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)

Nasal-paranasal oropharyngeal (NPOP) non-Hodgkin's lymphoma (NHL) is a disease of the very young (median age, 5 years) and of the aging adult (median age, 50-60 years). Of a total of 208 pediatric patients with NHL studied, 20 (9.6%) had primary NPOP. Sixty percent of the patients had Stage I and II disease. Primary sites were maxillary sinus in eight patients; tonsils in eight; posterior pharynx in two; mandible in one; and orbit in one patient. Histologically, the disease is different than that of the adults since most patients had B-cell lymphomas of the diffuse undifferentiated type (Rappaport) or small cell non-cleaved types (Lukes-Collins, Kiel, and Working Formulation). None of these patients had gastrointestinal involvement. All patients were treated with the LSA2-L2 regimen and radiation therapy was given to primary unresectable tumors and regional metastases. The lymphoma event-free survival was 75%, with a median observation period of 99+ months. In staging systems that refer mostly to amount of disease outside of the primary (such as ours, Murphy's, and the Ann Arbor staging systems) stage did not correlate well with disease-free survival. In the TNM staging of 1977, a staging system that refers to size of primary tumor as well as regional and systemic disease, stage correlated better with prognosis and survival. In our staging system, eight of 12 patients (66.7%) with Stage I and II disease; four of four with Stage III; two of two with Stage IVA; and zero of two with Stage IVB survived. In the TNM staging system, three of three patients with Stage II and III disease and 12 of 18 patients (67%) with Stage IV disease survived. All recurrences occurred early suggesting that early intensification of chemotherapy may produce better results.
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PMID:Primary nasal-paranasal oropharyngeal lymphoma in the pediatric age group. 230 88

The role of interstitial implantation in the radiotherapeutic treatment of base of tongue carcinoma remains controversial. At the University of Florida, essentially all patients with base of tongue cancer have been managed initially by radiation therapy (with or without neck dissection) with operation reserved for radiation therapy failure. Eighty-four patients with invasive squamous cell carcinoma of the base of the tongue were treated with continuous-course external-beam irradiation without interstitial implantation between October 1964 and July 1986. Treatment was administered once-a-day in 59 patients and twice-a-day in 25 patients. The median follow-up was 99 months (range, 25-284 months). No patient was lost to follow-up. Local failure occurred in 1/9 patients (11%) with T1 lesions, 3/30 (10%) with T2, 6/31 (19%) with T3, and 9/14 (64%) with T4. If one excludes from the local control analysis those patients who died of intercurrent or metastatic disease within 2 years with their primary tumor continuously controlled, then the rates of local control are as follows: T1, 3/4; T2, 22/25 (88%); T3, 20/26 (77%); T4, 5/14 (36%). An improved local control rate for T4 tumors was noted with twice-a-day fractionation. Eighty-eight percent of N0-N1 necks and 79% of N2-N3 necks were treated successfully by irradiation with or without planned neck dissection. Five-year rates of continuous disease control above the clavicles were as follows: Stage I-II, 100%; Stage III, 72%; Stage IVA, 78%; Stage IVB, 44%. Five-year absolute and relapse-free survival rates for the entire group were 43% and 58%, respectively. The incidence of bone exposure was 6%, and that of soft-tissue necrosis was 19%. In all but one case, the complication was mild to moderate in severity and healed with conservative management. These results compare favorably with those recently published in the literature supporting moderate-dose external-beam irradiation combined with interstitial implantation. We conclude that interstitial implantation is not essential for the successful radiotherapeutic treatment of base of tongue carcinoma.
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PMID:Is interstitial implantation essential for successful radiotherapeutic treatment of base of tongue carcinoma? 175 Sep 3

