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

The vast majority of head and neck nerve tumors are benign. Proper management involves accurate preoperative evaluation and a high degree of suspicion. Ideal treatment involves complete resection but debulking procedures have a definite role. Microneural dissection and reconstruction should be attempted in all cases. Malignant tumors of neural tissue are aggressive and are treated with radical surgical resection followed by radiation. Chemotherapy is reserved for unresectable or metastatic disease.
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PMID:Extracranial neurogenic tumors of the head and neck. 374 84

Soft tissue sarcomas are uncommon malignancies, less than 10% of which arise on the distal upper extremities. Consequently, experience with treatments which preserve both the limb and its function is lacking for tumors in this region. Sixteen patients with sarcomas arising in the hand and wrist and one with an aggressive desmoid tumor were treated by combined modality therapy at the Massachusetts General Hospital. Two patients had wide resections for multiple recurrent lesions, 5 had excisional biopsies, and 9 had incomplete excisions to preserve anatomic structures of the hand. One patient refused an amputation and had no surgery. Sarcoma patients were given postoperative radiation with a dose range of 50.2 to 69 Gy (median 68 Gy). The desmoid tumor received 44 Gy. A shrinking field technique with customized castings and cerrobend blocks was used to assure precision and minimize treatment volumes. Chemotherapy was reserved for metastatic disease. Local control was achieved in 14 patients who received combined modality treatment (87%), with a follow-up 1-12 years (median 33 months). Two of the three patients with local failures subsequently obtained a local control after salvage surgery and radiation. Four patients developed metastases, one with epitrochlear lymph node metastases was salvaged by amputation, the others died with lung disease 17, 37, and 111 months after treatment. Functional integrity of the limb was primarily dependent on the extent of surgical resection required. Among 12 patients with local and distant control, one patient (who had multiple wide resections of an extensive desmoid tumor preceding irradiation) lost over 50% use of her limb, but no patients required amputation for edema or pain control. Ten of the 12 patients with local and distant control had less than a 25% decrement in limb function and had no pain or edema associated with normal use of their hand. We conclude that for selected patients with sarcomas of the distal upper extremity, combined modality therapy consisting of conservative resection and careful radiation therapy is a viable alternative to amputation.
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PMID:Extremity preservation by combined modality treatment of sarcomas of the hand and wrist. 377 12

From 1939 through 1973, 2,807 patients with salivary gland tumors received definitive treatment at the Memorial Sloan Kettering Cancer Center. This included 1,965 patients (70%) with parotid gland lesions, 244 patients (8%) with neoplasms in the submandibular gland, and 607 patients (22%) with tumors which arose in the predominantly mucus secreting glands (minor salivary) which line the upper aerodigestive tract. The proportion with malignant tumors was 25, 43, and 82% in the parotid, submandibular and minor salivary glands, respectively; benign tumors occurred more often in women. Mucoepidermoid, acinic cell and most adenocarcinomas were subdivided according to histologic grade and all patients were retrospectively staged according to criteria established by the American Joint Committee on Cancer Staging. Treatment was almost exclusively surgical and the extent of the operation performed depended on the extent of the tumor rather than its histology. In patients with malignant parotid tumors, the facial nerve was sacrificed only if it was adherent to or directly involved by the tumor. Lymphadenectomy was usually reserved for those patients who had palpable metastases. Prolonged follow-up (10 years minimum in this study) is necessary in order to appreciate the slow growth of some salivary neoplasms. Results depended upon the complex interplay between the site of origin, the clinical stage, and the histologic appearance of the tumors. This study antedates our current interest in postoperative radiation therapy, but other reports suggest that combination therapy enhances local control.
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PMID:The management of salivary neoplasms: an overview. 383 29

