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)

Malignant melanoma is the most common metastatic lesion of the intestine, found at autopsy in approximately 60% of patients who die from melanoma. Common symptoms include bleeding, perforation and ileus/subileus. Patients with such symptoms should be operated on immediately, if they are not too reduced because of advanced disease. Long-term survival (five years) has been achieved in 34 of 179 (19%) of stage IVA melanoma patients after a radical operation procedure. Surgical removal of gastrointestinal metastases provides effective palliation in 80-95% of patients, who undergo laparotomy. We describe two patients with gastrointestinal metastases from malignant melanoma. A 33 year-old man had a large melanoma metastasis removed (non-radically) from the small intestine. He recovered rapidly, and experienced good palliative effect for three months, but died from a recurrence of the disease six months after operation. The other patient had a melanoma metastasis in the right lobe of the liver, which was treated by right hemihepatectomy. There has been no recurrence ten months after operation. We recommend surgical removal of abdominal melanoma metastasis if the surgery can be performed without unacceptable risk.
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PMID:[Surgical treatment of gastrointestinal malignant melanoma]. 819 66

From 1965 to 1986, 173 patients with gynaecological cancer received para-aortic radiation treatment using a biaxial-four-segmental-rotating field technique. Seventy-five patients with cervical cancer and proven lymph node involvement were eligible for analysis. Crude survival and disease-free survival in 37 patients with FIGO III and 15 patients with FIGO IVA, receiving initial para-aortic treatment were compared with the corresponding data from patients in whom para-aortic treatment was secondary applied when para-aortic metastases became clinically symptomatic. Five-year survival rates of 37.5% (FIGO III) and 27.3% (FIGO IVA) were encouraging as none of the patients in the secondary group survived for more than 16 months. The number of complications induced by the described method of survived for more than 16 months. The number of complications induced by the described method of para-aortic irradiation appears to be substantially lower than with other methods using equal doses. Five cases of severe but not life-threatening side-effects were observed among 173 treated patients.
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PMID:Radiation therapy of para-aortic lymph nodes in cancer of the uterine cervix. 846 66

Despite their high efficiency in treating cancer of the uterine cervix, surgery and radiotherapy can not cure (local and/or metastatic disease) a certain number of patients with initially adverse risk factors, mostly local or regionally advanced cervical carcinoma (stage III-IVA) or early stage (IB-II) disease with bulky primary lesion or involved regional nodes. Since the 1980s, many investigators have tried to determine whether or not there is any benefit in introducing chemotherapy earlier in the therapeutic plan for these patients: either initially before surgery or radiotherapy (neoadjuvant), or during radiotherapy (concurrent), or after local treatment (adjuvant). In this review we seek to sum up the published data available and to determine if at present there is a place for chemotherapy in the initial treatment of cervical cancer.
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PMID:[Is there a place for chemotherapy in the initial treatment of cervical cancer? Review of the literature]. 868 79

