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)

Follow-up serial computed tomographic scans of 124 patients treated for testicular cancer with either radiotherapy or retroperitoneal lymphadenectomy alone or in combination with chemotherapy were evaluated. Thymic enlargement occurred three to 20 months after initiation of treatment in 15 of the 124 patients. Thymic enlargement could histopathologically be demonstrated in seven patients as true hyperplasia. One of these seven patients however had evidence of metastatic disease with thymic infiltration by a malignant teratoma. Thus it may be impossible to distinguish benign thymus hyperplasia from tumor-infiltration on the basis of ct information alone and sternotomy may be required. No severe defect of cellular immunity could be found. There is no specific constellation of lymphocytic markers in peripheral blood which could indicate true thymic hyperplasia.
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PMID:[Thymus hyperplasia in patients with malignant testicular tumors]. 231 87

Sixty consecutive patients with Stage III or bulky Stage II nonseminomatous germinal testis tumors were treated with cisplatin, vinblastine, bleomycin combination chemotherapy (PVB). One patient died of acute toxicity after the first course of therapy, 16 entered complete remission (CR) after two or three inductions, and 36 underwent surgery for removal of residual masses after the third cycle. No residual tumor was found in 16 cases, 10 had mature teratoma, and residual malignant tumor was completely resected in 8 of 10 patients. On the whole, 52 of 59 cases (88%) who completed the therapy entered CR, 34 (58%) with PVB and 18 (30%) with PVB and resection of the residual disease. The major beneficiaries of surgery were patients with bulky metastases (17 of 45, 38%) and those with primary teratocarcinoma (13 of 24, 54%). All of the patients who entered CR received two additional inductions and no maintenance. After a median follow-up period of greater than 3 years, 40 patients (68%) remain continuously disease-free, 1 died in CR, and 3 of the 11 who had relapse were salvaged. All of the 32 patients with lung deposits less than 5 cm and/or lymph node metastases less than 10 cm entered CR after the combined treatment modality, and 29 (91%) are alive disease-free. Also, 20 of 27 patients (74%) with far-advanced disease (lung and lymph node metastases larger than 5 and 10 cm, respectively, extrapulmonary disease) entered CR after PVB and surgery, but only 11 (41%) are continuously disease-free. Early resection of the residual tumor during PVB combination chemotherapy greatly increased the CR rate, but relapses were very frequent in patients with far-advanced disease.
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PMID:Early resection of residual tumor during cisplatin, vinblastine, bleomycin combination chemotherapy in stage III and bulky stage II nonseminomatous testicular cancer. 240 28

We herein report a case of a retroperitoneal lymph node metastasis from a malignant teratoma with yolk-sac admixtures originating from the right testicle. The metastasis was missed on CT scanning due to a vena cava crossing over with the aorta in the region of the metastatic disease, but typical tumor marker elevation was seen on follow-up.
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PMID:Retroperitoneal lymph node metastasis from testicular tumor hidden by vena cava transposition. 241 65

Forty-five patients with metastatic germ cell tumour were treated with chemotherapy. Complete remission was achieved in 63% of all cases and in 65% of patients whose primary tumour arose in the testis or ovary. Surgical resection of abdominal masses persisting after chemotherapy was performed in seven patients, two of whom were found to have persistent tumours. Twenty-seven of the 33 patients with teratoma originating in the gonads remain in complete remission. Total serum LDH activity was elevated in 28 of the patients with measurable disease. The increased LDH was not accompanied by significant alteration in other hepatic enzymes nor were hepatic metastases demonstrable in these patients. Fractionation of the LDH demonstrated that the increased LDH in these patients was located in either iso-enzymes 1 or fractions 1 + 2. Alteration of the serum LDH activity correlated with the response to therapy and warrants further study.
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PMID:The management of metastatic germ cell tumours and the clinical utility of lactate dehydrogenase estimations. 241 41

Forty consecutive patients with far-advanced germinal testis tumors (lymph node metastases greater than 10 cm, pulmonary nodules greater than 5 cm, extrapulmonary spread, alpha-fetoprotein greater than 1000 ng/ml, human chorionic gonadotropin greater than 50,000 mIU/ml) were treated with five courses of cisplatin, etoposide, and bleomycin (PEB). Twenty-five patients underwent surgery for the removal of residual masses after the first three inductions. Fibrotic-necrotic tissue was resected in 11 cases, 12 had mature teratoma, and residual cancer was found in 2. After the combined-modality treatment, 37 patients (82.5%) entered complete remission (CR): 25 (62.5%) with PEB and 12 (30%) with PEB and complete removal of the residual tumor. One patient progressed on therapy, and two others had incomplete resection of the residual disease. Hematologic toxicity was moderate and gastrointestinal toxicity was very mild. After a median follow-up period of 24 months (range, 13-40), 33 patients (82.5%) remain continuously disease-free, and 4 experienced relapse. Only one of these was salvaged with further surgery and chemotherapy. First-line PEB therapy combined with early resection of residual tumor induced a very high continuous CR rate in patients with far-advanced germinal testis cancer, and toxicity was moderate.
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PMID:Cisplatin, etoposide, bleomycin first-line therapy and early resection of residual tumor in far-advanced germinal testis cancer. 241 83

