation. Electron microscopy confirmed the light microscopic findings. All 3 patients improved after cessation of chemotherapy and a short course of corticosteroid therapy. Our patients represent the first reported examples of an inflammatory leukoencephalopathy associated with the administration of 5-fluorouracil and levamisole. This syndrome may represent the pathological basis for 5-fluorouracil neurotoxicity, although we cannot completely exclude the role of levamisole.
 ...
PMID:Multifocal inflammatory leukoencephalopathy with 5-fluorouracil and levamisole. 163 34

To ascertain the range of neurological problems in patients with systemic cancer, we prospectively evaluated neurological symptoms, neurological diagnoses, and primary tumors in all patients with a history of systemic cancer examined by the Department of Neurology at the Memorial Sloan-Kettering Cancer Center, from Jul 1, 1990, to Dec 31, 1990. Of the 815 patients seen for neurological symptoms, less than half (45.2%) had metastatic involvement of the nervous system. The three most common symptoms were back pain (18.2%), altered mental status (17.1%), and headache (15.4%). The most common neurological diagnosis was brain metastasis (15.9%), followed by metabolic encephalopathy (10.2%), pain associated with bone metastases only (9.9%), and epidural extension or metastasis of tumor (8.4%). Of 133 patients with undiagnosed back or neck pain, 44 (33%) had epidural extension or metastases from tumor and 40 (30%) had pain associated with vertebral metastases only. In 15 (11%) the cause for the back pain was unrelated to metastatic disease. Of 132 patients seen on initial consultation for altered mental status, metabolic encephalopathy was the major neurological diagnosis (80; 61%); 20 (15%) had intracranial metastases. Of 97 patients with undiagnosed headache, 59 (61%) had a nonstructural cause. Fifty-three of these patients had either migraine, tension headache, or headache related to systemic illness (e.g., fever, sepsis). These results indicate that even in patients with systemic cancer, a group particularly prone to developing neurological disease that can be diagnosed radiologically, the role of clinicians remains important in helping distinguish noncancer-related and nonmetastatic neurological problems.
 ...
PMID:The spectrum of neurological disease in patients with systemic cancer. 163 35

In a series of 641 patients with small cell lung cancer, 189 (29.5%) had at least one neurologic disorder either at the time of presentation or during the subsequent clinical course of the cancer. The total number of neurologic disorders was 210, which included brain metastases (75.7%), meningeal carcinomatosis (6.7%), intramedullary metastases (2.4%), epidural metastases (11.0%), hyponatremia producing CNS symptoms (3.3%), and Eaton-Lambert syndrome (1.0%). The most common signs and symptoms were motor dysfunction and confusion. The overall survival of patients with any neurologic disorder was compared to that of patients without neurologic problems. There was no difference between the survival curves for the first year and a half, but patients without neurologic complications had a greater probability of long-term survival (log-rank P = 0.03). There were no statistically significant differences when this comparison was made according to stage of disease. When a neurologic disorder related to cancer occurred, the survival time from the date of that diagnosis was usually short. The neurologic disorder was the immediate cause of death in the majority of cases. In patients who achieved a complete remission, the administration of prophylactic cranial irradiation (PCI) significantly reduced the risk of developing brain metastases as the initial site of the relapse (log-rank P = 0.0034). After adjustment for performance status and extent of disease, the survival of complete responders treated with and without PCI was not significantly different. We conclude that neurologic complications are a frequent and serious problem in patients with SCLC.
 ...
PMID:Neurologic disorders in patients with small cell lung cancer. 283 Sep 55

Proton irradiation was applied to suppress the hypophyseal functions in patients with breast cancer metastases previously treated with other conventional methods. The procedure proved to increase the patients' lifetime and not to elicit any of the irreversible neurologic disorders, despite the severity of the underlying disease itself.
 ...
PMID:[Neurologic changes following proton irradiation of the hypophysis in patients with generalized breast cancer]. 284 53

The paper presents data on 52 cases of breast cancer disseminated into cranial vault bones (2 into the orbit). Metastases into the brain (11) and meninges (6) were detected in 17 cases with the aid of computed tomography of the brain and examination of cerebrospinal fluid. The latter cases were not included into the study group. Metastases into cranial bones were identified by craniography and scanning of the skeleton. Half the patients (18 out of 35) revealed the following neurologic syndromes which were determined by the site of metastases into cranial vault bones and tumor growth pattern (into cranial cavity or soft tissues of the head): lesions in ramus primus nervi trigemini, greater occipital nerve, migraine, pseudotumorous and pseudoencephalitic syndromes. Cases of such neurologic disorders require an all-round examination including ophthalmooscopy, EEG, computed tomography of the brain, craniography and scanning of the skeleton.
 ...
PMID:[Neurological disorders in patients with metastases of breast cancer to the cranial bones]. 373 93

Twenty-two patients with brain metastases of breast cancer treated by irradiation between 1974 and 1983 were reviewed. Significant neurologic improvement was obtained in 80%. The median duration of symptomatic palliation caused by irradiation and the median survival from the diagnosis of brain metastases were 3.0 months and 5.0 months, respectively. As a favorable prognosis can be expected for patients showing good performance, minor neurologic disorders, a long latent period between the first treatment of the primary lesion and the onset of the brain metastasis, and without extracranial metastases, irradiation with more than 40 Gy is recommended. Sequential CT examinations were useful to judge the effectiveness of treatment.
 ...
PMID:[Radiotherapy of brain metastases of breast cancer]. 409 72

