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

From 1965 to 1980, 35 patients were treated by radiation for palliation of symptoms related to metastatic renal cell carcinoma. The male:female ratio was 1.9:1. Eighty-six percent (30/35) of the patients were over 40 years of age at initial presentation. Sixty-three percent (22/35) of the patients showed symptoms of metastatic disease within three years of diagnosis of the primary malignancy. Sixty sites were irradiated in the 35 patients: 36 sites of metastatic bone pain, 14 obstructing and/or palpable masses, and ten sites treated for symptoms due to central nervous system (CNS) metastases. Efficacy of treatment was assessed at serial follow-up visits beginning one month after completion of radiotherapy. Bone pain responded at 77% of the treated sites. Mass effect responded in 64%. Disappointing results were obtained with CNS metastases. There was only a 30% response of brain and spinal cord lesions within the dose range that these patients were treated. No correlation between TDF equivalent dose of radiation administered and frequency of palliative response was found. In those sites where a response of bone pain to radiation was observed, 86% of the responses lasted the remainder of the patient's life. No correlation was found between TDF equivalent dose of radiation administered and duration of response. Radiation may be a useful palliative tool for bone pain and mass effect from metastatic renal cell carcinoma. Inordinately high doses need not be used to achieve the desired effect.
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PMID:The role of radiation therapy in the management of metastatic renal cell carcinoma. 618 7

Forty of 156 patients (26%) with small cell lung cancer developed central nervous system metastases (CNS metastases) in the course of the disease. CNS metastases were found in 8 patients at the time of the initial diagnosis and 32 patients had subsequent CNS involvement. CNS metastases were usually concurrent with disease progression at other sites and became more frequent as survival increased. With a median survival of 6 months in 1973 19% of patients developed CNS metastases as compared to 35% in 1978, when median survival had increased to 9.5 months. The value of prophylactic cranial irradiation is discussed.
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PMID:[Central nervous system metastases in small cell lung cancer]. 626 78

Sixty-six patients were entered into a prospective, randomized clinical trial evaluating the use of alternating noncross-resistant chemotherapy in patients with extensive small cell carcinoma of the lung. Sixty-five were evaluable. One regimen utilized cyclophosphamide, VP-16, vincristine, cisplatin alternating with doxorubicin (Adriamycin) and DTIC (CVVP-AD). The second regimen utilized doxorubicin, VP-16, vincristine, and cisplatin alternating with cyclophosphamide and DTIC (AVVP-CD). There was no statistically significant difference between the two chemotherapeutic programs in terms of regression rate, time to progression, or survival. Overall regression rate for CVVP/AD was 91% (29/32) including five complete regressions (CRs). For AVVP-CD, the total regression rate was 82% (27/33) including nine CRs. Combined, the overall regression rate was 86% with a CR rate of 22%. Time to progression for CVVP-AD and AVVP-CD was 28 and 26 weeks, respectively. The median survival time of CVVP-AD and AVVP-CD regimens was 40 and 42 weeks, respectively. Prognostic variables significantly correlated with survival were performance score and extensive liver metastases at diagnosis. Correlations between initial sites of disease led to the observation that patients with no central nervous system (CNS) metastases at diagnosis were more likely to have more extensive liver and lung involvement. Further analysis revealed the lung to be the most common site of first progression (46%) and liver second (28%). Patients with extensive involvement of the liver or lung progressed sooner in these sites than those with a lesser tumor extent. At some point in the study, 40% of the patients experienced CNS metastases. The efficacy of these two alternating regimens is comparable to most current regimens reported in extensive SMCLC. Whether cyclophosphamide or doxorubicin is used first seemed to make little difference. The alternate noncross-resistant regimen was rarely effective in producing tumor regression following initial progression.
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PMID:Evaluation of alternating chemotherapy and sites and extent of disease in extensive small cell lung cancer. 627 81