Locally advanced or recurrent cervical cancer is highly responsive to treatment and at least moderately curable with effective aggressive treatment. Radiation therapy is the mainstay of treatment for patients with this cancer. The roles for surgery and chemotherapy are as yet unproved, and both modalities are currently under investigation for their potential roles in the management of these conditions. Exenterative surgery clearly has an established utility for central pelvic failures after prior radiation therapy. Postsurgical pelvic recurrences are rarely successfully treated for cure, but considerable palliative effect is possible. The roles of intraoperative irradiation, sensitizing chemotherapy, and radical resection with interstitial irradiation are all under investigation at this time. Much has been learned over the past several decades about what parameters are important for successful radiation therapy for cervical cancers of stages IIB-IVA. While the traditional staging work-up for these patients included excretory urography, barium enema, examination under anesthesia, cystoscopy, and proctoscopy, there is now good evidence that computed tomography scan with intravenous contrast and office examination and biopsy are sufficient, with cystoscopy reserved for those few patients in whom clinical or imaging data suggest a higher risk of involvement. Surgical lymph node staging, especially of para-aortic lymph nodes, may be worthwhile in certain settings (e.g., for entry into research protocols), but it has no demonstrated role in routine clinical practice. Evidence is clear and convincing that effective treatment for these disease stages requires the inclusion of intracavitary brachytherapy. The role of interstitial brachytherapy is less clear, although there are some fervent advocates of this procedure. The debate continues about the use of low-dose-rate versus high-dose-rate brachytherapy. Treatment dose, volume, and length of treatment course are all important variables with outcome implications. The central disease requires a total dose of 8000-9000 cGy for maximal control probability, with larger tumors requiring the higher doses. The three-dimensional treatment volume must adequately surround the cancer and its likely routes of spread. Overall treatment time should be kept as short as possible, within the limits of conventional, tolerable fractionation. The potential theoretical advantage of hyperfractionated external-beam irradiation has yet to be verified in this disease but is of interest. It will be tested in an upcoming Gynecologic Oncology Group clinical trial. The negative prognostic significance of hypoxia in cervical cancers in general has been reported recently. While tumor cell hypoxia is almost certainly a problem in this disease, hypoxic cell sensitizers have not yet been found to improve treatment results. In clinical practice, reoxygenation probably occurs in these tumors. The role of paraaortic lymph node elective irradiation has been of interest for more than 20 years and was the subject of two randomized trials with quite different results. The Radiation Therapy Oncology Group trial found significantly improved survival in the treatment group assigned to receive paraaortic irradiation, when compared with the pelvic treatment group. However, a similar study by the European Organization for Research and Treatment of Cancer found no difference. The results of treatment today are substantially improved from those seen two decades ago. About 75% of patients with stage IIB disease and fully 50% of patients with stage IIIB disease are now cured with conventional irradiation alone. Clearly, there is still a need for further improvement. Of patients with urinary bladder involvement, 10%-20% are long-term survivors, as are 25%-30% of patients with para-aortic lymph node metastases. While these improvements are significant, there is clearly room for further progress. (ABSTRACT TRUNCATED)
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PMID:Optimal management of locally advanced cervical carcinoma. 902 35

Radiotherapy is standard treatment for women with locally advanced cervical cancer (stage IIB-IVA). Radiotherapy fails to control disease progression within the irradiated field in more than 40% of patients. The disease bulk is a major factor limiting the curative probability of pelvic radiotherapy. Chemotherapy has been integrated with pelvic radiotherapy with the goal of improving local tumor control and treating microscopic metastases outside the radiotherapy field. Simultaneous chemotherapy and radiotherapy, neoadjuvant chemotherapy followed by radiotherapy, and adjuvant chemotherapy after radiotherapy, have been investigated. Hydroxyurea during pelvic radiotherapy has been reported to be associated with an improved progression-free (P = .05) and survival (P = .066) advantage. Several randomized trials of concomitant radiotherapy with fluorouracil, mitomycin, or cisplatin have been completed, but no results are published. Neoadjuvant chemotherapy with cisplatin-containing regimens followed by radiotherapy has been studied in several randomized trials. Although tumor response after chemotherapy is reported in more than 50% of patients, no improvement in local disease control or in survival has been noted overall. In one large trial, neoadjuvant chemotherapy was inferior to standard pelvic radiotherapy in terms of local control and survival. Adjuvant chemotherapy after radiotherapy has been little studied, and no randomized trials have been reported. The results of trials in progress or completed but not yet reported will determine further clinical research directions. Chemotherapy during and after pelvic radiation therapy has been little studied.
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PMID:Concomitant and neoadjuvant chemotherapy in conjunction with radiotherapy in the management of locally advanced cervical cancer. 902 37

