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 series of 18 patients with odontoid fractures due to metastatic cancer were treated at Memorial Sloan-Kettering Cancer Center between 1974--1980. The primary source of cancer was breast (12 cases), lung (two cases), nasopharynx (one case), multiple myeloma (one case), colon (one case), and rhabdomyosarcoma (one case). The clinical features consisted of severe neck pain and neck stiffness in 17 patients; signs of cord compression were noted in only four patients. Tomography and computerized tomography were useful in identifying both the osseous and soft-tissue involvement by tumor. Initial treatment in all patients except those with myelopathy consisted of high-dose steroids, and immobilization in a hard collar. Ten patients were treated with radiation therapy alone; six patients underwent surgical fusion (four before and two after radiation therapy); and two patients died before completion of treatment. Conservatively treated patients were allowed to walk with the support of only a collar following radiation therapy. We believe that the initial management of patients with odontoid fractures secondary to cancer should be high-dose steroids and radiation therapy, unless displacement is marked. Assessment for surgical fusion should be made following radiation therapy, since conservative treatment may suffice in most patients. Early recognition is important so that treatment can be instituted before C1--2 subluxation becomes severe.
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PMID:Treatment of odontoid fractures in cancer patients. 745 32

Bone metastases are one of the most common and serious conditions requiring radiotherapy, but there is still a considerable lack of agreement on optimal radiation schedule. We analyzed patients with symptomatic osseous metastases from lung (72 patients) and breast (63 patients) carcinoma treated by palliative radiotherapy between 1983 and 1992. In this series, the incidences of symptomatic bone metastases appearing within 2 years after the first diagnosis of the primary lesion were 96% and 36% for lung and breast carcinomas, respectively. Thirty percent of bone metastases from breast carcinoma were diagnosed more than 5 years after the first diagnosis. Thus careful follow-up must be carried out for a prolonged period. Pain relief was achieved at almost the same rate for bone metastases from lung and breast carcinomas (81% and 85%, respectively), an the rapid onset of pain relief (15 Gy or less) was obtained in about half the patients for both diseases. The rapid onset of pain relief and the lack of association between the onset of pain relief and primary tumor argued against the conventional theory that tumor shrinkage is a component of the initial response. In contrast to the fact that almost all lung carcinoma patients had very poor prognoses, one third of the breast carcinoma patients were alive more than 2 years after palliative radiotherapy. Thus, the late effects of radiation, such as radiation myelopathy, must be always considered especially in breast carcinoma patients even when it is 'just' palliative radiotherapy for bone metastases.
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PMID:[Palliative radiotherapy for symptomatic osseous metastases]. 747 54

Approximately 200,000 men will be diagnosed with prostate cancer in 1994. While localized disease is potentially curable with surgery or radiation therapy, metastatic disease is incurable. The most frequent site of metastasis is bone. Spinal cord compression occurs in approximately 7% of men with prostate cancer. Back pain often heralds the diagnosis of spinal cord compression. In prostate cancer patients with back pain or signs of myelopathy or radiculopathy, plain radiographs of the spine and magnetic resonance imaging should be performed. Early diagnosis is of utmost importance. The neurologic status prior to treatment is the major determinant influencing outcome. Following diagnosis, corticosteroid therapy should begin immediately. Hormonal therapy should be instituted in those patients who have not previously undergone hormonal manipulation. The standard approach to definitive therapy is radiation. Surgical decompression plays a role in patients with severe myelopathy, spinal instability, and in those patients whose neurologic status deteriorates during or after radiation therapy.
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PMID:Spinal cord compression in prostate cancer. 754 40

Pulmonary blastoma (PB) is an uncommon primary lung malignancy. This neoplasm was first described by Barrett and Barnard in 1945. The tumor is composed of immature epithelial and mesenchymal tissues which may recapitulate early embryological lung development. Under the microscope, the globular component resembles immature bronchus and connective tissue as seen in embryonic lung. More than one hundred cases have been reported in the literature. PB is more frequent in older people and in males and tends to affect blacks at younger ages. Symptomatology varies from asymptomatic to symptoms of a non-specific pulmonary disease. Cough, hemoptysis, dyspnea, chest pain, respiratory distress, fever, anorexia and weight loss are the most common presenting features. The most common roentgenologic pattern is a well-demarcated peripheral lesion, encapsulated by compression or atelectatic lung tissue, although in some cases there is a tendency to lobulation and cavitation. The size of the mass varies from a small peripheral nodule to a mass occupying the entire lobe or hemithorax. The treatment of choice has been surgical excision, radiation and, in selected cases, a combination of chemotherapy with radiation. The prognosis of this malignancy is poor; overall five-year survival is approximately 16 percent. No correlation has been established between histopathologic criteria and survival. The factors that indicate poor prognosis are tumor recurrence, metastasis at initial presentation, tumor size over 5 cm and lymph node metastasis. Liver, central nervous system and bones are the most frequent location of distant metastases. A rare case is presented of a pulmonary blastoma with an upper lip metastasis occurring in a paraplegic male. Diagnosis was confirmed by autopsy findings.(ABSTRACT TRUNCATED AT 250 WORDS)
J Spinal Cord Med 1995 Jul
PMID:Pulmonary blastoma presenting as a solitary lip metastasis: case report and review of the literature. 755 26

