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

The survival of patients with locally advanced cancer of the cervix (stage IIB, IIIB, and IVA) treated with conventional intracavitary radium remains unsatisfactory. Over 50% of these patients are local failures and die with uncontrolled tumor in the pelvis. In 1978, we began performing transperineal interstitial implants to the parametria in patients with advanced disease. One hundred six evaluable patients (34 IIB, 67 IIIB, and five IVA) received one (99) or two interstitial implants (7) following 40-50 Gy of external supervoltage external irradiation. In addition, seven patients underwent exploratory staging laparotomies concurrently with the first implant procedure. Mean follow-up is 23 months and range is 12-60 months. Control of the pelvic tumor has been documented in 85%, 75%, and 40% of stage IIB, IIIB and IVA patients, respectively. Seven patients developed distant metastases and three died of intercurrent disease with no evidence of pelvic relapse. Nineteen patients (18%) developed radiation-related complications: proctitis or cystitis (six), rectal stenosis (six), ulceration and necrosis of the vaginal wall (one), and recto- or vesicovaginal fistula (six). It is noteworthy that 7/11 patients (64%) who had radioactive sources placed on the surface of the vaginal obturator as a substitute for an intrauterine tandem developed severe complications. We conclude that transperineal interstitial irradiation is both safe and an effective modality in the treatment of advanced cancer of the cervix.
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PMID:Treatment of locally advanced cancer of the cervix with transperineal interstitial irradiation. Report on 106 cases. 663 76

CT scanning was performed on 68 consecutive patients with newly diagnosed, untreated carcinoma of the uterine cervix (FIGO stage IB-IVA). Lymphography was performed in 61 cases. Surgical pathological correlation was obtained in 16 patients. CT and clinical stage accorded only in 68%, mainly because of CT errors in the determination of parametrial involvement. CT detected enlarged lymph nodes in 60.5%, compared to 39.5% of cases with lymphographically demonstrated nodal metastases; this discrepancy resulted mainly from the inability of CT to discriminate benign nodal changes. Our data suggest lymphography as radiological staging procedure in early stage (IB, IIA) carcinoma and the routine use of CT in advanced stage (IIB-IV) disease.
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PMID:Value of computed tomography and lymphography in staging carcinoma of the uterine cervix. 673 9

For 32 months, clinical and computed tomographic (CT) staging were compared prospectively in 75 patients with primary untreated cervix carcinoma. Clinical stages evaluated were IA (one patient), IB (nine) IIA (five,) IIB (18), IIIB (38), IVA (one), and IVB (three). CT agreed with clinical stage in 65%, upstaged tumors in 19%, and downstaged tumors in 16%. In comparison with surgical stage in 25 patients, CT was inaccurate in differentiating IB from IIB lesions but highly accurate in diagnosing IIIB, IVA, and IVB tumors. Pretreatment CT was most valuable in assessing parametrial and sidewall tumor extension, uterine size, endometrial tumor extension, pelvic adenopathy, and adnexal masses. Posttreatment CT in 15 patients was most valuable in assessing extrapelvic metastases to liver, paraaortic lymph nodes, and bowel mesentery. CT offers distinct advantages over current radiologic staging techniques and can be integrated into the present international Federation of Gynecology and Obstetrics classification of cervix carcinoma.
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PMID:Prospective comparison between clinical and CT staging in primary cervical carcinoma. 697 28

One-hundred-two patients with Stage III and IV malignant melanoma were analyzed to determine whether immunologic status in terms of skin testing along with sex and age played a role in recurrence and survival. Before treatment, patients had skin tests with five recall antigens (monilia, mumps, PPD, SK-SD, trichophyton) along with phytohemagglutinin (PHA). Univariate statistical analysis revealed sex as the major significant variable with respect to survival for Stage IVB patients, with female patients surviving longer than males. Patients with resected disease and greater SK-SD skin test reactivity tended to survive longer than those with impaired reactivity. Similarly, reactivity to trichophyton was associated with improved survival among patients with metastases. A multivariate analysis of the patients shows improved remission duration with mumps positivity in Stage III and Stage IVA patients. It appears that certain skin tets analyzed in this fashion have prognostic importance in these patients and should be analyzed with other variables of disease status.
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PMID:An analysis of skin tests and their relationship to recurrence and survival in stage III and stage IV melanoma patients. 707 48

