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)

Of 297 patients with metastatic testicular and extragonadal germ cell tumours (GCT), bone involvement was detected clinically in 3% (7/251) of those at first presentation and in 9% (4/46) of relapsed cases. This difference was not statistically significant (95% confidence limits -2%; +14%). Concurrent systemic metastases, commonly involving lung (7/11 cases) and para-aortic lymph nodes (6/11), were present in all patients with bone disease. All affected patients had localized bone pain and lumbar spine was the most frequent site involved (9/11). Spinal cord compression occurred in two patients while a third developed progressive vertebral collapse after chemotherapy and required extensive surgical reconstruction. At median follow-up of 4 years, survival among patients presenting with bone disease (6/7) was similar to overall survival in the whole group (84%) and appeared better than in those with liver (18/26, 69%) or central nervous system (6/9) metastases at presentation. Back pain in metastatic germ cell tumours is often due to retroperitoneal lymphadenopathy but lumbar spine osseus metastases must be recognized early if severe potential complications, such as spinal cord compression, are to be avoided. In this series, bone metastases were not seen in the absence of widespread systemic disease suggesting all solitary bony lesions in GCT patients should be biopsied.
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PMID:Bone disease in testicular and extragonadal germ cell tumours. 322 81

In order to determine the value of the pelvic part of the radical dissection of the groin, the histories of 23 patients with Stage II (UICC) melanoma with histologically proved metastases of the iliac or obturator lymph nodes, or both, were studied. Histologically proved primary melanomas were found in 19 patients, 18 were localized on the leg and one on the trunk. In four patients, the primary melanoma was unknown. Seven patients had received adjuvant radiotherapy. The time between node dissection and the moment of analysis was two years for 17 patients, five years for 11 patients and ten years for ten patients. Calculated actuarially, 42 per cent of the patients were still without distant metastasis after two years and 32 per cent after five and ten years. At the time of the analysis, ten patients were alive, nine without evidence of disease and three having survived for more than five years. Remarkably, the primary tumor of all three patients was "unknown" and they had all had adjuvant radiotherapy. In pooling the data of this series with those from the literature, it appears that, of 78 patients with Stage II melanoma and deep node involvement, 12 had a disease-free survival time of more than five years after therapeutic radical groin dissection. Involvement of deep nodes does not always seem to equate with systemic disease. We think that, when there is an indication for a therapeutic groin dissection, an en bloc superficial and deep lymph node dissection is warranted.
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PMID:Results of radical dissection of the groin in patients with stage II melanoma and histologically proved metastases of the iliac or obturator lymph nodes, or both. 328 33

The frequency of gastrointestinal (GI) cancers mandates innovative and individualized therapies. Chemotherapy used as sole treatment for these diverse malignancies has not been generally successful in providing palliation or improving patient survival. Radiotherapy has been more successful at controlling local manifestations of disease, but the high incidence of systemic metastases in most malignancies limits the impact of this modality on curability. Combinations of radiotherapy and chemotherapy may prove to be more valuable than single modality treatment in improving local control of tumors, decreasing systemic disease, and improving patient tolerance to treatment. A model for this approach is the current management of anal cancer, in which combined modality therapy has largely supplanted primary surgery. Data from trials in other primary tumor sites strongly suggest further exploration of combined treatments--surgical, radiotherapeutic, and chemotherapeutic--in GI malignancies. Nearly 25% of all malignancies diagnosed in the United States each year involve the GI tract; thus, there is a powerful imperative for the development of new therapeutic strategies in these diseases. Any discussion of the role of chemotherapy in GI cancers must necessarily be broad, because assessment must include diseases with highly variable surgical curability, histologies, and sensitivities to chemotherapeutic agents. In addition, whereas it has been quite easy to perform standard phase II trials in colorectal cancer, other disease sites, such as the esophagus, the pancreas, and the biliary tract, have been much less extensively studied. In spite of these limitations, there is a wealth of data in the literature concerning the use of chemotherapy in GI malignancies. This article, while not exhaustive, describes the current status of chemotherapy for these diverse diseases, with emphasis on the role of mitomycin C.
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PMID:Chemotherapy in gastrointestinal malignancies. 329 19

