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

Between 1982 and 1987, 74 patients (46 men and 28 women) had exploration for presumed metastases from high-grade soft tissue sarcoma of the head/neck, extremity, or trunk. Ages ranged from 11 to 75 years (median 38 years). Thirty (41%) had multiple procedures for recurrences (range two to six explorations). Median postthoracotomy time for the group of patients with histologically confirmed sarcoma (n = 63) was 20.3 months. Patients rendered free of disease at initial thoracotomy had significantly longer postthoracotomy survival times (26.8 months median) than those with unresectable metastatic disease (9 months median); p2 less than 0.0001). The prognostic significance of age, sex, location of primary tumor, disease-free interval, number of nodules on preoperative computed tomograms or conventional linear tomograms, number of metastases resected, and the use of postoperative chemotherapy were analyzed. In a univariate analysis, sex, age, and location of the primary tumor did not impact significantly on survival, nor did the use of postoperative chemotherapy. Initial disease-free interval of 1 year or less was associated with a significantly shorter survival time, and patients with five nodules or fewer on preoperative computed tomography had significantly longer survival times than patients with six nodules or more. Patients with three nodules or fewer on linear tomography had a longer postthoracotomy survival time than patients with four nodules or more. In patients whose malignant disease could be completely resected, the number of nodules resected at thoracotomy did not impact on long-term survival. According to proportional-hazards modeling, disease-free interval, sex, resectability, and truncal location were found to associate with length of survival after metastasis removal. We conclude that pulmonary metastasis resection in patients with soft tissue sarcoma is associated with long-term survival, and consistent indicators can define which patients may benefit from these interventions.
J Thorac Cardiovasc Surg 1989 May
PMID:Metastasectomy for soft tissue sarcoma. Further evidence for efficacy and prognostic indicators. 270 61

Ten patients underwent resection of primary or secondary cardiac tumor. Two-dimensional transthoracic echocardiography per se accurately located the endoluminal cardiac mass in nine patients, and transesophageal echocardiography demonstrated a right atrial tumor in the tenth case. The indications for urgent surgery included prior embolic events (3 cases), syncopal attacks (2) or echocardiographic evidence of a multilobulated mass (2 cases). The operative strategy was standardized for atrial tumors, but for malignant myocardial neoplasm both the anatomic site and the extent of tumor growth determined the surgical procedure. Histologic examination showed myxoma in seven cases, fibroma in one and metastases of malignant melanoma in two cases. The course after resection of endoluminal benign tumor was uneventful apart from transient atrial fibrillation in four cases. Follow-up echocardiography (after 4-28 months) showed no recurrent growth. In both cases of intracardiac metastases there was recurrence within 6 to 8 months after resection of the growth.
Scand J Thorac Cardiovasc Surg 1989
PMID:Urgent indications for surgery in primary or secondary cardiac neoplasm. 274 6

Between 1963 and 1986, 195 patients with carcinoma of the esophagus were seen in the Department of Radiation Oncology at the University of Southern California School of Medicine. Of these 195 patients, 137 had unresectable or inoperable tumors and received radiotherapy. A combination of radiotherapy and surgical therapy was used in 46 patients, 9 patients were treated with surgery alone, and three with chemotherapy alone. Among the nonsurgical patients, 13 scored less than 50 on the Karnofsky scale, 25 had distant metastases, and 69 lost more than 10% of their body weight. The majority (94%) had squamous cell carcinoma and a few (6%) had adenocarcinoma. Fifty percent had middle esophageal lesions, 30% had lower lesions, and 20% had upper esophageal lesions. Stage I was diagnosed in 13%, II in 27%, III in 29%, and IV in 27%; the disease was not staged in 5%. The 5-year actuarial survival rate for all patients was 4% (median 32 weeks). The 5-year survival rate of the 46 patients with combination therapy was 18%, and it was 2% for the remaining 149 patients (p less than 0.001). These figures are independent of stage of disease. The 2-year survival rate by stage was as follows: I, 25%; II, 21%; III, 5%; and IV, 0% (p less than 0.001). Complete response was obtained in 18% and partial response in 41%. Complete response was dependent on the tumor stage. It was 40% for stage I disease, 23% for stage II, 11% for stage III, and 6% for stage IV disease. Similarly, a larger percentage (39%) of the 46 patients with combination surgical/radiation therapy had a complete response than of patients treated by either radiotherapy alone (n = 137, 12%) or surgery alone (n = 9, 11%). Complete response and initial performance status were important factors influencing survival (p less than 0.001). Surgery with adjuvant irradiation offered a better survival rate than radiotherapy or surgery used as single modalities. Treatment results for patients with advanced carcinoma of the esophagus remain poor.
J Thorac Cardiovasc Surg 1989 Oct
PMID:Surgical therapy and radiotherapy for carcinoma of the esophagus. Treatment results in 195 patients. 279 68