One-hundred-two patients with malignant melanoma who had distant metastases surgically resected and were judged to be clinically free of disease (M. D. Anderson Stage IVA melanoma) were studied. The median survival for all the patients from time of diagnosis of stage IVA disease was 18 months. The site of the resected metastases did not appear to influence survival, being approximately the same for the brain (15 months), lung (16 months), intraabdominal (18 months), and skin and/or lymph nodes (23 months). The site of the resected metastases also did not influence the median disease-free interval. Patients who had metastases resected from several organs at the same time had a median survival of 15 months, which was similar to that of patients with one resected site. Patients who were rendered Stage IVA on several occasions by surgical excisions had a median survival of 36 months. Thirty-five patients received surgery only and 67 patients received adjuvant chemotherapy, immunotherapy, or combined chemoimmunotherapy after surgery. For the group treated with surgery only, the median disease-free interval and survival from diagnosis of stage IVA disease were 6 months and 16 months, respectively, and for the adjuvant group 6 months and 21 months, respectively. Specifically, by the type of adjuvant therapy, the median disease-free interval and survival from stage IVA for 23 patients receiving Corynebacterium parvum were 6.9 and 19 months; for 39 patients receiving BCG, eight months and 26 months; for 24 patients receiving BCG + DTIC, eight and 17.4 months; and for all 51 DTIC treated patients 6.3 and 17.8 months, respectively. Patients receiving BCG had a median survival superior to the surgery only group (P = 0.02). An increase in survival was seen predominantly in patients who achieved IVA status more than once and received BCG. Patients with recurrent soft-tissue metastases appeared to benefit most from BCG in prolonging the disease-free interval. Only 1/10 treated by surgery alone had a disease-free interval longer than 1 year, compared with 9/16 who received BCG (P = 0.01). Stage IVA melanoma appears to be distinctly different in prognosis from Stage IVB melanoma and should be classified separately. Patients with recurrent soft-tissue disease may benefit significantly from treatment with BCG.
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PMID:The natural history of resectable metastatic melanoma (Stage IVA melanoma). 711 98

The prognostic effect of pretreatment patient- and tumor characteristics, and the influence of radiotherapy schedule on local control, distant metastases, and crude survival were analyzed in 424 consecutive patients with FIGO stage IIB (n = 137), IIIA (n = 10), IIIB (n = 211) and IVA (n = 66) cancer of the uterine cervix. All patients were given radiotherapy alone. From 1974 and through 1977, the external and intracavitary combined radiotherapy was given continuously in 4 to 6 weeks. From 1978 and through 1983, the treatment policy was changed to split-course radiotherapy by introducing planned pauses, resulting in an overall treatment time of 10 to 12 weeks. The results were estimated by univariate actuarial- and Cox multivariate regression analyses. Multivariate analysis showed that significant adverse variables for local control were large lateral tumor diameter, young age, low hemoglobin at time of admission, many pregnancies, split-course strategy, and high FIGO stage. Risk of metastases increased with decreasing hemoglobin, increasing malignancy grade and split-course treatment. Poor survival probability were related to large lateral tumor diameter, high malignancy grade and FIGO stage, low hemoglobin, split-course therapy, and adeno/adenosquamous tumor type.
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PMID:Prognostic value of pretreatment factors in patients with locally advanced carcinoma of the uterine cervix treated by radiotherapy alone. 757 47

Thymomas is a rare disease. Staging systems and surgical adjuvant treatments remain controversial. We retrospectively reviewed the outcome and the prognostic factors in a series of 149 patients with non metastatic thymomas treated in ten French cancer centers between 1979 and 1990. Patients were staged according to the "GETT" classification derived from that of Masaoka. There were 13 stage I patients, 46 stage II, 58 stage III and 32 stage IV. Surgery consisted of complete resection in 63 patients, partial resection in 31 patients and biopsy alone in 55 patients. All patients received postoperative radiation therapy and 74 were given postoperative chemotherapy. Median follow-up was 7.7 years. Local control was obtained in 117 patients (78.5%) and was influenced by the extent of surgery (p < 0.0001). Metastases occurred in 26 patients. Seven patients developed grade 3-4 pulmonary and heart complications. One patient developed a malignant lymphoma after 24 cycles of chemotherapy. Disease-free survival (DFS) rates were of five years 92%, 75%, 60%, 39% and 48% in stage I, II, IIIA, IIIB and IVA patients, respectively. After complete resection, partial resection and biopsy alone, these rates were 74%, 60% and 38%, respectively. With a multivariate analysis, DFS rates were influenced by the extent of surgery (p < 0.001) and by chemotherapy (p < 0.001). Three other factors could predict a worse DFS: young age (p < 0.006), stages III-IV (p < 0.04) and mediastinal symptoms (p < 0.001), "GETT" staging correlated well with local control and survival. After complete resection, a 50 Gy postoperative radiation therapy can be recommended in patients with invasive thymomas. Despite a 65% local control rate after partial resection or biopsy alone in this series, a higher dose of radiation (> 60 Gy) must be evaluated. Despite the benefit of the chemotherapy in this retrospective and multicentric study, the role of this treatment remains to be assessed.
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PMID:[Radiotherapy of thymoma. Study of the literature apropos of a retrospective and multicenter series of 149 cases]. 770 40

