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

One hundred patients with inoperable (80) or unresectable (20) bronchogenic carcinoma without evidence of spread beyond the thorax and supraclavicular nodes were planned for radical radiotherapy. Seventy-six patients received continuous irradiation (6000 rads in 30 treatments in 6 weeks, TDF 99) and 24 received split course therapy (2 courses of 2500 rads in 10 treatments with a 3 week break between courses, TDF 88). Forty-three patients had squamous cell carcinoma or adenocarcinoma and were considered to have favorable prognostic factors, while 57 patients had unfavorable prognostic factors: undifferentiated large cell or small cell carcinoma, supraclavicular metastases, SVC obstruction, superior sulcus tumors, or bone erosion in continuity with the tumor. Ninety-two patients completed the planned course of treatment. In patients completing treatment, local control of cancer within the irradiated volume was achieved in 58.5% of continuously irradiated patients and 45.4% of patients receiving split course therapy. Median survival was 1.2 months in patients not completing treatment and 12 months for the patients who completed treatment; 19% of the total group survived 3 years. Median and 3 year survivals of 14 months and 20.4% and of 9 months and 11% were observed for patients treated continuously and by the split course techniques, respectively. Corresponding survival figures for patients with favorable and unfavorable prognostic signs were 21 months and 26%, and 4 months and 11%, respectively. Implications of these data for treatment planning and patient selection for radical radiotherapy in bronchogenic carcinoma are discussed.
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PMID:Radical radiation therapy of advanced lung cancer: evaluation of prognostic factors and results of continuous and split course treatment. 22 98

Angioinvasion is a well documented microscopic characteristic of follicular carcinoma of the thyroid. Patients with untreated tumors may die from local invasion or metastases to the lungs, bones, or other organs. A less well recognized cause of morbidity and death from this neoplasm is angioinvasion of cervical veins with direct extension into the great veins of the chest, to the heart. Six instances of this complication have been reported previously. The most common clinical presentation of patients with neoplastic thrombus within the great veins is the superior vena cava syndrome. In each case the patient died as a result of the vascular or cardiac involvement, shortly after diagnosis. The patient reported is the first in which follicular carcinoma with extensive angioinvasion was treated. A clinical diagnosis of superior vena cava syndrome was confirmed by angiographic studies. Resection of the primary thyroid tumor and the angioinvasive extension to the heart plus 131I therapy have controlled the malignancy for at least 3 years.
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PMID:Follicular carcinoma of the thyroid with massive angioinvasion: extension of tumor thrombus to the heart. 63 81

Between 1983 and 1988 90 patients with bronchial neoplasms needed emergency irradiation to treat superior vena cava syndrome. Pathohistologically verified were 30 cases with squamous cell carcinoma, twelve with adenocarcinoma, five cases with large cell carcinoma, 30 with a small cell carcinoma, and non-differentiated in five others. No histological examination was carried out in eight cases. Im 30 patients distant metastases were evident at the initial diagnosis. The average duration of follow-up was 118 days. The survival course proved to be independent of histopathological grading, previous treatment, and age. Similarly no influence of the fractionation employed could be seen. Very important to the prognosis however, were the stage of disease, the Karnofsky index, and dependent on that, the total reference dose applied. Patients with a Karnofsky index of 50% or lower survived on average only 17 days.
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PMID:[The superior vena cava syndrome as an emergency in radiotherapy]. 217 55

An occlusion of the superior vena cava by a tumor thrombus extending into the right atrium was diagnosed in three patients with a follicular thyroid cancer. All patients showed the typical clinical picture of the superior vena cava syndrome. A right parasternal thoracotomy was performed for preparation of the major vessels. The superior vena cava was opened and the entire intravascular tumor thrombus was removed. The cavotomy was closed directly in two patients. In the third patient the left brachiocephalic trunk was resected and reconstructed with a vascular (polytetrafluoroethylene) graft. This patient had bone and brain metastases and an occlusion of the graft 3 months after surgery after anticoagulation was stopped. The other two patients were clinically symptom free without local recurrence 13 and 50 months after surgery. An aggressive surgical approach is justified in grossly invasive thyroid cancer to decrease local recurrence and death rates, to correct the disturbing clinical symptoms of superior vena caval occlusion, and to prevent tumor embolism and the development of distant metastases. By reducing tumor mass, an even better basis for radioiodine treatment can be prepared.
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PMID:Intraatrial extension of thyroid cancer: technique and results of a radical surgical approach. 224 40

