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)

Forty-three patients with disseminated or inoperable carcinoma of the breast were treated with Metenolone Enanthate (Primobolan Depot) with doses of 400 to 1 200 mg/week for at least 3 months. Objective remissions lasting longer than 3 months occurred in 8 out of 41 evaluable patients. Soft tissue metastases responsed best. Liver and brain metastases were unaffected. The therapeutic efficiency of Primobolan Depot is comparable to that of testosterone propionate but the agent is less virilising.
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PMID:Treatment of disseminated carcinoma of the breast by metenolone enanthate. 122 96

Progesterone, like estrogens, is used in the treatment of metastatic breast cancer. The 3 most active derivatives are megestrol, norethisterone acetate, and medroxyprogesterone acetate (MPA). This study evaluates the use of MPA in treating metastatic breast cancer in 40 postmenopausal women (average age, 63 years; average duration of postmenopause, 14 years) who have either not responded to or have relapsed after therapy with estrogens and androgens. 18 patients received a depot preparation of MPA intramuscularly in a loading dose of 3.2 g over a 2-week period and then 400 mg at 2-4 week intervals. 22 patients received the drug orally in a dose of 200 to 300 mg daily. Patients were evaluated after 6 weeks of therapy. Criteria for evaluating response were those used by the Eastern Cooperative Oncology Group. Only 2 of 40 patients exhibited an objective response (disappearance of metastatic lymph node for 9 months in 1 and well-documented clinical improvement and control of brain metastases for 22 months in another). 2 patients had mixed responses of chest wall metastases (regression of some but not all lesions) lasting 3 and 4 months respectively. 5 patients had obvious subjective response (pain relief) but no objective response. Overall response rate was 22%: 4 objective responses (10%) and 5 subjectives responses (12%). Route of administration did not correlate with response. Tumor stimulation and clinical deterioration occurred in 4 patients. It appears that MPA therapy is costly and of minimal usefulness as secondary therapy in metastatic breast cancer. Further studies should focus on megestrol and norethisterone acetate which have been documented to have better response rates.
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PMID:Response to medroxyprogesterone acetate (NSC-26386) as secondary hormone therapy for metastatic breast cancer in postmenopausal women. 126 Jul 80

Although chemotherapy has been generally of limited clinical benefit in the treatment of metastatic malignant melanoma (MMM), fotemustine (FM) is a newly developed drug which is active against this disease. Twenty-four patients with histologically proven MMM were treated with fotemustine, with or without dacarbazine (DITC) according to different phase II trials. In the first schedule, three patients received FM alone on days 1, 8, 15 followed by a 5-week rest period. The second schedule consisted of FM administered on days 1 and 8 alternating with DTIC on days 15 and 16, followed by a 5-week rest period (19 patients). The third schedule, given to two patients, consisted of DTIC followed 4 h later by FM. The overall response rate was 8.3%. Response in those who were treated with alternating drugs, included one partial response (PR) in the brain which lasted 4 months, and one PR in brain metastases with complete response (CR) in lymph nodes for 4 months. Clinical and radiological evidence of regression was observed mainly in brain metastases (22.2%), reflecting the intracerebral activity of the drug. It seems that fotemustine is superior to any other drug currently available in the treatment of these metastases.
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PMID:Fotemustine--an advance in the treatment of metastatic malignant melanoma. 129 87

The present study was initiated by data on the anatomical occurrence of metastases from breast cancer. Metastases may occur at various organs, here grouped into ten categories, and simultaneous occurrences at several sites are common. Our aim was to identify and compare risk factors for development of metastases at each site. The influence of the various risk factors for recurrence at one specific site can be modelled as a standard competing risk problem, using well-established survival analysis techniques such as the Cox regression model. Recently a generalization to joint occurrences at more than one site has been proposed. The more general models allow comparison of the differential prognostic influence of various risk factors on recurrence at different sites. We applied these methods to data from the Danish Breast Cancer Cooperative Group on recurrence after breast cancer, and examined the effect of degree of anaplasia, number of positive lymph nodes, size of primary tumour, skin or deep fascial invasion, age of the patient and adjuvant treatment regimen, as possible risk factors. There were no differential effects of type of therapy on recurrence in different sites. However, chemotherapy had a marginally significant positive effect at all sites. Moreover the number of positive lymph nodes was associated with an increased risk of metastases, homogenous across sites, except for brain where an opposing trend was found. Similarly the degree of anaplasia was associated with a somewhat increased risk of metastases, homogenous except for brain. For brain metastases a significantly more pronounced effect of degree of anaplasia was found. Comparison of the results obtained from the two types of models reveals that the new more general models confirm fewer differences between the influence of the prognostic factors than the traditional regression models suggest.
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PMID:Differential influence of prognostic factors on the occurrence of metastases at various anatomical sites in human breast cancer. 131 83

Two young women taking phenytoin because of symptomatic brain metastases are described. Both patients, one with end-stage lung cancer and the other in complete remission after intensive chemotherapeutic treatment of a choriocarcinoma, became pregnant while using oral contraceptives in combination with phenytoin. One patient had the child, but died a year after the metastases became apparent, in the other the pregnancy was terminated. When prescribing phenytoin, attention should be paid to fertility--even in patients with end-stage cancer or after intensive, possibly sterilising, chemotherapeutic treatment.
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PMID:[2 patients with brain metastases who became pregnant during phenytoin administration]. 133 21

