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)

Eleven patients with inflammatory breast carcinoma were examined by computed tomography (CT) prior to treatment with radiation and chemotherapy. Determination was made of skin thickening of the affected breast, presence of diffuse breast tumor infiltration or mass, calcification, adenopathy; and metastases. All affected breasts demonstrated increased skin thickness relative to the nonaffected breast, ranging from 0.7 cm-3 cm. Each could further be characterized as having diffuse infiltration of the breast tissue (5), a focal mass lesion (4), or a combination of mass with associated infiltration (2). Two of the breast masses showed diffuse calcification. Only one patient had disease confined to breast tissue at the time of study. Nine patients presented with adenopathy; 7 axillary, 3 internal mammary, 2 supraclavicular, and 1 hilar. Bilateral adenopathy was noted in two patients. Distant metastases to lung, bone, or stomach were observed in 7 of 11 patients. Distant metastases and degree of adenopathy was not related to skin thickness, degree of tumor infiltration, or presence of a defined mass. Inflammatory breast cancer presents with a spectrum of computed tomography appearances. Computed tomography aids in the assessment of local disease, adenopathy, and distant metastases.
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PMID:Inflammatory breast cancer: CT evaluation. 149 5

Among 879 patients treated for breast cancer between 1975 and 1984, advanced disease was found in 125 (14%). A subgroup of 34 (4%) presented with untreated locally advanced disease without demonstrable distant metastases at the time of diagnosis (stage IIIB = T4abed, NX-2,MO). During the first 5 years (1975 through 1979), 17 patients were treated primarily with sequential radiotherapy and chemotherapy (Group A). From 1980 to 1984 (Group B), the management consisted of four courses of induction multi-drug chemotherapy followed primarily by mastectomy and additional chemotherapy. The mean follow-up for the most recent group (Group B) is 48 months. Follow-up was complete. While the local disease control rate was the same for both groups (76%), the survival was remarkably different. Group A patients experienced a median survival of 15 months, and only one survived 5 years. In Group B, the median survival was 56 months with nine patients (53%) alive between 40 and 76 months, seven (41%) of whom are 5-year survivors. While the overall mortality of patients with inflammatory breast cancer was greater in both groups when compared with the group with noninflammatory disease, the survival of patients in Group B was better than in Group A for both inflammatory and noninflammatory cancers (p less than 0.01). Estrogen receptor, nodal, and menopausal status did not influence survival. These data suggest that neoadjuvant chemotherapy improves survival for patients with stage IIIB breast carcinoma and delays the establishment or progression of distant metastases. Mastectomy is an important component in the treatment of this disease.
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PMID:Multimodal therapy in locally advanced breast carcinoma. 225 34

Ninety-nine patients presenting with non-metastatic inflammatory breast cancer were treated with an alternating protocol of radiotherapy and chemotherapy. The alternating schedule consisted of 8 courses of combined chemotherapy, including doxorubicin, vincristine, cyclophosphamide, methotrexate and 5-Fluorouracil, and 3 series of loco-regional radiotherapy delivering a total dose of 65 to 75 Gy to the breast tumor, 65 Gy to the axilla, and 50 Gy to the supraclavicular and internal mammary chain lymph nodes. Radiotherapy was started after the third course of chemotherapy. A 1-week gap was respected between each course of chemotherapy and each series of radiotherapy. Seventy-five percent of patients were in complete remission at the end of this induction treatment. The 3-year local control was 72% and the 3-year overall survival rate was 70%. An isolated local recurrence was observed in only 4% of patients. Approximately one-half of patients developed distant metastases. These results show that alternating radiotherapy and chemotherapy schedules deserve further investigation in locally advanced breast cancer.
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PMID:Alternating radiotherapy and chemotherapy in non-metastatic inflammatory breast cancer. 225 14

