Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0153690 (bone metastases)
 6,382 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Several recent studies in non-small cell lung cancer (NSCLC) have helped to clarify the role of chemotherapy in patients with this disease. The objective of this communication is to briefly review some of the more important topics in the treatment of NSCLC. The more effective available combination regimens are based on single agents that have shown efficacy in phase II trials. Of additional importance is the use of the single agents in the same dosage and schedules in which the activity was originally reported. The question of the influence of chemotherapy on survival is discussed in terms of (1) the significant prognostic factors, including performance status, serum LDH level, and the presence of extrathoracic disease, including the influence of bone metastases, and (2) two recent trials comparing chemotherapy with supportive care in patients with unresectable NSCLC. Several recent trials have approached the question of preoperative or neoadjuvant chemotherapy in patients with advanced intrathoracic tumor. These trials have provided provocative results that indicate that combined modality approaches will continue to be interesting topics of clinical research in the near future.
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PMID:Chemotherapy in non-small cell lung cancer: results of recent trials. 283 4

In a retrospective study of 254 women with carcinoma of the breast (mean age 55.4 years) the occurrence of bone pain was compared with results of skeletal scanning, skeletal X-ray examinations and routine biochemical findings. Typical signs of skeletal metastases were found in bone scans of 119 patients, 88 (74%) of whom had bone pain. Alkaline phosphatase was elevated in 54 (45%), LDH in 32 (27%), and gamma-GT in 69 patients (58%). There was a statistical correlation between the number of affected skeletal parts and the absolute level of alkaline phosphatase (P less than 0.001) and of LDH (P less than 0.05). Skeletal scans gave no evidence of bone metastases in 36 patients who had bone pains. In this group of patients alkaline phosphatase was elevated in 4, LDH in 1 and gamma-GT in 12 patients. Routine scanning of 254 patients revealed skeletal metastases in 12% without any clinical symptoms. Bone pain and (or) increased activity of alkaline phosphatase occurred in 91% of patients with skeletal metastases. In our view, bone scan in the postoperative control of breast cancer is justified only after onset of clinical symptoms and (or) if there is an abnormally raised alkaline phosphatase activity.
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PMID:[Is routine bone scanning justified during the after-care for breast cancer?]. 614 14

Among 2175 patients seen over the last three years in a non-specialized department of internal medicine with no intensive care unit, 100 had supranormal serum lactic dehydrogenase activities. These patients' case-reports have been analyzed. Nearly half the patients (47/100) had a malignant disease (cancer or hemopathy). Among the remaining patients, 19 had a hepatic disorder (alcohol hepatitis in 10, viral hepatitis in 8, and isoniazide hepatitis in 1), 7 had a heart disease (heart failure with hepatomegaly in 5, myocardial infarction in 2), and 27 had various other conditions (including hemolysis in 6 and polymyositis en 3). The value of serum LDH assay is obvious in situations other than acute conditions such as myocardial infarction of pulmonary embolism; these are better known and have not been studied here as their prevalence was low among the patients enlisted in our study. In comparison to other enzymes (alkaline phosphatase (AP), gamma-glutamyl transpeptidase (GGT), transaminases (GOT, GPT) that were also routinely assayed in our patients, abnormal serum LDH activities are much less common and their significance is quite different. An increase in serum and their significance is quite different. An increase in serum LDH activity indicates a serious condition, often with a fatal outcome. The "various other conditions" group includes patients with hemolysis, hepatitis and myositis; the other patients in this group either had severe infectious diseases or died suddenly in the first few days of their hospitalization before diagnosis had been established. Each etiologic group has been analyzed to asses the characteristics of patients with increased LDH activity according to each etiology. Analysis of coincident abnormalities of the other enzymes listed above shows marked differences between etiologic groups; diagnostic accuracy can thus be enhanced in certain conditions. Most patients with malignancies had poorly differentiated tumors, with metastases: 28 had an epithelial tumor, with hepatic and/or bone metastases in 23 cases, 5 had cancer of the liver, 10 had a malignant hemopathy (2 lymphomas, 5 myeloproliferative syndromes, 3 acute leukemias), and 4 had a sarcoma. Cancer of the lung is the most common malignancy (10 cases) and may be responsible for increased serum LDH activity even in patients without metastases. Serum LDH assay is of value for monitoring the course in patients with initially increased activities as it falls under effective therapy and rises during exacerbations.
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PMID:[Value and diagnostic significance of serum lactic dehydrogenase in internal medicine (author's transl)]. 628 24

