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

Over the last decade a new cancer treatment modality, electrochemotherapy, has emerged. By using short, intense electric pulses that surpass the capacitance of the cell membrane, permeabilization can occur (electroporation). Thus, molecules that are otherwise non-permeant can gain direct access to the cytosol of cells in the treated area.A highly toxic molecule that does not usually pass the membrane barrier is the hydrophilic drug bleomycin. Once inside the cell, bleomycin acts as an enzyme creating single- and double-strand DMA-breaks. The cytotoxicity of bleomycin can be augmented several 100-fold by electroporation. Drug delivery by electroporation has been in experimental use for cancer treatment since 1991. This article reviews 11 studies of electrochemotherapy of malignant cutaneous or subcutaneous lesions, e.g., metastases from melanoma, breast or head- and neck cancer. These studies encompass 96 patients with altogether 411 malignant tumours. Electroporation was performed using plate or needle electrodes under local or general anaesthesia. Bleomycin was administered intratumourally or intravenously prior to delivery of electric pulses. The rates of complete response (CR) after once-only treatments were between 9 and 100% depending on the technique used. The treatment was well tolerated and could be performed on an out-patient basis.
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PMID:Electrochemotherapy: results of cancer treatment using enhanced delivery of bleomycin by electroporation. 1297 56

The coregistration of planning CT and 18F-fluoro-deoxy-2-glucose (FDG) positron emission tomography (PET) with patient in the same treatment position is the principally well-established tool for improving the target coverage defined and the target planning volume to treat the metabolic target volume. Most of the interest in the coresgistred CT/PET images on volume delineation has focused on conformal radiation therapy of non-small cell lung cancer. In spite of technical difficulties related to the target volume displacements, and the sensitivity and the specificity of FDG-PET images < 100%, the target volume delineation is significantly changed by the coregistration of FDG-PET images and planning CT by either reduction of the radiation volume (excluding atelectasis or mediastinal lymph node) or the increasing of mediastinal lymph node involvement. Image fusion technique reduces the interobserver variability in target volume delineation. Furthermore, after induction chemotherapy image fusion leads to improve the patient management by detecting locoregional progression disease or the presence of metastatic disease. Other anatomic tumor sites are going to investigate such as: head-and-neck cancer, gynecologic cancer, oesophageal cancer, anal cancer, Hodgkin's disease, and non-Hodgkin's lymphoma. The impact on treatment outcome remains to be demonstrated.
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PMID:[The impact of integrating images of positron emission tomography with computed tomography simulation on radiation therapy planning]. 1567 44

Head and neck cancer comprises squamous cell carcinomas of the upper aerodigestive tract. There are similarities in their natural history, epidemiology and control. For these cancers premalignant changes can be identified. Smoking and drinking are the major risk factors. The geographical variations in incidence and mortality are indicative of differences in the prevalence of risk factors between countries. The dramatic increase in head and neck cancers is cause for great concern, particularly in Central-Eastern Europe. The great majority of these cancers could be prevented by reducing the prevalence of established risk factors. Screening could be used to detect both precancerous lesions and early invasive cancers; however, no study as yet has demonstrated a reduced incidence and mortality resulting from screening. When setting strategies for prevention, the socioeconomic differentials in incidence and mortality from head and neck cancers need to be taken into account.
Cancer Metastasis Rev 2005 Jan
PMID:Epidemiology of head and neck cancer: magnitude of the problem. 1578 69

Head and neck cancer can be a devastating disease. The mainstays of treatment for early stage disease are either radiotherapy or surgery. However, although disease responds well at this stage, the risk of a second primary cancer is high, with a development rate of about 4% per year. Advanced diseases are treated either by surgery with postoperative radiotherapy or by definitive radiotherapy, with surgery in reserve for salvage if necessary. Over the past two decades major advances have been made in surgery (reconstructive surgery, non-mutilating surgery). Either definitive or postoperative, radiotherapy is an integral part of the treatment for the majority of non-metastatic stages of disease and ways of improving the effects of radiotherapy are constantly being explored. Good activity has been reported for the use of altered radiation fractionation regimens, which allow the delivery of intensified radiation doses. In addition, in recent years randomized trials and meta-analyses have confirmed the survival benefit of adding chemotherapy to radiotherapy in a number of different settings. Cisplatin-based regimens have been identified as the most active and are now standard treatment choices. The survival benefits of chemotherapy appear to be limited to concomitant administration and do not extend to neoadjuvant administration, although this has demonstrated clinical utility in preserving organ function. Platinum-based combination chemotherapy is by many clinicians considered the standard approach to the treatment of recurrent/metastatic disease for patients who are able to tolerate such regimens, but the prognosis for these patients remains poor; this is particularly true for those whose disease progresses on such therapy. This paper discusses current approaches and recent advances in the treatment of head and neck cancer, specifically squamous cell carcinoma, and suggests future management aims for the different disease stages.
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PMID:Current clinical outcomes demand new treatment options for SCCHN. 1598 95

