UMLS:C0027627 - FACTA Search

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Query: UMLS:C0027627 (metastases)
103,950 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Forty-four patients with non-small cell carcinoma of the lung were treated every 3 weeks with vinblastine (4 mg/m2/day iv X 2) and cisplatin (20 mg/m2/day iv X 3). Of the 28 patients with metastatic disease, eight (29%; 90% confidence interval of true response, 17%-47%) achieved objective response, for a median duration of 27 weeks. Median survival in this group was 47 and 28 weeks for responders and nonresponders, respectively. Of the 16 patients with advanced regional disease, 11 (69%; 90% confidence interval of true response, 49%-86%) achieved objective response. Thirteen of these patients received consolidation radiotherapy (4500 cGy/25 fractions/5 weeks), with a boost of 1000 cGy/5 fractions/1 week in those patients who achieved response. In the three patients who did not receive radiotherapy, two died during the induction phase, one from grade 4 leukopenia and sepsis and the second from unrelated factors. The third patient had systemic progression of disease during induction chemotherapy. Six patients experienced overall improvement in their chemotherapy response from the radiotherapy. Two patients who did not respond to the chemotherapy achieved partial response with irradiation. Four patients who had partial response to the chemotherapy achieved complete response with irradiation, and seven patients had no further change in their degree of response to irradiation. The overall median survival of this group was 81 weeks. Maintenance chemotherapy was not given. After radiotherapy, the site of first failure was outside the radiation field in nine of 13 patients (69%). Hematologic toxicity was dose-limiting. Other toxic effects that were not dose-limiting included nephrotoxicity, neurotoxicity, and acute nausea and vomiting. In the patients with advanced regional disease, there was no increase in the radiation toxicity attributable to the chemotherapy. We conclude that: (a) this dose schedule of vinblastine and cisplatin has reproducible activity in non-small cell carcinoma of the lung; (b) the response and median survival of patients with advanced regional disease are superior to those of patients with metastatic disease; and (c) in patients with advanced regional disease, treatment with chemotherapy followed by radiotherapy yielded an overall response rate of 81% (90% confidence interval of true response, 60%-93%) and improved survival compared to a similar group of patients studied by others receiving radiotherapy alone. We recommend further testing of this concept.
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PMID:Cisplatin and vinblastine chemotherapy for metastatic non-small cell carcinoma followed by irradiation in patients with regional disease. 395 44

We evaluated the efficacy and the complications of 65 silicone elastomer catheters inserted percutaneously for long-term venous access for administration of chemotherapy, antibiotics, and blood products in patients with metastatic cancer. Treatments were administered either in the hospital or in the outpatient clinic, using a portable infusion pump. The median indwelling time of catheters was 238 days (range, two to 521). The projected duration of catheter function, when the electively removed catheters were censured, was 310 days. Twenty-three catheters were removed because of malfunction, while the remaining either were discontinued electively (20) or were functioning at the conclusion of the study (22). The problems necessitating removal of 23 catheters were inadvertent dislodgement from loose sutures (eight), mechanical damage to the catheters (four), sepsis (four), phlebitis (four), intraluminal blockage with a clot (two), and cellulitis (one). We conclude that silicone elastomer catheters are safe and reliable for extended venous access for cancer chemotherapy. They are easy to insert and remove and can be replaced with a guide wire without requiring surgical intervention.
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PMID:Evaluation of silicone elastomer catheters for long-term intravenous chemotherapy. 401 68

Twenty-seven chondrosarcomata of the pelvis were treated by local resection with preservation of the limb. Twenty-two were grade I or II, and 5 were grade III or IV. Attention is drawn to the importance of tomodensitometry in assessing the extent of the tumor before operation. An en bloc resection was well wide of the tumour in 16 cases, close to the tumour in 10 cases and involved the tumour in one case. Post-operative complications were varied. There were 6 nerve paralyses after iliac resection, 3 cases of sepsis after resection of the anterior part of the pelvic ring, and 3 cases of sepsis and 2 vascular complications after peri-acetabular resections. The average follow-up was 5 years. Three had metastases and three had local recurrences, one of whom died later from pulmonary metastases. No local recuRrence was seen in cases with wide resection. The functional results were satisfactory in 6 out of 7 partial resections of the ilium and in 4 out of 5 resections of the anterior part of the pelvic ring. They were only fair after peri-acetabular resections and complete resections of the ilium. After peri-acetabular resections, the results were about the same after ilio-femoral arthrodesis or Girdlestone operations. It is not appropriate to reconstruct the pelvic ring after resection limited to the anterior part of the pelvis but it is indicated after resections of the whole of the ilium, particularly in children to avoid shortening of the limb with pelvic shift.
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PMID:[Resection with preservation of the lower limb in chondrosarcoma of the pelvis]. 408 64