Thirty-four children with malignant germ cell tumors of the testis were seen at the Institut Gustave-Roussy from 1970 through 1980, after orchiectomy alone. The tumor was classified according the WHO classification (immature teratoma, embryonal carcinoma, choriocarcinoma, yolk sac tumor). Twenty-four of the 34 children had a stage I yolk sac tumor (YST) defined as a tumor completely removed by the inguinal approach, without clinical node involvement and/or metastases. No lymphadenectomy was performed. All the patients had an alphafetoprotein (AFP) determination before or after orchiectomy. For those (23/24) with an elevated level of AFP the clinical stage I was assigned if the AFP decreased regularly to normal values by 3 months after orchiectomy. Twelve patients received systemic chemotherapy every 3 months [methotrexate, actinomycin D, cyclophosphamide (Cytoxan)]; 12 did not receive any treatment after orchiectomy. An AFP evaluation was assayed for all of these regularly. The 3-year survival rate was 96% and the 3-year relapse-free survival rate was 84%, with no difference found between the two groups receiving or not receiving systemic chemotherapy. This series confirms the advisability of a conservative approach for clinical stage I YST, employing orchiectomy and evaluation including AFP determinations. Ten percent to 20% of patients will suffer a relapse, which can be demonstrated by an increasing level of AFP, and these children can be treated at this time. With this approach, 80% of patients having clinical stage I YST can be treated by orchiectomy alone and will not suffer any sequelae or complication of either lymphadenectomy or chemotherapy. For the few who do relapse, treatment at the time of relapse is curative for the majority. This approach requires absolute adherence to a strict follow-up program.
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PMID:Optimal treatment of clinical stage I yolk sac tumor of the testis in children. 241 37

A multiple regression analysis was performed of factors affecting the prognosis of 93 patients with metastatic malignant teratoma treated at the Royal Marsden Hospital between 1979 and 1981. In a subgroup of 53 patients, where exact tumour bulk could be calculated from sequential CT scan slices, a correlation was seen between tumour marker level and volume of metastatic disease. On analysis of the risk of relapse after initial chemotherapy, the independent adverse influence was detected of serum AFP greater than 500 micrograms/l and of bulky disease defined by clinical staging. An adverse influence of high serum HCG levels was not seen, probably due to the small number of patients in this series with this presenting feature.
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PMID:Prognosis following chemotherapy for metastatic malignant teratoma. 244 91

We have evaluated the 7-drug, alternating, high-dose cisplatin regime for germ cell tumours, designated POMB/ACE, in 55 patients with advanced malignant teratomas and 5 patients with bulky metastatic seminomas. All of the latter and 5 of the teratoma patients had relapsed following radiotherapy, chemotherapy or both. The previously untreated teratoma patients included 13 whose tumours were extragonadal. The primary testicular tumour patients comprised 16 with large and 21 with very large volume metastases according to the Medical Research Council criteria. POMB/ACE is effective therapy for poor risk patients with germ cell tumours (including those with the most advanced disease, i.e. hepatic and cerebral metastases) and prolonged treatment after marker normality seems unnecessary. It is a complex regime with significant toxicity and cannot be recommended for the treatment of patients with germ cell tumours who have an excellent prognosis with simpler, shorter and less toxic treatment.
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PMID:Chemotherapy for poor risk germ cell tumours. An independent evaluation of the POMB/ACE regime. 246 34

PVB or VAB-6 combination chemotherapy was given to 41 funicular orchiectomized cases of unresectable retroperitoneal metastases of nonseminoma testicular tumors. Seven of them also revealed metastases to the lung. Complete regression of retroperitoneal metastases was observed in 7 and greater than 50% regression--in 20 cases. Six patients showed complete regression of pulmonary lesions. Chemotherapy raised an opportunity for retroperitoneal lymphadenectomy in 31 cases. Lung metastasis was also removed in one patient. Following chemotherapy, histological examination failed to detect metastases in 17 cases, differentiated teratoma elements were found in 6, while tumor cells were identified in the remaining patients. Three-year survival rate for radically treated patients was 55.5% (m = 8.9). Long-term results were shown to depend mainly on the effectiveness of chemotherapy.
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PMID:[Treatment of patients with retroperitoneal metastases of nonseminoma tumors of the testis]. 246 38

A retrospective study reports 65 patients with metastatic disease from nonseminomatous germ cell testicular tumors who underwent a salvage lymphadenectomy either to remove a residual mass or to confirm a complete clinical response after polychemotherapy. Scarring was found in 23 patients (35%), differentiated teratoma in 25 patients (39%) and residual cancer in 17 patients (26%). Of the 12 patients staged as complete responders 2 were found to have cancer, 4 teratoma and 6 fibrosis. Neither tumor markers nor CT scan could accurately predict which patients with residual masses would have cancer, mature teratoma or necrosis. Thus needle biopsy or limited resection is inadequate in its ability to detect persistent vital tumor. After a follow-up of 10-106 months 49 patients (75%) are living with no evidence of disease. 12 patients (19%) died of tumor progress. The most critical prognostic determinant was the nature of the tissue resected. 21 (91%) of 23 patients with only fibrous or necrotic elements are living with no evidence of disease. However, of 17 patients with persistent cancer in the resected tissue only 8 patients (47%) fared well. Our experience confirms the original concept which called for postchemotherapeutic tumor surgery in all patients who demonstrated either a partial or complete clinical response.
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PMID:Significance of salvage lymphadenectomy in the therapeutical concept of advanced nonseminomatous germ cell tumors. 254 11


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