The lymph node staging is a very important prognostic parameter for patients with presenting with head neck cancer and is influencing the selection of the different therapeutic strategies including surgery, chemotherapy, radiotherapy or a combination of them. The accuracy of imaging techniques, such as US, MR imaging, and CT, depends on the appropriateness of radiological criteria used for diagnosing lymph node metastases. Size of nodes and evidence of necrosis are still the most important radiological criteria. However, the size shows great variability. A spherical lymph node larger than 10mm is an indicator for a malignant node, whereas an oval shape and/or a fatty hilus are more benign signs. But there are many limitations and different cut offs published in the literature, indicating that the size of a lymph node is not a reliable criteria for the assessment of lymph nodes in the head and neck region. Today new high-resolution MRI sequences and the development of specific contrast agents are offering new possibilities in the diagnostic work-up of head and neck lymph nodes. Ultrasmall superparamagnetic iron oxide particles (USPIO's) are resulting after intravenous application in a reduction of the T2 relaxation time. This is causing a signal decrease on T2-weighted MR images in benign lymph nodes after administration of USPIO's, whereas malignant lymph nodes do not show a significant signal decrease. Some clinical studies presented already very promising results. Based on the fact, that the size evaluation of lymph nodes in the head and neck has not changed during the last decade, this paper will mainly focus on MRI with new contrast agents and new techniques as diffusion weighted imaging (DWI).
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PMID:Cervical lymph nodes. 1833 39

Head and neck cancer (HNC) is the fifth most common cancer in the world. In the US alone, HNC accounts for 3-5% of all malignancies annually. Squamous cell carcinoma arising from the mucosa of the upper aerodigestive tract is the most common type of HNC and accounts for 90% of HNC diagnoses. Despite continued advances in the therapeutic options, the disease-free survival, functional outcome, toxicity of therapy and overall survival have remained less than optimal for patients with locally advanced, recurrent or metastatic disease. Therefore, new approaches for the treatment of patients with HNC, particularly patients with advanced stage, are clearly needed. Among the new therapies, molecular-targeted and biological therapies have gained special attention. While clinical trial data support the use of epidermal growth factor receptor (EGFR) inhibition in metastatic and locally advanced HNC, numerous trials are seeking to establish a clear role for new therapies targeting EGFR, the receptor for the type I insulin-like growth factor, as well as anti-angiogenesis agents.
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PMID:Promising newer molecular-targeted therapies in head and neck cancer. 1868 86

Head and neck cancer patients are at high risk for developing second primary tumors. This is known as field cancerization of the aero-digestive tract. In a previous study, we showed that patients with multiple primary tumors were more likely to have p53 mutations in histologically normal mucosae than patients presenting with an isolated tumor. Based on this observation, we postulated that p53 mutations in normal tissue samples of patients bearing a single primary tumor could have a clinical value as a biomarker for the risk of developing second primary tumors. Thirty-five patients presenting with a single primary tumor were followed-up for a median of 51 months (range 1 month to 10.9 years) after biopsies of histologically normal squamous cell mucosa had been analyzed for p53 mutations with a yeast functional assay at the time of the primary tumor. During this follow-up, recurrences and non-sterilization of the primary tumor, occurrence of lymph node metastases, and of second primary tumors were evaluated. Sixteen (45.7%) patients were found to have p53 mutations in their normal squamous cell mucosa, and 19 (54.3%) patients showed no mutation. No relationship was found between p53 mutations and the occurrence of evaluated events during follow-up. Notably, the rate of second primary tumors was not associated with p53 mutations in the normal squamous mucosa. The correlation between p53 mutations in histologically normal mucosae and the incidence of second primary tumors is generally low. The benefit of analyzing p53 mutations in samples of normal squamous cell mucosa in every patient with a primary tumor of the head and neck is doubtful.
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PMID:p53 Mutation in histologically normal mucosa of the aero-digestive tract is not a marker of increased risk for second primary carcinoma in head and neck cancer patients. 1903 74