Forty-two patients with advanced testis carcinoma without previous chemotherapy were treated with VAB-4, and 41 were evaluable. The program consisted of three in-hospital inductions 16 weeks apart, and outpatient treatments every three weeks. Of the patients, 80% achieved complete remissions (CR). Chemotherapy alone induced CR in 61%, partial remissions (PR), in 24% and minor response (MR), in 15%. An additional 20% of patients (six PRs and 2 MRs) achieved CR following resection of residual tumor deposits. With a median follow-up of 27 months, the median duration of CR has not been reached. Of those achieving CR to chemotherapy alone, 12% had relapses. Bulk and extent of metastatic disease, histology of primary tumor, and tumor markers at the beginning of therapy influenced the frequency of CR. Of those with minimal disease, 90% achieved CR. The CR rate was 67% for those with advanced thoracic disease and 29% for those with advanced abdominal disease. Patients who had embryonal carcinoma and those who had no elevation of alpha-fetoprotein had a higher frequency of CRs. Myelosuppression with a leukocyte count drop less than 1000/mm3 occurred in three patients, and no patient had chronic renal failure or pulmonary fibrosis. One patient died from sepsis while in complete remission.
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PMID:VAB-4 combination chemotherapy in the treatment of metastatic testis tumors. 616 66

Sixty-five patients with metastatic melanoma were treated with vinblastine, bleomycin, and cis-diammine dichloroplatinum (VBD). Sixty-four patients were evaluable for response and toxicity. Twelve (19%) of 64 responded. Three patients (5%) achieved a complete response and nine patients (14%) achieved a partial response. Eleven (22%) of 50 previously untreated patients responded. Nine (30%) of 30 women responded while only three (9%) of 34 men responded. All three complete responses were in previously untreated women. Ten (19%) of 52 patients with visceral metastases responded and two (17%) of 12 patients with soft tissue metastases responded. The duration of complete responses was 23, 25, and 32 weeks. The median duration of the partial responses was 20 weeks (range, 12-28 weeks). Major toxicity was encountered. Leukocyte counts less than 1.0 X 10(9)/L were seen in 27% of the patients. There was one sepsis-related death. Platelet counts less than 50 X 10(9)/L were seen in 22% of patients. Mucositis was common. VBD can cause regression of advanced visceral metastatic disease but the low response rate, short duration of response, and major toxicity abrogates most of its utility as initial treatment for metastatic melanoma.
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PMID:Vinblastine, bleomycin, and cis-platinum for the treatment of metastatic malignant melanoma. National Cancer Institute of Canada Melanoma Group. 619 80

Liver metastases are a common cause of death in colon carcinoma. The dual blood supply of the liver permits regional perfusion while hepatic catabolism fo 5-fluorouracil (FU), floxuridine (FUdR) permit higher drug exposures than systemic (IV) administration. We have studied the effect of continuous intra-arterial chemotherapy (FU: 5-10 mg/kg/day and FUdR: 0.2 mg/kg/day) and whole liver irradiation (1000 rad every 4 weeks, total dose of 3000 rad) for metastatic colon carcinoma to liver. Eighteen patients with metastases to liver only are reported using this combination therapy. Seven patients had percutaneous placement of a catheter via the brachial artery, two had operative placement of a catheter via the gastroduodenal artery, all of which were connected to the Cormed infusor system, nine had operative placement of the Infusaid implantable pump with catheter placement into the hepatic artery via the gastroduodenal artery. The median survival for the entire group was 241 days. In those patients whose liver function tests (bilirubin and alkaline phosphatase) were less than two times normal, the median survival was 770 days. The median survival of the patients with greater than two times normal LFT's was 178 days. Two patients died of complications of the treatment. One who developed irreversible radiation hepatitis but at autopsy had only two areas of microscopic tumor foci in the liver and another who had received only 15 days of infusion and 1000 rad to liver. This patient developed irreversible chemical enteritis secondary to chemotherapy infusion into the superior mesenteric artery. Three patients have undergone abdominal reexploration and one at autopsy, who were found to have no gross evidence of tumor in the liver despite previous pathologic confirmation. It appears that some patients with minimal tumor burdens can have sterilization of their tumors. There were three cases of reversible liver function abnormalities. Complications associated with conventional intra-arterial chemotherapy (artery thrombosis, catheter sepsis and dislodgement, pump infusion variation and pump failure) were not seen with the Infusaid delivery system. The pump is refilled every 2-3 weeks via percutaneous puncture. All therapy was given on an outpatient basis. Pump acceptance and tolerance was 100%. Intra-arterial chemotherapy can now be accomplished without the morbidity associated with it in the past. The combination of chemotherapy and liver irradiation may offer improved survival in selected patients.
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PMID:Intra-arterial chemotherapy using an implantable infusion pump and liver irradiation for the treatment of hepatic metastases. 621 14

