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)

74 patients with disseminated non-seminomatous testicular cancer were randomly entered on a prospective sequential combination chemotherapy regimen with mandatory crossover, consisting of either vinblastine/bleomycin or adriamycin/cis-dichlorodiammineplatinum (II) (DDP) as initial therapy. Independent of the randomization the overall remission rate in 71 evaluable patients was 89% including 54% complete remissions. 35% of the patients remained disease-free at 2+ to 28+ months with a median of 12 months. By additional surgical removal of residual pulmonary metastases in two patients the complete remission rate was increased to 40/71 (56%), and the number of patients with no evidence of disease to 27/71 (38%). According to the life-table method the two-years survival rates were 63% for complete responders and 29% for all other patients, which was significantly lower. 53 patients (75%) were alive at 3 to 28 months with a median of 9 months. Additional advanced abdominal disease, initially elevated beta-HCG and LDH and extension of pulmonary disease were of significant negative influence on the prognosis. The evaluation of single chemotherapy courses revealed equal efficacy of both combinations. However, response to adriamycin/DDP occurred in 46% of the courses, when vinblastine/bleomycin had failed, while response to vinblastine/bleomycin occurred only in 21% of the courses when adriamycin/DDP had failed. Thus different patterns of cross-resistance between these alternative regimens may exist.
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PMID:[Sequential combination chemotherapy with vinblastine/bleomycin and adriamycin/cis-dichlorodiammineplatinum (II) in non-seminomatous testicular cancer. I. Results of a prospective randomized phase III-study with 71 patients with disseminated disease (stage IV) (author's transl)]. 616 Dec 73

Thirty patients with nonseminomatous testicular cancer and no evidence of metastases outside the retroperitoneum were evaluated for discrepancy between the clinical and pathologic stages and also for frequency of elevations of the serum levels of human chorionic gonadotropin (hCG) and alphafetoprotein (AFP). When marker-level data were not considered in the staging, the clinical and pathologic stages differed in 47% of the patients; the inclusion of marker data reduced the staging error to 37%. Seven of ten patients with clinical Stage I, pathologic Stage II disease had normal marker levels (false-negative results). However, there were no false-positive results: abnormal marker levels before retroperitoneal lymphadenectomy always signalled persistent tumor unless the level could be accounted for by the metabolic decay rate of marker produced by the primary tumor. Comparison of marker-level data from these patients with data from 48 patients with Stage III disease demonstrated increasing frequency of elevated marker levels with increasing stage (P less than 0.001). Serial determinations of HCG and AFP are helpful in clinical staging and are necessary in clinical management.
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PMID:Human chorionic gonadotropin and alphafetoprotein in the staging of nonseminomatous testicular cancer. 616 91

To determine the point at which transformation of the germ cell occurs during meiosis in nonseminomatous testicular cancer, the sex chromosome compositions of 15 cell lines derived from primary tumors or metastases of 12 patients with testicular cancer were analyzed by trypsin G-banding analysis and Y-body staining. The simultaneous existence of both X- and Y-chromosomes in a single cell has been confirmed in 14 cell lines. This suggests that transformation of the cell occurs before the first meiotic division because it is known that segregation of X- and Y-chromosomes occurs during the first meiotic division. An incidental finding was the presence of Barr bodies in some cell lines containing more than one X-chromosome, which is consistent with the known primitive nature of testicular cancer and its ability to differentiate independently from the male host.
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PMID:Cytogenetic evidence for premeiotic transformation of human testicular cancers. 616 59

Radiotherapy provides a high cure rate for patients with stages I and II seminoma but the results for those with stage III disease have been disappointing. We report on 19 patients with high stage seminoma who have been treated with platinum, vinblastine and bleomycin (14 patients) or platinum, vinblastine, bleomycin and doxorubicin hydrochloride (5 patients). Of the 19 patients 12 (63 per cent) had complete remission of the disease and the remaining 7 had partial remission. To date, 11 patients (58 per cent) remain free of disease. Of the 6 patients with no prior irradiation 5 achieved complete remission, while the 1 failure had massive hepatic metastases. The median followup was 19 months (range 12 to 37 months). These results parallel that achieved with the same chemotherapy regimen in patients with stage III nonseminomatous testicular cancer.
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PMID:Disseminated seminoma: re-evaluation of treatment protocols. 616 50

Since 50% of patients with testicular tumour have retroperitoneal metastases at the time of presentation, there has been little argument that the area of primary drainage requires further treatment following orchiectomy. Patients with nonseminomatous germ cell tumours in stages A and B are candidates for retroperitoneal lymphadenectomy because this procedure is of therapeutic value and allows accurate staging of the disease. The development of extremely effective modern, cyclic, multidrug chemotherapy for extensive nonseminomatous testicular tumour has led to a rethinking of the role of lymphadenectomy in treating testicular cancer. Clinical staging is still not 100% accurate even with modern techniques. Lymphadenectomy, therefore, continues to be an important step in managing patients with nonseminomatous germ cell tumours. These facts are endorsed by the authors' review of 72 cases of nonseminomatous germ cell tumours managed at McGill University teaching hospitals over a 10-year period. The authors also discuss the indications for retroperitoneal dissection.
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PMID:Lymphadenectomy for testicular carcinoma. 617 91

