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)

Two hundred eight cases of intraductal breast carcinoma (DCIS) were selectively treated; 97 with mastectomy, 96 with radiation therapy, and 15 using excisional biopsy only. Mastectomy patients tended to have larger tumors, involved biopsy margins, palpable and often multifocal tumors. Breast preservation patients tended to have smaller, often occult, tumors with clear surgical margins. Before 1983, mastectomy was more common; during and after 1983, breast preservation was more common. Comedocarcinomas were the most frequent tumors. They were the largest, had the highest percentage of microinvasion (20%), and had the highest recurrence rate (8%). Noncomedo DCIS had a recurrence rate of 1%, one of 103 tumors. The recurrence rate for comedocarcinomas treated with radiation therapy was nearly three times higher than for those treated with mastectomy (11% versus 4%). One of 164 (0.6%) axillary lymph node dissections yielded positive nodes. Nine patients have recurred: two in the mastectomy group and seven in the breast conservation group (P less than 0.1). Eight of nine recurrences were the comedo subtype (P less than 0.05). Three patients developed metastatic disease, two of whom have died. Axillary dissection for intraductal carcinoma of the breast is unlikely to yield involved nodes and is not indicated for most cases. It should be reserved for lesions revealing microinvasion. Conservative therapy for comedocarcinoma must be viewed with caution.
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PMID:Intraductal carcinoma of the breast (208 cases). Clinical factors influencing treatment choice. 216 38

In 481 patients, with sonographically suspected neoplastic involvement of the liver, we performed an ultrasonically guided fine-needle aspiration biopsy with 22-gauge Chiba needle. In the 441 controlled cases, we obtained 68.5% true positive, 26.5% true negative, and 5% false negative, with a sensitivity of 93.2%, specificity of 100%, and overall accuracy of 95%. The true positive include 42.1% hepatocellular carcinomas, 28.1% metastases from known extrahepatic malignancy, 24.5% metastases from unknown primary site, 5% hepatic involvement by non-Hodgkin lymphomas, and 0.3% undetermined malignancy. Also, in a larger series, ultrasonically guided fine-needle biopsy confirms its high specificity and overall accuracy. The cytologic assessment of the obtained material is almost always adequate. The use of immediate cytologic staining reduces the number of passes in each lesion with absence of insufficient sampling. Biopsy with fine cutting needles should be reserved only for cases not diagnosed by cytology.
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PMID:Ultrasonically guided fine-needle aspiration biopsy: a highly diagnostic procedure for hepatic tumors. 216 50

Thirty-seven patients with 69 suspected hemangiomas found by means of computed tomography (CT) and/or ultrasound were studied with both 0.5-T magnetic resonance (MR) imaging and single photon emission CT (SPECT) with technetium-99m-labeled red blood cells. Using a criterion of "perfusion-blood pool mismatch," SPECT readers diagnosed 50 of 64 hemangiomas and all five "nonhemangiomas" (sensitivity, 78% [95% confidence interval, 0.664 - 0.864]; accuracy, 80% [0.69 - 0.877]). Qualitative analysis of lesion signal intensity on T2-weighted spin-echo MR images allowed readers to diagnose 58 of 64 hemangiomas and four of five nonhemangiomas (sensitivity, 91% [0.814 - 0.96]; accuracy, 90% [0.807 - 0.951]). Because of the significantly higher cost of MR imaging and its inability to categorically differentiate hemangiomas from hypervascular metastases, the authors consider SPECT to be the method of choice for diagnosing hepatic hemangiomas. MR imaging should be reserved for the diagnosis of lesions smaller than 2.0 cm and for those 2.5 cm and smaller adjacent to the heart or major hepatic vessels; in such cases MR imaging was found superior to SPECT.
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PMID:Definitive diagnosis of hepatic hemangiomas: MR imaging versus Tc-99m-labeled red blood cell SPECT. 219 77

One hundred seventy-two patients with advanced breast cancer were randomized to receive oral standard-dose megestrol acetate (MA), 160 mg/d or high-dose MA, 800 mg/d. All but two patients had one prior trial of tamoxifen therapy for either metastatic disease (74%) or as adjuvant treatment (26%). Pretreatment characteristics were similar for both arms. High-dose MA resulted in a superior complete plus partial response rate (27% v 10%, P = .005), time to treatment failure (median, 8.0 v 3.2 months, P = .019), and survival (median, 22.4 v 16.5 months, P = .04) when compared with standard-dose therapy. These differences remained significant after adjustment for other covariates. Thirty-four patients were given high-dose MA after failure of standard-dose MA treatment, and none responded. Weight gain was the most distressing side effect, with 13% of standard-dose and 43% of high-dose patients gaining more than 20 lbs. Four major cardiovascular events occurred in patients receiving high-dose treatment and one in patients given standard doses. Other toxicity was modest. High-dose MA may represent a significant improvement in secondary endocrine therapy for advanced breast cancer patients refractory to initial endocrine treatment, but its use on a regular basis should be reserved until these results are confirmed by other clinical trials.
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PMID:High- versus standard-dose megestrol acetate in women with advanced breast cancer: a phase III trial of the Piedmont Oncology Association. 223 Aug 68

