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)

Fifty-seven patients with malignant gestational trophoblastic disease (GTD) were treated by the Gynecologic Oncology Unit of the Tygerberg Hospital, Parowvallei, RSA, between 1977 and 1986. Treatment was primarily with triple chemotherapy (MAC) followed by citrovorum factor. The total remission rate in the 23 patients with high risk malignant GTD was 78.3% but in the 16 patients categorized as poor prognosis metastatic disease the remission rate dropped to 68.8%. The third world background in the majority of our patients, the poor general health, and the language barrier indirectly influenced the management of these patients. Psychological problems were evident in 60.9% of our patients. This often resulted in poor patient compliance which adversely influenced the outcome of the disease.
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PMID:High risk malignant gestational trophoblastic disease: experience with triple chemotherapy (MAC) in Third World circumstances. 246 40

Out of 472 patients with gestational trophoblastic disease directed to the Institute of Oncology in Warsaw in the period 1.4.1977-1.4.1987, 145 (30.7%) have been qualified for treatment. Lasting cure was obtained in all of 105 patients with the disease restricted to the uterus, in 13 of 14 (92.8%) with metastatic disease with favourable prognosis and in 20 out of 25 (80.0%) with metastatic disease with poor prognosis. In 102 patients treated exclusively chemically the procreative ability has been preserved, 33 of these women gave birth to a total of 44 healthy children.
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PMID:[Gestational trophoblastic disease. Clinical course and results of treatment]. 256 36

The sonographic findings of the pelvic lesions in persistent trophoblastic disease were evaluated prospectively in 57 patients. The appearance ranged from minimal lesions in the myometrium to complex lesions extending into the parametrium. A grading system was devised based upon the extent of the disease in the pelvis. The different grades correlated well with the plasma human chorionic gonadotrophin level at the time of the ultrasound examination. Findings of the hepatic lesions were evaluated in 69 patients managed during the same period. Thirteen were diagnosed to have metastatic disease on hepatic arteriography, of which 11 were correctly diagnosed by ultrasonography. The sensitivity and specificity of sonography in detecting metastasis in the liver from trophoblastic disease were 86.7 and 91.8 per cent, respectively. Two sonographic patterns were observed: a) the discrete hyperechoic lesions in three patients and b) the diffuse hyperechoic lesions in eight patients. In addition, ultrasonography could depict the size and internal structure of the pelvic and hepatic lesions much better than arteriography. Therefore, it is concluded that sonography is a very useful tool in the assessment of these lesions in persistent trophoblastic disease.
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PMID:Sonographic patterns of pelvic and hepatic lesions in persistent trophoblastic disease. 258 Sep 92

The course of 51 patients with high-risk metastatic gestational trophoblastic tumor was reviewed. The clinical characteristics and therapy of patients who died were compared to patients who attained remission to identify parameters that are associated with treatment failure. The presence of liver, brain, or intestinal metastases and the failure of prior chemotherapy were found to portend a poor prognosis (P less than 0.001, P less than 0.05). Other high-risk factors such as markedly elevated HCG levels, time interval greater than 4 months from the antecedent pregnancy to treatment, and post-term choriocarcinoma were not independently associated with treatment failure. The mean prognostic score and the mean number of high-risk factors for patients who died were 13 and 3, as compared to 7 and 2, respectively, for patients who achieved remission (P less than 0.001, P less than 0.001). Alternative intensive chemotherapy regimens need to be developed to improve remission rates in patients with liver, brain, or intestinal metastases, failed prior chemotherapy, or a high prognostic score.
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PMID:Analysis of treatment failure in high-risk metastatic gestational trophoblastic disease. 282 99

Metastatic gestational trophoblastic disease poses problems in diagnosis and management and has a poorer prognosis than the non-metastatic variant. The lung is the most common site of metastases. This paper reviews 97 patients with pulmonary metastasis developing after gestational trophoblastic disease who were seen at one centre over 26 years. Most patients had an antecedent molar pregnancy but an associated choriocarcinomatous lesion in the uterus was absent in the majority. In many patients the pulmonary lesion was asymptomatic. Whilst chemotherapy was the treatment of choice, selective thoracotomy in cases with solitary lung nodules reduced the treatment time and need for aggressive multi-drug combination regimens. The overall survival rate at 2 years after diagnosis was 65%. A higher mortality was found when the antecedent pregnancy ended at term, when the time interval between the preceding pregnancy and diagnosis of pulmonary metastases was greater than 1 year, when multiple pulmonary secondaries were present or when cerebral metastases occurred. The main causes of death were cerebral haemorrhage, respiratory failure and pulmonary embolism.
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PMID:Pulmonary metastases in gestational trophoblastic disease: a review of 97 cases. 282 61