We performed hepatic artery infusion chemotherapy (HAI) combined with 5-FU-MMC-EPIR for bile duct cancer metastasized to the liver. We report a case for which we obtained PR. The case was a 59-year-old woman, who was diagnosed to have multiple liver metastases with an increase of CEA and LDH after 6 months from absolute curative resection for middle bile duct cancer. The patient was catheterized into the proper hepatic artery through the right femoral artery, and 5-FU 500 mg qw, MMC 4 mg q2w, and EPIR 30 mg q4w were infused via a reservoir. Two months after the treatment was begun, CEA and LDH values became normal. At the same time, PR was obtained and was shown upon CT, which continued for 5 months. After an 8-month period during which the patient was an outpatient at PS-0, multiple bone metastases appeared, and the radiotherapy was combinedly utilized for each lesion. The side effect of this method was decrease of leukocytes and blood platelets, but it disappeared by discontinuing medication. The patient died two years after the first operation, a year and four months from the time HAI was begun. It was possible to continue this treatment with PS 1-2 on an outpatient basis until one month before the patient's death. We concluded that hepatic artery infusion chemotherapy is an effective therapeutic method.
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PMID:[A case of liver metastasis from bile duct cancer effectively treated with hepatic artery infusion chemotherapy]. 794 38

The purpose of this study was to analyze the results of initial radiotherapy for bone metastases (BM) from breast cancer and to investigate the prognostic factors. Between 1981 and 1995, 65 women (109 lesions) received initial radiotherapy for BM, aiming at a total dose of 50 Gy/25 Fr. Significant relief of pain was obtained in 61 (88.4%) of 69 estimable lesions according to the RTOG score. The control rates of pain including the prevention of pathological fractures or myelopathy were 80.4% at 5 years and 64.3% at 10 years. The median survival time of all patients was 11 months, and the survival rates were 56% at 1 year, 31.6% at 3 years, 17.9% at 5 years and 10.7% at 10 years, with five long-term survivors. Univariate analysis showed that a normal state of LDH, no other metastatic organs, a disease-free interval longer than two years, good performance status (0 or 1), BM limited to the axial bones, maintenance chemo-hormonal therapy and an age of more than 55 years were good prognostic factors. Multivariate analysis showed that LDH, age and performance status were significant predictors of prognosis. It is important to note the prognostic factors at the initial treatment of BM from breast cancer. We consider that further prospective studies are needed to determine the optimal treatment schedule, including radiotherapy and its combination with chemohormonal therapy, for BM.
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PMID:[Clinical results and prognostic factors of radiotherapy for bone metastases from breast cancer]. 1006 13

Bone metastases diffusely invading the bone marrow from gastric cancer often manifest a rapid clinical course and the prognosis is very poor due to hematologic disorders such as DIC (disseminated intravascular coagulation) and/or MAHA (microangiopathic hemolytic anemia). The objective of this study was to clarify the clinicopathological features and prognosis of patients with gastric cancer in whom diffuse bone metastasis associated with hematologic disorders were evident. Thirty-eight patients with bone metastasis from a primary gastric cancer were thus selected and placed into 2 groups consisting of 15 with diffuse bone metastasis with DIC and/or MAHA, and 23 patients who had bone metastasis without hematological disorders. We compared the clinicopathological features and prognosis between the two groups. The clinicopathological features in patients with diffuse bone metastasis accompanied by hematologic disorders were significantly related to undifferentiated adenocarcinoma, a relatively younger age, elevated levels of serum ALP-BI and LDH, and a lower frequency of extraosseous metastasis. The median survival time after manifestation was 2 and 11 months for the patients with or without hematologic disorders, respectively. The prognosis was significantly worse in cases of DIC with the median survival being only one month. Since, prognosis of diffuse bone metastasis from gastric cancer is significantly poor, close attention should be directed to the specific clinicopathologic features related to diffuse bone metastasis plus hematologic disorders. Regarding high risk patients, a regular follow-up of the serum chemistry levels and a bone scan will aid in the early detection of the disease.
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PMID:Diffuse bone metastasis with hematologic disorders from gastric cancer: clinicopathological features and prognosis. 1020 99

Therapy of metastatic RCC is still unsatisfactory. To date, biochemotherapy with IL-2 s.c., IF a2 s.c. and 5-FU i.v. is probably the best treatment available. Response rates range between 30 and 40%. Toxicity is tolerable. Patients belonging to the low risk group, (presenting none of the following risk parameters: BSR > 70 mm, LDH > 280 U/l, neutrophilic granulocytes > 6000/microliter, hemoglobin < 10 g/l, extrapulmonary or bone metastases) show the best results. Response rates of 60% and 2-year survival rates of 65% can be achieved. When selecting candidates for biotherapy, risk parameters as mentioned above should be considered. Patients presenting these criteria do not profit from biochemotherapy. Nephrectomy in metastatic RCC is indicated in symptomatic patients. As part of an integrated treatment regimen with biotherapy in asymptomatic patients, nephrectomy should be performed only after response to biotherapy. These patients show a long-lasting progression-free survival. A randomized study proving the benefit of cytoreductive surgery, however, does not exist. Experimental research recently developed numerous strategies for potential therapy. The most interesting and hopeful starting points are gene manipulation and angiogenesis. Clinical trials, however, have to be awaited.
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PMID:New treatment modalities--the urologist's view. 1036 55