Malignant thymomas are extremely rare in children, with only 27 cases reported thus far in the pediatric surgical literature. We report four additional cases diagnosed at this institution over the past 20 years (ages 3 to 14 years). Clinical presentations included superior vena cava syndrome, cough, dyspnea, cyanosis, enlarging mediastinal mass, spontaneous pneumothorax, and pleuropericardial effusion. Three patients underwent incomplete resection of the mass or biopsy because of "unresectability" and were treated with radiotherapy and adjunctive chemotherapy. One patient underwent near complete macroscopic resection as well as radiotherapy and chemotherapy. All patients died at intervals ranging from 6 months to 2 1/2 years after diagnosis. Three patients were found to have metastatic disease prior to death or at autopsy. In one case, the initial pathological diagnosis was lymphocytic thymoma. After ultrastructural studies were performed, the diagnosis was changed to thymic T-cell lymphoma. This patient subsequently developed acute lymphoblastic leukemia 3 months after surgical resection followed by radiotherapy. Malignant thymomas are highly aggressive tumors in children. A radical surgical approach with complete excision of the tumor and contiguous structures in continuity, with adjunctive radiotherapy and chemotherapy remains the only hope for survival in children with these rare lesions.
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PMID:Malignant thymoma in children: a 20-year review. 227 28

A case report on a 27 year old woman with an inoperable angiosarcoma of the right atrium is presented. The tumor localization was established by echocardiography, computed tomography and cinecardiography. There was no evidence of distant metastases at diagnosis. After exploratory thoracotomy with surgical biopsy a radiotherapy was started covering the whole heart and the mediastinum. Superior Vena Cava Syndrome was improved quickly and reducing the target volume to the right atrium after 40 Gy radiotherapy was continued up to a total dose of 60 Gy. A complete remission was documented by echocardiography and computed tomography. Chemotherapy ("VAPAC") for distant metastases led to partial remission. The patient died 15 months after diagnosis from brain metastases. Autopsy revealed no macroscopic evidence of tumor in the right atrium. A combined modality approach with surgical tumor mass reduction followed by high dose locoregional radiotherapy (60 Gy) and combination chemotherapy (e.g. "VAPAC") is suggested.
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PMID:Primary angiosarcoma of the heart. 261 5

MRI is synonymous with proton imaging. It provides detailed images of gross anatomy and pathology owing to the excellent soft-tissue contrast, signal void of flowing blood, versatile geometry, and freedom from streak artifacts, as well as other advantages summarized in Table 8-2. In the CNS, MRI has emerged as the most sensitive imaging modality in virtually all pathologies--some reservations remaining concerning acute hemorrhage, focal calcifications, and bone detail. Hence, it should be considered the premier noninvasive examination in the evaluation of the cancer patient with any suspicion of CNS pathology. Economics and availability must, of course, be considered when evaluating MR's role relative to CT. MR clearly provides the best means of excluding pathology, particularly in the posterior fossa, and must be considered after a negative CT examination with persistent clinical suspicions. MRI must also be considered in routine surveillance, if the earliest possible detection of metastasis, demyelination, and other pathologies is to be achieved. MRI should be considered in the evaluation of vertebral metastases, spinal cord compression, and back pain because of its ability to depict CSF, spinal cord, disk, and vertebral body as distinct structures and its sensitivity to marrow disease. In the extremities and pelvis, clearer depiction of soft tissues, vessels, and marrow is a proven advantage. Hence, MRI is indicated in the evaluation of prostate/bladder/rectal carcinoma, uterine/cervical carcinoma, soft tissues/bony sarcomas, and bone metastasis/infarction. In the abdomen, MRI's display of the retroperitoneum and sensitivity to liver lesions indicates its use in the evaluation and staging of renal/adrenal carcinoma, retroperitoneal sarcomas, primary liver tumors, and metastases. Moreover, MRI is also indicated in the evaluation of liver or adrenal masses of uncertain histology owing to a limited specificity of the MR signal for adenoma, carcinoma, and hemangioma. In the chest, MRI's advantages are currently limited owing to the excellent quality of CT images of mediastinum and lung parenchyma and the deleterious effects of respiratory motion. MRI's primary indications in the chest are for the distinction of mediastinal and hilar masses from vessels and aneurysms; evaluation of lumenal patency and superior vena cava syndrome; detection and display of pericardial effusion and the relationship of tumor to the pericardium; and evaluation of internal cardiac anatomy, thrombi, and tumor. Because of rapid technological advances, statements concerning MRI's limitations must be guarded.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Nuclear magnetic resonance imaging in oncology. 333 79

