Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0027627 (metastases)
 103,950 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Results of disease-oriented phase II trials with cis-dichlorodiammineplatinum(II) (cis-platinum) in 135 adequately treated patients with advanced urothelial tumors at Memorial Sloan-Kettering Cancer Center are presented. In four protocols which used cis-platinum alone or in combination with Adriamycin and/or cyclophosphamide in 95 patients with bladder cancer, no significant difference (46%--54%) in the number of partial remissions (PRs) in previously untreated patients was noted. The median duration of response in three of the four protocols was 5--7 months. A review of the literature indicates that cis-platinum used singly produced remissions in 45% of 67 patients (95% confidence limit, 12%--57%). In the treatment of superficial bladder tumors, intravesically administered cis-platinum induced few complete or sustained remissions. The difficulties in evaluating response with intravesical therapy are discussed. The importance of patient selection, particularly the need to include patients with objectively measurable disease parameters, in phase II trials is stressed. Differences in patient characteristics and response criteria will necessitate prospective randomized trials of cis-platinum alone versus cis-platinum combination regimens in the treatment of metastatic disease. cis-Platinum was inactive (12% PRs) in 25 patients with prostatic cancer who had objectively measurable parameters. It is of interest that PRs were obtained in three of six patients (50%) with penile cancer. A review of the literature and the data in the present series indicates that cis-platinum has no value in the treatment of metastatic hypernephroma.
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PMID:Phase II trials with cis-dichlorodiammineplatinum(II) in the treatment of urothelial cancer. 38 26

A fifty-three-year-old man with epidermoid carcinoma of the penis metastatic to the right inguinal lymph nodes and adjacent areas was found to have persistent hypercalcemia. Associated with this biochemical abnormality was an elevated parathormone activity in the absence of any bony metastases. Other than a transient response to furosemide-inducded diuresis he was refractory to treatment with oral inorganic phosphates and mithramycin. Ablation of the primary tumor did not affect his hypercalcemia. However, when therapy using external irradiation and parenteral bleomycin was directed to the metastases, his serum calcium stabilized and became normal and remained so until further progression of his humor. We postulate that the penile cancer metastases were elaborating parathyroid hormone-like substances responsible for the hypercalcemia and suppression of normal parathyroid activity.
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PMID:Metastatic carcinoma of penis complicated by hypercalcemia. 112 68

A case of penile cancer was observed in a 20-year-old patient with very extensive remote metastases. On autopsy metastases were found to the heart and brain which are exceptionally rare in penile cancer.
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PMID:[Metastasis of penile cancer to the heart in a 20-year-old patient]. 146 97

Of the 101 patients with penile cancer, we have analyzed 66 from whom we had enough information: 42 (63.3%) patients with corpora cavernosa invasion (T2-3) and 24 (36.6%) without (T1). With respect to the tumor grade, in 36 (54.3%) patients it was well differentiated (G I), in 23 (34.8%) moderately (G II) and in 7 (10.6%) poorly differentiated (G III). We also analyzed the inguinal lymph node condition. Of the 66 patients, 28 (42.4%) developed nodal metastases, and 38 (57.6%) were considered free of nodal metastases and disease with an average follow-up of 76.2 months (range 38-192). The presence of metastatic nodes was influenced by both tumor stage and grade with significant differences between T2-3 and T1 (p = 0.001) and between G II-III and G I (p < 0.01), but each of them alone was not a sufficiently reliable predictive factor. In order to associate local stages and tumor grades in relation to the presence of metastatic nodes, we checked that none of the patients with T1, G I (group 1) developed nodal metastases, and therefore, 'wait and see' should be the suitable approach. Twenty (80%) of the patients with T2-3, G II-III (group 2) developed metastatic lymph nodes, thus, in this group, an early lymphadenectomy should be performed. In the remaining 22 patients with T1, G II-III and T2, G I (group 3), 8 (36.4%) showed metastatic lymph nodes; in this group, other factors such as age, cultural level and obesity should be taken into account when deciding on lymphadenectomy.
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PMID:Corpus cavernosum invasion and tumor grade in the prediction of lymph node condition in penile carcinoma. 147 25

Antiblastic chemotherapy of the urological tumors proves to be effective in germ-cell testicular tumor, in bladder cancer and in penis cancer, while a real effective anti-cancer therapy for prostatic and renal cell cancer has not found yet. There is not a significant difference between BVP and BEP regimens as first-line treatments of the good risk germ-cell testicular tumors. On the contrary BEP showed a lower toxicity and an higher efficacy in the treatment of the poor risk patients. Considering salvage therapies, PEI regimen proves to be as the most effective, also in the management of patients pretreated with BEP; high dose chemotherapy with autologous bone marrow transplant is currently examined as third-line therapy. In the treatment of bladder cancer the most effective drugs are Methotrexate, Adriamycin, Vinblastine and Cyclophosphamide, that, when combined, are sensitively more efficacious. The different chemotherapies achieved elevated percentage of Complete and Partial Responses (CR+PR): however these results are maintained in only 10% of the cases. So far the aim of the last studies is to improve the results both with a modification of posology and of the schedule of administration, and with the employ of growth-factors to reduce toxicity. An appreciable improvement in the treatment of locally advanced penis cancer has been achieved employing VBM regimen as adjuvant therapy, especially for patients with extrinsic lymph-nodal metastases, who underwent bilateral inguinal and iliac lymphadenectomy.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Chemotherapy of urologic metastases]. 157 May 24