We analyzed long-term treatment results in 51 patients with locally advanced uterine cervical carcinoma (IIB, 4; IIIB, 43; IVA, 4) treated with neoadjuvant intra-arterial (I-A) chemotherapy (cisplatin) via the uterine artery and irradiation. Thirty patients (58.8%) developed recurrence. Twelve had pelvic recurrence alone, 8 had distant metastases alone, and 10 had both pelvic and distant failure. The 5-year cumulative pelvic control rate, absolute survival rate, and disease-free survival rate were 55.3, 47.1, and 39.4%, respectively. Eight of 51 patients (15.7%) suffered late complications. These results suggest that our neoadjuvant I-A chemotherapy prior to irradiation has limited additional value for long-term prognosis in patients with locally advanced uterine cervical carcinoma.
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PMID:Therapeutic value of neoadjuvant intra-arterial chemotherapy (cisplatin) and irradiation for locally advanced uterine cervical cancer. 919 Sep 68

A single line source brachytherapy (BT) technique has been developed at Clatterbridge to boost the dose to the primary tumour after whole pelvis external beam radiotherapy (EBRT) for the radical treatment of carcinoma of the cervix. 226 patients with invasive carcinoma of the uterine cervix were treated with radiotherapy alone using this technique (median age 57 years; range 25-87 years). 49 patients had Stage IB disease, 97 had Stage II, 73 had Stage III and seven patients had biopsy confirmed Stage IVA disease. Patients with low bulk disease were given 40-42.5 Gy in 20 fractions while those with bulky disease received 45 Gy in 20 fractions or 50 Gy in 25 fractions. On completion of EBRT, 186 patients (82.3%) proceeded to intracavitary BT using a linear arrangement of sources with the Selectron (Nucletron) remote afterloading unit. Most of the patients (137/226, 60.6%) received a single insertion of 20 Gy to point "A", at a preferred dose rate within the range 0.95-1.05 Gy h-1. In another 30 patients (13.3%), BT was possible at a later date after further tumour regression. Only 10 patients (4.4%) did not receive BT as part of their treatment. The 5 year actuarial cause-specific survival rate was 79% in Stage I disease, 61% in Stage II, 31% in Stage III and 71% in the small number of patients with Stage IVA disease. The 5 year pelvic control rates were 88% for Stage I, 69% for Stage II, 45% for Stage III and 71% for Stage IVA. Significant prognostic variables for survival and local pelvic control on univariate analysis included disease stage, patient age, tumour bulk, nodal status, anaemia, renal failure and overall treatment time. Tumour grade was a significant prognostic variable for survival but not for local tumour control. The extent of parametrial involvement was a significant prognostic variable for survival and local control for Stage IIB but not for Stage IIIB. There was a statistically significant decrease in survival and local tumour control for patients receiving > or = 70 Gy to point "A", or > or = 55 Gy to point "B". On multivariate analysis, the independent prognostic variables for survival and local control were disease stage, overall treatment time and renal failure. Patient age was also an independent prognostic variable for survival while nodal status was an independent prognostic variable for local control. A high proportion of the patients had adverse prognostic features resulting in a very high actuarial risk of distant metastases of 38.1% at 5 years (68.8% for Stage III patients). The overall treatment time was significantly longer in Stage III patients compared with Stage I and Stage II patients. The actuarial rate of Grade 2 late radiation morbidity was 2.7% and 4.3% for the urinary tract and bowel respectively while that of Grade 3 morbidity was only 0.6% and 1.4%, respectively. Good local control can be achieved for patients with nonbulky tumours using relatively low biological doses while minimizing the risk of late treatment related toxicity. Several changes in treatment policy have been made in an attempt to improve local tumour control and possibly survival, particularly for Stage III patients and patients with bulky disease.
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PMID:An audit of the treatment of carcinoma of the uterine cervix using external beam radiotherapy and a single line source brachytherapy technique. 950 45