Fifty patients with 63 symptomatic vertebral metastases (18 sites: pain only, 28 sites: radiculopathy with pain, 17 sites: myelopathy) were treated by radiotherapy. Primary lesions were located in the lung (9 cases), breast (9 cases) colorectal area (9 cases), prostate (7 cases) and so on. We correlated the radiologic findings, symptoms and clinical effects with metastatic features which were classified into 4 types by MR imaging: non-deformity, expanding, vertebral collapse, and destructive mass. Each type of metastasis was accompanied with or without epidural tumor. Osteolytic metastases were apt to create features of deformity (expanding type: 18 vertebrae, vertebral collapse type: 17 vertebrae, destructive mass type: 9 vertebrae). The features of osteoblastic metastases were no deformity (18 vertebrae) and expanding type (2 vertebrae). The symptom of pain only occurred most frequently in the lumbosacral spine. The vertebral body deformity of symptomatic sites was relatively slight (non-deformity type: 6 sites, expanding type: 6 sites, vertebral collapse type: 6 sites), and epidural tumors were seen at only 2 sites. The effect of radiotherapy was excellent (complete pain relief: 64.7%, partial pain relief: 29.4%). Radiculopathy occurred most frequently in the lumbar spine. Vertebral body deformity was noted in most symptomatic sites (expanding type: 9 sites, vertebral collapse type: 10 sites, destructive mass type: 2 sites). Complete relief was obtained in 6 sites (22. 2%), partial relief in 18 (63.0%). Myelopathy occurred most often in the thoracic spine, followed by the lumbar spine. The vertebral body deformity was severe (expanding type: 3 cases, vertebral collapse type: 3 cases, destructive mass type: 6 cases). Epidural tumors were also present in all but one case. Six of 13 patients treated with radiation alone improved. These 6 patients had non-deformity or expanding types with epidural tumor. No improvement was seen in the vertebral collapse type with epidural tumor or destructive mass type.
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PMID:[Radiotherapy for vertebral metastases: analysis of symptoms and clinical effects by MR imaging]. 759 66

Radiation therapy is the elective treatment of inoperable non small cell lung cancer, but is potentially curative only for a few of them: failures result from distant metastases and/or from progressive local disease. During the last years, following the progress in chemotherapy, combining radiation and drugs is becoming a more common approach. Nevertheless, one of the main concerns remains the potential interference between both modalities leading to an increased toxicity, which may outweigh all potential benefit. Several organs can be a target for acute or late toxicity: lung (pneumonitis and fibrosis), esophagus (acute esophagitis, stenosis), heart (pericarditis, impaired ventricular functions, heart failure, coronary stenosis), spinal cord (transient myelopathy, radiation myelitis), skin (moist desquamation, fibrosis, telangiectasia). The current published trials combining drug and radiation appear to be a rather safe approach especially when avoiding concomitant treatment. However, several points remain unsolved: the optimal combination scheme, the real risk of late damage observation including the second cancer occurrence risk. This risk is uneasy to evaluate due to the long latency period. The way of describing the late damage is crucial, seeking for a more precise system of evaluating, recording and reporting late effects, taking into account objective damage as well as the patient's symptoms. Therefore, combining drug and radiation should preferentially be performed within prospective studies, with precise evaluation procedures.
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PMID:[Non small-cell bronchial cancers: toxicity of the association radiotherapy-chemotherapy. Review of the literature]. 794 85

We report on a patient with systemic sarcoidosis who was presented with myelopathy and backache. Plain spinal films were normal, CT scan showed sclerotic lesions within the vertebrae. MRI showed more extensive involvement of the spine with multiple vertebral lesions which were hypointense on both T1W1 and T2W1 and did not enhance with gadolinium. MRI also showed high signal lesions within the cervical and lumbar spinal cord on T2-weighted images (T2W1) which were isointense on T1-weighted images (T1W1) and did not enhance. Vertebral biopsy results were consistent with the diagnosis of sarcoidosis. MRI is very sensitive in detecting sarcoidosis of bone but non-specific and other types of sclerotic or lytic bone lesions (notably metastases) need to be excluded.
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PMID:Sarcoidosis of the spinal cord with extensive vertebral involvement: a case report. 873 85

