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)

Cerebral and meningeal involvement in patients with primary extracranial neuroblastoma (NB) is unusual although it is generally present in disseminated disease. The intensification of chemotherapy that has prolonged survival in these children has changed the pattern of relapse presentation, as occurs with isolated central nervous system (CNS) disease. We report 4 patients with secondary CNS metastases. Three infants of 16, 14, and 10 months of age, diagnosed with primary abdominal NB stage 4, presented neuromeningeal metastases during maintenance chemotherapy with seizures and cranial hypertension as the first manifestation. Another 8-year-old patient diagnosed with NB stage 3 presented local relapse with later neuromeningeal metastases. All died in the following 3 months. The possibility of CNS relapse in patients with NB should be considered when neurological symptoms and signs appear. These new relapse forms overshadow the prognosis of these children.
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PMID:Secondary central nervous system metastases in children with neuroblastoma. 888 12

Small cell lung cancer (SCLC) is a systemic disease that usually presents with locally bulky disease in the lung and mediastinal nodes, with either subclinical (limited stage) or detectable (extensive stage) extrathoracic metastases. Treatment with local modalities alone leads almost invariably to systemic relapse, and treatment with only systemic therapy usually results in recurrence at sites of initially demonstrated disease. Although prophylactic cranial radiation is far from an ideal solution to the problem of CNS metastases in patients with SCLC, it presently seems preferable to the alternative of observation and generally ineffective palliative treatment at time of relapse in the CNS.
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PMID:Prophylactic cranial irradiation for patients with small cell lung cancer. An enduring controversy. 900 62

From September 1983 to September 1994, 23 patients with Central Nervous System (CNS) metastases from ovarian carcinoma were observed in our institution. The mean age at the time of CNS metastases diagnosis was 59 years, the mean interval between diagnosis of ovarian carcinoma and documentation of the CNS involvement was 35 months. All the patients presented neurological symptoms. One patient had meningeal carcinomatosis; 22 presented parenchymal lesions. Nine patients had a single CNS lesion and 13 had multiple metastatic sites. CNS was the only site of disease in 9 patients, while 8 had concomitant extraperitoneal dissemination. Four patients received hormonal treatment with a mean survival (MS) of 3 months; 14 received radiotherapy alone (MS 5.5 months), 5 underwent surgical resection of solitary lesion followed by radiotherapy (MS 17 months). Number of CNS lesions, extent of the disease at time of CNS metastases and the treatment were the factors which significantly affected survival. The prognosis of these patients appears poor, however, early diagnosis followed by multimodal treatment may result in significant palliation an improve overall survival in a selected group of patients.
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PMID:[Brain metastases in patients with malignant ovarian epithelial tumors]. 900 65

In children with primary extracranial neuroblastoma (NB), intrinsic central nervous system (CNS) metastases (brain parenchyma or leptomeninges) are thought to occur rarely. This study was done to evaluate our anecdotal experience, which suggested that CNS involvement is becoming more frequent. Reports of computed tomographic (CT) and magnetic resonance (MR) imaging scans, biopsies, cerebrospinal fluid (CSF) cytologies, and autopsies were reviewed for children with stage IV NB diagnosed in 1978-1993 and followed at the Children's Hospital of Pittsburgh. Of 43 children over the age of 1 year, CNS metastases were documented in 7 (16.2%). Six patients developed signs or symptoms best explained by the presence of CNS tumor and had radiographic and/or histologic evidence of parenchymal disease (cortical masses on CT and MR, n = 3; suprasellar mass on CT, n = 1; diffuse leptomeningeal carcinomatosis by MR and/or autopsy, n = 2). CSF cytologies were positive in the one patient so tested. An additional asymptomatic patient had extensive CNS involvement at autopsy. In two of these children, the CNS was the first or only site of recurrent disease. It is concluded that intrinsic CNS disease is not uncommon in children with NB over the age of 1 year and there has been a trend toward its increasing recognition in recent years. Whether this is a function of wider use of diagnostic tools or a true change in natural history over time with increased intensity of chemotherapy is not clear. A study that prospectively monitors children with advanced neuroblastoma, radiographically and with CSF cytologies (prior to treatment and at 6-monthly intervals), is under way and should help to better define the natural history in the context of current therapies.
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PMID:Recognition of central nervous system metastases in children with metastatic primary extracranial neuroblastoma. 918 8