A high index of suspicion for penile cancer and a low threshold for biopsy of all penile lesions that do not respond to a short trial of conservative therapy are the primary requirements for early diagnosis and treatment of patients with penile cancer. Survival is related to stage; however, there is a considerable difference between clinical and pathologic stage. This discrepancy is attributable to the difficulty in determining corpora cavernosal invasion and inguinal lymph node metastases because of concomitant inflammatory changes and inaccuracies in diagnostic imaging modalities. Aggressive clinical staging may identify otherwise occult tumor and improve locoregional control and survival.
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PMID:Penile cancer. Clinical presentation, diagnosis, and staging. 157 15

One of the most important aspects in oncology is the definition of clinically relevant subgroups of patients whose disease wil have different behavior to enable decision making about therapeutic methods. The appropriate management of regional adenopathy in patients with penile cancer has generated a number of controversies. Generally, clinical determination of the extent of local disease is difficult. About 50% of patients with node enlargement have no tumor on histologic examination, and 20% of patients with clinically negative nodes have micrometastases. Lymph node biopsies, including sentinel node biopsy, are of limited staging value. Patients with lesions that do not invade the corpora and who have no palpable nodes should be followed carefully at 2- to 3-month intervals after excision of the primary tumor. Those with persistent adenopathy should undergo superficial lymph node dissection first, and if positive nodes are found, bilateral deep node dissection should be performed. Bilateral inguinal and pelvic lymphadenectomy is recommended for patients with lesions invading the corpora with clinically negative or positive nodes because of the high incidence of lymph node metastases in such cases (Table 1). When adenopathy persists after excision of the primary tumor, we advocate first a limited pelvic dissection. If the pelvic nodes are negative or not extensively involved, bilateral groin dissection should be performed, preferably in two stages. Percutaneous fine-needle aspiration of palpable or nonpalpable nodes can be helpful in preoperative staging in patients with penile cancer. Potential areas of study include identification of better risk factors and improvement of preoperative staging methods. This goal is hampered by the fact that penile cancer is a rare finding.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Controversies in ilioinguinal lymphadenectomy for cancer of the penis. 157 22

We review the literature on penis cancer. The disease is rare and most of the cumulative experience is reported in retrospective series. Multi-institutional international collaboration will be needed for prospective studies of certain facets of this disease which are at present controversial. Suggested areas of research are how to treat early invasive tumours, the diagnosis and treatment of inguinal metastases, the improvement of radiotherapy techniques, the development of effective chemotherapy and effective combinations of therapies. This will potentially lead to a more sparing of organs. It is also necessary to study palliation, and aspects of quality of life. The incidence may be further reduced by educating the public about the condition and about genital hygiene, including the necessity for the early treatment of phimosis.
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PMID:[Penile cancer]. 169 41

Epidermoid carcinoma of the penis, although rare, is a very aggressive tumor type. The presence or absence of inguinal metastasis is an essential prognostic factor. Treatment of these metastases is one of the current controversies in urological practice; i.e., when and to what extent lymphadenectomy should be performed. Of 24 patients with penile carcinoma, 10 had undergone regional lymphadenectomy over the past 8 years at our institution. Following treatment of the primary penile tumor, 6 patients had palpable inguinal nodes that persisted after treatment with antibiotic and antiinflammatory agents for 6 weeks. Of these, 3 had a positive node biopsy. They were submitted to regional lymphadenectomy which revealed node metastasis in 5 cases (2 pN3, 2 pN2 and 1 pN1). The patients with no palpable nodes were closely followed and were submitted to lymphadenectomy when these appeared (3 cases). The fatal outcome of 2 cases (both pN3) prompted us to perform lymphadenectomy prophylactically in the last case, a 40-year-old male with pT2G2 N0 penile cancer. This approach is advocated in patients under 65 with invasive penile carcinoma (pT greater than 1) or a high histological grade of malignancy (G2 and G3).
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PMID:[Controversies over regional lymphadenectomy in carcinoma of the penis]. 179 57

The existing hypothesis of a viral etiology of penile cancer has been further supported. Exposure to ultraviolet radiation might be another etiologic factor. Controversies still exist as to whether immediate or delayed inguinal lymphadenectomy should be performed in all patients or only in those who are at high risk for developing metastases (histologic dedifferentiation, vascular invasion). 5-Fluorouracil, cisplatin, bleomycin, and methotrexate are active cytostatic drugs in penile cancer and may have a role in the multimodality treatment of this condition. The sensitivity of abdominal computed tomography in detecting adrenal tumors is reported to be 20% to 41%, and the specificity, 85% to 99%. Immunohistopathology may facilitate the differential diagnosis between malignant and benign adrenal cortical tumors. In a retrospective analysis of 105 patients with adrenal cortical cancer, the overall 5-year survival was 22%. Seventy-nine percent of the tumors were hormone producing. Mitotane yielded biochemical and objective responses without impact on survival.
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PMID:Penile and adrenal cancer. 189 24


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