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)

The close observation of patients treated for testicular cancer led to the suspicion of intrathoracic and/or mediastinal metastases on radiologic examination in a number of patients without other evidence of relapse. This report presents two patients with combined seminomatous and nonseminomatous germ cell tumors with isolated sarcoid reactions of hilar and interlobular lymph nodes, detected concomitant with diagnosis and 12 months after diagnosis, respectively. Histologic examination appears to be imperative in these cases to avoid unnecessary chemotherapy.
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PMID:Sarcoid reaction mimicking intrathoracic dissemination of testicular cancer. 217 50

There is little public awareness that testicular cancer is the commonest malignancy in men aged 20 to 44 years. Early diagnosis correlates with an improved chance of cure and a reduction in the severity of treatment. There have been major advances in treatment in the past decade, so that 80 per cent of patients with metastases can expect a cure. The family practitioner must be active in the management of this disease by educating his or her patients, by remaining vigilant to the possible diagnosis of this entity, and by referring patients to specialist urologists or to cancer centres with a specific interest and expertise in the management of this disease. With the vast improvement in techniques of management, when applied in specialist centres, errors of clinical judgment by inexperienced practitioners could now become the commonest cause of death from this disease.
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PMID:Towards the earlier diagnosis of testicular cancer. 217 37

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

Pulmonary resection for metastatic disease in 341 patients resulted in a cumulative survival rate of 36.6% at 5 years and 26.6% at 10 years with an operative mortality of 0.9%. 5-year survival rate was 44.3% in colorectal carcinoma (n = 85), 36.2% in cervical cancer of uterus (n = 35), 40.6% in renal cell carcinoma (n = 32), 50.3% in breast cancer (n = 23), 50.0% in testicular cancer (n = 16), 17.9% in osteosarcoma (n = 33), 34.1% in soft part sarcoma (n = 38). The patients with resected metastatic pulmonary lesions from colorectal and renal cancer showed a good 5-year survival, and then the survival decreased gradually. On the other hand, the survival for testicular and breast cancer, osteosarcoma and soft part sarcoma decreased rapidly in the first 2 to 3 years, but a plateau was reached. Each primary malignancy should be analyzed individually because of the differences of their biologic behaviors. Significant factors influencing survival were (1) patients selection for pulmonary resection, (2) the biologic growth rate of each primary malignancies, and (3) effectiveness of chemotherapy for primary malignancies. Presumably, a good 5-year survival rate after thoracotomy would be a reflection of a length bias, caused by the biologic behavior of the metastatic pulmonary disease. The true benefit for the surgical approaches to metastatic neoplasm of the lung are still controversial.
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PMID:[Surgical resection of metastatic neoplasms of the lung]. 234 92

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

Two hundred and twenty-eight patients with advanced testicular cancer were entered into a randomized study of chemotherapy comprising cis-platinum (P) 20 mg/m2-, days 1-5 every 3 weeks for four courses, bleomycin (B) 30 mg weekly for 12 weeks, and vinblastine (V) at either the low dose of 0.15 mg/kg or the high dose of 0.20 mg/kg on days 1 and 2 every 3 weeks for four courses. In this interim analysis, 64 patients were randomized to high dose PVB. Forty-five (71%) achieved a complete response, and 13 (25%) a partial response. Seventy patients received low dose PVB of whom 50 (71%) achieved a complete response and 16 (23%) a partial response. Thus there is no difference in the efficacy of this combination chemotherapy with respect to the dose of vinblastine, but the low dose schedule was less toxic (particularly to bone marrow). It was also apparent that the response rate varied with the volume of metastatic disease, irrespective of the dose of vinblastine. Patients with low volume metastases had a complete response rate (CR) of 88%, while those with high volume had a CR rate of 60%. In a second randomization, 68 patients achieving CR were randomized to receive either 1 year of further (maintenance) chemotherapy with cis-platinum and vinblastine, or no further chemotherapy. One of 37 patients (3%) receiving treatment and 2 of 31 patients (6%) not receiving treatment relapsed, with a follow-up of at least 10 months. Thus maintenance chemotherapy appears not to be necessary in the treatment of advanced testicular cancer.
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PMID:EORTC Genito-Urinary Group studies in advanced testicular cancer--past and future. 241 35

Cisplatin, vinblastine and bleomycin (PVB) is very effective therapy in disseminated testicular cancer, but toxicity is severe. A further reduction of vinblastine might reduce the acute toxicity of PVB without compromising the response rate in good-risk patients. Starting in March 1982, 42 consecutive patients with minimal or intermediate advanced disease (lymph node metastases less than 10 cm, lung nodules less than 5 cm) began a 0.2-mg/kg vinblastine PVB regimen, provided that serum alpha-fetoprotein (AFP) levels were not greater than 1000 ng/ml and human chorionic gonadotropin (HCG) values were not greater than 50,000 mIU/ml. Only 9 patients (21.4%) had leukocyte counts less than 1000/mm3, 6 (14%) had infections, but none had documented sepsis. Gastrointestinal and neuromuscular toxicities were mild. Of the 42 patients, 41 (97.6%) entered complete remission (CR), 8 with surgery. After a median follow-up period of 26 months (range, 19-40 months), 35 patients (83.3%) are continuously disease-free. Of the 6 patients with AFP levels greater than 400 ng/ml and/or HCG values greater than 1000 mIU/ml, only 2 (33.3%) entered continuous CR, versus 33 (91.6%) of the 36 patients with normal or less elevated markers (P less than 0.01). PVB with a 0.2-mg/kg vinblastine dosage is very effective and well-tolerated therapy in selected good-risk patients with disseminated germinal testis cancer.
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PMID:Successful treatment of good-risk disseminated testicular cancer with cisplatin, bleomycin, and reduced-dose vinblastine. 242 65

Since June 1979, the authors have had the opportunity to treat a renal homograph recipient who developed primary embryonal cell testicular carcinoma with retroperitoneal and pulmonary metastases. This patient was treated with an induction chemotherapy protocol of vinblastine sulfate, bleomycin, and cisplatin and has remained free of disease through June 1985, without loss of his renal homograph. Cisplatin-based cytoxic drug therapy can be delivered safely to a renal transplant recipient without causing kidney damage, and, in this case, achieved a cure of metastatic testicular cancer.
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PMID:Curative, platinum-based cytoxic drug therapy in a renal transplant recipient with metastatic testicular cancer. 242 86

Dramatic advances have been made over the last decade in the management of testicular cancer. There are three identifiable reasons for this. The first is the widespread availability of tumour markers to assess the state of disease and its response to therapy. The second is CT scanning, which has revolutionized our ability to locate with fine anatomical detail the location of metastases. The third is the development of effective, intensive chemotherapy together with the understanding of its side-effects and optimum usage. Problems still remain in patients who fail to respond completely to existing therapy. In addition, the profound side-effects of chemotherapy mean that much effort is being invested in the development of less toxic but equally effective forms of treatment.
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PMID:Advances in the management of testicular cancer. 242 72

The experience gained in the treatment of 111 cases of testicular tumor is summarized in the paper. Methods of management of testicular cancer in the eighties differ significantly from those employed in the seventies. A set of drugs used is different. The share of cases of monochemotherapy has decreased markedly. PVB and VAB-6 schemes are highly effective inducing complete or partial remission in 80-90% of cases. Issues of treatment of patients with massive metastases in retroperitoneal lymph nodes and lungs remain unresolved. Timely diagnosis of dissemination will improve chemotherapy results.
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PMID:[Management and drug therapy of patients with disseminated testicular tumors]. 243 Mar 61


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