Eleven patients with invasive thymoma (seven males and four females) were seen from 1977 to 1983. All patients were adults with a median age of 46 years (range, 24-62), and presented after surgical exploration with nonremovable primary and with one or more of the following patterns of tumor extension: supraclavicular lymphadenopathy (four patients), superior vena cava syndrome (two), pleural effusion (nine), and pericardial effusion (three). The following distant metastases were also observed: lung (six patients), liver (one), skin (two), peritoneum (two), bone (one), and brain (one). The chemotherapy was administered in 4-day courses. All patients received the following: 50 mg/m2 of cisplatin iv and 40 mg/m2 of doxorubicin iv on Day 1, 0.6 mg/m2 of vincristine iv on Day 3, and 700 mg/m2 of cyclophosphamide iv on Day 4. The course was repeated every 3 weeks. Toxic effects were tolerable, as expected for the drug combination adopted. Four of 11 patients achieved objective complete regression of disease and six of 11 had partial remission, for an overall response rate of 91%; one patient had stable disease for 7 months. Six patients have died and the median survival has been 12.5 months, ranging from 5 to 23 months.
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PMID:Chemotherapy of invasive or metastatic thymoma: report of 11 cases. 654 51

A clinical review with analysis of prognostic factors, including the impact of the initial management modality, was conducted on 137 patients with superior vena cava syndrome (SVCS) seen at the Veterans General Hospital-Taipei between 1989 and 1993. Malignant diseases account for most of the SVCS in our Chinese patients. Patients received diagnostic intervention for their underlying diseases without obvious complications. Whether or not there is a development of SVCS in lung cancer patients, showed prognostic significance in non-small cell lung cancer (NSCLC) and no significance in small cell lung cancer (SCLC). Those with SVCS as the initial manifestation of malignant disease had a poor prognosis compared to those who developed SVCS later. Survival is best in lymphoma/leukemia patients, followed by malignant thymoma and SCLC, and worst in NSCLC and metastatic cancer. The rapid onset of symptoms from SVCS had a short median survival in lung cancer and significantly compromised survival in SCLC. The overall survival of SCLC with SVCS was not affected, regardless of whether the initial therapy had been radiotherapy or chemotherapy.
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PMID:Superior vena cava syndrome revisited. 774 20

A group of 79 patients with non-resectable lung carcinomas (T1, 1; T2, 13; T3, 34; T4, 19; recurrence, 12) underwent endobronchial iridium-192 high-dose rate afterloading therapy (5 Gy/session total dose: 5-25 Gy, mean 11.6 Gy). In 39 cases the fair general condition and absence of metastases allowed external-beam irradiation (EBR) to be administered (50-70 Gy total dose; 2gy/day), starting 1 week after the brachytherapy session. In nine cases with superior vena cava syndrome, EBR (30 Gy total dose; 3 Gy/day) was administered concomitantly. Improvement in symptoms of respiratory obstruction was noted in 87% of our patients. The mean duration of palliation was 17.1 weeks in the group without and 34.7 weeks in that with additional EBR. The median survival time was 6 months without and 13 months with additional EBR. In T4 cases EBR had no impact on the 1-year survival (30.8% vs 24.4%, P > 0.05). The rate of severe complications was 7%, without significant differences between cases with or without EBR.
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PMID:Intraluminal irradiation in the treatment of malignant airway obstruction. 799 20


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