After stratification for extent of small cell lung cancer, 109 patients were randomized to receive cycles of chemotherapy with cyclophosphamide, doxorubicin, and VP-16-213 [CAVP16 (regimen I)] or to receive CAVP16 to maximum response (minimum of three courses) and then chemotherapy with CCNU, methotrexate, vincristine, and procarbazine (COMP) alternating with CAVP16 (regimen II). A group of patients who achieved complete remission were randomized to receive whole-brain irradiation or to have observation only. Of the 44 patients with limited disease, 28 (64%) achieved a complete remission and 11 (26%) achieved a partial remission. Of the 65 patients with extensive disease, 26 (40%) achieved a complete remission and 28 (46%) achieved a partial remission. There were no significant differences between the regimens in response or survival. The projected median survival times are 14 and 10 months for limited and extensive disease, respectively. Nearly 30% of patients with limited disease will be 2-year, disease-free survivors. Twenty-nine patients were randomized to receive cranial irradiation or observation only; none of the 15 irradiated patients developed cerebral metastases, but five of 14 randomized to observation relapsed in the brain (P = 0.02). One patient died with necropsy evidence of only intracranial disease. The principal hematologic toxic effect was leukopenia. There were 31 febrile episodes (21 infectious) during neutropenia and four toxic deaths. Nonhematologic toxicity was mild. Cranial irradiation in patients who achieve complete remission delays or reduces the incidence of CNS metastases. Although alternating chemotherapy is not beneficial, combination chemotherapy with CAVP16 alone is highly effective treatment modality for small cell.
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PMID:Combination chemotherapy for small cell carcinoma of the lung: continuous versus alternating non-cross-resistant combinations. 627 87

CLM developed in 60 of 526 patients (11%) with SCLC seen at the NCI between August 1969 and June 1980. Life table analysis revealed an overall 25% risk of CLM at 3 years. CLM was diagnosed during all phases of the patients' clinical course, but the majority (83%) were cases diagnosed at the time of progressive systemic disease. Univariate log rank analysis indicated that pretreatment factors associated with the development of CLM included: involvement of the brain, spinal cord, bone marrow, liver or bone; extensive disease; and male sex. Patients who did not obtain a complete response to systemic therapy were at greater risk of developing CLM than complete responders. Multivariate analysis of these factors indicated that liver metastases were most strongly associated with the time to development of CLM, followed in order of importance by bone and CNS metastases. Patients usually presented with signs and symptoms reflecting involvement of multiple areas of the neuraxis including the cerebrum, cranial nerves and spinal cord; 51 of the 60 patients had intracerebral metastases and 27 had spinal cord lesions during their clinical course. Autopsy features including focal or diffuse involvement of the leptomeninges with infiltration of the Virchow-Robin spaces were similar to meningeal lymphoma and leukemia, except that CLM was rarely the sole manifestation of CNS tumor. Median survival following the diagnosis of CLM was 7 weeks. However, most deaths were attributed to systemic disease, and treatment with intrathecal chemotherapy and irradiation often provided palliation. With the increased awareness of this complication, an antemortem diagnosis increased from 39% prior to 1977, to 88% of patients after 1977.
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PMID:Carcinomatous leptomeningitis in small cell lung cancer: a clinicopathologic review of the National Cancer Institute experience. 627 48

The records of 227 patients with small cell lung cancer (SMCLC) treated between January 1974 and July 1978 in a series of randomized trials were reviewed to determine the influence of central nervous system (CNS) metastases on survival. Sixteen patients were excluded because of single agent chemotherapy (11), lack of CNS irradiation despite proven metastases (2), prior chemotherapy (2), and concomitant metastatic second primary (1). Of 211 evaluable patients, 100 presented with limited disease and 111 with extensive disease, 25 of whom had CNS metastases at presentation, 21 ("CNS-limited") as the only site of metastases. Treatment of limited patients consisted of chemotherapy and thoracic radiation, while chemotherapy alone was used for extensive patients. No prophylactic brain irradiation was used, but CNS radiation was given to almost all patients when CNS metastases developed. Median survivals were: limited, 13.8 months; CNS-limited, 15.1 months; and extensive 8.6 months (P less than 0.0001). There was no significant difference in the survival experience of limited and CNS-limited patients, although none of the CNS-limited patients experienced long-term remissions. Thirty-five of the limited patients and 21 of the extensive patients subsequently developed CNS metastases. Their median survivals following CNS metastases were 3.7 months and 1.6 months, respectively. In conclusion, CNS metastases as the sole site of metastatic disease at diagnosis of SMCLC is not necessarily a bad prognostic sign, while the subsequent development of CNS metastases may be.
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PMID:The effect of CNS metastases on the survival of patients with small cell cancer of the lung. 629 19