Phase II studies using ifosfamide both alone and combined with vindesine and cisplatin have shown the effectiveness of this drug in patients with Ewing's sarcoma (ES) who had relapsed during VAC (vincristine, actinomycin, cyclosphosphamide)/VAd (vincristine, Adriamycin) therapy. In November 1984, these results led the SFOP to adopt a protocol consisting of (1) initial chemotherapy with three cycles of IVA (ifosfamide, 3 g/m2 on days 1 and 2; actinomycin D, 750 mg/m2 on days 1-3; vincristine, 1.5 mg/m2 on day 1) alternating every 3 weeks with IVAd (vincristine on day 22; ifosfamide on days 21-23; Adriamycin, 60 mg/m2 on day 22); (2) radical surgery if possible; (3) local radiotherapy (RT); and (4) maintenance chemotherapy with alternating IVA and VAd (vincristine, Adriamycin) for up to 9 months. In May 1987, 87 patients with previously untreated ES entered the study; 61 had localized ES. To date, 54 patients with localized disease and 22 with metastatic disease have finished initial chemotherapy; 40 patients with localized disease have been evaluated. In all, 28 patients (70%) were in complete remission (17 patients) or had a tumor regression of greater than 50% 11 patients) and were considered to be good responders; 12 patients were considered to be poor responders. After local radiotherapy in all but 7 patients and surgical resection in 29, 52 of 54 were considered to be in clinical remission. A total of 13 patients with metastatic disease were good responders at the completion of the initial chemotherapy. These results confirm the efficacy of primary chemotherapy using ifosfamide for the treatment of ES.
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PMID:Initial chemotherapy including ifosfamide in the management of Ewing's sarcoma: preliminary results. A protocol of the French Pediatric Oncology Society (SFOP). 266 89

An analysis of 455 patients with head and neck carcinomas and clinically positive neck nodes who were treated with radiation therapy alone to their primary tumors (with or without a neck dissection) was conducted to determine the relative role of several prognostic factors in the subsequent development of distant metastases (DM). The factors analyzed were N stage, node location (upper neck only vs. lower with or without upper neck), T stage, primary site (oral cavity, oropharynx, nasopharynx, hypopharynx, supraglottic larynx), modified AJCC stage, and neck treatment. All patients were treated between 1964 and 1985 and had a minimum follow-up of 2 years. The N stage and node location were the most significant prognostic factors in the subsequent development of distant metastases. The incidence of distant metastases increased with increasing neck stage (N1, 11%; N2, 18%; N3, 27%), and in four of five neck stages (N2B being the exception), the incidence of distant metastases was greater for those patients with metastatic adenopathy in the lower neck. The incidence of distant metastases by modified AJCC stage was 12/111 (11%) for Stage III, 34/146 (23%) for Stage IVA, and 41/198 (19%) for Stage IVB. The primary site and T stage had little influence on the subsequent development of distant metastases. A multivariate analysis of the clinical factors confirmed the importance of neck stage and node location in estimating the probability of distant metastases. Control of disease above the clavicles and the addition of a neck dissection also significantly affected the chance of developing distant metastases.
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PMID:Does node location affect the incidence of distant metastases in head and neck squamous cell carcinoma? 275 56

Ninety-six patients with cervical cancer underwent surgical staging prior to radiation therapy. An equal number of patients were explored by transperitoneal and extraperitoneal surgery. Three different extraperitoneal approaches were utilized. All patients had bilateral paraaortic lymphadenectomy and selective pelvic nodal sampling. Intraperitoneal cytology and selected biopsies were performed. A 52% correlation existed between clinical and surgical staging. Radiotherapeutic treatment decisions were subsequently based on findings at operative staging. Nine percent of patients undergoing transperitoneal staging experienced a small bowel injury after radiation requiring surgical correction. No patients undergoing extraperitoneal surgery experienced postradiation small bowel morbidity. Extended field radiation was administered to 17% of patients, and a 30% five-year disease-free survival rate was observed. Although prognostic stratification is enhanced with surgical staging, using current radiotherapy techniques, the majority of patients with paraaortic nodal metastases will fail treatment. Based on our experience, only 2.5% of patients in a Stage IIB-IVA category will benefit from radiotherapeutic treatment decisions made as a consequence of staging laparotomy.
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PMID:The influence of surgical staging on the evaluation and treatment of patients with cervical carcinoma. 308 90