We report a patient with renal cell carcinoma metastatic to the left trigone, which mimicked an intraventricular meningioma. The metastasis was recognized 1.3 years after removal of the primary tumor, a longer disease-free interval than any previously reported cases with brain metastases of renal cell carcinoma. The patient is now free of disease of years after resection and 17 years after the discovery of the primary tumor. Metastatic disease should be considered in all patients with prior resection of renal cell carcinoma who experience the onset of neurological disease, even after a prolonged disease-free interval. Long term survival is observed after the resection of solitary metastases, particularly if these appear after a prolonged disease-free interval.
 ...
PMID:Metastatic renal cell carcinoma mimicking a meningioma. 663 36

Neoplastic meningitis (NM) occurs in approximately 8% of all cancer patients. To confirm a clinical impression that NM is relatively common in patients who undergo surgical resection of an isolated cerebellar metastasis (ICM), a retrospective study was performed. All patients who underwent a surgical resection of an isolated CNS metastasis at The Johns Hopkins Hospital between January 1991 and June 1993 were identified. Their charts, laboratory and pathologic data, radiologic studies, survival and cause of death were reviewed. A total of 66 patients were identified fifty-five patients underwent a surgical resection of a supratentorial metastasis while 11 patients (6 females and 5 males) underwent a surgical resection of an isolated cerebellar metastasis. The ages of patients with cerebellar metastases ranged from 23 to 74 years at the time of diagnosis with a median age of 49 years. All 11 patients had stable systemic disease and an excellent performance status. Five patients had tumors from lung, 2 from breast, and 4 from other sites. Each was expected to have a long survival. However, 4 of the 11 patients (36%) developed unequivocal NM at 1, 3, 6, and 7 months following surgical resection and all died within 1 month from the diagnosis of NM. Two patients had a positive CSF cytology and the other two had multiple enhancing leptomeningeal metastases on MRI. Two additional patients died of progressive neurological disease without evidence of local recurrence, yet were never formally evaluated for NM and two were lost to follow-up. Thus, the incidence of NM in this patient population is at least 36%. In the 55 patients who had resections of supratentorial metastases, only 1 patient (2%) developed NM. This study suggests that NM following surgical resection of an ICM may be common and may result in the premature demise of patients with excellent performance status, minimal systemic disease, and a reasonable life expectancy. Further studies are needed to determine if prophylactic intrathecal chemotherapy administered perioperatively could diminish the incidence of clinically apparent NM in this patient population.
 ...
PMID:Neoplastic meningitis following surgical resection of isolated cerebellar metastasis: a potentially preventable complication. 904 83

Therapeutic options for the treatment of malignant brain tumors have been limited, in part, because of the presence of the blood-brain barrier. For this reason, the Sixth Annual Meeting of the Blood-Brain Barrier Disruption Consortium, the focus of which was the "Importance of Dose Intensity in Neuro-Oncology Clinical Trials," was convened in April 2000, at Government Camp, Mount Hood, Oregon. This meeting, which was supported by the National Cancer Institute, the National Institute of Neurological Disorders and Stroke, and the National Institute of Deafness and Other Communication Disorders, brought together clinicians and basic scientists from across the U.S. to discuss the role of dose intensity and enhanced chemotherapy delivery in the treatment of malignant brain tumors and to design multicenter clinical trials. Optimizing chemotherapy delivery to the CNS is crucial, particularly in view of recent progress identifying certain brain tumors as chemosensitive. The discovery that specific constellations of genetic alterations can predict which tumors are chemoresponsive, and can therefore more accurately predict prognosis, has important implications for delivery of intensive, effective chemotherapy regimens with acceptable toxicities. This report summarizes the discussions, future directions, and key questions regarding dose-intensive treatment of primary CNS lymphoma, CNS relapse of systemic non-Hodgkin's lymphoma, anaplastic oligodendroglioma, high-grade glioma, and metastatic cancer of the brain. The promising role of cytoenhancers and chemoprotectants as part of dose-intensive regimens for chemosensitive brain tumors and development of improved gene therapies for malignant gliomas are discussed.
 ...
PMID:Importance of dose intensity in neuro-oncology clinical trials: summary report of the Sixth Annual Meeting of the Blood-Brain Barrier Disruption Consortium. 1130 17

Paraneoplastic neurologic disorders (PND) are remote medical complications of cancer that cannot be attributed to direct effects of the neoplasm or its metastases. PND are uncommon, disabling syndromes that have been recognized for more than 50 years. Despite their rarity, these diseases are the subject of intensive research and clinical fascination. This review highlights notable recent publications related to PND. In recent years, the broad clinical spectrum of PND has become even more apparent. PND can affect any part of the central or peripheral nervous system and often affect multiple areas simultaneously. These disorders are often associated with neuron-specific autoantibodies in the serum and cerebrospinal fluid. In clinical practice, detection of these antibodies is crucial for the diagnosis because the neurologic symptoms usually precede the diagnosis of cancer. Recent publications have described new antibody specificities associated with PND and expand our ability to identify patients serologically. Once diagnosed, detection of cancer can be difficult, but the use of positron emission tomography has been shown to be a useful supplement to standard imaging procedures. PND are thought to be autoimmune disorders precipitated by the immune response to cancer. Observations and laboratory studies in PND patients have shown that activation of cytotoxic T cells is an important component of the disease. These studies not only shed light on the pathogenesis of PND and the mechanisms of effective antitumor immunity but may eventually lead to improved treatment.
 ...
PMID:Paraneoplastic neurologic syndromes. 1663 27


1 2 Next >>