VP 16-213 in standard doses is active against a number of solid tumors. Its penetration into the cerebrospinal fluid (CSF) is very limited at these dose levels. In 10 patients treated with high-dose VP 16-213 (0.9-2.5 g/m2), CSF levels of up to 0.54 microgram/mL were detected. In two patients with central nervous system (CNS) metastases of small cell lung cancer (SCLC) a response was seen after 1.0 and 1.5 g/m2 intravenously. High-dose VP 16-213 can possibly play a role in the treatment of CNS metastases of SCLC. Its application in late intensification regimens as a form of prophylaxis of CNS metastases should be investigated.
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PMID:Penetration of VP 16-213 into cerebrospinal fluid after high-dose intravenous administration. 632 90

A report is presented on 12 patients with extrapulmonary small cell carcinoma. In 9 patients the primary tumor could be localized (cervix in 3, esophagus in 3, prostate in 2, pancreas in 1) whereas no primary was found in 3. Seven of 12 patients presented with distant metastases and four developed metastases later. Five of 12 had CNS metastases (brain metastases in 4, spinal cord compression in 1). Six patients were initially treated by surgery or radiotherapy (2 and 4 respectively). All six developed distant metastases during or shortly after local treatment. Five of 6 patients initially treated with chemotherapy responded to the treatment. Three of 12 patients are surviving 18+, 80+ and 81+ months after the initial diagnosis without evidence of disease. The biology and clinical course of extrapulmonary small cell carcinoma are similar to those of its pulmonary counterpart. In planning therapy for extrapulmonary small cell carcinoma, particular importance should be attached to systemic treatment.
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PMID:[Extrapulmonary small-cell carcinoma - a rarity with important therapeutic consequences]. 632 92

Thirty-four patients with renal cell carcinoma and brain metastases were reviewed to define important prognostic factors and treatment results. The following covariates were analyzed to determine their influence on survival: disease-free interval, serum calcium, number of central nervous system (CNS) metastases, weight loss, performance score, age, radiation therapy, surgery, and surgery plus radiation. The mean survival for all patients was 7.0 months (range, seven days to 32 months). The patients with a good performance score of 0-2 survived significantly longer (mean survival, 10.2 months) than those with a poor performance score of 3-4 (mean survival, 2.8 months; p = 0.0019). Surgery was associated with significantly improved survival (mean survival, 13.8 months versus mean survival, 4.2 months; p = 0.014). However, all the surgical patients were from the good performance score group, suggesting patient selection. Radiation was associated with an improved mean survival of 8.6 months versus 3.2 months. Performance score is a significant prognostic factor. Furthermore, the data support treatment with radiation therapy for patients with multiple CNS metastases and surgery followed by postoperative radiation therapy for patients with single CNS metastases.
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PMID:Brain metastases in patients with renal cell carcinoma: prognosis and treatment. 669 68

Among 737 malignant tumors, 93 (12.6%) cases showed metastases within the brain substance. There was no predominance for one of the both hemispheres. However, the cerebellum was a privileged site for metastases (48 out of 93 cases, 51.6%). Multiple metastatic nodules of the brain were found in 65 cases; single metastases occurred 18 times (ratio 3.6 to 1). 11 cases displayed a carcinosis of the leptomeninges and 5 a carcinosis of the brain (table 3). Within the cerebrum we observed 1,060 metastatic nodules (fig. 1). 210 secondary deposits, i.e. one sixth of all nodules, were localized in the cerebellum. Concerning the distribution patterns of the metastases, it is remarkable that an increasing frequency of nodules was seen from the frontal lobes (241) to the parietal (259) and occipital lobes (276), whereas the temporal lobes (146) were significantly less affected. 936 out of a total of 1,270 brain metastases (73.7%) showed a size of the nodules not larger than a pea (table 8.) The source of more than two thirds of all metastatic deposits (875/1,270 = 68.9%) was a carcinoma of the lung (bronchial carcinoma, resp.). With the exception of metastases in the pituitary gland, pineal gland and choroid plexus (compare with the 3rd communication on CNS metastases) 18.6 metastatic brain nodules were observed per lung carcinoma. However, the highest frequency per case with brain metastases was registered in thyroid cancer (40 nodules, table 8).
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PMID:[Metastases of the central nervous system: A prospective study. 2nd Communication: site and distribution patterns of brain metastases]. 709 Jun 2


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