Total hepatectomy plus liver transplantation was performed on 105 patients considered unsuitable for liver resection. Postoperative 5-year actuarial survivals correlated with the pathologic stage of the tumor: stage I 75%, stage II 68%, stage III 52.1%, and stage IVA 11%. The overall 5-year survival for all patients was 36%. Nodal disease, bilobar tumor, and macroscopic venous invasion were significant poor-prognosis features. In addition, 12 patients with pT4N1M0 lesions (also stage IVA) had hepatectomy plus more extensive en bloc regional resection (Whipple procedure or cluster resection) plus transplantation in an effort to prevent local recurrence. Only 2 of these 12 patients (16.7%) are alive and free of disease after 2 years. Seven patients (58%) have died from tumor recurrence usually originating from distant metastases an average of 10.6 months after transplantation. Successful transplantation for hepatoma depends on screening programs to identify early stage disease. Successful outcome of transplantation for late stage disease, which includes most of the patients in our series, awaits the development of neoadjuvant therapy to control distant microscopic metastases, which are almost certainly present though not apparent at the time of transplantation.
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PMID:Liver transplantation for hepatocellular carcinoma. 774 Aug 11

In patients with locally advanced cervical cancer, most of the treatment failures occur within the pelvis. In an attempt to improve local control, 40 patients with bulky tumors (stage IB > 5 cm, stage IIB with distal parametrial invasion, and stage III-IVA) were treated between 1988 and 1992 with concurrent chemoradiation (CCR). The whole pelvis received a midplane dose of 45 Gy over 33 days. Daily radiation dose was 1.8 Gy, with twice-daily fractionation in the last 20 patients. Chemotherapy was administered on the 1st and 21st days of radiation therapy (RT) consisting of cisplatin (60 mg/m2), followed by 5-fluorouracil (600 mg/m2/day continuous i.v. infusion) over 96 hr (and decreased to 40 and 400 mg/m2, respectively, in the last 23 patients). CCR was first followed by a single intracavitary application and then by a parametrial boost in stage IIB-III patients and in stage IVA patients with disease reaching the pelvis side wall. Then surgery (colpohysterectomy with lymphadenectomy or pelvic exenteration) was performed in 35 patients. Median follow-up time was 2.6 years (0.6-5.6 years). Acute toxicity (WHO grade 3-4 diarrhea) in 13 patients led to 6 RT interruptions and 4 incomplete RTs. One patient died of a septic episode without leukopenia after completion of CCR. Five postexenteration complications required a second surgical procedure, of which one patient died with tumor and small bowel fistula. One patient developed small bowel late complication and another patient developed urinary late complications. No postoperative or late complications were observed in patients treated with twice-daily fractionation. Pelvic control was achieved in 32 of 40 patients (81 and 74% in stage IB-IIB and stage III-IVA, respectively). Sites of failure were the pelvis (6 cases), metastases (7 cases), and both (2 cases). Two-year survival and DFS rates were 61 and 66%, respectively, in stage IB-IIB and 77 and 65% in stage III-IVA. High SCC-TA4 values significantly worsened DFS rates. In patients with stage III-IVA tumors, additional surgery could be an important component of this treatment strategy and may be compatible with CCR using twice-daily fractionation radiotherapy. However, these results must be confirmed by a large-scale prospective study.
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PMID:Concomitant chemoradiation prior to surgery in the treatment of advanced cervical carcinoma. 802 Aug 42

Endometrial stromal sarcoma (ESS) is a rare uterine malignancy with a variety of morphologic characteristics and clinical courses. We describe a case of high-grade malignant ESS in an adolescent girl, arising in a rudimentary uterine horn and presenting symptoms of an acute abdomen. The patient underwent a total abdominal hysterectomy with bilateral salpingo-oophorectomy and omentectomy due to a stage IVA high-grade ESS. An adjuvant chemotherapy and radiotherapy treatment was recommended, but 10 days after her discharge the condition of the patient deteriorated, with diffused metastases into the lungs and the abdomen, and finally she succumbed to the disease 1 month after her first admission to the hospital.
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PMID:High-grade endometrial stromal sarcoma in a 16-year-old girl. 802 Aug 47


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