Five observations of hepatoblastoma in boys of 10 months to 4 years of age are presented. Tumor mass in the right part of the abdominal cavity was detected 1--9 months before death. Three patients died of pulmonary cardiac insufficiency, 2 of cateterization sepsis and hepatic insufficiency. The liver weight varied from 840 to 3500 g. Two children had intrahepatic metastases, one of them also had extrahepatic metastases into the portal lymph nodes and lungs. In 2 observations hepatoblastoma was of an epithelial structure, in 3 cases of a mixed type. It is suggested that hepatoblastoma, as well as liver carcinoma in adults, occurs more frequently in males.
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PMID:[Hepatoblastoma in children]. 625 73

Hepatic tumors have been associated with oral contraceptive (OC) use. Klatkin's literature review of 1976 yielded a total of 237 cases of OC-associated hepatic tumors; 9% of these were considered malignant. This paper presents a case of liver cell adenoma which developed when a 34-year old patient was using OCs. Contraceptive use was discontinued and the lesion regressed, but a hepatocellular carcinoma developed 3 years later. The woman presented in 1976 complaining of acute right upper quadrant abdominal pain. A hemorrhagic hepatic tumor 16 cm in diameter was diagnosed after an exploratory laparotomy. The patient discontinued use of Ovulen 21 which she had been using for 5 years and was followed up with serial liver scans. The mass shrank to approximately 5 cm in diameter by January 1979 and remained stable until November 1979 when liver scan revealed that the tumor had reverted to its 16 cm size. In December 1979, a partial hepatectomy was done but it was complicated by a cardiac arrest. A postpericardiotomy syndrome developed after the operation. 5 weeks postoperatively, in January 1980, the patient suffered constrictive pericarditis and a pericardial stripping operation was done. The patient later died of sepsis with high output cardiac failure, shock, and adult respiratory distress syndrome. Ultrastructural studies of the tumor revealed a well-differentiated hepatocellular carcinoma. The features of the tumor (e.g., travecular growth, necrosis, hemorrhage) have been the criteria, in addition to vascular invasion and metastases, used to classify previously reported cases as malignant. Autopsy of the patient revealed no metastatic lesions. Cytoplasmic structures suggestive of a phospholipid disturbance were also observed and were thought to be related to drug interference with phospholipid metabolism. An interesting observation was the regression of the tumor after discontinuance of pill use. The mechanisms of its renewed growth and its malignant change remain unknown. Lesions such as this should be given a guarded prognosis even if the appearance is benign. Possible metabolic or enzyme deficiency in the few women in whom hepatic tumors develop is raised.
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PMID:Hepatocellular adenoma. Its transformation to carcinoma in a user of oral contraceptives. 626 14

Major hepatic resections were performed on 138 patients for a variety of conditions. There was one intraoperative death. Including this patient, there were 15 deaths within 30 days of the operation (operative mortality 10.9%). Important postoperative complications were intra-abdominal sepsis (17%), biliary leak (11%), hepatic failure (8%), and hemorrhage (6%). The results of 30 resections for the benign lesions, liver cell adenoma, focal nodular hyperplasia, hemangioma, and cystadenoma showed no operative mortality and low morbidity. Of 26 patients with hepatocellular carcinoma, seven died within a month of operation. The cumulative survival of the 26 at five years was 38%, and of the 19 who survived the procedure, 51%. Poor survival followed resections for cholangiocarcinoma and "mixed tumors." The five-year cumulative survival of 22 patients who had colorectal metastases excised was 31%. Apart from a patient with carcinoid, prolonged survival was rare after resection of other secondaries and after en bloc resections for tumors directly invading the liver. Hepatic resection was of value in the management of some patients with hepatic trauma, Caroli's disease, liver cysts, and intrahepatic stones.
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PMID:Major hepatic resection. A 25-year experience. 629 17

Rhabdoid tumor of the kidney (RTK), originally described as a monophasic sarcomatous variant of Wilms' tumor, is now recognized as a highly malignant, non-Wilms' tumor possibly of neuroectodermal origin. Twenty-one National Wilms' Tumor Study patients with this tumor were treated in the years 1969 through 1978. Mean patient age was 18 months with 16 of the 21 younger than 2 years at diagnosis. Two patients were Stage 1, 10 Stage II, 5 Stage III, and 4 Stage IV. One patient only is continuously disease free and another is surviving disease free following excision of bilateral pulmonary metastases. One patient died of sepsis early during therapy. Thus 18 of the 19 patients who relapsed died, 15 within 1 year of diagnosis, all with progressive tumor growth. The rapid appearance of metastases (mean 4 months), often to multiple sites, and short subsequent survival signal a very malignant tumor resistant to current treatment stratagems.
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PMID:Clinical aspects of the rhabdoid tumor of the kidney: a report of the National Wilms' Tumor Study Group. 631 Mar 57

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