In carcinoma of the breast the disease stage at diagnosis determines therapy and is closely related to prognosis. To date no single biochemical marker of disseminated breast cancer has been described although beta 2 microglobulin values in the serum have been suggested as a discriminant between localized and systemic disease. Using a new method of beta 2 microglobulin estimation, we carried out a prospective study of levels in 53 patients with breast cancer who were studied repetitively over a 2 yr period. No relationship could be determined between beta 2 microglobulin values and the stage of the disease. Moreover beta 2 microglobulin levels, even when elevated, did not predict early metastasis. Repeated beta 2 microglobulin estimations during treatment of metastatic disease had limited usefulness in that patients with responsive disease usually showed a fall in beta 2 microglobulin, whereas there was generally no change in non-responsive patients. These changes were, however, often within the normal range and seemed to offer a marginal improvement in assessment.
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PMID:Cancer of the breast and beta 2 microglobulin. 329 12

Neoadjuvant, or preoperative, chemotherapy for esophageal cancer has become an area of increasing interest because of the failure of conventional therapy (surgery or radiation) to improve disease-free or overall survival. Several autopsy series have demonstrated that, in many symptomatic western patients, esophageal cancer is a systemic disease. Neoadjuvant chemotherapy thus, in theory, allows a simultaneous attack on both the primary and metastatic disease. A number of single-arm, phase II multimodality trials have been completed. Toxicities of chemotherapy, while substantial, have been tolerable. With careful attention to detail, operative morbidity and mortality has not been increased. Large-scale randomized trials are needed to evaluate the impact of this technique on disease-free and overall survival.
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PMID:Neoadjuvant chemotherapy and surgery of cancer of the esophagus. 333 Feb 76

The overall local recurrence rate following resection of colorectal cancer with restoration of continuity with staples in Wellington was 24%. Nine of 11 patients with local recurrence following resection of rectal tumours had distant metastases at the time of diagnosis of their local recurrence. Using a predictive model to retrospectively estimate the probability of local recurrence it was found that nine of these 11 patients would have been expected to have had a lower local recurrence rate had they undergone abdominoperineal resection of the rectum initially. Since local recurrence is simply a local manifestation of systemic disease in 90% of patients, however, it is suggested that patients would prefer restoration of bowel continuity in preference to rectal excision and stoma formation, there being such little survival advantage for the latter procedure. The utility of the predictive model is therefore questioned.
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PMID:Local recurrence and the EEA stapler--examination of a predictive model. 346 42

From July of 1974 to June of 1978, 131 patients with Stage II carcinoma of the breast were randomly assigned to one of three treatment arms in order to assess the efficacy of adding immunotherapy to adjuvant chemotherapy. All patients had metastases in the axillary lymph nodes, but no clinical evidence of systemic disease. Prognostic factors were relatively equally distributed among the three treatment arms. All patients received adjuvant chemotherapy consisting of cytoxan, methotrexate, and 5-fluorouracil (CMF). In addition, patients received adjuvant immunotherapy consisting of Bacille Calmette Guerin (BCG) or BCG plus a tumor cell vaccine. This vaccine was a mixture of allogeneic breast cancer cell lines grown in tissue culture. Fourteen patients receiving tumor cell vaccine developed hepatitis B, leading to the abandonment of this arm of the study. Side effects of chemotherapy were tolerable. No statistically significant difference could be demonstrated in recurrence rate or survival. However, the two groups receiving adjuvant chemo-immunotherapy had a slightly shorter time to recurrence and lower overall survival. The use of chemo-immunotherapy as administered in this study did not improve the clinical course of patients with Stage II breast cancer and was associated with significant morbidity.
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PMID:Adjuvant chemo-immunotherapy in stage II carcinoma of the breast. 352 43

This report describes 21 cases of nodular regenerative hyperplasia (NRH) and its clinical and radiologic features. NRH of the liver is an established pathologic entity that should not be confused with focal nodular hyperplasia, hepatocellular adenoma, or the regenerative nodules associated with cirrhosis. Correct diagnosis will prevent an unnecessary hepatic lobectomy should NRH be mistaken for hepatocellular adenoma. Unlike focal nodular hyperplasia, NRH may bleed, may be associated with portal hypertension in one-half of cases, and is often associated with a systemic disease such as a myelo- or lymphoproliferative disorder. Correct diagnosis is important because the prognosis in patients with NRH and portal hypertension is better than that in patients with portal hypertension due to cirrhosis. Radiologically, multiple nodules, large masses, or an apparently normal liver (containing nodules less than 0.5 cm in diameter) were visible. The nodules may take up technetium sulfur colloid and have variable echogenicity on sonography. They are often hypodense on CT without significant enhancement. The nodules may fill from the periphery on angiography, are vascular, and sometimes contain small hypovascular areas due to hemorrhage. A large nodule may rupture and cause hemoperitoneum. These findings may resemble some features of focal nodular hyperplasia, hepatocellular adenoma, or metastases. NRH is probably underdiagnosed owing to a lack of recognition of the entity and limited sampling of liver tissue by needle biopsy. Scintigraphy, sonography, and CT of the liver should be performed in cases of idiopathic portal hypertension to detect NRH. In cases with compatible findings, multiple needle biopsies or a laparoscopically guided needle biopsy or wedge liver biopsy should be recommended for definitive diagnosis.
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PMID:Nodular regenerative hyperplasia of the liver: clinical and radiologic observations. 354 83