Twenty patients with Stage IVA and IVB cervic cancers were treated with Californium-252 (Cf) neutron brachytherapy (NT) in a feasibility trial between 1976 and 1986. Eleven patients had Stage IVA disease; nine patients had Stage IVB disease. Patient compliance with therapy was poor in four of nine patients with Stage IVB disease, and the 50% survival time was 6 months. In Stage IVA disease there were 18% 3-year survivals. For those that failed, the 50% survival time was 7.5 months. Because of the frequency of disseminated metastases, effective adjuvant therapy needs to be developed to use after the tumor debulking therapy, especially for Stage IVB disease. A single early Cf-NT implant followed by 6000 cGy of whole-pelvis fractionated radiation would accomplish this adequately for local tumor control and palliation.
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PMID:Feasibility study of Californium-252 for the therapy of stage IV cervical cancer. 313 Jan 79

A total of 1054 patients with histologically confirmed invasive carcinoma of the uterine cervix were treated with radiation therapy alone between 1959 and 1982. All patients are available for a minimum of 3 years follow-up. Radiation therapy consisted of external irradiation to the whole pelvis (1000-2000 cGy) and parametria (for a total of 4000-6000 cGy) combined with two intracavitary radioactive source insertions (6000-7500 cGy to point A). Patients with Stage IIB, III, and IVA have been consistently treated with somewhat higher doses of external irradiation and intracavitary insertions. A small group of 54 patients with Stage IIB or IIIB had pelvic lymphadenectomy following the irradiation (1960-1964). There was a strong correlation between the tumor regression within 30 days from completion of radiotherapy and the incidence of pelvic recurrences or distant metastases for each of the anatomical stages. The 10-year survival rate for Stage IB was 76%, Stage IIA 60%, Stage IIB 45%, and Stage III 25%. Many of the deaths were due to intercurrent disease. Thus, the 10-year tumor-free survival was 80% for Stage IB, 60% for Stages IIA and IIB and 35% for Stage III. In Stage IB total doses of 6000 cGy or higher to point A resulted in 94% pelvic tumor control. In Stage IIA, the pelvic tumor control was 87% with doses of 6000 cGy to point A or higher. However, in Stage IIB the pelvic tumor control was 58% with doses below 6000 cGy, 78% with 6001-7500 cGy and 82% with higher doses. In Stage IIIB the pelvic tumor control was 42% with doses below 6000 cGy, 57% with 6001-7500 cGy and 68% with higher doses. Tumor control in the pelvis was correlated with the following 5 year survivals: Stage IB-95% (353 patients); Stage IIA-84% (116 patients); Stage IIB-84% (308 patients); Stage IIIB-74% (245 patients). The 5-year survival for patients that recurred in the pelvis was 30% for Stage IB, about 15% for Stages IIA-B and only 5% in Stage III. Patients with tumor control in the pelvis had a significantly lower incidence of distant metastases than patients who initially failed in the pelvis (9.3% vs. 58.6% in Stage IB, 21.6% vs 52.6% in Stage IIA, 19.8% vs 16.7% in Stage IIB, and 31.2% vs 50% in Stage III). In Stage IIB the figures were 19.8% and 16.7% because the initial pelvic recurrence was frequently concurrent with distant metastases.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Analysis of pelvic tumor control and impact on survival in carcinoma of the uterine cervix treated with radiation therapy alone. 335 Jul 17