We report the cases of 37 patients with carcinoma of the lung revealed by brain metastases. The most frequent clinical manifestation was focal neurological symptoms associated with headache and vomiting in 50% of the cases. X-ray films of the chest were abnormal in 34 patients. At the time of diagnosis 11 patients also presented with extra-cerebral metastases. The histological type of the primary lung tumor was obtained by examination of the thorax in 32 cases and in 5 cases from brain or lymph node metastases: 11 patients had small-cell lung carcinoma and 26 had non small-cell lung carcinoma. The overall actuarial median survival was 4.5 months, irrespective of the histological type. The group of 20 patients who underwent neurosurgery had a longer median survival (10 months versus 4.5, p < 0.05), and in the subgroup where brain and lung resections were combined the median survival was even longer (13 months). Cerebral relapses occurred in 12 patients: in 7 out of 15 patients with brain surgery but without adjuvant brain radiotherapy, and in 5 out of 16 patients with brain radiotherapy without neurosurgery. No cerebral relapse was observed in the group of 5 patients who had complete resection followed by radiotherapy of the brain. This demonstrated a clear benefit from postoperative radiotherapy. Conventional chemotherapy induced objective responses only in the small-cell carcinoma group and could be too toxic when combined with simultaneous radiotherapy, but it proved a useful adjuvant treatment in patients with radiotherapy of the brain.
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PMID:[Cerebral metastasis disclosing primary bronchogenic cancers]. 133 93

A 3-year-old boy presented with multiple brain metastases 21 months after the resection of stage II Wilms' tumor. Metastasis to other organs was not found. He was treated by total removal of a large metastatic tumor in the left temporal lobe and post-operative radiotherapy and chemotherapy. He has been in complete remission for 20 months after surgery. Cerebral metastasis from Wilms' tumor without systemic metastases is very rare. It is speculated that brain metastases occurred in this patient because most of the anticancer agents used in the primary treatment for Wilms' tumor were not able to cross the blood brain barrier.
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PMID:[Brain metastases from Wilms' tumor without systemic involvement--a case report and review]. 133 62

The best possible treatment for a single metastasis to the brain is complete surgical excision followed by whole brain irradiation. A survey was done to determine the proportion of patients with brain metastases who had surgical excision of the lesion. The number of patients with a preoperative diagnosis of cerebral metastases who underwent surgical excision in Tan Tock Seng Hospital from 1985 to 1989 was obtained from the operation records. An average of 11 surgical excisions were done for cerebral metastases annually. To estimate the number of cases of single brain metastases seen annually in Singapore, figures of cases of cancer of the lungs, breast and colorectum from 1978 to 1982 were obtained from the Singapore Cancer Registry. Based on a conservative estimate that 20% of these cancers metastasize to the brain, that 50% are single metastasis and of these, half are suitable surgical candidates, our calculations show that there are at least 67 cases of surgically excisable single brain metastasis in Singapore annually. This means that more than 84% of patients with a single brain metastasis are not getting the best possible treatment. The reasons may be due to patients' fear of operation and to lack of awareness among physicians on advances in the management of brain metastases. Patient education and physician update on recent advances in treatment will allow patients to obtain the best possible treatment.
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PMID:Surgery for brain metastases in Singapore. 141 62

This study clarified whether and when the blood-brain barrier in experimental brain metastases is impaired by using hydrosoluble sodium fluorescein (MW 376) as a blood-brain barrier function indicator. Cells from eight human tumor lines (four melanomas, two breast carcinomas, one colon carcinoma, and one renal carcinoma) were inoculated into the internal carotid artery of nude mice. Brain metastases at different stages of development were sampled and the permeability of the blood-brain barrier around the metastases determined. Histologic examination showed two patterns of tumor growth. In the first, tumor cells formed isolated, well-defined nodules in the parenchyma of the brain. In lesions smaller than 0.2 mm2, the blood-brain barrier was intact. In the second, small diffuse nests of tumor cells were distributed throughout the brain parenchyma. The blood-brain barrier was intact until the small tumor cell colonies coalesced to form large tumor masses. These results suggest that the permeability of the blood-brain barrier varies among different experimental brain metastases and that its function is related to the growth pattern and size of the lesions.
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PMID:Differential permeability of the blood-brain barrier in experimental brain metastases produced by human neoplasms implanted into nude mice. 144 46

Brain metastases are common and often occur in patients whose systemic cancer is quiescent. When brain metastases occur, they considerably decrease the quality of life in patients who otherwise might be functional. An early diagnosis and vigorous treatment of the brain metastasis, while only rarely curative, may lead to a useful remission of the brain symptoms and may both enhance the quality of the patient's life and prolong survival. Patients with known cancer and neurological symptoms should all undergo appropriate diagnostic tests which include either CT scan or magnetic resonance imaging and, if a lesion is found and a definitive diagnosis can not be established, biopsy. Single or solitary brain metastases in patients with good systemic performance status should be strongly considered for surgical extirpation which will both make the diagnosis and deliver definitive treatment to the lesion. Patients with poor systemic performance status and/or multiple brain metastases are candidates for whole brain radiation therapy. Whole brain radiation therapy is also indicated in patients after successful surgical extirpation of a single metastasis. The role of focal radiation therapy and chemotherapy in the treatment of brain metastases is still being evaluated. Preliminary evidence suggests that focal radiation therapy is probably useful for the treatment of relapsed metastases and that chemotherapy may be useful in the primary treatment of small or asymptomatic brain metastases. Appropriate use of therapeutic modalities directed at brain tumors will ameliorate symptoms in most patients and usually increase survival and enhance the quality of the patient's life.
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PMID:Management of brain metastases. 144 68


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