To more clearly characterize the role of computed tomography in staging the mediastinal lymph nodes of patients with lung cancer, we analyzed computed tomographic and surgical findings in the chest in 345 consecutive patients with lung cancer who underwent operative staging. Patients were grouped according to the TNM staging system of the American Joint Commission, central or peripheral location of the primary tumor, lobar location of the tumor, and maximum tumor diameter as determined by computed tomography or gross pathology. One third of patients with abnormal findings on the computed tomographic scan did not have mediastinal lymph node metastases. Mediastinal metastases occurred frequently in patients with central cancers (38%). The predictive value of a negative scan in all patients was high (greater than or equal to 90%) except for patients with central T3 lesions (72%), left upper lobe lesions (83%), and central adenocarcinomas (75%). However, only the differences between central T3 and central T2 or T1 lesions, and between central adenocarcinomas and central squamous cell carcinomas, were unlikely to be due to chance alone (p less than 0.05). None of the lobar differences were statistically significant. The frequency of mediastinal metastases in patients with peripheral lesions was 15% (28 of 192 patients); computed tomography correctly identified enlarged mediastinal lymph nodes in all but seven patients. However, there were no true-positive computed tomographic scans in 59 patients with peripheral lesions 2 cm in diameter or smaller; accordingly, we suggest that computed tomography is not indicated for the sole purpose of mediastinal staging in this group. Ninety-four percent of patients in this series undergoing thoracotomy with a curative intent had a curative resection. Only 4% had unresectable lesions; palliative resections were done in 2%.
J Thorac Cardiovasc Surg 1987 Nov
PMID:Mediastinal lymph node evaluation by computed tomography in lung cancer. An analysis of 345 patients grouped by TNM staging, tumor size, and tumor location. 282 7

Five histologically confirmed tumors of the carotid body and seven lymph node metastases in the area of the carotid bifurcation were investigated with real-time sonography. In addition, 10 patients underwent measurements of intratumorous flow by way of a pulsed Doppler system. The typically hypervascular tumors of the carotid body revealed flow signals with standardized adjustment of Doppler sonography. The hypovascularized lymph node metastases did not demonstrate flow on Doppler sonography. In all patients, either preoperative angiography or enhanced computerized tomography was done and these studies confirmed the degree of vascularization of the mass as determined by Doppler sonography. Duplex sonography permitted noninvasive demonstration of hypervascular tumors in the area of the carotid bifurcation, a finding highly suggestive of nonchromaphil paraganglioma of the carotid body.
Cardiovasc Intervent Radiol 1987
PMID:Duplex sonography of tumors of the carotid body. 282 55

This study is based on a retrospective analysis of 163 patients with stage III non-small cell lung cancer randomized to one of three Lung Cancer Study Group postoperative resection-adjuvant treatment protocols. All patients underwent rigorous surgical/pathologic staging including required removal and examination of bronchopulmonary, hilar, subcarinal, and paratracheal lymph nodes. Patients were grouped as follows: group I, only subcarinal nodes diseased (N = 40); group II, only high paratracheal nodes diseases (N = 32); group III, only mid-mediastinal nodes diseased (N = 48); and group IV, subcarinal nodes plus nodes from any other site diseased (N = 43). Patient deaths and tumor recurrences were recorded. The death rate was highest for patients with metastases to subcarinal nodes plus nodes in another site (group IV). Pairwise comparisons of the survival rates of patients in each group disclosed a significant difference between group III and IV (p less than 0.02). In view of this observation, the Lung Cancer Study Group recommends that all patients have rigorous mediastinal lymph node staging done at the time of pulmonary resection to establish prognosis and criteria for study of adjuvant treatment interventions.
J Thorac Cardiovasc Surg 1988 May
PMID:Should subcarinal lymph nodes be routinely examined in patients with non-small cell lung cancer? The Lung Cancer Study Group. 283 10

Extended operation for lung cancer and mediastinal carcinoma involving the aortic arch or superior vena cava was performed in six patients. In three patients with lung cancer invading the right side of the mediastinum, sleeve pneumonectomy (two patients) or sleeve lobectomy was followed by resection and reconstruction of the superior vena cava with ringed polytetrafluoroethylene grafts. One patient with squamous cell carcinoma and T4 N1 M0 disease was alive and free of disease more than 34 months after the operation. The other patients with adenocarcinoma (T4 N1 M0) and adenosquamous cell carcinoma (T4 N2 M0) died 18 and 5 months after the operation of systemic metastases. In two patients with invasion of lung cancer into the left side of the mediastinum, resection and reconstruction of the aortic arch and left common carotid artery were performed by a femoro-femoral bypass. These patients had adenocarcinoma (T4 N2 M0) and large cell carcinoma (T4 N1 M0) and died of systemic metastases and bleeding during reoperation 12 and 4 months after the initial operation. In one patient with mediastinal squamous cell carcinoma, resection and reconstruction of the aortic arch and left subclavian artery were performed by application of a temporary bypass graft between the ascending and descending aorta. This patient was alive and free of disease more than 17 months after the operation.
J Thorac Cardiovasc Surg 1989 Mar
PMID:Extended operation for lung cancer invading the aortic arch and superior vena cava. 291 38