Head-neck cancer is an area requiring more attention to a highly demanding therapy which has not been fully developed yet. Despite advances in diagnosis and treatment, including improvements of surgical techniques, radio- and chemotherapy and prevention strategies, the survival rates of patients with recurrent head-neck cancer are low. New drugs, including those targeting the epidermal growth factor receptor, p53 gene, RAS protein post-translation modification, the proteosome, vascular endothelial growth factor, cyclooxigenase-2 and other molecular pathways, are promising agents for management of head-neck cancer. Their potential is being tested in various settings, including chemoprevention, recurrent and metastatic disease and combination with radiotherapy and/or cytotoxic agents. Cytotoxic drugs could produce better effects if administered locally--laser thermal cisplatin application. The metronomic low-dose chemotherapy will prove effective. The anticoagulant therapy undoubtedly has its place. The potential lies in sound ongoing academic clinical trial--biomarkers leading to maximally promising pharmacogenomic based therapy. Better comprehension of tumor biology and mechanisms of resistance is necessary as well as the institution of reliable assays for clinical use.
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PMID:Head-neck cancer drug therapy--could it be improved? 1892 91

Head and neck cancer is a challenging disease that is expected to account for greater than 500,000 new cases worldwide in 2008. Toxicity has impeded advances in chemotherapy and radiation for head and neck cancer, and the prognosis for patients with recurrent and/or metastatic disease remains poor. Over the past decade, clinical research in head and neck cancer has focused on improving the efficacy of current multimodal approaches by targeting cellular pathways associated with carcinogenesis. Blocking the epidermal growth factor receptor (EGFR) and the vascular endothelial growth factor receptor (VEGFR) have emerged as primary strategies that account for the success of current targeted therapies in cancer. Recent studies with cetuximab, a monoclonal antibody inhibitor of the EGFR, have demonstrated survival benefits across the range of treatment settings in advanced head and neck cancer, and it is the only targeted therapy approved for use in this malignancy. In this review, the authors present the current development status of targeted therapies, focusing on those that have potential to impact the management of head and neck cancer in the near-term future. Trials are ongoing in all stages of disease and with a variety of modalities and agents, and those trials should provide critical insight into the best way to use these agents to improve patient outcomes.
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PMID:Targeted therapies in squamous cell carcinoma of the head and neck. 1915 11

Neuropathic pain is still an under-diagnosed and undertreated problem in third world countries. This retrospective study was undertaken to detect the prevalence, etiology and treatment profile of neuropathic pain in cancer. During January-December 2007, 716 new cancer pain patients were examined in Tata Memorial Hospital Pain Clinic. A total of 180 patients with a mean age of 47.14 yrs were found to have neuropathic pain characteristics on the basis of clinical impression, site of pain and the underlying cause i.e. due to tumor itself or cancer therapy. Head and neck cancer (32.2%) was found to be the most common cause of neuropathic pain, followed by breast (20.6%), thoracic (14.4%), genitourinary or gynecology (10.0% each), GI (9.4%), and medical oncology (2.8%). About 56% patients were post surgery, 44.4% post chemotherapy and 51.1% patients were post radiotherapy. The most common site of pain was thoracic (36.7%) due to primary or secondary metastatic disease. Pricking type of pain was the most characteristic feature (47.8%) followed by shooting pain (38.3%). The mean pain score was 5.96 +/- 1.5 (SD) and mean duration (months) of pain was 2.8 +/- 2.5. Neuropathic pain was found commonly associated with somatic pain (59.4%). The most common pharmacological agents prescribed were: tricyclic antidepressants (93.9%), anticonvulsants (66%), Opioids (85%), and nonsteroidal anti-inflammatory drugs (NSAIDs) (97.2%). Only 35% patients followed up more than once at the pain clinic. The most common and challenging patients were of orofacial pain. Nerve blocks techniques have a limited role in neuropathic pain.
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PMID:Prevalence, etiology, and management of neuropathic pain in an Indian cancer hospital. 1949 12


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