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

With reference to the recent literature, a representation of case-history, therapy and prognosis of bronchial carcinoma is made. Inhalation of tar products by smoking, as well as predominantly occupational dust are the important etiological factors for the increase in bronchial carcinoma. Because of the long occult progression of the disease the diagnosis based on clinical symptoms is made very late. Only a greater effort in organisation and diagnostics permits an early detection in high-risk groups. Therapeutic success has remained constant since the sixties. Up to now only the consequent pre-operative selection of patients has been significant for improvement of surgical results. Five-year cures are more frequent after lobectomy than after pneumonectomy. In radiation therapy, the use of high-voltage gamma rays in contrast to conventional deep radio-therapy, has not brought any significant improvement. An additional intensive and individual care and follow-up of patients is of vital importance. The optimal curative radiation dose is 6000 rad. Particularly pre-operative irradiation is important to prepare some inoperable patients for curative surgery. Postoperative radiation therapy is also valuable for doubtful radical surgery and after exploratory thoracotomy. Palliative radiation therapy results in rapid disappearance of symptoms; with generalized disease or in suspicion for formation of metastases, chemotherapy should be preferred. This is particularly true for anaplastic, small and large cell carcinomas, and their rapidly growing metastases. In those cases, combination of polychemotherapy may decrease the tumor size and increase the length of remission. The prognosis depends on microscopic tumor type, stage of the disease, and therapy. Abnormal excretion of steroids and immunological disturbances are prognostic at the time of diagnosis.
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PMID:[Bronchial carcinoma. Problems and treatment with special reference to radiotherapy (author's transl)]. 7 Jul 93

Ten hyperthermic isolation-perfusions with melphalan were performed for invasive malignant malenoma of the limbs. Four cases at stage II and with in transit metastases (up to 15 cm in diameter) had a complete regression. However, no improvement of survival was noticed: 4 out of 5 stage II patients who died, within 1 year after perfusion, developed a generalized disease. Systemic chemotherapy was administered in 3 patients after perfusion, but they died from distant metastases. The need for an adequate adjuvant treatment added to isolation perfusion is discussed.
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PMID:Hyperthermic isolation-perfusion with melphalan, a preliminary appraisal of local and general effects in malignant melanoma. 89 96

The success of renal cell carcinoma (RCC)-nephrectomy with radical lymph node dissection in stage I and II disease is undisputed. Through these measures 23% of metastases are controlled. The five-year survival time in stage III disease, however, stagnates at 35% +/- 14% despite radical surgery. Also, the additional tumor-vaccine-therapy of the Mainz-Joint-Study-Group was successful only in stage I and II disease, whereas stage III disease did not benefit from this therapy. As 50% of all radically operated patients developed metastases within three years after surgery, the call by radio-oncologists for supplementary radiotherapy beginning with stage III disease must be put foreward. The problems of therapy and chances of survival in generalized disease are demonstrated in 100 of our cases treated by surgery, radiotherapy and with MPA (medroxyprogesteroneacetate). Whereas Schmiedt et al. show a total survival time of 10,3 months after diagnosis of metastatic disease, the Offenbach patients achieved 16,5 months with a median survival time of 11,75 months. The necessity of therapeutic intervention is confirmed by the fact that the most favorable median survival time, 15,75 months, was achieved in metastatic disease involving three organs. We present here the special features of the individual organ manifestations and point out that not only the mean and median survival time, but also the very widely varying survival times in individual cases, make conscientious oncological post-treatment follow up and management a requirement.
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PMID:[Long-term results in the treatment of 100 metastatic hypernephroid carcinomas]. 213 18

