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

The decision to perform surgical versus nonoperative palliation for unresectable pancreatic cancer is influenced by a number of factors. In most cases, patient symptoms clearly dictate the management. In patients with symptoms of duodenal obstruction at the time of presentation, surgery is the only option. In patients with obstructive jaundice alone, the options for management must be weighed against factors such as overall health status, projected survival, and procedure-related morbidity and mortality. A prospective multicenter trial recently analyzed factors influencing perioperative morbidity and mortality following both curative and palliative surgery for pancreatic cancer. This analysis demonstrated that preoperative diabetes, low Kanofsky's index, and liver metastases are significant risk factors in predicting perioperative morbidity and mortality in patients undergoing palliative procedures for pancreatic cancer. Another analysis focusing on tumor characteristics suggested that for patients with Stage I and Stage II disease (i.e., with no evidence of systemic metastases), survival and the potential for late duodenal obstruction favor surgical management. In summary, although patient management must be individualized, most patients with pancreatic cancer in good medical health and with no evidence of systemic disease are most appropriately managed with surgical palliation. This option affords patients the best chance of avoiding the late complications of recurrent jaundice, duodenal obstruction, and disabling pain. Surgical palliation can generally be completed with an acceptable perioperative morbidity and mortality and a hospital stay of approximately 2 weeks. Finally, only surgical exploration can offer full opportunity for resection for cure.
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PMID:Surgical palliation of unresectable pancreatic carcinoma. 754 19

The value of tumour-associated antigens CEA and CA 15-3 was studied in patients with breast cancer over a 4-year period. A total of 252 patients with primary or recurrent disease had available and corresponding CEA and CA 15-3 values at diagnosis and during follow-up and were studied in detail. Preoperative and three-monthly serial postoperative levels were measured in each patient. Ten of 11 patients presenting with primary and concurrent metastatic disease had elevated CA 15-3 levels (> 25 I.U./ml) as compared to 6 with CEA (> 5 ng/ml). Fourty-seven patients developed locoregional recurrence of which 15 had concurrent metastatic disease. CA 15-3 was elevated in 14 cases while CEA in 11. Of 32 patients with locoregional recurrence alone, 18 later developed metastatic disease at a mean follow-up time of 17.5 months. There was a significant correlation between CA 15-3 value at locoregional recurrence and time to subsequent metastasis (r = 0.-0.57, P = 0.0133). CEA was elevated in 64%, CA 15-3 in 87% and either marker in 94% of 87 patients diagnosed with metastatic disease. Of 53 patients with serial markers and metastatic disease, 72% (38/53) had rising CA 15-3 levels prior to diagnosis with a mean lead time of 9.9 months. Use of CEA in conjunction improved lead time detection to 83%. This study demonstrates that CA 15-3 is superior to CEA at detecting metastatic disease at initial presentation and during follow-up. Use of CEA in conjunction with CA 15-3 improves the detection of systemic disease.
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PMID:The clinical value of CEA and CA 15-3 in breast cancer management. 762 25

The authors reviewed the records of 231 patients who underwent resection of brain metastases from nonsmall-cell lung cancer between 1976 and 1991. Data regarding the primary disease and the characteristics of brain metastasis were retrospectively collected. Median survival in the group from the time of first craniotomy was 11 months; post-operative mortality was 3%. Survival rates of 1, 2, 3, and 5 years were 46.3%, 24.2%, 14.7%, and 12.5%, respectively. One hundred twelve women survived significantly longer than 119 men (13.8 vs. 9.5 months, p < 0.02). Patients with single metastatic lesions (200 patients) survived longer than those (31 patients) with multiple metastases (11.1 vs. 8.5 months, p < 0.02). Patients with supratentorial tumors survived longer than patients with cerebellar lesions. A high Karnofsky performance scale score before surgery also indicated increased survival. In multivariate analyses, incomplete resection or no resection of primary lung tumor, male gender, infratentorial location, presence of systemic metastases, and age older than 60 years were significantly correlated with shorter survival. Approximately one-third of the patients died of neurological causes, one-third of systemic disease, and one-third of a combination of both. The results of this series confirm that the overall prognosis for patients with even a single resectable brain metastasis is poor, but that aggressive therapy can prolong life with quality of life preserved and can occasionally permit long-term survival.
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PMID:Survival after surgical treatment of brain metastases from lung cancer: a follow-up study of 231 patients treated between 1976 and 1991. 767 8