The prognosis for patients with inflammatory breast cancer has improved in recent years. This review was undertaken to evaluate current management in three Milwaukee (Wis) hospitals and to identify determinants of prognosis. We identified 25 patients with inflammatory breast carcinoma diagnosed between 1967 and 1987. Most of the patients were treated with combination chemotherapy and radiation therapy, and 10 had mastectomies. The 5-year survival of patients without initial distant metastases was 24%. The 5-year survival of patients who received chemotherapy before local treatment was 40%. Patients who had clinically involved axillary nodes or a palpable mass in the breast had poorer survival than those who did not; the presence of dermal lymphatic invasion had no significant effect on survival. Initial chemotherapy has become an important part of the care of patients with inflammatory breast cancer. It remains uncertain whether mastectomy improves on irradiation in achieving local control or improves survival.
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PMID:Combined therapy for inflammatory breast cancer. 233 Dec 13

From September 1983 to March 1988, 57 patients with locally-advanced breast cancer were treated at the Istituto Nazionale per la Ricerca sul Cancro in Genoa, Italy. All patients received 3 cycles of induction chemotherapy with estrogenic recruitment before surgery (diethylstilbesterol-DES-FAC) and 6 additional cycles of chemotherapy (3 DES FAC alternating with 3 DES CMF) after surgery. Stage III A (15) patients reached 86% local relapse-free survival (LRFS), 68% disease-free survival (DFS), and 85% overall survival (OS). Stage III B (42) patients had 82% LRFS, 59% DFS, and 33% OS at 5 years. The first site of relapse was locoregional in 35% of the patients: 19% chest wall recurrence, 3.5% chest wall and lymph nodes, and 7% regional nodes; 5% of the cases presented synchronous local and systemic recurrence; distant metastases represented 21% of the initial relapse rate. This therapy appears to improve the prognosis of III A patients more than that of III B patients. Unsatisfactory results were obtained in inflammatory cancer, with 54% of local recurrences. The present study indicates that radiotherapy is necessary to improve local control and to increase DFS in inflammatory breast cancer. Moreover, the use of radiation therapy also improves the results in III A and III B patients.
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PMID:[The role of radiotherapy in the multimodal treatment of locally advanced breast carcinoma]. 235 62

Between 1974 and 1982 inclusive 18 male patients were treated for breast carcinoma. 12 patients had postoperative radiotherapy whereas 4 were referred for treatment of recurrent or metastatic disease. One patient showed signs of inflammatory breast cancer and was treated with chemo-radiotherapy and one was being followed up in our department after radiotherapy for prostatic cancer in 1970. Median overall survival was 52 months and the median disease-free interval was 21 months.
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PMID:[Male breast cancer]. 300 91

Cloned cell lines of human breast cancer can be growth inhibited by tamoxifen and this inhibition can be reversed by estrogen. We wondered whether tamoxifen inhibition of breast cancer followed by estradiol reversal would increase the efficacy of chemotherapy by increasing the fraction of rapidly cycling cells. We describe a clinical trial in which 110 patients were prospectively randomized to chemotherapy consisting of cytoxan 750 mg/m2 and adriamycin 30 mg/m2 on Day 1 plus 5-FU 500 mg/m2 and methotrexate 40 mg/m2 on Day 8 vs the same chemotherapy plus tamoxifen 20 mg/m2 Days 2-6 and premarin 0.625 mg Q 12-H X 3 on Day 7. Chemotherapy was given in 21-day cycles. 108 patients were evaluable. No difference exist for any important prognostic variables. The first 55 patients were randomized to a regimen in which 5-FU preceded methotrexate by 24 h; thereafter, all patients received methotrexate followed in 1 h by 5-FU. No difference in any response parameter was seen between these two 5-FU methotrexate schedules. No differences in percent of protocol chemotherapy administered or observed toxicity was seen between the 2 regimens. Objective response rate was nearly identical--57% without and 64% with additional hormones. Prior adjuvant chemotherapy with L-PAM had no observable effect on response rate, response duration or survival. In a limited number of patients with inflammatory breast cancer we saw a significantly higher response rate (93 vs 61%; P = 0.03) than in patients with recurrent metastatic disease. Time to progression (13 vs 17 months) and survival (17 vs 23 months) of responders significantly favored the treatment arm including tamoxifen and premarin. Greater benefits of additional tamoxifen and premarin were seen in partial vs complete responders. This may have resulted from lower doses of chemotherapy given to patients achieving a complete remission. An additive effect of hormones plus chemotherapy cannot be entirely excluded as the explanation for the improved results seen with the addition of tamoxifen for 4 days plus 1 day of premarin. We believe that our results suggest that further efforts to increase the efficacy of chemotherapy by perturbing tumor growth rates may be worthwhile.
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PMID:Increasing the response rate to cytotoxic chemotherapy by endocrine means. 2333 Jan 78