Craniospinal irradiation is the gold standard treatment used in non metastatic medulloblastoma as prophylaxis against central nervous system (CNS) metastases. However, given the severe late effects caused by this procedure in children under 3 years of age, most pediatric oncologists are currently treating these patients with conventional chemotherapy in order to postpone or even avoid irradiation. In the French Society of Pediatric Oncology (SFOP) this attitude has been adopted since 1990. Among the patients treated without radiotherapy, 20 relapsed while on conventional chemotherapy and were entered in a study of high-dose chemotherapy (HDC) followed by autologous bone marrow transplantation (ABMT). Their median age at diagnosis was 23 months (range: 5-71 months) and the relapse occurred at a median time of 6.3 months after the initiation of chemotherapy. Complete surgical removal of the local relapse was the first treatment in 4/20 patients who were not evaluable for response. Sixteen of the 20 patients had measurable disease at the primary site (9 patients), or at metastatic sites (3 patients) or both (4 patients). The conditioning regimen consisted of combination busulfan 600 mg/m2 over 4 days and thiotepa 900 mg/m2 over 3 days. After recovery from aplasia, patients with a local relapse received local radiotherapy limited to posterior fossa. Among the 16 patients with measurable disease, 6 complete responses, 6 partial responses, 3 non response, were observed following HDC (response rate 75%). One patient was not evaluable. For the 20 patients, the event free survival (EFS) is 50%. Among the surviving patients, the median follow-up is 39.5 months post BMT (range: 21-92 months). Ten patients who developed a local relapse or local progression are alive with non evidence of disease (NED) without craniospinal irradiation. Among the 7 patients who developed a metastases or progression of metastases, only 1 is alive. Toxicity was high but manageable. One complication-related death occurred 1 month post BMT. With a 75% response rate, this HDC proved to be very efficient in relapsed medulloblastoma. A longer follow-up is necessary to demonstrate whether, after a local relapse, HDC could replace craniospinal irradiation as prophylaxis against CNS metastases.
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PMID:[High-dose chemotherapy in relapse of medulloblastoma in young children]. 920 72

Three patients with hydrocephalus secondary to central nervous system (CNS) metastases from lung or breast cancer are reviewed representing less than 5% of patients with CNS metastases seen at The Cancer Center of Boston over a 10-year period. The clinical picture is characterized by ataxia and mental confusion with dilated ventriculi on computed tomography (CT) scan of the brain. Computerized tomography of the brain and microscopic analysis of the cerebrospinal fluid are complementary in establishing the diagnosis of meningeal carcinomatosis. Surgical management by ventricular peritoneal shunt is an important component to multimodality therapy. The clinical course and extended survival in three patients provides a basis for recommending palliative surgical bypass as a therapeutic intervention with or without intrathecal chemotherapy, radiation, or both.
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PMID:Malignancy-related hydrocephalus: clinical features and results of ventricular peritoneal shunt procedure in three patients. 970 35

The objectives of this population-based study were to assess putative prognostic factors for central nervous system (CNS) metastases among patients with cutaneous malignant melanoma, to assess the cumulative risk of CNS metastases in different subsets of patients with recurrent disease, and to describe patient outcome. At a median follow-up of 11 years, 201/2516 patients with melanoma had developed CNS metastases, corresponding to a cumulative risk at 5 years of 7%. In 41 of these 201 patients the CNS metastases were recorded as the first site of recurrence. In a Cox's multivariate model, primary tumor thickness and ulceration in stage I patients were independent risk factors. The cumulative rates of incidence of CNS metastases 5 years after local or regional recurrence as first event were 5 and 42%, respectively. These results may help to form an individually based risk assessment, which might be of value for melanoma patients in certain occupations.
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PMID:Central nervous system metastases of cutaneous malignant melanoma--a population-based study. 983 75