A continuous series of 649 patients, treated by modified radical mastectomy for primary breast carcinoma, is analyzed after a median follow-up of 92 months. 'True isolated' locoregional recurrences (LR), defined as LR not preceded or followed by distant metastases within 6 weeks, appeared with a cumulative actuarial incidence rate of 6%, 14% and 19% after 1, 5 and 7 years respectively, whereas the respective figures for distant metastases (M1) were 10%, 37% and 48%. The main initial parameters, predicting both the LR-free and the M1-free interval, are presented by statistical analyses in the following order of importance: number of invaded lymph nodes in the axilla, tumor size (T) and histological grading of differentiation. The same factors also predicted the imminence of M1 once LR had occurred, as well as survival after LR. A higher incidence of M1 after LR was also correlated with estrogen-receptor negative tumors and with those LR occurring within one year after mastectomy. LR occurred at the chest wall (65%), in the sub-clavicular fossa (16%) and the axilla (6%); the remaining 13% occurred in two of the sites. There was a trend towards longer survival after chest wall recurrence than after LR recurrence at another site. Axillothoracic irradiations postmastectomy gave a lower rate of LR in 227 patients than did a regimen of 12 months adjuvant chemotherapy with irradiation restricted to the internal mammary lymph nodes in 120 subsequent patients: 17 vs 25% at 5 years (P = 0.03 when adjusted by initial nodal involvement and T-size). Total excision of LR (repeated if new LR occurred) gave better rates of local ultimate control and survival than other kinds of treatments, with or without adjuvant local or systemic therapy. LR is not always a sign of imminent generalized disease. Actuarial 5-year survival after LR is 26.2% overall whereas, if only 'true isolated' LR are considered, the survival is 37%.
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PMID:Locoregional recurrences after 649 modified radical mastectomies: incidence and significance. 255 47

Interdisciplinary protocols for management of advanced adenocarcinoma of the ovary have resulted in prolonged patient survival. A subset of patients is emerging in whom central nervous system (CNS) relapse occurs even following negative second-look procedures (SLP). Seven of 342 eligible patients entered in a National Cancer Institute of Canada Trial for Ovarian Cancer, from February 1, 1980 to March 31, 1984, had CNS relapse. All patients received adriamycin and cisplatin. SLP was performed in 5 patients, 3 of whom were complete responders (CR). Two additional patients failed to complete their chemotherapy and had progressive pelvic disease. The median age of these 7 patients was 57 years, their overall survival time was 28 months, compared with an average age of 58 years and survival of 21.6 months, for the entire group. Two patients had prolonged survival after their CNS relapse; 1 patient lived 26 months, and the other, who underwent craniotomy for primary management of the metastasis survived 18 months. Confirmation of metastatic disease was obtained in 4 of the 7 patients. The results of this study suggest that management of CNS involvement in adenocarcinoma of the ovary should be determined by overall performance status even in the presence of generalized disease.
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PMID:Advanced carcinoma of the ovary with central nervous system relapse. 313 78

Preoperative serum concentrations of carcinoembryonic antigen (CEA), tissue polypeptide antigen (TPA) and a monoclonal-antibody-defined carcinoma-associated carbohydrate antigen, CA-50, were measured in 272 consecutive patients with histopathologically proven rectal carcinoma. The levels of all three tumour markers correlated directly to the stage of the disease. The serum TPA reflected both the local tumour burden and any metastatic spread, as shown by analysing mean levels of S-TPA and by the use of a Walker and Duncan regression model. S-CA-50 separated patients with and without distant metastases, but not with regard to the local tumour burden. Although the level of S-CEA correlated to the tumour stage, it did not discriminate patients with respect to locally advanced growth or generalized disease. In a multivariate analysis, the serum level of TPA was found to be the most informative preoperatively. Both S-CA-50 and S-CEA gave information additional to that provided by S-TPA in the prediction of the tumour stage (Dukes' stage A-D), and S-CA-50 was also useful in the prediction of metastatic disease.
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PMID:Preoperative serum markers in carcinoma of the rectum and rectosigmoid. I. Prediction of tumour stage. 316 69

Between 1974 and 1977, a total of 254 patients with stages T1-3a, N0-1, and M0 operable breast cancer (node negative and node positive, stratified) were randomized to either modified radical mastectomy alone or the same surgery and adjuvant chlorambucil, methotrexate, 5-fluorouracil (LMF) plus BCG. After a median follow-up of 9 years (January 1985), we concluded that LMF plus BCG significantly increased relapse-free survival (RFS) in 240 fully evaluated patients, especially postmenopausal women. This gain in RFS ceased to transform into a gain in overall survival (OAS) after 7 years of median follow-up for the whole patient group. In the 122 node-negative patients studied, LMF plus BCG produced a marked increase in RFS up to the fifth year and in OAS up to 8 years after initial surgery, thus prolonging significantly the median disease-free interval compared with surgical control patients. This trend favoring LMF plus BCG-treated patients continues. Although median time to first relapse and to generalized disease were increased in relapsing patients by LMF plus BCG, the subsequent intervals from local relapse to distant disease and from distant metastases to death were equal for both treatment regimens. Subjective and objective acute toxicity from LMF plus BCG was mild. At 9 years of median follow-up, fewer second tumors were noted in the node-negative group receiving LMF plus BCG than in surgical controls.
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PMID:Swiss adjuvant trial (OSAKO 06/74) with chlorambucil, methotrexate, and 5-fluorouracil plus BCG in node-negative breast cancer patients: nine-year results. 353 85

