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)

Intravenous urography (IVU) was performed in 289 patients at the time of diagnosis of malignant gestational trophoblastic disease (GTD). Ninety-five percent of these studies were normal, and none of the urologic abnormalities detected provoked alteration of the patients' tumor-related therapy. In the detection of renal metastases, false-positive and false-negative intravenous urograms were encountered. It is concluded that IVU lacks sufficient sensitivity and specificity in the detection of renal metastatic GTD; alternate screening methods are recommended.
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PMID:Renal metastases of malignant gestational trophoblastic disease: the use of intravenous urography in staging. 298 6

Seventy-three patients with metastatic high-risk gestational trophoblastic disease were treated with methotrexate, actinomycin D, and cyclophosphamide chemotherapy at the Brewer Trophoblastic Disease Center between 1968 and 1982. Forty-six patients were treated primarily with methotrexate, actinomycin D, and cyclophosphamide because of the presence of one or more high-risk factors. Twenty-seven additional patients who had not responded to initial single-agent chemotherapy with methotrexate and/or actinomycin D were subsequently treated with methotrexate, actinomycin D, and cyclophosphamide. Adjuvant surgery and radiotherapy were used in selected patients. The overall cure rate was 51% (37 of 73): 63% (29 of 46) for primary treatment and 30% (eight of 27) for secondary treatment (P less than .01). Several factors that influenced response to primary treatment with methotrexate, actinomycin D, and cyclophosphamide chemotherapy were determined: 1) clinicopathologic diagnosis of choriocarcinoma versus invasive mole (59 versus 100%), 2) metastases to sites other than the lung and/or vagina (44 versus 74%), 3) antecedent term gestation compared with hydatidiform mole or abortion (50 versus 75%), and 4) presence of three or more high-risk factors (27 versus 74%). There were no significant differences in cure rates during the course of the study period.
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PMID:Treatment of high-risk gestational trophoblastic disease with methotrexate, actinomycin D, and cyclophosphamide chemotherapy. 298 66

Placental site trophoblastic tumor is a rare variant of trophoblastic disease. The malignant form of this disease with metastasis and death is even more infrequent, as is evident from only five cases in the literature. A 30-year-old black woman who died from this disease is presented. Patients with metastases are at extremely high risk with no reported survivors and must be treated aggressively with chemotherapy and cytoreductive surgery. This type of trophoblastic tumor apparently exhibits a different biologic behavior as compared with choriocarcinoma.
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PMID:Malignant placental site trophoblastic tumor. 299 36

From 1975 to 1983, 195 patients were treated for persistent or metastatic gestational trophoblastic disease. Fifteen patients with liver metastases were analyzed. All were treated with chemotherapy alone, none received hepatic irradiation, and no patient bled from her hepatic metastases. Thus, the need for prophylactic hepatic irradiation to prevent hemorrhage is doubtful. The good results obtained in the studied patients emphasize the significance of using vigorous primary multiagent chemotherapy in high-risk gestational trophoblastic disease patients.
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PMID:Hepatic metastases in gestational trophoblastic disease. 299 63

Methotrexate and folinic acid was administered as primary therapy in 185 patients with gestational trophoblastic disease between 1974 and 1984. Methotrexate and folinic acid induced complete remission in 147 (90.2%) of 163 patients with nonmetastatic disease and in 15 (68.2%) of 22 patients with low-risk metastatic disease. Sustained remission was achieved in 132 (81.5%) patients following only one course of chemotherapy. All patients with methotrexate resistance subsequently achieved remission with Actinomycin D or combination chemotherapy. Methotrexate when administered with folinic acid was associated with granulocytopenia, thrombocytopenia, and hepatotoxicity in 11 (5.9%), 3 (1.6%), and 26 (14.1%) patients, respectively. The human chorionic gonadotropin (hCG) regression curve served as a reliable guide for the administration of chemotherapy and enabled the attainment of a high remission rate while limiting chemotherapy exposure. Methotrexate and folinic acid achieves an excellent therapeutic outcome with limited chemotherapy exposure and effectively limits systemic toxicity.
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PMID:Ten year's experience with methotrexate and folinic acid as primary therapy for gestational trophoblastic disease. 300 16

The Authors describe a treatment program for malignant trophoblastic disease based on a combination chemotherapy. The results of their clinical experience concerning 41 cases confirms the high cure rate for low risk metastatic disease (100%) with the only failures limited to the high risk patients (64.7% cure rate).
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PMID:Malignant trophoblastic neoplasias. Clinical experiences. 300 95

Six patients with severe vaginal bleeding were treated with transcatheter embolization of selected pelvic vessels. Three patients had Stage III(b) carcinoma of the cervix, one with dysfunctional uterine bleeding and two patients had gestational trophoblastic disease (GTD) with bleeding from vaginal metastases. Bleeding stopped in four of the six cases. Reasons for failure in the other two cases are given. No other reports of bleeding from vaginal metastases in metastatic GTD treated in this way have been seen in the literature.
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PMID:Transcatheter embolization of pelvic vessels to stop intractable hemorrhage. 300 82

Five patients with gestational trophoblastic disease whose presenting symptom was hemorrhage from vaginal metastases have been added to our previous report. The clinical features, management, and responses to treatment are outlined. All the patients required suturing of the bleeding lesions under general anesthetic to arrest the hemorrhage. In addition one patient needed selective arterial embolization. This did not compromise the response to chemotherapy. We confirm our previous view that the presence of vaginal metastases should be classified as a high-risk factor and that these patients be treated with multiple agent chemotherapy from the outset.
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PMID:Gestational trophoblastic disease: the significance of vaginal metastases. 301 14

From 1971 to 1981, twenty patients with poor-prognosis metastatic gestational trophoblastic neoplasia (GTN) were treated with moderate-dose methotrexate (1 g) and folinic-acid rescue (MD-MTX-FAR) as initial therapy. Seven (35%) were cured with MD-MTX-FAR, and salvage chemotherapy was successful in an additional seven, for a total cure rate of 70%. The ultimate outcome is similar to that reported for MAC triple therapy during this era. Hematologic and mucosal toxicity were negligible and no serious complications were encountered. We now use combination chemotherapy in patients with poor-prognosis GTN as first-line treatment. However, these results suggest that there may be advantages to the incorporation of MD-MTX-FAR in combination regimens in place of low-dose methotrexate, because of reduced toxicity and potential benefits for the prophylaxis and treatment of cerebral metastases.
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PMID:Poor prognosis metastatic gestational trophoblastic disease: experience with moderate dose methotrexate plus folinic acid rescue as initial therapy. 302 4

Eight patients with malignant gestational trophoblastic disease had CT of the pelvis as part of their staging before chemotherapy. CT appearance of the uterus fell into three major types: normal size with irregular areas of hypodensity, uniform enlargement with areas of hypodensity, and focal areas of enlargement with or without areas of hypodensity. Patients with the second and third types were much more likely to have distant metastases and to require hysterectomy for successful treatment. CT findings of tumor nodules in the parametrium or myometrium were confirmed in three of the four surgical specimens of the uterus available for correlation. Myometrial tumor nodules were seen as areas of focal enlargement or as irregular eccentric areas of hypodensity. In one patient, parametrial extension was seen as an enhancing mass adjacent to the uterus. CT may be accurate in defining the extent of myometrial and adnexal disease and may have prognostic and therapeutic value.
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PMID:Malignant gestational trophoblastic disease: CT findings. 302 72


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