It has been estimated that approx 60-70% of cancer patients harbor overt or subclinical metastases at diagnosis, and it is the eradication of such systemic disease that largely determines survival. Preclinical tumor model systems employed to evaluate potential new treatment strategies should aim to represent the process and patterns of metastasis of their clinical counterparts as closely as possible. Severe combined immune-deficient (SCID) and nu/nu mice have been extensively used as hosts for the growth of human tumor cell lines and in some cases fresh tumor material. However, in most instances the resulting neoplasms fail to metastasize, and the aberrant immune systems of such animals has limited their use mainly to passive therapies of localized disease. Recently, the development of specially selected tumor variants and the use of appropriate orthotopic sites for implantation has provided several models in which dissemination can be demonstrated. Where the gene coding for a potential target antigen has been cloned, and where its overexpression or mutation is associated with malignancy (e.g., c-erbB-2, H-ras), transgenic mice may yield tumors that will develop in these immunocompetent hosts. In some cases such tumors exhibit metastasis. A third approach is to transfect human genes of interest into appropriate rodent tumors expressing the desired metastatic phenotype. These various approaches are compared with particular reference to mammary carcinoma biology.
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PMID:Preclinical models for the evaluation of targeted therapies of metastatic disease. 773 34

The diagnosis of malignant melanoma is based on clinical grounds and a properly performed biopsy, preferably excision, so that the type of melanoma and the thickness can be assessed by methods described by Clark and Breslow. These facilitate clinical and pathologic staging. Excisions with conservative margins for thin lesions (less than 1.0 mm in thickness) and more extensive margins for thicker lesions are appropriate. The issue of elective lymph node dissection is controversial. Most authors agree it is not indicated for lesions less than 1.0 mm thick and may offer little advantage for lesions greater than 4.0 mm thick. Several retrospective studies show a survival advantage in patients with "intermediate" thickness melanomas who may have occult nodal metastases. However, there are prospective randomized clinical trials supporting the concept that positive lymph nodes are a manifestations of systemic disease, and survival is equivalent in patients who have subsequent therapeutic lymph node dissections. A procedure using intraoperative lymphatic mapping and selective lymphadenectomy may identify those patients who are likely to benefit from lymphadenectomy.
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PMID:Malignant melanoma. Primary surgical management (excision and node dissection) based on pathology and staging. 863 48

The majority of patients with locally advanced, unresectable, non-small cell lung cancer (NSCLC) treated with conventional radiation therapy develop distant metastases and succumb to the disease. Thus, NSCLC should be viewed as a systemic disease, and attempts to control micrometastatic disease with chemotherapy should have a greater impact on survival. This does not eliminate the role of radiation therapy, as locoregional control is equally important. Combined chemoradiotherapy has become the major area of clinical research to improve long-term outcomes in patients with locally advanced NSCLC. The optimal chemoradiotherapy sequence is yet to be determined. Several randomized studies have demonstrated that sequential chemotherapy followed by definitive thoracic irradiation is superior to the same radiation therapy alone. The overall impact has been on both survival and incidence of distant metastasis. A number of pilot studies (phase II) have tested concurrent chemoradiotherapy in patients with locally advanced NSCLC. At the University of Maryland Cancer Center, we are evaluating the efficacy of thoracic radiation (60 Gy) with concurrent weekly carboplatin, which has known activity in NSCLC and also has radiosensitizing effects. Preliminary results show that the combination is feasible and well tolerated; median survival rates compare favorably to those seen in the combined-modality arms of the randomized, sequential studies. Definitive conclusions based on the results of the reported studies are not possible, yet there seems to be a potential benefit to adding chemotherapy to radiation therapy. These trials need to be confirmed before they can be used to define a "standard of care" for patients with locally advanced, unresectable NSCLC.
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PMID:Combined chemotherapy and radiation in locally advanced non-small cell lung cancer. 805 78

The records of 89 patients who underwent surgery for solitary or multiple parenchymal brain metastases of lung cancer at the Osaka Center for Adult Diseases between 1978 and 1990 were reviewed with follow up until March 1992. The aim of this retrospective analysis was to identify prognostic features that were associated with a favourable outcome. The benefits of brain tumour surgery were evaluated in terms of the cause of death (brain metastasis, tumour in another organ, or treatment related) as well as the postoperative changes in functional state indicated by the Karnofsky scale. The overall mean survival time was 11.6 months, and the one and two year survival rates were 24% and 8%. The brain lesion itself was the cause of death in only 19% of the patients; the other 81% died of systemic disease. Functional state improved after surgical excision of the brain tumour in 36%, remained unchanged in 53%, and worsened in 11%. These data suggest that surgical intervention is beneficial for patients with parenchymal brain metastases. Variables significantly associated with a favourable prognosis included surgical excision of the primary lesion, adenocarcinoma as the histological diagnosis, the use of adjuvant treatment, especially chemotherapy, a preoperative score of over 80% on the Karnofsky scale, and metastasis confined to the brain with no extracranial metastatic foci or residual primary tumour. Additional but non-significant contributors to a good prognosis included age under 65 or 70 years, early tumour stage (stage 1), curative lung cancer surgery, a single metastatic brain tumour (v multiple lesions), a solid tumour (v cystic), and a supratentorial location of the brain metastasis. The disease free interval and the cerebrospinal fluid cytology were not significant prognostic factors. On the basis of these findings, it is concluded that the surgical removal of brain metastases of lung cancer should be undertaken if the primary tumour has already been removed whether or not there are extracranial metastases, and that postoperative chemotherapy should generally be given.
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PMID:Surgical treatment of brain metastases of lung cancer: retrospective analysis of 89 cases. 805 19