Eight cases of the Zollinger-Ellison syndrome were diagnosed at St Vincent's Hospital in the period 1966-84. Although a rare tumour, its true incidence is almost certainly greater than the number of cases represented in this series. The Zollinger-Ellison syndrome should be suspected in all cases of recurrent peptic ulceration, in cases of peptic oesophagitis not responding to medical treatment, in some cases of diarrhoea and in those cases of peptic ulceration associated with hypercalcaemia. Rarely the gastrinoma may first present as a mass in the head of the pancreas causing obstructive jaundice. Diagnosis has been made easier by estimation of fasting serum gastrins and the use of the secretin test. Localization is difficult. The treatment of the condition remains contentious. In those cases shown to be harbouring a so-called solitary gastrinoma, laparotomy should be performed with a view to resection. If the gastrinoma cannot be localized then it is reasonable to use H2 blocking agents to control hypersecretion. The presence of hypercalcaemia due to hyperparathyroidism must be controlled by parathyroidectomy. Total gastrectomy is reserved for those few cases who for one reason or another are not controlled by adequate H2 blocking therapy. In the presence of malignant gastrinoma with metastatic disease, hypersecretion is controlled by the use of H2 blocking agents. In this group cytotoxic chemotherapy may be used in an attempt to control the mass effects of the tumour.
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PMID:The Zollinger-Ellison syndrome: a review of the St Vincent's Hospital, Melbourne experience. 386 9

A retrospective analysis of 151 patients with breast cancer over 2 years was performed to assess laboratory values as predictors of metastatic disease demonstrated by technetium-99 bone scan. In 105 patients with normal alkaline phosphatase (AP) and lactate dehydrogenase (LDH) values, only one positive bone scan (0.95%) was obtained. If either the AP or LDH value was abnormal, 15 of 29 scans (51.7%) were positive. If both values were abnormal, six of nine patients (66.7%) had positive bone scans. Of 41 patients with either an elevated AP or LDH, 26 (63.4%) were shown to have metastatic breast disease. In our subgroup of 120 consecutive admissions for primary evaluation and treatment of breast cancer, the 95 patients with normal AP and LDH values had 41 negative bone scans and no evidence of distant metastases in any patient. According to these results, we recommend that breast cancer metastatic screening be done by alkaline phosphatase and LDH determinations, and that isotope scans should be reserved for those patients having normal values or symptoms that suggest metastases.
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PMID:A reevaluation of bone scans in breast cancer. 391 16

A retrospective clinicopathologic review of 32 patients with mammary sarcoma exclusive of angiosarcoma or lymphoma was performed. For 25 patients with previously untreated lesions, the median tumor diameter was 4 cm and 14 patients had high or intermediate grade lesions. One of 22 patients treated by mastectomy and one of three patients treated by local excision died of sarcoma yielding an actuarial 5-year survival of 91%. None of the 25 patients had received adjuvant chemotherapy and only one treated by mastectomy had post-operative radiation therapy. Seven other patients were referred for treatment of recurrent mammary sarcoma. In this group, median size of the primary tumor was 6 cm and four had high or intermediate grade histology. Tumor control was achieved for only one of five patients with local recurrence and neither of the two with distant metastases. Median survival was 6 months following initiation of treatment for recurrence. Whenever possible breast sarcomas should be classified according to histologic cell type and grade. For lesions not readily classified, the terms unclassified or anaplastic sarcoma should be used. The diagnosis of stromal sarcoma is best reserved for those infrequent sarcomas that can be traced to the specialized periductal and perilobular stroma of the breast. Total mastectomy is recommended for most patients with postoperative radiation therapy indicated when the adequacy of the margin is in doubt. The role of adjuvant chemotherapy in the primary management of mammary sarcoma is yet to be determined.
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PMID:Sarcoma of the breast. A study of 32 patients with reappraisal of classification and therapy. 397 55

