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)

From March 1983 to June 1986, 100 patients with locally advanced squamous cell carcinoma of the head and neck were randomized to receive either two courses of chemotherapy prior to local therapy (group A), or local therapy alone (group B). Local treatment consisted of primary radiotherapy in all patients. When a poor response was observed after 55 Gy, surgery was performed. The chemotherapy regimen was a combination of cisplatinum, bleomycin, vindesine, and mitomycin C. The response rate to induction chemotherapy (group A) was 50% for the primary tumor (CR: 10% and PR: 40%). At the end of radiotherapy, the overall tumor response rates in the two groups A and B, were 77% and 79% respectively. Complete disappearance of the primary tumor occurred more often than that of the lymph node metastases. The response rate to induction chemotherapy for lymph node metastases was 27.1% (CR: 9% and PR: 18.1%). An initial major response to chemotherapy predicted subsequent efficacy of irradiation on 90% of the cases, while a failure of chemotherapy had no predictive value in this respect. The survival rates in groups A and B were 66.5% vs. 65.1% at 1 year and 35% vs. 46.2% at 2 years. Local disease-free and disease-free intervals were similar in both groups. A Cox's multi-step regression analysis revealed two significant independant prognostic factors: size of primary tumor and nodal status. After adjustment for these factors, the chemotherapy did not seem to improve the effectiveness of the local treatment in terms of loco-regional control and survival.
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PMID:Induction chemotherapy in advanced head and neck cancer. Preliminary results of a randomized study. 265 Jul 23

In a study of 445 patients with colorectal cancer referred to our center during a 3-yr period, we investigated the following parameters and their interrelationships: sex, marital status, ethnic origin, place of residence, stage of disease, delay in diagnosis and factors responsible for delay. Localized disease was found in 52% of the patients, regional disease in 29% and metastatic disease in 19%. The incidence of colorectal cancer was significantly higher in Jews of European (occidental) descent than in Jews of Asian or North African (oriental) descent or in Arabs. The median and mean ages were significantly higher in the occidental than in the oriental Jewish group and significantly lower in the Arabs than in the oriental Jews. Diagnosis was delayed for more than 6 weeks in 52% of the patients. Responsibility for the delay could be attributed to the patient in 54% of these cases and to the physician in 47%. Administrative factors were responsible for the delay in 26%. (In 27% of the above delayers there was more than one agent responsible for the delay.) On average, patients in whom diagnosis was delayed had more advanced disease than those without delay. Also, patients with advanced disease had a longer delay on average than those with localized disease. The stage of disease at diagnosis was more advanced in the oriental than in the occidental Jews. No correlations were found between delay in diagnosis and either age or sex. There were more widowers with delay (21%) than with no delay (16%). In patients living outside Haifa delay was more prolonged than in those residing in the city. Educational programs aimed at the population at risk of developing neoplasm and especially at those likely to undergo delay in diagnosis are recommended. Postgraduate courses should be designed to instruct physicians on how to minimize delay in diagnosis.
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PMID:Colorectal cancer: incidence, delay in diagnosis and stage of disease. 369 78

In a study of 523 patients with breast cancer, delay in diagnosis was examined in relation to stage of disease, age and ethnic origin. Localized disease was found in 44% of the patients, regional disease in 40%, and metastatic disease in 9%. Stage was unknown in 7%. The incidence of breast cancer was significantly higher in Occidental Jews (of European origin) than in Oriental Jews (of Asian or North African origin) or in Arabs. The median and mean age were significantly higher in the Occidental Jewish group. Older patients (greater than 70) had more advanced disease and longer delay. Diagnosis was delayed (greater than 6 weeks) in 43% of the patients. Diagnosis was attributable to the patient in 69% of cases and to the physician in 30%. There was no delay in diagnosis for most of the patients with localized disease, whereas there was for most of those at an advanced stage. When there was a delay, it was longer in those with advanced disease. Delay due to physician responsibility was longer than the delay due to patient responsibility. Although the percentage of patients with delayed diagnosis was similar in the three ethnic groups studied, the stage of disease was significantly more advanced in Oriental Jews and Arabs than in Occidental Jews. The possible explanations for these findings are discussed. The importance of patient education aimed at breast self-examination and the role of the physician in preventing delay in diagnosis are stressed.
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PMID:Factors affecting delay in diagnosis of breast cancer: relationship of delay to stage of disease. 374 80