Seventy-four neuroblastoma patients were analyzed according to the clinical data including age, stage, bone metastases, primary tumor localization, tumor diameter, LDH, and serum ferritin. Histological examination of tumor specimens comprised calculation of proliferative index (PI) on slides stained with anti Ki-67 antibody and assessment of microvascular density (MVD) on anti-CD34 stained sections. Wide range of PI (1.5-79; median 37.8%) and MVD (41-385; median 172/mm2) values was observed. Significant relationship between higher PI and tumor diameter more than 5 cm (40.3 vs 37.2%) was found. Lower PI was found more frequently in stroma-rich tumors. Significantly higher median MVD was found in infant tumors and in smaller tumors <5 cm. Tendency to inverse relationship between PI and MVD was observed. The high values of both PI and MVD were found in some aggressive tumors in patients >1-year old. We evaluated the new parameter: proliferative-vascular index (PVI) as PVI=PIxMVD which ranged from 213-18333. Among eleven patients >1 year old, with PVI >7000, seven (64%) had a poor outcome within the mean period of 22 months. Our results suggest that the simultaneous estimation of proliferative activity and vascularity of neuroblastomas could be studied as a prognostic indicator. Further investigations are needed to confirm this finding.
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PMID:A correlation of microvascular density and proliferative activity to clinical and histological characteristics in neuroblastoma. 1665 96

There is controversy over whether to scan extrathoracic sites for metastases in patients with non-small cell lung cancer (NSCLC). We tested the efficiency of clinical factors to determine whether metastasis has occurred, and whether routine scanning for NSCLC is required. Nine hundred and forty five patients scanned for extrathoracic metasates were included. Clinical factors indicating metastasis were determined using multivariate analysis. Of the 945 cases, 377 (39.9%) had metastasis. Bone metastases were determined by focal skeleton pains, elevated serum alkaline phosphatase levels, adenocarcinoma, KPS</=70, sensitivity of 90.6, specificity of 12.7, PPV of 16.3, NPV of 87.8, and silent metastases rate (SMR) of 9.4%. Brain metastases were determined by neurological symptoms, adenocarcinoma, hematocrite <40 for men and <35 for women, KPS</=70, sensitivity of 89.9, specificity of 7.9, PPV of 9.2, NPV of 88.3, and SMR of 10.1%. Abdominal metastases were determined by abdominal pain/tension, hepatomegaly, elevated GGT levels, serum LDH levels >500 IU, a N2 or N3 case, KPS</=70, sensitivity of 95.9, specificity of 7.1, PPV of 13.3, NPV of 92.1 and SMR of 4.1%. Of the 224 patients with stage I and II disease, 73 had metastasis with a rate of 10.9% silent metastasis. We concluded that routine scanning of NSCLC for staging is necessary.
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PMID:Detecting extrathoracic metastases in patients with non-small cell lung cancer: Is routine scanning necessary? 1756 97

The present thesis consists of 8 published articles focusing on interleukin-2 based immunotherapy in metastatic renal cell carcinoma (mRCC). This disease represents a significant challenge, as the tumor is resistant to current chemotherapy, hormonal therapy and radiation therapy. However, IL-2 based immunotherapy may induce dramatic durable tumor regression by manipulating the immune system, however, only in a minority of patients. Two critical questions have driven the present thesis. First, which properties of the immune system are responsible for the dramatic tumor regression seen in some patients with mRCC following IL-2 administration? And second, can histamine increase the efficacy of IL-2 based immunotherapy by ending the immune suppression induced by phagocyte-generation of reactive oxygen species? 120 Danish patients, 41 UK patients and 20 Swedish patients were treated with low- or intermediate dose IL-2 based immunotherapy in an outpatient setting. As monitoring of the Danish patients, 443 serial blood samples and 225 serial tumor core biopsies were obtained. The regimen of outpatient low-dose subcutaneous IL-2 and IFN-alpha in mRCC is safe and active. In the Danish patients, an estimated 5-year survival rate of 16% was observed. From the blood and tumor analysis, an understanding emerged that IL-2 based immunotherapy is a "targeted therapy" requiring intratumoral immune cells (CD4+, CD8+, CD56+, CD57+ T- and NK cells) for treatment effect. In contrast, monocytes and neutrophils were harmful for the outcome of IL-2 based immunotherapy. In progressing patients, the leukocyte subsets in blood and tumor tissue remained unaffected by cytokine therapy. The fate of a patient with mRCC prior to IL-2 and IFN-alpha based immunotherapy cannot be determined by measuring baseline tumor features of FasL expression or Ki-67 (MIB-1) proliferation marker. We established a biological rationale for the potential use of histamine in conjunction with IL-2 in mRCC. A large confirmatory randomised phase III trial of IL-2 with and without histamine in mRCC appropriately stratified for monocytes and neutrophils in blood and tumor tissue is warranted. In a multivariate analysis, 5 clinical features (PS, bone metastases, lymph node metastases, low hemoglobin and high LDH) plus 3 supplemental immunological factors (intratumoral CD57+ NK cells <50 cells/mm(2), intratumoral neutrophils >0 and blood neutrophils >6.0) were independent prognostic factors of short survival in patients with mRCC receiving IL-2, identifying subgroups with estimated 5-year survival rates of 60%, 25% and 0%, respectively. These features may help to select patients more likely to benefit from IL-2 based immunotherapy.
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PMID:Interleukin-2 based immunotherapy in patients with metastatic renal cell carcinoma. 1820 77


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