Fifteen patients with disseminated non-seminomatous testicular cancer, 13 of whom had advanced disease, underwent surgery for residual tumor after induction chemotherapy. Complete remissions were achieved in 7 of 9 patients with mediastinal or pulmonary metastases and in 2 of 6 patients with retroperitoneal metastases. Patients with alpha-fetoprotein (AFP) levels over 10(4) ng/ml at diagnosis and/or a positive AFP preoperatively failed to achieve complete remission. Complete remissions were obtained in all 8 patients who had resection of necrosis, mature teratoma, immature teratoma or mature teratoma with malignant foci, but in only 1 of 7 patients who had resection of embryonal carcinoma or yolk sac tumor with other components. Of 9 patients with complete remission, 8 have remained free of disease after a median follow-up time of 29 months (range 6-66 months) and one had a contralateral non-seminomatous testicular cancer removed after 60 months. In addition to being therapeutically successful, the combined use of chemotherapy followed by surgery for residual tumor may lead to a better understanding of the influence of chemotherapy on the biology of testicular carcinoma.
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PMID:Surgical resection of residual tumor after chemotherapy in non-seminomatous testicular cancer. 618 74

More than 350 patients with testicular germ cell cancer have been treated with cisplatin combination chemotherapy. Seventy-two with metastases to the thorax who had operation are discussed here. In a subgroup of 24 patients with additional retroperitoneal disease, a one-stage median sternotomy was performed in 18 patients, and a thoracotomy in 6, with retroperitoneal node dissection. Seventeen patients had similar pathological lesions in the thorax and retroperitoneum; in 7, the lesions differed. There was no operative mortality in the entire group. Overall, chemotherapy altered the metastases to mature teratoma in 28 patients, and 27 are long-term survivors. Among 22 patients with fibrotic, necrotic masses, 19 are long-term survivors; 6 of the 22 with persistent carcinoma had chemotherapy postoperatively and are long-term survivors. The overall cure rate for patients with disseminated testicular cancer is approximately 80%. Among those who had a one-stage thoracoretroperitoneal procedure, long-term survival is 83%; for the entire thoracic surgical group, it is 74%.
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PMID:The importance of one-stage median sternotomy and retroperitoneal node dissection in disseminated testicular cancer. 619 80

In a former series of 60 resected Stage II nonseminomatous germinal testis tumors the authors succeeded in demonstrating that adjuvant cisplatin, vinblastine, and bleomycin (PVB) was able to significantly improve survival (100% in 11 treated versus 28.5% in 7 historical controls, P less than 0.01) only in patients with retroperitoneal metastases greater than 5 cm, macroscopic extranodal spread, tumor invasion into retroperitoneal veins (pathologic Stage II-C). Forty-eight evaluable patients with clinical nonbulky Stage II nonseminomatous testis cancer underwent retroperitoneal lymphadenectomy as primary treatment. Four courses of postoperative PVB were administered only to 18 clinically understaged patients (14 pathologic Stage II-C, and 4 postoperatively reclassified as Stage III). The remaining 30 patients were followed at monthly intervals. After a median follow-up of 25 months, relapses were: 1 (10%) in 10 pathologic Stage I patients; 8 (40%) in 20 pathologic Stage II-A and II-B; null in the 18 treated. Eight of the nine patients (89%) who had relapse entered continuous complete remission following salvage therapy. The overall 2-year disease-free survival in this case series is 98%. Retroperitoneal lymphadenectomy followed by compulsive follow-up and selective use of aggressive chemotherapy is an alternative to remission induction chemotherapy as primary treatment in clinical nonbulky Stage II nonseminomatous testis cancer, and to immediate adjuvant chemotherapy in all patients with resected Stage II disease.
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PMID:Retroperitoneal lymphadenectomy and aggressive chemotherapy in nonbulky clinical Stage II nonseminomatous germinal testis tumors. 619 70

Under Cisplatinum/Vinblastine/Bleomycin treatment six of 82 patients with nonseminomatous testicular cancer developed a Bleomycin-induced pulmonary toxicity. After a total Bleomycin dose of 300-360 mg all six patients showed multiple nodular densities near the pleura in the basal lung areas on the computed tomographic scanning (CT). Disseminated interstitial infiltrates, mostly in the lower lung fields were spontaneously observed by means of chest X-rays in only one case. In two other cases only minimal changes were found retrospectively. In five cases the diffusion capacity did not decrease significantly. Diffusion capacity, vital capacity and oxygen fell significantly in only one case. The latter was also the only patient showing clinical symptoms. The lung changes were completely reversible in four patients 4-6 months after cessation of Bleomycin. In two patients there were reversible residual changes after a timespan of 20 and 24 months. Two patients received no further antineoplastic treatment, two were under maintenance therapy, two under further induction chemotherapy because of the assumption of lung metastases. None of the six patients show any evidence at present of testis tumor (observation period 17-34 months). It can be difficult to distinguish between Bleomycin-induced lung damage and tumor metastases by radiological means. We were able to differentiate by observing the clinical course of the six patients. In case of doubt a histological examination is strongly recommended.
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PMID:[Bleomycin-induced pulmonary infiltrations in the treatment of testicular cancer]. 620 Jun 44

To define prognostic factors of testicular cancer and to develop a strategic therapy based on clinical, pathological and biological findings, 77 cases of non seminomatous testis tumor, observed in G.F. Leclerc Center from 1967 to 1977, have been analysed. For all these patients early chemotherapy program was associated with surgery; radiation therapy was reserved for stages with retroperitoneal metastatic disease. Results of this review confirmed the interest of such medical treatment which improved survival in all stages of disease. Some prognostic factors could be detailed from these cases: nature of tumoral components, invading of lymph node, presence or not of biological markers; identification of these would unable us to choose the best adjuvant chemotherapy program and to define its place in the management of testis tumor's treatment.
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PMID:[Adjuvant chemotherapy in treatment of non seminomatous germinal testicular tumor. Results and reflexions about 77 cases (author's transl)]. 624 89


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