Fifty dogs with pheochromocytoma were identified in a retrospective study of a 9-year period. For 24 of 50 dogs (48%), the tumor was an incidental finding during necropsy or surgery. Presenting signs were referrable to the nervous system in 7 of the 26 symptomatic dogs (27%); were referrable to the cardiopulmonary system in 7 of 26 dogs (27%); or were nonspecific, reflecting general systemic disease, in 17 of 26 dogs (65%). Abnormal clinical findings were highly varied but were also generally referrable to the cardiopulmonary and nervous systems. Six of 7 dogs (86%) evaluated were hypertensive (systolic range, 164 to 325 mm Hg; diastolic range, 110 to 198 mm Hg). Serum biochemical findings were nonspecific, although 11 of 39 dogs (28%) were hypercholesterolemic. Abdominal fluid samples were analyzed in 6 dogs; 3 were nondiagnostic, and 3 were interpreted as lymphosarcoma. The imaging studies that were of most value included abdominal radiographs (mass identified in 9 of 16 dogs [56%]), caudal vena caval angiography (tumor thrombus correctly diagnosed in 4 of 7 dogs [57%]), and abdominal ultrasonography (mass seen in 5 of 6 dogs [83%] and tumor thrombus seen in 3 of 5 dogs [60%]). Local tumor invasion was present in 26 of 50 dogs (52%), regional lymph node metastases in 6 of 50 dogs (12%), and distant metastases in 12 of 50 dogs (24%). Cause of death was tumor-related in 19 of 50 dogs (38%) and non-tumor related in 28 of 50 dogs (54%).
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PMID:Pheochromocytoma in 50 dogs. 806 61

Primary intracranial tumours develop in 420 adult Norwegians each year. Of these tumours, gliomas are the most frequent, followed by meningiomas, pituitary adenomas and acoustic neurinomas. Glioblastomas represent more than 50% of the gliomas. Less than 10% of the patients with glioblastoma survive for two years, despite aggressive therapy (surgery, radiotherapy and chemotherapy). The prognosis for low grade gliomas is much better. In the case of meningiomas, 95% of the tumours are benign. The primary treatment for meningiomas is surgery. If surgery is impossible, radiosurgery should be considered. Pituitary adenomas are often hormone-secreting (e.g. prolactin, growth hormone, adrenocorticotrophic hormone). Many prolactinomas are treated with bromocriptine alone. The rest of the pituitary adenomas are treated by microsurgery and radiotherapy. The prognosis for patients with pituitary adenomas is good. Acoustic neurinomas, which in most cases are benign, are treated by microsurgery or radiosurgery. Postoperative morbidity due to cochlear nerve and facial nerve dysfunction is a problem. Brain metastases are far more frequent than primary intracranial tumours. Solitary metastases in patients with stable systemic disease should be treated by surgery or radiosurgery.
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PMID:[Intracranial tumors in adults (over 15 years)]. 833 22

This retrospective study describes patients with loco-regionally metastasized melanoma of the head and neck. All patients underwent a therapeutic lymph node dissection. The 3-year survival rate was 35%. Duration of disease-free interval, number of lymph nodes involved, and extent of neck dissection proved of no influence on survival rates. Locoregional recurrence occurred in 10 patients and always proved to be a sign of systemic dissemination. Ultimately, 19 patients developed systemic disease. More than 40% developed cerebral metastases and the cerebrum was the second most involved site. As cerebral involvement occurs often in head and neck melanoma, a computed tomography or magnetic resonance imaging scan of the brain is recommended in the routine work-up before lymph node dissection. Furthermore, because the extent of the surgical procedure had no influence on local recurrence rate and overall survival, a selective approach, preserving functional structures, is advocated.
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PMID:Therapeutic lymphadenectomy in melanomas of the head and neck. 840 8


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