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

Treatment with a combination of radiation therapy and chemotherapy currently allows about 80 per cent of patients with epidermoid carcinomas of the anal canal to retain anorectal function, with about a 70 per cent likelihood of cure at 5 years. In these programs, radical surgery is reserved for the management of residual cancer or of radiation- or chemotherapy-induced anorectal toxicity. Several different schedules of combined modality therapy are in use, but an important common element in most schedules appears to be the concurrent administration of radiation and 5-fluorouracil. The improvement in local control rates with combined radiation and chemotherapy, as compared to most series treated by either radical radiation or radical surgery, has not been matched by a marked improvement in survival rates, and the risk of distant metastases does not appear to have been altered by these combinations. The success of the combinations in improving local control has allowed the indications for local excision to be defined more narrowly, and should reduce the risks of local recurrence associated with conservative surgery.
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PMID:Current management of epidermoid carcinoma of the anal canal. 329 50

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

Patients with retinoblastoma diagnosed from 1969 to 1980 have been followed up for periods of up to 17 years. Data from a previous study of patients diagnosed from 1962 to 1968 have been included for analysis of incidence and second primary tumours, and for study of trends in treatment. The registration rate in Britain (which may be about 10% less than the true incidence) is about one in 23,000 live births, approximately 40% of cases being known to be genetic. There is no apparent trend in incidence during the period covered by these two studies. The three-year survival rate in 88%. Patients with bilateral tumours have a better survival rate than those with unilateral tumours for the first few years, but their long-term survival rate is worse because of later deaths from ectopic intracranial retinoblastoma or second primary neoplasms. Older children tend to have a worse prognosis, which is related to the fact that their tumours are diagnosed at a more advanced stage. There is a significantly higher survival rate for boys than for girls; this is partly accounted for by difference in age and stage at diagnosis between the sexes. Children referred to units specialising in the treatment of retinoblastoma have a higher three-year survival rate than those treated at other hospitals. Comparing methods of treatment between the periods 1962-8 and 1969-80, we find there has been a trend towards more conservative treatment. The use of chemotherapy is now usually reserved for recurrences and metastases and for palliative treatment in terminal retinoblastoma.
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PMID:Retinoblastoma in Great Britain 1969-80: incidence, treatment, and survival. 341 51

Giant cell tumor GCT of bone remains a difficult and challenging management problem because there are no absolute clinical, radiographic, or histologic parameters that accurately predict the tendency of any single lesion to recur or metastasize. Enneking's and Campanacci's radiographic classifications and surgical staging are helpful in planning the initial surgical treatment, because they have observed that a number of the active (Stage 2) lesions and most of the aggressive (Stage 3) lesions have a higher incidence of local recurrence when treated by curettage alone. The bad reputation of curettage and bone grafting is undeserved and arose because of the indiscriminate application of this technique to lesions irrespective of their surgical stage. The ideal aim in the management of GCT is to eradicate the tumor and still save the joint. Curettage, possibly with adjuvant chemical or thermal cauterization, and with bone grafting or polymethyl methacrylate instillation, maintains the structural integrity of the bone and allows for early function. Good results with these techniques when applied to Stage 1 and many Stage 2 lesions may be expected in 70%--80% of the cases. Repetitive freezes with liquid nitrogen, though resulting in a lower recurrence rate, carry with them a not insignificant risk of local complications, require prolonged bracing, and incur the risk of late fracture. When GCTs occur in expendable bones, en bloc resection is the treatment of choice. En bloc resection of major joints requires a facility with reconstruction techniques including the use of allografts, large autogenous grafts and fusion, or custom arthroplasty. These are technically difficult procedures with many early and late complications. Patients have restricted function, and may require prolonged bracing even when uncomplicated. These techniques are therefore reserved for the Stage 3 and selected Stage 2 lesions. Hand lesions have been ineffectively treated by curettage and grafting, and are best treated by early en bloc or ray resection. Multicentric lesions should be handled as individual primary tumors would be in those locations. Radiation therapy has its major role in the treatment of giant cell tumors of the spine and sacrum that are not amenable to complete surgical resection, though long-term sarcomatous change must be looked for. Because of the complex management problem this rare tumor presents, it is recommended that management of giant cell tumor of bone, including the biopsy, the definitive surgery, and the follow-up examination, be carried out by individuals and institutions familiar with this entity.
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PMID:Giant cell tumor of bone. 351 36

The use of imaging procedures for breast cancer staging and follow-up should be based on the natural history of the disease as well as the accuracy, cost, and availability of the studies themselves. Early detection of metastases may provide palliation but probably does not affect survival. For staging, chest X-ray and mammogram are both recommended on all patients; radionuclide bone scan is advised in the presence of either an elevated alkaline phosphatase, axillary metastases, or a primary tumor measuring more than 2 cm; abdominal CT should be performed if liver chemistries are abnormal; CT brain scan is the procedure of choice for neurological symptoms. Chest CT should be reserved for selected patients with an abnormal chest X-ray. Follow-up recommendations include annual chest X-rays and mammogram, bone scans every 5 years when a staging scan was indicated, and CT of the liver and/or brain in the presence of appropriate symptoms or laboratory values.
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PMID:Imaging techniques and guidelines for evaluation and follow-up of breast cancer patients. 355 14

