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)

The beta subunit of human chorionic gonadotrophin (beta-hCG) and Schwangerschaftsprotein 1 (SP1) were measured by radioimmunoassay in the serum and cerebrospinal fluid (CSF) of 46 postmolar and postpartum patients who developed gestational trophoblastic disease. There was a significant correlation between beta-hCG and SP1 serum levels. The mean serum SP1 level in high-risk patients was significantly higher than that in low-risk patients. There was a significant correlation between serum and CSF beta-hCG levels. The ratio of serum to CSF beta-hCG levels was low in the three patients with clinical evidence of intracranial metastasis. SP1 was present in the CSF of only one of these three patients, but it could be detected in the CSF of another four patients without clinical evidence of metastases in the central nervous system. The two low-risk patients with SP1 present in the CSF showed poor response to intramuscular methotrexate.
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PMID:Schwangerschaftsprotein 1 (SP1) in serum and cerebrospinal fluid of patients with gestational trophoblastic disease. 618 78

Choriocarcinoma is known to be sensitive to chemotherapy. Remission rates of 70% are reported for patients with metastatic disease. The Southeastern Regional Trophoblastic Disease Center of Duke University has reviewed its experience with the treatment of cerebral metastases from choriocarcinoma. Fourteen patients were identified as having cerebral metastases from a group of more than 500 patients with gestational trophoblastic disease (GTD) other than primary hydatidiform mole. The remission rate of 50% (7/14) was achieved by vigorous, multiagent chemotherapy and combined cerebral irradiation therapy. This series of patients is reviewed with regard to diagnosis, details of multiagent chemotherapy with cerebral irradiation, complications, and survival. The key factors for successful outcome seem to be early diagnosis and vigorous therapy.
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PMID:Cerebral metastatic choriocarcinoma: intensive therapy and prognosis. 624 7

The administration of chemotherapy to a patient with persistently elevated titers of hCG without metastases after hydatidiform mole implies a diagnosis of nonmetastatic gestational trophoblastic neoplasia (NMGTN). At present, a diagnosis of NMGTN following evacuation of hydatidiform mole is usually made after a plateau of three values of hCG over 2 weeks (days x, x + 7, x + 14), and patients are given chemotherapy on the basis of such a plateau. The frequency of the diagnosis of NMGTN from four United States Centers is presently 26% and this compares with a frequency of choriocarcinoma of 16% in the prechemotherapy era. Data are presented to demonstrate that a plateau of 3 or 4 weeks may be justified before a diagnosis of NMGTN is made and chemotherapy is given in patients who may be followed up closely.
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PMID:Criteria toward the definition of nonmetastatic gestational trophoblastic disease after hydatidiform mole. 627 94

Gestational trophoblastic disease (GTD) is a group of tumors with a cure rate of 90-100% with appropriate treatment. The patients with a poor prognosis have metastatic disease involving structures other than the pelvic organs or the lungs. The medical records of 70 patients with histologically proven GTD were reviewed to determine the usefulness of diagnostic imaging modalities in the staging and follow-up of GTD. The level of chorionic gonadotropin (hCG) is more sensitive in determining the persistence of disease or its response to therapy, but is of little use in evaluating the site of metastases. Diagnostic imaging modalities are most useful in determining the presence and sites of metastases so that appropriate treatment is instituted.
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PMID:Utility of diagnostic imaging in the staging of gestational trophoblastic disease. 628 68

Three hundred fifty-nine patients with gestational trophoblastic disease (choriocarcinoma and invasive mole) received complete treatment at the Brewer Trophoblastic Disease Center of Northwestern University Medical School from 1962 through 1978. Data were gathered as of December 31, 1978, to permit a minimum follow-up of 2 years. An overall remission rate of 92% was achieved: 100% (185/185) for nonmetastatic disease and 83% (144/174) for metastatic disease. All 200 patients with invasive mole and 129 of 159 patients (81%) with choriocarcinoma were cured. Chemotherapy was the main form of treatment, with adjuvant surgery and radiation therapy being used in selected patients. Five factors were determined to significantly influence response to treatment in patients with metastatic disease: 1) clinicopathologic diagnosis of choriocarcinoma versus invasive mole (71 versus 100%, P much less than .0005); 2) pretreatment human chorionic gonadotropin titer greater than 100,000 IU/liter and time greater than 4 months from pregnancy event to treatment (62 versus 93%, P much less than .0005); 3) metastases to sites other than lung and/or vagina (37 versus 92%, P much less than .0005); 4) antecedent term gestation compared with hydatidiform mole, abortion, and ectopic pregnancy (56 versus 79%, P less than .02); and 5) prior unsuccessful chemotherapy compared with no previous treatment (48 versus 83%, P much less than .0005). The value of secondary chemotherapy and adjuvant irradiation was evaluated. Relapse from remission was also studied.
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PMID:Gestational trophoblastic disease: treatment results at the Brewer Trophoblastic Disease Center. 628 7

