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

Pure testicular seminoma has historically been treated primarily with radiation therapy, and excellent results have been achieved. Recently, several aspects of the treatment of seminoma have been questioned; namely, the value of mediastinal irradiation in Stage II disease, and whether a dose response curve existed for seminoma. Because these questions have remained unanswered, we undertook a retrospective review of all patients with pure testicular seminoma treated in the Department of Radiation Oncology at Indiana University Medical Center. From 1961-1981, 54 patients with pure testicular seminoma were given megavoltage irradiation with curative intent. Thirty three patients were Stage I, with tumor confined to the testicle with no evidence of nodal spread. Fifteen patients were Stage IIA, with metastases less than 5 cm in size in the retroperitoneal nodes. Four patients were Stage IIB, with metastases greater than 5 cm in size in the retroperitoneal nodes. One patient was Stage III, with supradiaphragmatic metastases confined to the mediastinum and supraclavicular area. One patient was Stage IV, with evidence of extralymphatic metastases. The crude survival rate (corrected for intercurrent death, except for treatment toxicity) for the entire group was 87%. For Stage I, it was 91%, Stage IIA-80%, Stage IIB-75%, Stage III-100%, and Stage IV-0%. All patients had a minimum follow-up of 2 years with a range of 2 to 21 years. Evaluation of the Stage I patients reveals that 2500 rad in 3 weeks appears to be adequate in controlling microscopic disease, as there were no in-field recurrences when this dose was given. Those patients with Stage IIA and IIB disease who received greater than or equal to 3500 rad to macroscopic disease had 100% (7/7) survival and local control, while those receiving less than or equal to 3000 rad had a 66.6% (8/12) survival with three of four demonstrating persistent or recurrent abdominal disease. Thus, we feel that macroscopic disease requires 3500 rad to 4000 rad for control. All Stage II and III patients had planned mediastinal irradiation. No patients who received mediastinal irradiation recurred in the mediastinum. Whether this is because of our treatments or the natural disease process remains unanswered. Overall, we were able to salvage 12.5% (1/8) of our recurrences, while 37.5% (3/8) died from toxicity of their salvage therapy.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Testicular seminoma: analysis of treatment results and failures. 308 8

Classical and anaplastic seminoma are traditionally treated with radiation therapy and are said to have the same prognosis. A retrospective study was undertaken of 90 seminoma patients treated with radiation therapy between 1961 and 1985. The classical group consisted of 71 patients of whom 50 had stage I and 21 had stage II disease. The anaplastic group consisted of 19 patients of whom ten had stage I and nine had stage II disease. The median follow-up time was 64 months for the entire group. The 10-year relapse-free survival rate for the classical group was 94% and for the anaplastic group was 70% (P less than .05). For patients with classical stage I disease, the relapse-free actuarial survival rate was 98%; for patients with anaplastic stage I disease, it was 64% (P less than .02). For the classical stage II disease group, the relapse-free actuarial survival rate was 84% and for the anaplastic stage II disease group, 75% (P less than .70). Four patients in the classical group (6%) had relapses; of these, one patient had local recurrence of tumor, and three had distant metastases. In the anaplastic group, four patients (21%) had relapses; two patients had local recurrence of tumor, and two had distant metastases. Therefore the data suggest a difference in survival and relapse rates between classical and anaplastic seminoma.
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PMID:Classical and anaplastic seminoma: difference in survival. 312 52

Thirty-three cases of seminoma with palpable abdominal disease were treated at the Cancer Control Agency of B.C. between 1948 and 1983. Twenty-three had disease confined to the abdomen (Stage IIB), eight had simultaneous involvement of mediastinal and supraclavicular nodes (Stage IIIB) and two had bone or pulmonary metastases (Stage IV). Five and 10-year disease-specific actuarial survivals for the whole group were 87% and 81%, respectively. Corresponding relapse-free survival was 64%. Of the twenty-three IIB cases, 15 had primary treatment with abdominal radiation only, and eight had prophylactic mediastinal/supraclavicular radiation. Although relapse in IIB was more common in the group receiving abdominal radiation only, survival was unchanged. For the entire IIB group, 5- and 10-year disease-specific actuarial survivals were 91% and 84%, respectively, and corresponding relapse-free survival was 74%. The eight IIIB patients were treated primarily with radiation. Four patients relapsed, all in extranodal sites. Two of these died of disease. Both Stage IV patients required radiation and chemotherapy for long-term disease control. Stage IIB disease can be treated primarily with abdominal radiation, but radiation alone is inadequate when bulky abdominal disease is associated with supradiaphragmatic lymphatic spread or hematogenous metastases.
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PMID:Management of seminoma with bulky abdominal disease. 333 45

We report a case of a teratoma thrombus within the inferior vena cava subsequent to chemotherapy for embryonal carcinoma of the testis. A review of the literature indicates that intracaval metastases occur in approximately 1 per cent of the patients with bulky retroperitoneal disease. Seminoma and embryonal carcinoma have been identified previously within the inferior vena cava, and teratoma is now added to that list. The potential lethality of teratoma owing to local growth alone is underscored by its intracaval presence in this case. We recommend close inspection of the inferior vena cava at operation for bulky disease to exclude an intracaval thrombus, as well as complete excision of all residual masses following chemotherapy for testis cancer.
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PMID:Metastatic testicular teratoma invading the inferior vena cava. 337 82