Following intra-arterial chemotherapy (5-fluorouracil), wide hepatic resection was performed in three patients with metastases from colorectal cancer. These surgical procedures had been considered to be unfeasible before chemotherapy in two of the three cases because of the extension of the metastases. In contrast to the results of preoperative imaging techniques (CT scan, ultrasonography), the histologic response of tumors to chemotherapy was found to be significant (1/3) or complete (2/3). Since after chemotherapy these imaging procedures are unable to determine whether the observed lesions are tumoral, fibrotic or necrotic, a laparotomy after hepatic intra-arterial chemotherapy is proposed to obtain specimens for histopathologic examination and an assessment of resectability. This procedure should be reserved for patients in whom substantial benefit can be expected considering the extension of primary and metastatic disease.
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PMID:[Response to hepatic intra-arterial chemotherapy for metastases of colorectal cancer. Anatomo-pathological evaluation apropos of 3 cases of secondary hepatic excision]. 355 63

The patient described here, with malignant non-beta islet cell tumor of the head of the pancreas, was treated by resection of the tumor and metastases. Additional pathology of perforated duodenal ulcer and pyloric stenosis required vagotomy and pyloroplasty. The maintenance of normal gastrin levels after the operation indicates a good prognosis. We believe that the low-risk Zollinger-Ellison patient should be treated surgically and the tumor removed. When no tumor can be detected, parietal cell vagotomy should be performed to assist the pharmacological control of the gastric acid hypersecretion. Extensive surgery, such as total gastrectomy, is no longer the treatment of choice and is reserved for the so-called "cimetidine failure."
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PMID:Conservative surgery in Zollinger-Ellison syndrome: report of a case with an eight-year follow-up. 359 93

The International Staging System for Lung Cancer provides for classification of six levels of disease extent in five stage groups that relate to patient management and prognosis. Stage 0 is reserved for patients with carcinoma in situ. The Stage I and II definitions provide for classification of two levels of disease extent completely contained within the lung that have different prognostic and therapeutic implications. Definitive resection is the first choice of therapy for patients with non-small cell lung cancer in these stage groups. The Stage II category takes into account the erosion of survival expectations in the optimum group of T1 and T2 patients as a consequence of intrapulmonary lymph node involvement. Although small cell carcinoma is infrequently encountered as Stage I and Stage II disease, these classifications may be useful in the structure of investigational programs involving adjuvant surgery. The exclusion of distant metastases and the division of Stage III into two levels of extrapulmonary disease allow for selection of patients for specific treatment plans. Patients with non-small cell tumors with Stage IIIa disease usually are candidates for definitive surgical treatment. The specificity of the T and N definitions in the Stage IIIa and IIIb categories identifies patients for whom particular radiotherapy treatment plans are structured and protocol assignments are made. It is consistent with patient management concepts that all those with distant metastases are classified as having Stage IV disease. Implications of the system for selection of surgical, radiotherapeutic, and chemotherapeutic regimens are rational for all cell types. The classification meets the requirement for simplicity and can be readily applied in a broad spectrum of clinical and teaching environments. It is, however, sufficiently specific to be useful for reporting results of investigational therapies. Prospective use of the classification should encourage precision in clinical evaluations that exploit full use of refinements in imaging technologies. The cooperative efforts of the Task Force on Lung of the AJCC and the TNM Committees of the UICC to bring this classification system to fruition and international acceptance have been described. It has been adopted by these groups and others, including the International Association for the Study of Lung Cancer, the Japanese Cancer Committee, and the Spanish Society of Respiratory Disease, as their official recommendation for staging lung cancer.
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PMID:The new International Staging System for Lung Cancer. 362 29

Sixty-four cases of stage I vulvar squamous cell carcinoma were analyzed histologically to define a patient subset at minimum risk for recurrence or nodal metastases. Three patterns of invasion were predefined: carcinoma in situ with early stromal invasion (33%), pushing (8%), and infiltrative (59%). Infiltrative pattern and invasion deeper than 1.5 mm equally predicted nodal metastases (P = .045), although depth measurement in biopsy specimens was subject to sampling error. Confluence and absence of carcinoma in situ each predicted extranodal recurrence (P = .011). Local recurrence appeared more related to inadequate surgical margins than failure to perform radical vulvectomy. Carcinoma in situ with early stromal invasion represents a group at zero risk for nodal metastases. We recommend wide local excision for all stage I lesions. In general, omission of lymphadenectomy should be reserved for cases of carcinoma in situ with early stromal invasion.
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PMID:Histologic prognosticators in stage I squamous cell carcinoma of the vulva. 365 90

On the background of the advantageous prognosis of patients with testicular tumors we define subgroups in which therapy can be reduced. Basing on the distribution of metastases, especially the localisation of solitary nodes, staging LA may be limited to certain regions in patients with non-seminomas. The modification of irradiation fields for seminomas is difficult as the predictive value of negative diagnoses (CT, sonography, lymphography) is only 77%. As the topography of metastases does not differ within the various T-categories, the necessary extent of irradiation cannot be related upon them. In clinical stage I contralateral iliacal fields have not to be included. In left-sided tumors no positive solitary nodes were found in the ipsilateral iliac region, subsequently we suppose that this area might be preserved. In right-sided tumors occasional solitary nodes in the ipsilateral field are not necessarily due to an infiltration of the epididymis; therefore we recommend in general a prophylactic irradiation of the ipsilateral iliac region. An inguinal irradiation should be reserved only for pre-operated patients and an involvement of the scrotal wall.
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PMID:[The T category and metastasis in testicular tumors]. 366 Feb 26


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