Between March 1978 and April 1984, 144 patients with 148 moderately advanced to advanced primary squamous cell carcinomas of the head and neck received treatment with curative intent with twice-a-day irradiation (120 cGy/fraction, 4-6 hour interfraction interval). Eighty-eight percent of the patients had AJCC Stage III-IV cancers. One hundred and thirty-two patients received irradiation alone to the primary site with or without radical neck dissection, with surgery reserved for salvage. The total doses administered were 7440-7920 cGy in the majority of instances. In 19 patients with oropharyngeal lesions, a 1000-1500 cGy radium needle boost was added after the basic dose. Twelve patients received preoperative irradiation (5040-6000 cGy) followed by primary resection and radical neck dissection. Local control results following irradiation alone to total doses of greater than 7000 cGy with minimum 2-year follow-up were 25/31 (81%), 38/50 (76%), and 5/25 (20%) for T2, T3, and T4 cancers, respectively. Local control rates did not correlate well with total dose. Local control following preoperative irradiation plus primary resection was obtained in 4 of 5 T3 and 2 of 3 T4 primary lesions. The 5-year actuarial rates of neck control were 100% for N0 (45 patients), 90% for N1 (25 patients), 77% for N2 (23 patients), 50% for N3A (9 patients), and 70% for N3B (42 patients). The 5-year actuarial rates of continuous disease control above the clavicles were 73% for Stage III, 64% for Stage IVA, and 32% for Stage IVB. The actuarial 4-year rate of continuous disease control above the clavicles was 78% for Stage II. For patients whose disease was controlled above the clavicles, distant metastases developed in 4% of patients with Stage II-III disease and in 18% of patients with Stage IV disease. Radiation complications following irradiation alone to the primary site correlated with total dose. Complications of planned neck dissection(s) were acceptable. Complications of salvage surgery at the primary site were similar to those seen in patients treated once a day. The actuarial 5-year survival rates, according to modified AJCC stage, were 59% for Stage III, 37% for Stage IVA, and 23% for Stage IVB. The actuarial 4-year survival rate for Stage II was 69%. Compared to historical control groups treated with once-a-day, continuous-course irradiation at our institution, twice-a-day treatment has produced local control results that are higher by 10-15 percentage points.
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PMID:Hyperfractionation for head and neck cancer. 335 Jul 19

From 1982 through 1985, 49 women with advanced cervical cancer were treated with concurrent radiation and cisplatin to assess tolerance to the combined modality regimen and its efficacy in comparison to historical controls at the same institution. Eligibility criteria included clinical stage IV disease; para-aortic lymph node metastases; and bilateral, unresectable, and/or multiple (greater than 3) pelvic node metastases. Nodal status was assessed by extraperitoneal surgical staging in the majority of patients with clinical stage I-IVA disease. There was no increase in acute or chronic toxicity compared to historical controls. No patient required reduction of the planned dose of radiation because of acute toxicity. Comparison with historical controls suggests a modest improvement in relapse-free survival in the cisplatin-treated group with positive para-aortic nodes (59% vs. 54% at 2 yr and 59% vs. 42% at 3 yr). We conclude that adjuvant cisplatin can be given simultaneously with radiation for advanced cervical cancer without excessive toxicity or compromise of the radiation regimen. However, confirmation of the modest improvement in relapse-free survival rates for patients with positive para-aortic nodes and identification of other subsets of patients who may benefit will require a prospective randomized trial.
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PMID:Tolerance and preliminary results of simultaneous therapy with radiation and cisplatin for advanced cervical cancer. 335 86

Of 120 patients with FIGO stage IIA-IVB squamous cell carcinoma of the cervix treated with standard radiotherapeutic techniques, 41 (34.2%) relapsed with hematogenous or serosal metastases. Development of such metastases was individually associated with patient age less than or equal to 55, bilateral bulky parametrial extension, and histologically positive paraaortic nodes. Poor histologic differentiation exerted significant negative influence only in patients age less than or equal to 55. Neither surgical staging nor vascular injury predisposed to hematogenous dissemination. Radiotherapy techniques differed only in increased time to completion, from 84 to 100 days in clinical IIB and IIIB patients developing metastases. Local or regional pelvic recurrences, although associated with an increase in hematogenous or serosal metastases, were not accompanied by concomitant relapse in extrapelvic nodes. Twenty-six of 41 metastases were limited to single organ systems, with pulmonary sites most common (43.9%). A direct (non-nodal) route of hematogenous dissemination of 31% was documented within clinical stages IIA and IIB. One hundred percent concordance between bilateral bulky parametrial involvement and positive pretreatment paraaortic nodes occurred in clinical stage IIIB and IVA patients with metastatic relapse. Our data from the period 1976-1985 do not substantially differ from earlier reports on the incidence or distribution of hematogenous or serosal metastases, despite our implementation of contemporary local/regional radiotherapy prescriptions. The potential for hematogenous and serosal metastases in high-risk patients with advanced squamous cervical carcinoma merits consideration of alternative treatment protocols and precise definition of the role of pretreatment surgical staging procedures.
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PMID:The influence of hematogenous and serosal metastases on advanced (FIGO IIA-IVB) squamous cell carcinoma of the cervix. 382 88


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