In two years 359 patients with breast cancer were evaluated in a cooperative follow-up programme in which the organisation and documentation were done in hospital, the medical care and investigations by the family doctor. 72% of 316 evaluable patients remained in regular control. 63% chose the family doctor for follow-up while the others preferred hospital. In the first year 71-80% attended their appointments, in the second year 60-74%. Statistically significant parameters for detection of metastases were the following: general condition, local signs, palpable lymph nodes, markedly increased ESR, alkaline phosphatase, chest radiograph, and bone scan. Cumulative freedom from recurrence in the whole group diminished from 1.0 to 0.631 in 25 months, cumulative survival from 1.0 to 0.876 in 20 months. In both groups there were significant differences between stages I, II and III. Forty patients (16%) out of 250 developed a recurrence within 2.25 years, in five (2%) a second carcinoma developed. There was a high proportion of local recurrences (20 out of 40) and these often led to generalised disease (11 out of 20).
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PMID:[Programmed after care of breast cancer. Results of a follow-up model after 2 years later]. 628 57

Advanced ulcerating and infiltration tumors are commonly found in the hypopharynx, whereas early well-defined lesions are rarely diagnosed. The pathologic reports of 242 uniformly studied surgical specimens after total pharyngolaryngectomy for cancer of the hypopharynx were reviewed. The histologic analysis of 26 cancers (10.7%), which were recorded as having an entire or predominant superficial type of spreading, demonstrated that also in the hypopharynx a "superficial extending carcinoma" (SEC) may occur. SEC of hypopharynx was pathologically defined as a poorly or moderately differentiated squamous cell carcinoma, generally located in the pyriform sinus, which spreads superficially. It was limited to the mucosa (2.9%), but more frequently early infiltrated the underlying muscle or gland structures (6.2%), regardless of the presence of lymph node metastases or lymph vessels invasion. Although the concept that SEC of the hypopharynx may be an expression of a generalized disease of the mucosa must be carefully considered in surgical management, it appeared that this carcinoma in its "pure" intramucosal form may be associated with a good prognosis and a long survival.
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PMID:Superficial extending carcinoma of the hypopharynx: report of 26 cases of an underestimated carcinoma. 664 60

From January, 1969 through July, 1979, 37 children with neuroblastoma were cared for at the Oklahoma Children's Memorial Hospital. Nineteen patients with extensive disease were studied to examine the interrelationships of chemotherapy, radiation therapy and secondary surgery. Eleven children had secondary surgery in the abdomen or cervical region with one postoperative death. All patients had chemotherapy and ten had radiation therapy between the primary and secondary operation or death. Five children survived. Four of five survivors were less than one year of age at diagnosis and initial treatment. Fourteen of 15 patients, one year of age or older, died. Each case had pathologic examination of tumor before and after therapy. All survivors showed sequential maturation of tumor tissue but only one nonsurvivor had this finding. Unusual metastatic spread was found in patients having combined therapy. Multimodal therapy for advanced neuroblastoma accentuates the need for sensible timing and utilization of secondary operative procedures. The secondary procedures ideally eradicate the primary focus of tumor, and may also serve to excise selective areas of metastatic disease or to biopsy residual disease in aiding continuing therapy. Secondary surgery ought to follow the onset of radiation therapy by four to six weeks, or of chemotherapy by 12 to 24 weeks. This delay allows maximum control of primary and generalized disease, as well as maturation, differentiation, encapsulation and shrinkage of extensive initially unresectable primary tumors.
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PMID:The impact of chemotherapy and radiation therapy on secondary operations for neuroblastoma. 736 19


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