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)

Radiotherapy is an indispensable modality in the palliation of cancer. All palliative care programs should be acquainted with its indications and have a close working relationship with a radiation oncology department. The technical aspects of the subject may be intimidating to many staff and patients, and departments need to improve their outreach and education. The main indications are: pain relief (particularly bone pain), control of hemorrhage, fungation and ulceration, dyspnea, blockage of hollow viscera, and the shrinkage of any tumors causing problems by virtue of space occupancy. In addition, it has an important role in the palliation of three oncological emergencies: superior vena caval obstruction, spinal cord compression, and raised intracranial pressure due to cerebral metastases. More pragmatic fractionation schedules are being developed that are compatible with good results in terms of palliative end points, giving shorter courses with fewer hospital attendances for patient and family comfort and convenience. More clinical research and evaluation of palliative radiotherapy are required.
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PMID:The role of radiotherapy in palliative care. 171 70

Complications of breast cancer involving the skeleton include hypercalcaemia, bone pain and fracture. These complications arise because of progressive osteolysis which is in turn dependent on the activation of osteoclasts by tumour and host tissues. Clodronate is a powerful inhibitor of osteoclastic bone resorption which led us to evaluate its potential in metastatic breast cancer. When given intravenously it lowers serum calcium in the majority of hypercalcaemic patients. A convenient regimen is 600 mg iv as a single dose infused over several hours. We have additionally shown in a double-blind cross-over study that this regimen also has a significant effect on bone pain. This had led us to assess the longer term effects of clodronate by mouth in a prospective double-blind study of patients with established skeletal metastases. These studies are not yet complete but the agent appears to prevent hypercalcaemia and trends are emerging which indicate that the incidence of bone pain and fractures may also decrease.
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PMID:Treatment of skeletal disease in breast cancer with clodronate. 172 12

A phase II study of 153Sm ethylenediaminetetramethylene phosphonate (153Sm-EDTMP) palliative treatment was conducted on 23 patients with painful disseminated skeletal metastases. The administered activity of 153Sm-EDTMP was determined by prospective dosimetry and the radiation absorbed dose to bone marrow was fixed at 2 Gy. Symptomatic relief of bone pain was experienced by 14 of 23 evaluable patients (61%) with a median duration of 8 weeks (range 0-40). Toxicity was limited to myelosuppression with median nadir counts of leucocytes 3.3 x 10(9)/1 (range 1.0-7.5) and platelets 133 x 10(9)/1 (range 24-176) occurring at 2 weeks and 4 weeks, respectively. Retreatment with 153Sm-EDTMP was studied in 15 patients, including in 4 of the 23 patients treated with a single dose. The retreatment median radiation absorbed dose to red marrow was 1.9 Gy given at a median of 9 weeks (range 6-38) after initial treatment. Good control of pain was obtained in 13 of these patients (87%). Both the median duration of pain control (24 weeks) and survival (9 months) in the retreated group were substantially greater than for patients treated with a single dose, where duration was 8 weeks and survival 4 months. Additional toxicity in the retreated patients was confined to anaemia which required blood transfusion in 9 of the 15 patients (60%).
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PMID:A phase II study of treatment of painful multifocal skeletal metastases with single and repeated dose samarium-153 ethylenediaminetetramethylene phosphonate. 172 Mar 21

Malignant pheochromocytoma may present as a widespread metastatic disease, which is little or non-responsive to external beam radiotherapy and chemotherapy. The prognosis of these patients is bad due to both the progressive metastasis and the secretion of excess catecholamines which may cause hypertensive episodes. For these conditions [131I]metaiodobenzylguanidine (131I-MIBG) therapy may be an alternative treatment modality to induce both tumor remission and reduction of hormonal activity of the disease. The experience with 131I-MIBG therapy in four patients with metastatic malignant pheochromocytoma at The Netherlands Cancer Institute is reviewed. One patient with abdominal tumor recurrence and metastases to the lymph nodes and lungs had a partial remission of disease for 3 years; a second had a mixed response together with palliation and two other patients had stable disease, but were relieved of bone pain and severe hypertension, respectively. It is essential to be aware of the medication the patient is using, as many drugs are known or may be expected to interfere with the uptake and/or retention of 131I-MIBG by the tumor cells. The case of a significant reduction of 131I-MIBG uptake and retention by Labetalol in one of the patients is discussed. It is concluded that 131I-MIBG therapy may induce objective remission in patients with malignant pheochromocytoma and is certainly meaningful in the reduction of hormonal activity, the control of hypertension and the relief of pain from metastases.
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PMID:[131I]metaiodobenzylguanidine therapy of malignant pheochromocytoma: interference of medication. 182 43

This study compared goserelin monotherapy with goserelin plus flutamide in the treatment of stage C or D prostatic cancer. Patients were stratified according to whether distant metastases were present or absent. After a mean follow-up of 33 months, combined treatment with goserelin and flutamide produced a higher response rate and a more rapid normalization of abnormal levels of prostatic acid phosphatase and prostatic specific antigen than treatment with goserelin alone. A more prompt relief of bone pain was also evident. An advantage, though not statistically significant, in terms of progression and survival was demonstrated in the combination group when metastases were present before the start of treatment. In both groups, the median for progression as well as the PCA-related and nonrelated death was not achieved during the study period.
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PMID:Combined treatment (goserelin plus flutamide) versus monotherapy (goserelin alone) in advanced prostate cancer: a randomized study. 183 39