Inflammatory breast cancer is the most aggressive breast neoplasm and one of the most ominous solid tumors. Because of distinct clinical characteristics, diagnosis can usually be made on clinical grounds. Biopsy including the overlying skin may demonstrate dermal lymphatic invasion, although the absence of dermal lymphatic invasions should not deter aggressive therapy. Surgery or irradiation alone has little effect on the natural history of this disease since lymphatic invasion and distant metastases are often present at presentation. Inflammatory breast cancer should be considered a systemic disease. Accordingly, aggressive combined modality therapy including multi-drug chemotherapy, surgery, and irradiation have prolonged disease-free survival and overall survival.
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PMID:Inflammatory breast cancer: advances in therapy. 307 91

Twenty-six consecutive patients with nonmetastatic inflammatory breast cancer (IBC), were treated in a single institution using the same protocol, and all were followed for at least 48 months. The first phase of treatment consisted of two monthly cycles of combination chemotherapy with Adriamycin (Adria Laboratories, Columbus, OH), vincristine, cyclophosphamide and 5-fluorouracil. Local treatment was then undertaken using in all cases a cobalt 60 beam to deliver 45 Gy to the entire mammary gland and lymph-draining areas. Local treatment was completed either by mastectomy, or by conservation of the breast and interstitial irradiation of the primary tumor site. Chemotherapy was resumed after completion of local treatment for a total of 6 cycles. Metastatic disease occurred in 19 of 26 patients from 8 to 55 months; five patients are alive and free of disease from 48 to 81 months. Failure to control local disease or local recurrences was noted in two of ten patients undergoing mastectomy, and in seven of 13 patients with conservation of the breast. While this difference is not statistically significant we concluded that methods of breast conservation which limit the high dose volume to the tumor site do not assure local control in IBC. The median disease-free survival and overall survival of 12 and 31 months, respectively, are not satisfactory. Better systemic treatment is needed.
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PMID:Treatment of inflammatory breast cancer with combination chemotherapy and mastectomy versus breast conservation. 334 69

About 80% of patients with breast cancer ultimately die of metastatic disease at 20 years. Distant metastases are more important as a cause of death than local or regional relapses. It is for this reason that adjuvant chemotherapy is necessary, especially in young patients and those with extensive disease. Initial chemotherapy preceding any local or regional treatment is justified on the grounds that both surgery and anaesthesia lead to immunodepression. Further, the value of initial chemotherapy has been demonstrated in many experimental and clinical trials by Nissen-Meyer, Bonadonna and Cooper (1-3). In the present study 145 patients, including 67 with inflammatory breast cancer (IBC), were treated with 4-6 weeks of Velbe, thiotepa, methotrexate, fluorouracil and prednisone, with Adriblastin added for patients with IBC, T greater than 7 cm, or N2, N3. Because of tumour regression of greater than 50% observed in 80% of the patients, the majority (123 patients) then received radiotherapy alone (cobalt + iridium), resulting in complete remission in all these cases. Maintenance treatment with the same drugs was prescribed for 6-18 months depending on the initial stage. Tumour regression appears to be an important prognostic factor. Median follow-up is only 17 months, the longest being 42 months. Overall survival at 2 years for IBC is 90%, with a disease-free survival of 80%. Cosmetic results are excellent. While these results are encouraging, longer follow-up is needed to confirm this improvement.
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PMID:Neoadjuvant chemotherapy of breast cancer. 352 69


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