In patients with non-metastatic but inoperable non-small cell lung cancer that is locally too extensive for radical radiotherapy (RT), but who have good performance status, it is important to determine whether thoracic RT should be the minimum that is required to palliate thoracic symptoms or whether treatment should be more intensive, with the aim of prolonging survival. A total of 509 such patients from 11 centres in the UK between November 1989 and October 1992 were admitted to a trial comparing palliative versus more intensive RT with respect to survival and quality of life. They were allocated at random to receive thoracic RT with either 17 Gy in two fractions (F2) 1 week apart (255 patients) or 39 Gy in 13 fractions (F13) 5 days per week (254 patients). Survival was better in the F13 group, the median survival periods being 7 months in the F2 group compared with 9 months in the F13 group, and the survival rates 31% and 36% at one year and 9% and 12% at 2 years, respectively (hazard ratio = 0.82; 95% CI0.69-0.99). There was a suggestion of a trend towards greater benefit in fitter patients. Metastases appeared earlier in the F2 group. As recorded by patients using the Rotterdam Symptom Checklist, the commonest symptoms on admission were cough, shortness of breath, tiredness, lack of energy, worrying and chest pain. These were more rapidly palliated by the F2 regimen. Psychological distress was generally lower in the F13 group. Three patients (two F13, one F2) exhibited evidence of myelopathy. As recorded by patients using a diary card, 76% of the F2 compared with 81% of the F13 patients had dysphagia associated with their RT. This was transient, lasting for a median of 6.5 days in the F2 group compared with 14 days in the F13 group. In conclusion, the F2 regimen had a more rapid palliative effect. In the F13 group, although treatment-related dysphagia was worse, survival was longer.
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PMID:Randomized trial of palliative two-fraction versus more intensive 13-fraction radiotherapy for patients with inoperable non-small cell lung cancer and good performance status. Medical Research Council Lung Cancer Working Party. 897 64

There are many radionuclides currently used in oncologic imaging including technetium 99m diphosphonates, gallium 67, thallium 201, technetium 99m sestamibi, and others. The specific interactions of each of these agents with computed tomography (CT) and magnetic resonance imaging (MRI) are extensive. The radionuclide bone scan using 99mTc diphosphonate is the most frequently performed nuclear medicine examination in oncologic imaging. The bone scan can be used as a model to generalize the interactions of nuclear medicine with CT and MRI. The applications for the bone scan and many other nuclear medicine procedures in oncologic imaging include evaluating for metastases, assessing the response to therapy, and guiding radiation therapy planning. Bone scan findings that are equivocal for metastases can be evaluated with other imaging modalities. Areas of abnormal uptake in the axial skeleton can be evaluated with CT or MRI, whereas those in the appendicular skeleton can be evaluated with plain radiographs, followed by CT or MRI if necessary. The bone scan is valuable in oncologic imaging because of its high sensitivity for lesion detection, its ease in whole body imaging, and its low cost. The major disadvantage of the bone scan is that it lacks fine anatomic detail, which is of particular importance in the cancer patient with local back pain, radiculopathy, or myelopathy. Because local back pain with or without radiculopathy is the earliest symptom of spinal cord compression in 90% of patients, an MRI is the study of choice because of its exquisite depiction of anatomy. A myelogram followed by a postmyelogram CT can be performed if there are contraindications to an MRI. The basic principle of high sensitivity for lesion detection and ease in whole body imaging provided by nuclear medicine and fine anatomic detail provided by CT and MRI can be applied also to the use of other radionuclides in oncologic imaging.
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PMID:Oncologic imaging: interactions of nuclear medicine with CT and MRI using the bone scan as a model. 914 56

Over 4.5 years, 32 patients with spinal epidural metastases were decompressed and stabilized. Median survival was 9.5 months. Myelopathy was the predominant indication (41%) for the operation, intractable pain (microinstability) the second most important. The type of tumor spreading and biomechanics necessitated ventral decompression and stabilization in 65%. Corporectomy or extensive laminectomy was always combined with internal fixation and bone cement. With the exception of six patients (5 early deaths), all patients were able to walk after surgery. The Karnofsky index was improved significantly from 35 to 66%. The longest survival time was found in breast carcinomas and myelomas. Preoperative radiological embolization was a keystone in the treatment. Indication for surgery in spinal metastases is critical and needs an interdisciplinary approach. When the patient is suffering from higher degrees of paresis or even paralysis, he/she is no longer an ideal candidate for the operation. The same applies in the presence of uncontrolled primary tumors and neoplastic disease of the GI tract and the bronchus.
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PMID:[Spinal stabilization in extradural metastatic disease. Indications and follow-up of 32 cases]. 922 80


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