A total of 124 patients with bronchial carcinoid were seen at Memorial Sloan-Kettering Cancer Center between 1949 and 1983. Of these, 68 were female and 56 were male. The age range was 12 to 82 years (median 55 years). Eleven of the tumors were incidental pathological findings at autopsy or operation and were excluded from survival data determinations. At the time of diagnosis, 82 patients had disease confined to the lung or bronchus, 19 had regional lymph node metastases, and 12 had distant metastases. Patients with distant metastases were more commonly male and smokers, and their tumors were mainly atypical carcinoids histologically, compared with those of patients with localized disease. Patients with distant disease were treated with external radiation and/or chemotherapy, and their median survival was 8 months. Of the 101 patients with disease localized to one hemithorax, endobronchial resection was performed in six and pulmonary resection in 95 (pneumonectomy 14, bilobectomy nine, lobectomy 52, sleeve resection five, segmentectomy 15). Recurrence following endobronchial resection was observed in four of six patients. Disease-free actuarial survival (calculated by the Kaplan-Meier method) following pulmonary resection was 92% at 5 years and 77% at 10 years. Factors predisposing to recurrence were tumor size greater than 3 cm (p less than 0.004), an atypical carcinoid on histologic study (p less than 0.001), and regional lymph node metastases (p = 0.01). Disease-free survival at 5 and 10 years in 19 patients who had regional lymphatic metastases was 74% and 53%, compared with 96% and 84% in those without lymphatic metastases. We conclude that (1) carcinoid tumors are malignant and 10% of patients present with metastases and (2) for patients with clinically localized tumors, the prognosis is determined by the size and histologic features of the tumor and the status of the regional lymph nodes, which must be assessed at thoracotomy.
J Thorac Cardiovasc Surg 1985 Jan
PMID:Bronchial carcinoids. Review of 124 cases. 298 73

Twenty-one patients aged 16 years or less had been treated for a primary mediastinal germ cell tumor at the Children's Hospital, Boston Massachusetts, during the last 54 years. There were 13 boys and eight girls with the average age at diagnosis being 7 years (range 2 weeks to 16 years). Twelve mediastinal germ cell tumors were classified as pure teratoma, five contained embryonal carcinoma admixed with other germ cell components, and four were pure embryonal carcinoma. Of 12 patients with pure teratoma, 10 underwent complete surgical resection and were alive and well 1 to 13 years later; two children left untreated died of complications related to local tumor growth. Complete surgical resection was possible for only two of nine patients with embryonal carcinoma; both received adjuvant therapy and were alive and well 3 and 20 years later. Seven patients received radiation and/or chemotherapy but died of residual or metastatic disease. Successful treatment for children with embryonal carcinoma requires an operation aimed at either debulking or complete resection (if possible) coupled with early and aggressive combination chemotherapy. The role of radiation in primary therapy remains undefined with regard to curative intent.
J Thorac Cardiovasc Surg 1985 Jun
PMID:Mediastinal germ cell tumors in childhood. A clinical and pathological study of 21 cases. 298 18

From 1974 through 1983, 125 patients underwent operation at Memorial Sloan-Kettering Cancer Center for non-small cell carcinoma of the lung invading the chest wall. (Excluded are those with superior sulcus tumors or distant metastases at presentation.) Eighty patients were male and 45 were female. Ages ranged from 33 to 88 years (median 60 years). Histologically, the tumors were epidermoid carcinoma in 46%, adenocarcinoma in 46%, and large cell carcinoma in 8%. All patients underwent thoracotomy (pneumonectomy 19, bilobectomy seven, lobectomy 75, wedge resection 10, and no pulmonary resection 14), with an operative mortality of 4%. At thoracotomy, mediastinal lymph node dissection was routinely performed, and the postsurgical stage was T3 N0 M0 in 53%, T3 N1 M0 in 13%, and T3 N2 M0 in 34%. Extrapleural resection was performed in 66 patients. En bloc resection of chest wall and lung was performed in 45 patients with an operative mortality of 2%. Complete resection of tumor was possible in 77 patients (62%). Extension of tumor beyond the parietal pleura significantly decreased resectability. The median survival of 48 patients having incomplete resection was 9 months, despite perioperative interstitial and external radiation. The actuarial 5 year survival rate (Kaplan-Meier) of 77 patients having complete resection was 40%. This percentage was not significantly influenced by the patient's age or sex or by tumor size or histologic type. Lymphatic metastases significantly reduced survival, with a 5 year actuarial survival rate of 56% for patients with T3 N0 M0 disease and 21% for those with T3 N1 M0 or T3 N2 M0 disease (p = 0.005). The extent of tumor invasion of the chest wall appeared to influence survival, but in the absence of lymphatic metastases the difference at 5 years was not significant. Complete resection offers a significant chance for long-term survival in lung cancer directly extending into parietal pleura and chest wall. Extrapleural resection or en bloc chest wall resection can be performed with a low operative mortality and an expected 5 year survival in excess of 50% in the absence of lymphatic metastases.
J Thorac Cardiovasc Surg 1985 Jun
PMID:Chest wall invasion in carcinoma of the lung. Therapeutic and prognostic implications. 298 19


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