Therapy of metastatic melanoma still remains difficult. All therapeutic strategies have to consider the individual patient's condition and number and localisation of the metastases. Solitary metastases in lung, CNS, soft tissues and lymph nodes have to be removed by surgery. Multiple metastases are treated with a systemic chemoimmunotherpy. Promising approaches use interleukin-2, interferons, DTIC, temozolamide, vindesine and cisplatin. Radiotherapy is the treatment of first choice for bone and CNS metastases. These therapeutic strategies have improved the prognosis of metastatic melanoma. Additional multi-center trials and experimental approaches will help to reach the goal of a curative systemic therapy for metastatic melanoma.
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PMID:[Systemic therapy of metastatic melanoma]. 1042 Aug 16

In advanced stages of malignant melanoma (MM), metastases to the CNS are frequently observed. Few results are available on trophic factors and immunological features involved in the process of invasion and adhesion of circulating metastatic cells into the CNS. A direct comparison of remote metastases found in different locations of the same patient might help to identify such properties. For this purpose, we screened a panel of MM cell cultures, which had been established from patients with surgically removed MM lesions of the CNS, for expression and regulation of immunorelevant molecules. The results were compared with standard controls and cultures established from non-CNS metastatic lesions of the same patients. No significant differences were observed for expression of HLA-I, HLA-II, ICAM-1 and the melanoma-associated antigens Mage-3, MelanA and tyrosinase. Constitutive expression of the neuronal cell adhesion molecule (NCAM) was found in all CNS-derived samples and in fewer than 50% of non-CNS derived cultures. IFN-gamma was found to have a weak up-regulating effect in all non-CNS-derived cultures, except normal melanocytes. However, in 6/7 CNS-derived cultures, pre-treatment with IFN-gamma reduced expression of NCAM to 28% to 77% of the level in untreated cultures. The presence and regulation of NCAM differs between MM cells derived from CNS metastases and non-CNS-derived melanocytic cells. Thus, NCAM might be a candidate immunoregulating molecule involved in the formation of CNS metastases of MM.
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PMID:Inverse regulation of neuronal cellular adhesion molecule (NCAM) by IFN-gamma in melanoma cell cultures established from CNS lesions. 1044 20

The guidelines of testicular cancer were elaborated and agreed upon interdisciplinarily. Standard therapy of stage I seminoma is infradiaphragmatic radiotherapy. Possible alternatives are adjuvant carboplatin therapy (still in test procedure) and, in case of lacking risk factors, the watch-and-wait strategy. If small metastases of lymph nodes exist, radiotherapy requires a higher dose and a larger beam field. Standard therapy in clinical stage IIC-III is cisplatin-based multidrug chemotherapy. In regard to nonseminomatous germ cell tumor there are no universal recommendations: retroperitoneal lymphadenectomy (RLA) with protection of ejaculation function, watch-and-wait strategy as well as adjuvant chemotherapy have the same cure rate but differ in relapse rate and morbidity. Knowing the crucial risk factors - depending on the expected relapse rate - it will be possible to recommend adjuvant chemotherapy or wait-and-see strategy in the future. In case of lymph nodes up to 5 cm, three different therapeutic strategies are possible. They reach the same cure rate, but are associated with different morbidity: primary nerve-sparing RLA plus adjuvant chemotherapy, primary nerve-sparing RLA without adjuvant chemotherapy, and primary chemotherapy. Advanced stages are related to three different groups in reference to their prognosis. At present, they are still treated with three or four cycles of PEB. In current protocols, patients with 'poor prognosis' receive high-dose therapy afterwards. These results have to be taken in consideration when updating the guidelines. The present guidelines also give notes for the therapy of TIN, residual tumor resection (RTR), management of CNS metastases, and therapy of recurrences.
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PMID:Guidelines for the diagnosis and therapy of testicular cancer and new developments. 1059 90


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