Examinations of the liver using magnetic resonance (MR) and computed tomography (CT) were performed on 50 patients with hepatic metastases. MR and CT were comparable in their ability to detect metastases, which generally appeared hypointense compared with normal liver parenchyma on T1-weighted MR images and hyperintense on T2-weighted images. The MR imaging techniques that were most reliable in detecting metastases were inversion recovery and a relatively T2-weighted, spin-echo technique (TR = 1,500 msec, TE = 60 msec). We conclude that CT, because of its shorter imaging time, greater spatial resolution, and lower cost, should remain the preferred screening test for hepatic metastases. MR imaging should be reserved for patients with equivocal CT findings and for patients in whom there is persistent clinical suspicion of hepatic metastases despite a negative CT examination.
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PMID:Hepatic metastases studied with MR and CT. 401 5

Twenty-six patients with advanced melanoma metastases confined to the lower extremity underwent 28 therapeutic limb perfusions without a major complication or treatment-related death. A complete response to treatment occurred in 21 patients (81 percent). Of 16 patients, response persisted until death in 13 and was noted at 75, 87, and 96 months follow-up in 3. In five patients, response lasted a median of 5 months (range 3 to 14 months), and repeat perfusion in two of these patients was not beneficial. Unfortunately, despite locoregional disease control, most patients died from distant metastases at a median of 15 months after treatment. In fact, regardless of response to perfusion, the 3 year survival rate of patients with advanced metastatic melanoma of the extremity was only 25 percent or less. Thus, although limb perfusion can be a safe and highly effective means of achieving locoregional disease control, there appears to be little survival benefit. Therefore, perfusion should be reserved for palliative treatment of selected patients with locally advanced melanoma.
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PMID:Value of therapeutic hyperthermic limb perfusion in advanced recurrent melanoma of the lower extremity. 401 70

The results of skeletal scintigraphy performed at presentation in 465 women with histologically confirmed carcinoma of the breast were correlated with tumour size, node status, clinical course and survival during a follow-up of at least 2 years and up to 9 years. Skeletal metastases were eventually confirmed in 17.6% of the population under study, but were identified at presentation by scintigraphy in only half of these. The incidence of significant scintigraphic abnormalities ranged from 1.5% in patients with T0 and T1 node negative tumours to 20.3% in T4 node positive tumours. Patients with scintigraphic evidence of metastases had a significantly shorter survival than those without; 13.6% of the patients with an abnormality considered to be significant on the criteria employed in this study failed to develop confirmatory evidence of skeletal metastases during the period of follow-up. Alternative criteria are proposed which would substantially decrease the incidence of false positives without increasing the incidence of false negatives. Even so, it is concluded that there is no evidence that routine skeletal scintigraphy affects management of newly diagnosed patients with carcinoma of the breast. Unless an algorithm can be defined which requires the information provided by skeletal scintigraphy in order to determine clinical management, this investigation is not justified as a routine staging procedure and should be reserved for patients in whom there is a clinical suspicion of metastases and for clinical trials.
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PMID:Bone scintigraphy in breast cancer: a nine-year follow-up. 406 11

The role of modern techniques of 99mTc methylene diphosphonate bone imaging in the management of lymphoma patients was assessed by comparing results of 107 bone scans in 16 patients with Hodgkin's disease, and 45 patients with non-Hodgkin's lymphoma to simultaneous radiologic, clinical, and histopathologic features as well as to subsequent disease course. The sensitivity and specificity were both greater than or equal to 0.96 in both Hodgkin's disease and non-Hodgkin's lymphoma and the overall accuracy by site was 98%. The scan proved to be useful in the definition and follow-up of skeletal lymphomatous disease in both symptomatic and asymptomatic patients, and defined abnormalities which were not predicted by either serum alkaline phosphatase activity or the presence of bone marrow involvement. In no patient, however, did the bone scan result by itself alter either initial staging or estimates of extent of disease at the time of relapse. Bone scanning, therefore, cannot be recommended as a screening procedure in patients with lymphoma; rather, this test is best reserved for the definition and follow-up of skeletal metastases in patients with active, concomitant, extraosseous disease.
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PMID:Role of 99mTc methylene diphosphonate bone imaging in the management of lymphoma. 407 10


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