Radiotherapy is the standard treatment for locally advanced cervical cancer; nevertheless it fails to control disease progression within the irradiation fields in more than 40% of cases, particularly in patients with bulky tumor. Distant metastases are not infrequent in more advanced cases. Chemotherapy has been integrated with radiotherapy to improve local control and treat distant subclinical metastases. Schedules of combined treatment more frequently represented by neoadjuvant chemotherapy followed by radiation (NACT) and by concomitant chemotherapy and radiation (CT-RT). A review of the recent literature is presented. The role of NACT is controversial: high response rates are reported but doubtful advantages in terms of survival or local control have been shown. In randomized trials, hydroxyurea concomitant to radiation improves local control and survival, particularly in stage IIIB and IVA. Several randomized trials of concurrent chemoradiation with 5FU, cisplatin and mitomycin C are underway, but few have been published: no significative differences are reported in term of local control or survival. Acute toxicity is higher than in radiation alone, but usually manageable. For the analysis of late morbidity a longer follow-up is required. Large randomized trials of adequate radiotherapy versus concomitant chemoradiation are necessary to refine our understanding of the benefits of this integrated treatment.
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PMID:Neoadjuvant chemotherapy to radiation and concurrent chemoradiation for locally advanced squamous cell carcinoma of the cervix: a review of the recent literature. 962 Feb 50

Vascular endothelial growth factor (VEGF) is closely related to angiogenesis in various human cancers. However, little is known of its circulating levels in hepatocellular carcinoma (HCC). We examined circulating VEGF levels in chronic liver disease to assess their clinical significance. Plasma VEGF concentrations were determined, by enzyme immunoassay, in patients with chronic hepatitis (CH; n = 36), liver cirrhosis (LC; n = 77), and HCC (n = 86) for a cross-sectional study. Plasma VEGF levels in healthy controls (n = 20) and CH, LC, and HCC patients were 17.7 +/- 5.4 (mean +/- SD), 30.6 +/- 22.8, 34.4 +/- 27.0, and 51.1 +/- 71.9 pg/ml, respectively. The levels were significantly elevated in the HCC group, compared with the control, CH, and LC groups. Plasma VEGF levels in stage I, II, III, IVA, and IVB HCC patients were 27.6 +/- 16.1, 26.5 +/- 13.7, 35.8 +/- 15.3, 45.4 +/- 39.4, and 103.1 +/- 123.2 pg/ml, respectively. The stage IVB patients with remote metastasis showed significantly marked elevation compared with the patients at the other stages. Platelet numbers were weakly correlated with plasma VEGF levels in the HCC group. Plasma VEGF level was highly elevated in patients with HCC, particularly those with metastatic disease. We consider that plasma VEGF is a possible tumor marker for metastasis of HCC. Circulating VEGF may be derived mainly from the large burden of tumor cells, and partly from platelets activated by the vascular invasion of HCC cells.
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PMID:Circulating vascular endothelial growth factor (VEGF) is a possible tumor marker for metastasis in human hepatocellular carcinoma. 965 17

We studied the long-term outcome of percutaneous isolated hepatic perfusion (PIHP) for patients with hepatocellular carcinoma. This study included 31 patients with Stage IVA and 5 with IVB disease treated by PIHP until December, 1997. The mean age and tumor diameter were 55 and 7.7 cm, respectively. Twenty-two had portal vein invasion, 13 had hepatic vein invasion, and all patients had multiple intrahepatic metastases of more than 5 tumor foci. The PIHP with adriamycin or cisplatin was undertaken in a total of 50 treatments in these 36 patients. CR was observed in 6 and PR in 13 with an overall response rate of 59%, excluding 4 patients who were not evaluable. Five of 6 patients with CR remain free of disease at 7 to 54 months after the first treatment. The overall survival rate was 67% at 1 year and 32% at 5 years. The survival rates of Stage IVA patients (1-year = 71%, 5-year = 36%) were higher than Stage IVB patients (1-year = 20%, 5-year = 0%). The 5-year survival rates of patients with vascular invasion (Vp1-3 = 23%, Vv1-3 = 8%) were lower than those without it (Vp0 = 47%, Vv0 = 51%). These results indicated that PIHP achieved a 5-year survival rate of approximately 40% in patients with multiple advanced hepatocellular carcinoma in the absence of distant organ metastases and marked vascular invasion, and yielded complete long-term remission in some of these patients.
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PMID:[The long-term results of percutaneous isolated hepatic perfusion for patients with advanced hepatocellular carcinoma]. 970 4


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