Eight cases of alveolar rhabdomyosarcoma of the female genitalia were diagnosed from 1963 to 1983 at The University of Texas M. D. Anderson Hospital. The primary sites were vulva in two, perineum in five, and broad ligament in one patient. When possible, therapy was initiated with local tumor excision (five patients). Surgery was followed by local or regional radiation (six patients) and chemotherapy (seven patients). Of the eight patients, five died within 9 months, one died 27 months after diagnosis, and only two are 5-year survivors. The aggressive behavior of this tumor is evidenced by autopsy findings of widespread metastases. Metastatic disease to the bone was present in four patients and to the breast in three patients. Local disease was controlled in two patients who died of distant metastases. Current therapy recommendations include excisional surgery, local radiation, and combination chemotherapy. A need for more effective chemotherapeutic programs is evident.
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PMID:Alveolar rhabdomyosarcoma of the female genitalia. 401 76

Sixty-two patients less than 40 years of age were admitted with adenocarcinoma of the colon and rectum between 1967 and 1981 at the Methodist Hospitals of Memphis. These represented 3.2 per cent of a total of 1909 patients with the disease during the same time period. Eighty-one per cent presented less than 6 months after onset of symptoms; pain and bleeding being the most common complaints. Inflammatory bowel diseases and polyposis were uncommon. Fifty-eight per cent of the lesions were within reach of the sigmoidoscope. Localized disease was present in 37.9 per cent, with one-third presenting with distant metastases. Sixty-five per cent were considered curable at initial laparotomy. Only 2 per cent of the lesions were well differentiated, and mucin production was noted in 32.3 per cent of the specimens compared to 8.6 per cent in the total group. Vascular invasion was noted in 24 per cent and perineural invasion in 11 per cent. Five-year survival was only 17.6 per cent, although this increased to 33 per cent in those undergoing curative resection. Survival in the total group of 1909 patients was 35.5 per cent at 5 years. The poorer survival in the young patients does not seem to be on the basis of delay in diagnosis, premalignant states, or distribution of lesions, but rather it reflects an inherently more virulent lesion. This impression is supported by a greater incidence of mucinous tumors (a poor prognostic indicator) and higher incidence of advanced disease, especially in the second and third decades.
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PMID:Adenocarcinoma of the colon and rectum in patients less than 40 years of age. 669 26

In a prospectively randomized trial evaluating pancreatic resection with adjuvant radiotherapy (intraoperative radiotherapy [IORT] vs. external beam radiotherapy [EBRT]), lymph nodal involvement was examined and correlated with outcome. Twenty-six patients underwent pancreatic resection and received either IORT or EBRT (Stages II-IV). Patients who were stage I received surgery alone. Regional nodal metastases were present in 15 of 26 (57%) patients. Seven patients suffered treatment-related mortality. Survival, mortality, and morbidity were unaffected by the type of radiotherapy. The survival of patients with negative nodes (median survival 24 months, range 10 to > 109) appeared superior to the survival of patients with nodal involvement (median survival 11.5 months; range 4-39). Even in patients with locally advanced disease extending into extrapancreatic tissues, two node-negative patients appeared to survive longer (12 and 53 months) than 10 node-positive patients with similarly extensive local disease (median survival 11.5 months; range 4-39). Local disease control, however, appeared to be independent of nodal involvement, with eventual local recurrences in 6 of 8 node-negative patients and in 4 of 7 node-positive patients who were evaluable for local disease control by autopsy or by antemortem laparotomy.
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PMID:Lymph node involvement and pancreatic resection: correlation with prognosis and local disease control in a clinical trial. 830 88

The combination of concomitant external beam radiotherapy (ERT) and neoadjuvant hormonotherapy was shown to be able to significantly improve local control and disease-free survival in locally advanced prostatic carcinoma. (RTOG study 8610). Aim of this analysis was to assess the clinical results observed in a population of patients undergoing this combined treatment and, more particularly, to examine the prognostic impact of local control. 84 patients (T2: 47%, T3: 49.4%, T4: 3.6%) underwent concomitant ERT (dose to pelvic volume: 45 Gy; mean dose to prostatic volume: 65 Gy) and neoadjuvant hormonotherapy (flutamide: 250 mg three times/daily for 30 days; LH-RH analogue: 1 oral dose every 28 days starting 2 months prior to radiotherapy and for its whole duration). With a median follow-up of 36 months, 3.6% of patients were deceased; hematogenous metastases and local disease progression were recorded in 16.7% and 4.8% of patients, respectively. Local disease progression was shown to be significantly correlated with the incidence of metastases. In fact, the actuarial incidence of metastases at 5 years was 100% and 27% in patients with and without local recurrence (p = 0.0043) respectively. Overall, metastases-free local and biochemical recurrence-free survival was 89.2%, 66.5%, 85.0% and 41.9% respectively. At univariate analysis (logrank) the clinical stage (T) was shown to be significantly correlated with the incidence of metastases (p = .0004) and local progression (p < .0001). In conclusion, this study has confirmed the low rate of local progression with the combination of hormonotherapy and radiotherapy and the significant correlation of local control with the incidence of hematogenous metastases.
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PMID:Radiation, hormonotherapy, survival and local control in prostatic carcinoma. 993 71