Twenty-nine cases of bone metastases from renal cell carcinoma were examined. Eight had metastatic bone pain as the initial symptom and were diagnosed that the primary lesion was in a kidney. In eight cases bone metastases appeared after treatment of the primary site. Seven had only bone metastases and another 22 cases had multiple metastases in organs such as the lung and lymph node when the bone metastasis was found. Curable surgical treatment was performed in only 2 cases. The survival curve of these patients were: 1 year; 41 per cent, 2 year; 30 per cent and 3 year; 15 per cent. Bone scan used for detection of bone metastases of carcinoma frequently ends with false positive results. CT scan and angiography are available for differential diagnosis of bone metastasis. We examined 6 cases (9 lesions) of bone metastases from renal cell carcinoma (3 pelvic bones, 2 lumbar bones, 2 femurs and 2 humerus). All lesions were hypervascular by angiography and were easily diagnosed as bone metastases. For early detection of bone metastases from renal cell carcinoma, angiography is useful because hypervascularity and tumor stain are easily detected even in such small lesions as 2 cm. Angiography was also useful for chemoembolization.
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PMID:[Evaluation of bone metastases from renal cell carcinoma]. 205 4

From May 1986 until July 1987, oral morphine hydrochloride in water solution was used in terminal patients, under a strict protocol of administration, and complying with the basic principles of Palliative Care. A retrospective study was carried out on the 40 patients who had received the drug for more than three consecutive days. As shown in Table 1, the average age of the treated patients was 70 years. The ambulatory patients represented 27.5% of the sample. The average initial dose was 60 mg, and the average maintenance dose was 120 mg. The median treatment time was 45 days. "Good" results were achieved in 85% of the patients, and "fairly good" in the remainder ("good" results were defined as "satisfactory symptom control, good life quality"--in this group there were some patients who obtained total suppression of the symptoms and optimal life-quality, i.e. "excellent" results; "bad" results were defined as "total absence of therapeutic effect"; and "fairly good" results, the intermediate cases). The more frequently treated symptoms were: 67.5%, pain due to tumor mass; and 20%, pain due to nerve compression-invasion, bone pain, and dyspnoea due to pulmonary metastases or primary lung cancer: total symptoms was more than a hundred per cent, because a number of patients had more than one symptom. Whenever necessary, adjuvant drugs were employed. Side effects were seen in 37% of the patients (specially nausea, vomiting, constipation, and somnolence for more than four days).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Oral morphine in the treatment of patients with terminal disease]. 213 Feb 44

From february 1988 to march 1989, 6 patients with locally advanced bladder cancer (T3b-T4, N0-N1, M0) were treated with 4 courses of neoadjuvant MP chemotherapy (methotrexate 300 mg/mq. + cisplatinum 100 mg/mq). In two patients chemotherapy was stopped because minimal or no response after two courses. Partial response (RP) was achieved in three patients (50%). Two patients died 2 and 5 month later. One patients developed metastases at 11 month. The remaining three cases showed NED at 3, 4 and 15 months of follow-up. In the same period 4 patients with metastatic bladder tumor were treated with M-VAC chemotherapy according to Yagoda before the cystectomy. M-VAC obtained a complete response in one case, and PR in 3 cases. All the metastases showed evidence of objective tumor regression. Reduction of bone pain was observed in one case. One patient died 15 months later with bone massive involvement. Another patient developed invasive tumor at 13 months. Two patients were disease-free at 3 and 5 months, respectively. Toxicity was more frequent in patient treated with M-VAC than with MP chemotherapy. M-VAC, we believe, represents a reliable neoadjuvant treatment of advanced metastatic bladder cancer.
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PMID:[Neoadjuvant chemotherapy of locally advanced tumors of the bladder: preliminary experience]. 214 8

Twenty-seven cases of classical bronchial carcinoid were followed up for at least 10 years after curative resection. Surgery was conservative in 15 cases. True lymph-node metastases were identified at operation in two cases. Distant metastases were confirmed in two patients after 5 and 10 years, respectively. One died of unrelated cause 10 years, and the other is alive 19 years, postoperatively. Radiotherapy relieved bone pain in both cases, and chemotherapy halted disease progression in one of them. In immunostaining the original histologic material, all carcinoids expressed neuron-specific enolase, and most expressed chromogranin A, synaptophysin and serotonin. Demonstration of ACTH and related opiopeptides did not portend a more aggressive course or identify cases with nodal metastases. Despite their low malignant potential, long-term follow-up of bronchial carcinoids is warranted. Even in the rare cases of distant metastases, long-term survival seems to be the rule. The occasional presence of nodal metastases and/or demonstration of ACTH and other opiopeptides, while more frequent in neuroendocrine carcinomas, are not inconsistent with bronchial carcinoids and seemingly do not alter their overall favorable prognosis.
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PMID:Long-term follow-up of classical bronchial carcinoid tumors. Clinicopathologic observations. 216 32

One hundred and forty-three patients (Group 1) with histologically proven nasopharyngeal-carcinoma (NPC) had bone scintigraphy with 99Tcm methylenediphosphonate (MDP) or dihydroxypropanediphosphonate (DPD) within 2 months of the initial diagnosis. A further 162 patients (Group 2) had bone scans during the course of follow-up if there were symptoms of bone pain or evidence of metastases at other sites. Twenty-three per cent (33/143) of the newly diagnosed NPC patients (Group 1) had evidence of bone metastases. Of these 143 patients, 101 were T0-T2, 16 were T3 and 25 were T4. Thirty-six patients had no neck nodes (NO), 44 were N1, 25 N2 and 38 N3. Of the 162 patients in Group 2, 96 (59%) had a positive bone scan. The commonest sites for bony metastases from NPC were the spine, ribs, pelvis and lower limbs in order of frequency. There is a highly significant association with the nodal stage but no association with the UICC T staging which is not adequate in nasopharyngeal carcinoma. In our part of the world, bone metastases from NPC are a common cause of an abnormal bone scan.
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PMID:Bone scintigraphy in nasopharyngeal carcinoma. 220 25


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