In summary, neither radiation nor surgery is clearly superior. The benefits of surgery include: 1) emotional satisfaction that the tumor has been removed, 2) accuracy of surgical staging, 3) preservation of the ovaries, 4) no secondary uterine cancer (a very uncommon problem), and 5) complications that are more readily correctable. Radiation offers the major advantages of being useful in most patients regardless of age or medical condition and is the choice for large cancers. Because stage IB cervical cancer is a very diverse pathological entity with a number of potential prognostic factors (including cell type, depth of invasion, tumor volume, lymphatic space involvement, and occult lymph node metastases), and because patients present with a number of other conditions (including excess weight, advanced age, prior pelvic surgery or infection, and severe medical illness), we are fortunate to have two good methods for treating cervical cancer. Prospective randomized studies will be necessary in the future to better define specific advantages in the various clinical settings. But, in general, the following have proven most expedient: 1) class I hysterectomy, for microinvasive cancer of 3 mm invasion or less without lymphatic space involvement, 2) modified, extended hysterectomy (class II) and pelvic lymphadenectomy for lesions of 3 mm and lymph vascular space involvement or when the lesion seems to just exceed 3 mm and for very early adenocarcinoma, 3) an extended hysterectomy (class III) and pelvic lymphadenectomy for larger IA2, IB, and IIA lesions that are less than 4 cm, particularly for the pregnant or younger patient, and when ovarian conservation is desired, 4) radiation therapy is used for lesions over 4 cm and for women with severe medical illness making extended hysterectomy too hazardous, 5) combination therapy and chemotherapy are now reserved for study in poor prognosis patients with very large lesions (greater than 6 cm), occult metastases, and unfavorable histologic criteria (Table 2).
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PMID:Surgery or radiation for early cervical cancer. 228 54

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

Poor long-term results following the surgical management of small cell carcinoma have contributed to the opinion that small cell carcinoma is a non-surgical disease; polychemotherapy is generally given preference. As nowadays adequate therapy (chemotherapy) achieves control of local tumor growth as well as of extended metastases, surgical resections should be discussed from a different viewpoint: "Does surgery profit from modern chemotherapy?" In our clinic, 1332 patients have been operated on for bronchogenic carcinoma from 1973 to 1983: 170 (12.8%) suffered from small cell carcinoma. The indications for surgery were either non-histologically classified tumors (e.g. peripheral coin lesions) or small cell carcinomas stage I, and only in rare cases for palliative reasons. Lobectomy, including bronchoplastic and arterioplastic resections (n = 108), was the most common procedure. The postoperative mortality was 15%, the average survival 341 days, the latter having improved significantly since 1979 when a postoperative polychemotherapy (ACO) was instigated. Recent results of surgical resection after primary chemotherapy are encouraging. Nevertheless, this new concept is reserved for the few cases of strictly limited disease and must be controlled by future studies.
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PMID:Surgical resection and adjuvant chemotherapy for small cell carcinoma. 242 46

Endoscopically placed biliary endoprostheses were used to treat obstructive jaundice in 71 patients with ampullary carcinoma. Successful placement of an endoprosthesis was achieved in 68 patients (95.8%). Bilirubin declined in 67 patients (98.5%). There was no procedure-related mortality. Twenty-two patients (31%) received further surgical therapy, and 47 received an endoprosthesis as their only therapeutic intervention. In the latter group, bilirubin normalized in 44 of 46 patients surviving longer than 30 days (95.7%). Mean survival was 466 days (median 410, range 23-1515), which compares favorably with surgical palliation. Complications mainly involved clogging of the endoprosthesis, which was easily treated endoscopically and, more significantly, duodenal stenoses secondary to continued tumor growth in almost 25% of the patients. Although endoscopic drainage is a safe and effective method of relieving biliary obstruction in patients with ampullary carcinoma, we feel it should be reserved for poor surgical candidates and for those patients with a limited life expectancy due to metastatic disease.
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PMID:Carcinoma of the ampulla of Vater. The role of endoscopic drainage. 245 91

Renal carcinomas have a very variable natural history and are generally not very sensitive to medical treatment particularly chemotherapy. The response rates obtained in metastatic cancer with various drugs and combinations do not exceed 15% for a duration of response of several months. The most effective drugs are vinca alkaloids such as vinblastine. Over recent years, interferon has been tested in this type of tumour with discordant results reported in the literature. However, it seems that by using high doses of the order of 15 to 20 million units per m2, three times a week, the response rates are of the order of 20% for a duration which may be as long as one year in responding patients. In combination with vinblastine, some authors have obtained response rates of the order of 40%. Treatment is especially effective in the case of lymph node recurrence or small lung metastases. It is of no value in cases of visceral, bone or hepatic dissemination. It is frequently poorly tolerated systemically because of the high doses administered and it is expensive. It should therefore be reserved to young patients and to patients with an reasonable life expectancy. In cases of operated renal cancer at risk of recurrence because of local or lymph node spread, no adjuvant medical treatment has yet been proven to be effective.
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PMID:[Value of medical treatment of cancer of the kidney]. 247 15

Primary mediastinal seminoma is an uncommon lesion and should be included in the differential diagnosis of mediastinal tumors. Symptoms and signs may not be clear and in most cases the diagnosis is made by sternotomy or thoracotomy. Our recommendation is that patients with primary mediastinal seminoma should undergo curative resection or reductive surgery. Curative resection should be followed by radiation therapy. Chemotherapy with cisplatin-containing combinations should be reserved for patients who have metastases at the time of diagnosis.
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PMID:[Primary mediastinal seminoma]. 266 40


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