The treatment of locally advanced prostatic cancer is the most controversial subject in urological oncology. Localized disease is best treated by radical prostatectomy or radiotherapy. Metastatic cancer is treated by surgical or medical castration. Second line therapeutics will be overviewed. Each treatment decision is based upon the pathological stage and differentiation of the tumour, the life expectancy and comorbidity of the patient.
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PMID:[Cancer of the prostate: what treatment for what stage?]. 1052 94

Ultrasound (US) remains an excellent first line investigation of the gallbladder and for indicating diagnoses and defining levels of extrahepatic biliary obstruction and screening for liver metastases. It is extremely useful in assisting interventional procedures and assessing the status of hepatic vessels. As a nonoperative procedure, endoscopic ultrasound (EUS) can accurately locate and locally stage pathology of the pancreas and periampullary region and even provide reliable biopsy evidence in experienced hands. A limitation, of course, is its field-of-view restriction, which prevents identification of distant metastatic disease. This restriction is not present with laparoscopic ultrasound (LUS), which apart from being an operative procedure, has all the other advantages of EUS and in addition can identify nodal, hepatic, and extrahepatic metastatic spread. Greater use of intraoperative biopsy should assist in identifying nodal disease but requires the readily available services of a pathologist. Local disease may be even more definable using the newer technology of intraductal ultrasound (IDUS). Intraoperative ultrasound (IOUS), whether direct or via the laparoscope, is now an indispensable tool for all surgeons who want to perform hepatobiliary-pancreatic surgery at the highest level.
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PMID:Ultrasound of the hepatobiliary-pancreatic system. 1063 43

The aim of this study was to investigate the role of multimodality treatment in patients with anaplastic thyroid carcinoma. From 1992 to 1999, 39 consecutive patients with a histologically or cytologically proven anaplastic thyroid carcinoma were referred to the Thyroid Center of Padua General Hospital. There were 28 females and 11 males with a median age of 69 years (range 39-88 years). About one-third of patients had a history of preceeding nodular goiter. Two patients had areas of differentiated thyroid carcinoma at histological examination. Local disease was present in 26 patients while distant metastases, mainly to the lung, were present in 22 at diagnosis or quickly developed during the observation period in all the others except one. Thirty-two patients were previously untreated: 9 of them were in good general condition, 1 had limited lung metastases, and the tumor mass was considered resectable by the surgeon. These 9 patients were treated with cisplatin once a week and radiotherapy (RT) 36Gy in 18 fractions over three weeks, followed by total thyroidectomy (TT) and by further chemotherapy (CHT) with adriamycin and bleomycin in 4 patients. Seven patients, 3 with lung metastases at diagnosis, had undergone TT, followed by RT in 5, in another hospital and were subsequently referred to our center due to the presence of distant metastases. Therefore, a total of 16 patients (Group 1) was treated with TT, RT and CHT in various order. Nine patients with distant metastases at diagnosis (Group 2) received CHT; one of them had a disappearance of lung metastases and was then treated by TT and further CHT. Group 3 consisted of 14 elderly patients in poor general conditions; 4 of these received local RT, while the remaining did not receive any treatment. Four complete responses were seen in patients from Group 1, and 1 from Group 2. One patient without distant metastases at diagnosis is alive and free of disease 6 months after TT and adjuvant CHT, and 12 months after diagnosis. Three had long-term survival (14, 24, 27 months) with a disease-free interval of 6-8-10 months. The patient from Group 2 who was treated in a second time by TT is alive without disease after 60 months. Median survival rate was 11 months for Group 1, 5.7 months for Group 2 and 4 months for Group 3. In some patients multimodality treatment (TT, RT and CHT) is associated with increased survival. Nine out of 16 patients, who underwent surgery and complementary treatment, had no local progression. In all but one distant metastases developed, mainly in the lung, during or after post-surgical CHT. The best results were obtained in younger patients with less advanced disease. Early diagnosis is mandatory. Only a few patients responded to CHT, confirming that anaplastic thyroid carcinoma is often resistant to anticancer drugs. Our experience with combination modalities suggests that aggressive and appropriate combinations of RT, TT and CHT may provide some benefit in patients with anaplastic thyroid carcinoma. Preoperative CHT and RT may enhance surgical resectability of the primary tumor.
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PMID:A multimodality therapeutic approach in anaplastic thyroid carcinoma: study on 39 patients. 1119 10


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