Many lines of evidence support the view that BC is all too often a systemic disease and that micrometastases become enhanced after resection of the primary. Assuming that these two basic considerations do in fact apply, it can be argued that systemic treatment as the initial attack against operable BC has several advantages over the conventional postoperative adjuvant therapy: (a) Systemic treatment before operation may destroy clonogenic cells in the primary tumor which are responsible for the development of metastases; (b) primary tumor shrinkage following systemic therapy may serve as an early, simple, and inexpensive index of the overall chemosensitivity of the tumor; (c) systemic treatment as soon as the diagnosis is made may prevent the development of drug-resistant mutations, which are likely to form spontaneously early in the natural history of the disease; (d) preoperative chemotherapy may suppress the production of tumor-elaborated substances that protect the tumor from immune destruction by the host; (e) the average delay of about 1 month in the treatment of micrometastases in the postoperative adjuvant setting leads to at least a 30% increase of micrometastatic tumor burden, which can be prevented by preoperative treatment; (f) a number of other considerations suggest that the maximal chemosensitivity of each tumor exists at the earliest possible point in time, i.e., at the time of diagnosis; (g) after the initial postchemotherapy immunosuppression immunity recovers, in fact exceeding the pretreatment level, and if surgery is performed during this phase of heightened immunity chemotherapy is utilized as an immunostimulating agent; and finally (h) as more effective systemic agents are discovered, locoregional treatment with surgery and/or radiotherapy may become progressively more limited and it may ultimately be possible to dispense with these modalities. Experimental evidence scattered in the literature over the past three decades attests to the value of preoperative chemotherapy. Likewise, progressively greater numbers of uncontrolled studies have found preoperative chemotherapy most rewarding in miscellaneous sarcomas and in advanced tumors of the head and neck, kidney, and testes, as well as in a variety of other sites, including the breast.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Preoperative chemotherapy: advantages and clinical application in stage III breast cancer. 389 58

To assess the prognostic significance of peritumoral vessel invasion, data were examined for 1,510 women entered into the Ludwig Breast Cancer Group Trials I to IV evaluating adjuvant therapy for operable breast cancer with axillary nodal metastasis. Vessel invasion by tumor cells was identified by routine light microscopy in 59 per cent (889 of 1,510) of the patients and was equally distributed between premenopausal/perimenopausal (60 per cent, 468 of 778) and postmenopausal (58 per cent, 421 of 732) women. In logrank analyses stratified by nodal status (one to three or four or more positive nodes), the four-year disease-free survival (DFS) rate was significantly lower in patients with vessel invasion than in women without vessel invasion (50 per cent versus 65 per cent, P less than 0.0001). This DFS difference was seen for both premenopausal/perimenopausal (P = 0.0004) and postmenopausal (P = 0.0002) patients. The four-year overall survival rate was also lower in patients with vessel invasion (71 per cent versus 82 per cent, P = 0.0006), both for premenopausal/perimenopausal (P = 0.002) and postmenopausal (P = 0.04) women. The presence of vessel invasion was significantly associated with increasing numbers of positive axillary lymph nodes, rising tumor grade, nonstellate tumor border growth pattern, and higher steroid hormone receptor content of the primary tumor. The assessment of peritumoral vessel invasion continued to have prognostic significance for DFS (P less than 0.0001) and overall survival (P = 0.003) when evaluated in multivariate models controlling for treatment assigned, nodal status, tumor size, estrogen receptor status, menopausal status, and age. Depending on the subpopulation, patients with vessel invasion had a 41 per cent to 54 per cent greater risk of treatment failure than those without vessel invasion and a 29 per cent to 64 per cent greater risk of death. The percentage of treatment failures at distant sites was higher for women with than for those without vessel invasion (27 per cent versus 18 per cent, P = 0.003). In patients with axillary lymph node metastases, peritumoral vessel invasion may be a sign of increased systemic disease burden.
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PMID:Prognostic significance of peritumoral vessel invasion in clinical trials of adjuvant therapy for breast cancer with axillary lymph node metastasis. 390 76


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