The serial CT characteristics of nodal metastases from pure seminoma treated with chemotherapy were evaluated in 18 patients. Fifty percent of masses at presentation contained areas of low attenuation; none had calcification. After chemotherapy, masses completely resolved in four patients, partially resolved in 12 patients, and remained unchanged in one patient. The remaining patient developed progressive liver metastases during therapy and died. Pathologic evaluation of residual masses in four patients demonstrated only fibrosis. Residual masses in nine other patients demonstrated further partial resolution or remained stable over the following year; two developed calcification. These patients exhibited no clinical evidence of disease for a median follow-up of 22 or more months. Persistent but stable or resolving masses are common after chemotherapy for advanced seminoma. Unlike their nonseminomatous counterparts, they most often represent fibrosis in patients with no other clinical evidence of disease and do not warrant surgical excision.
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PMID:CT evaluation of advanced seminoma treated with chemotherapy. 348 47

The chest radiographs and CT scans of 200 patients with pure testicular seminoma were reviewed. The radiographs showed evidence of intrathoracic metastatic disease in 25 patients (12.5%). Of these, 17 had an abnormal mediastinal contour, seven had pulmonary metastases, five had pleural effusions, and two had discrete pleural masses. CT showed evidence of intrathoracic metastatic disease in 30 patients (15%). This included mediastinal nodal enlargement in 21, pulmonary metastases in 12, pleural effusions in six, and pleural masses in two. CT not only showed disease in five patients with normal chest radiographs, but also showed additional sites of disease in four other patients with abnormal chest radiographs. The results suggest that mediastinal nodal enlargement is the most common intrathoracic manifestation of metastatic testicular seminoma. CT is more accurate than chest radiography in the detection of metastatic seminoma in the chest and defines the extent of metastatic disease more precisely.
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PMID:Intrathoracic manifestations of metastatic testicular seminoma: a comparison of chest radiographic and CT findings. 349 31

Computed tomography (CT) is the diagnostic modality of choice in the staging of abdominal malignancies. Metastatic disease in the lymph nodes is defined on CT as nodal enlargement. The presence of enlarged nodes does not preclude inflammatory involvement. There are clues that will indicate whether enlarged nodes are malignant or not (i.e., associated bony destruction). This paper will delineate normal nodal anatomy of the abdomen and pelvis. Clinical examples will be used to demonstrate normal structures simulating adenopathy and malignant adenopathy will be illustrated in lymphoma, seminoma, carcinoma of the cervix, prostate, and other pelvic malignancies.
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PMID:Nodes or no nodes: CT of adenopathy. 351 74

The clinical records of 47 patients with testicular seminoma treated between 1973 and 1984 were reviewed. The mean age was 41 years. There were relatively few blacks and patients of mixed race--4% and 17% respectively. The incidence of associated testicular maldescent was statistically significantly higher among the black and mixed-race patients (40%) than among the white patients (8%). Forty-three patients underwent retroperitoneal irradiation after orchidectomy, with a 5-year survival rate of 87% at a median follow-up of 52 months. There were no relapses at follow-up in 27 stage I patients; 1 of 8 patients with stage IIA and B (non-bulky) disease relapsed after 12 years, and relapses occurred in all 5 patients with stage IIC (bulky) seminoma. Retroperitoneal and mediastinal irradiation has controlled disease in 2 patients with stage III disease without bulky metastases. One patient with stage IV seminoma treated with irradiation relapsed. One of the patients with stage I disease has developed a major bowel complication following 3,000 cGy fractionated irradiation. Our experience with cis-platinum-based chemotherapy includes noting its effectiveness in a patient with unresectable locally advanced testicular seminoma. We recommend retroperitoneal irradiation after orchidectomy for patients with stage I and IIA/B disease and cis-platinum combination chemotherapy after orchidectomy for those with more advanced disease.
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PMID:Seminoma of the testis at Groote Schuur Hospital, 1973-1984. 357 81

Between February 1983 and July 1985, 52 patients with Clinical Stage I seminoma were observed after orchiectomy without lymph node irradiation. Seven patients (13%) have relapsed, six in retroperitoneal lymph nodes and one with abdominal node and pulmonary metastases. Relapses were diagnosed 6 to 23 months after orchiectomy, four occurring in the first year and three in the second year. Of eight patients with raised serum concentrations of HCG prior to orchiectomy none has relapsed, whereas of 14 patients with normal HCG levels one has relapsed. The significance of these observations for future management policy is discussed.
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PMID:Surveillance after orchiectomy for stage I seminoma of the testis. 358 Jul 75

The role of bone scintigraphy was assessed by follow-up and review of 61 patients with testicular tumours. Skeletal metastases were present in all five patients who died with seminoma and in two of the eight whose deaths were due to teratoma. The only patient with skeletal metastases to have a prolonged survival had a mixed teratoma/seminoma. Bone scintigraphy is indicated in patients with recurrence after radical treatment for seminoma and may be indicated in patients presenting with stage IV seminoma, to identify a sub-group with the worst prognosis. In other patients it is indicated only if there is a specific clinical suspicion of bone metastases.
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PMID:Bone scintigraphy in testicular tumours. 366 6


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