Between 1968-1984, eight women with renal metastases of gestational trophoblastic disease were treated at the Southeastern Regional Trophoblastic Disease Center. Two (1.3%) of 154 patients referred for primary therapy and six (14%) of 42 patients referred for secondary therapy of metastatic gestational trophoblastic disease had renal metastases. All eight had coexistent pulmonary metastases. Four had central nervous system and other systemic metastases. All had high-risk metastatic gestational trophoblastic disease by assessment of individual risk factors and analysis of a prognostic index score. Three women with limited systemic tumor burden are alive after receiving multiagent chemotherapy and nephrectomy.
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PMID:Renal metastases of gestational trophoblastic disease: a report of eight cases. 284 18

Between January 1980 and October 1987, 115 evaluable patients were treated in Sheffield for persistent gestational trophoblastic disease (GTD) with a low dose methotrexate regimen (LD-MTX). Each course comprised MTX 50 mg given by i.m. injection for 4 doses on alternate days. Courses were repeated every 2 weeks and serum beta-hCG was used to monitor response. Overall, 80/115 (70%) of patients attained durable complete remissions (CR). Twenty-nine patients received the 'AVC' salvage combination of actinomycin-D 0.5 mg i.v. for 5 days, sequenced with cyclophosphamide 500 mg i.v. and vincristine 1 mg i.v., both given for 3 doses on alternate days. Sixteen (55%) patients attained a durable CR but 11 (38%) required further measures, 7 ultimately requiring hysterectomy. Two (7%) died during treatment. With 4 deaths overall (3 from metastatic GTD and 1 from infarction of the bowel), actuarial survival is 94% at over 7.5 years. A new Charing Cross prognostic scale weighted especially for hCG levels, number and sites of metastases, interval between pregnancy and start of treatment (score 0-6 each factor), was applied retrospectively to obtain a total score for each patient. Thus, 21/26 (81%) patients who scored greater than 8, required additional treatment after LD-MTX, compared with 18/89 (20%) of lower scoring patients (p less than 0.001). Because of the frequent morbidity associated with prolonged chemotherapy as well as the development of drug-resistant GTD, it is concluded that the 'high-risk' patients should receive more intensive combination chemotherapy at the outset.
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PMID:Results of low-dose methotrexate treatment of persistent gestational trophoblastic disease in Sheffield 1980-1987. 284 67

The clinical history of a patient with a placental-site trophoblastic tumor is presented. The diagnostic and therapeutic value of dilatation and curettage, the human chorionic gonadotropin titer, hysteroscopy, laparoscopy, chemotherapy, and hysterectomy is discussed, as well as the possibility of metastatic disease. In this patient there was radiological evidence of pulmonary metastasis with apparent spontaneous regression. A proposal is made to change the name of this disease to gestational trophoblastic neoplasia of low potential malignancy.
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PMID:Placental-site trophoblastic tumor: diagnosis, treatment, and biological behavior. 285 76

The role of surgery in the management of gestational trophoblastic neoplasms has changed over the years and warrants continuous re-evaluation. Surgical removal of the bulk of the disease in an attempt to shorten the hospital course and decrease the amount of chemotherapy required appears to be of value. This approach to therapy should therefore be considered in most patients with nonmetastatic disease without regard to the histologic diagnosis if they have completed their families. "Debulking" of primary uterine disease in the presence of metastases may decrease the chemotherapy necessary for cure and removes a potential source of resistant disease. Pulmonary surgery improves survival rates for patients with a solitary, resistant lung tumor and is advisable under the circumstances outlined herein. Craniotomy is rarely of value in the management of tumor in the brain but may be necessary in emergency situations caused by intracerebral hemorrhage. Surgery to control complications of the disease has been proved to be safe with acceptable morbidity even if performed during chemotherapy. Thus, although chemotherapy has replaced surgery as the primary management of patients with gestational trophoblastic disease, there remain a significant number of patients in whom surgery plays a significant role.
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PMID:Integration of surgery and other techniques in the management of trophoblastic malignancy. 285 35

Persistent normal human chorionic gonadotrophin (hCG) levels for a period of 1 year after treatment is considered to be a reliable criterion of complete and sustained remission in patients with gestational trophoblastic disease. This is because such patients rarely require further therapy. Two patients are presented who developed recurrent disease after being in remission for 18 and 21 months. One of the patients initially had metastatic disease in the lungs; the other had tumor in the lungs and brain. Both of the patients have remained clinically free of disease after retreatment; one patient for 31 months and the other patient for more than 4 years. The management of the patients is presented with an emphasis on the requirement for long-term surveillance. Possible mechanisms to account for the reactivation of disease after a prolonged latency period are considered.
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PMID:Late recurrence of gestational trophoblastic disease. 298 Nov 92


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