Forty-eight of 399 patients referred to the John I. Brewer Trophoblastic Disease Center of Northwestern University Medical School from 1962 to 1979 for treatment of gestational trophoblastic disease (invasive mole or choriocarcinoma) died. All patients who died had histologically documented metastatic choriocarcinoma. The time from pregnancy event to treatment was greater than 4 months and/or the pretreatment human chorionic gonadotropin titer was greater than 100,000 IU/L in 64% of these patients. Seventy-one percent of fatal cases developed in association with term pregnancies, abortions, or ectopic pregnancies rather than hydatidiform moles. Fifty percent of patients who died had metastases to the liver, brain, and/or peritoneal cavity when they first presented for treatment. The most common causes of death were hemorrhage from one or more metastatic sites (42%) and pulmonary insufficiency (31%). Factors primarily responsible for the treatment failures in these patients were: (1) presence of extensive disease at the time of initial treatment; (2) inadequate initial treatment; and (3) failure or presently used chemotherapy protocols in advanced disease. Secondary chemotherapy, radiation therapy to sites other than the brain, and adjuvant surgical procedures failed to improve survival in these high-risk patients.
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PMID:Fatal gestational trophoblastic disease: an analysis of treatment failures. 628 66

Metastatic gestational trophoblastic disease may be categorized into "good prognosis" and "poor prognosis" groups on the basis of the level of the pretreatment human chorionic gonadotropin titer, the location of metastases, the duration of disease, type of antecedent gestation, and the response of prior therapy. One hundred twenty-six patients with metastatic disease were treated from 1966 through 1979. All patients were treated as inpatients. Sixty-three "good prognosis" patients required an average of 65 days of intensive inpatient chemotherapy and all achieved sustained remission. Sixty-three "poor prognosis" patients were treated. Thirty-eight patients achieved sustained remission after an average of 112 days of intensive chemotherapy. Twenty-five patients (40%) succumbed to disease, after an average of 162 days of therapy. The probability of successful outcome of therapy falls rapidly after 150 days of treatment. Toxicity and deaths are reviewed.
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PMID:Intensive inpatient therapy and survival in gestational trophoblastic disease. 630 83

Six patients with gestational trophoblastic disease whose presenting symptom was hemorrhage from vaginal metastases are discussed. The clinical features, management, and response to treatment are outlined and it is suggested that the presence of vaginal metastases should be regarded as a poor prognostic factor and an indication for multiple cytotoxic agent chemotherapy.
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PMID:Gestational trophoblastic disease: the significance of vaginal metastases. 631 92

The relationship between human chorionic gonadotropin (HCG) titers in urine and the number of discrete metastatic pulmonary nodules was studied in patients with persistent trophoblastic disease, after evacuation of hydatidiform mole, and before starting chemotherapy. A significant difference in HCG titers was found between patients with 0 to 2 nodules and patients with 5 or more nodules. A weak linear relationship was found. The distribution of 57 discrete pulmonary nodules in 13 patients was plotted by lung zones (upper, middle, and lower thirds). Twenty-eight percent of the nodules were in the upper third of the lungs. Two patients had solitary apical nodules. This differs from the characteristic predominantly basilar distribution of blood-borne metastases of other neoplasms. Pulmonary spread may have occurred during curettage of moles, when the patients were recumbent and pulmonary blood flow was redistributed to the upper portions of the lungs.
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PMID:Gestational trophoblastic tumors metastatic to the lung. Radiologic--clinical correlations. 631 59

The current study reviews post-term choriocarcinoma at the New England Trophoblastic Disease Center (NETDC) in order to expand knowledge of its clinical features. Between June 1965 and June 1981, 366 patients with persistent gestational trophoblastic disease were managed at the NETDC and 15 (4.1%) of these patients had choriocarcinoma following term pregnancy. Post-term choriocarcinoma has a propensity for early metastasis with frequent involvement of the liver and brain. Metastases were detected in 13 (86.7%) patients with post-term choriocarcinoma at the time of diagnosis. Seven patients (53.8%) with metastatic post-term choriocarcinoma had hepatic and/or cerebral involvement. Complete remission was achieved in both patients with nonmetastatic disease and in 8 (61.5%) patients with metastatic disease. When the time interval from the antecedent term delivery to diagnosis was less than 4 months, 7 (87.5%) of 8 patients achieved complete remission. The 5 patients who died from post-term choriocarcinoma all had hepatic and/or cerebral involvement. Patients with post-term choriocarcinoma should undergo a meticulous metastatic evaluation and if metastases are detected these patients should be treated with primary combination chemotherapy and with the selective use of irradiation and surgical therapy.
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PMID:Choriocarcinoma following term gestation. 631 46


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