Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0178874 (tumor progression)
 40,807 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Sixteen patients who developed CT or MRI scan evidence of recurrent diffuse astrocytoma after radiation therapy and nitrosourea-containing chemotherapy received ifosfamide (2500 mg/m2/day for 3 consecutive days) and mesna (500 mg/m2/dose, 5 doses/day for 3 consecutive days). Toxicity consisted primarily of leukopenia in that 60 percent of patients developed leukocyte nadirs less than 1500/mcL. Excessive somnolence occurred in three patients and may have contributed to a case of fatal pneumonia in one patient but was reversible in the other two. No patient had CT or MRI scan evidence of tumor regression. One patient remains stable at 11.3 + months, but all other patients developed evidence of progressive disease less than 6 months from initiation of therapy. The median times to tumor progression and death were 2.0 and 4.8 months, respectively. In conclusion, while ifosfamide and mesna can be given safely at this dose and schedule, there is no evidence of antitumor effect. The degree of leukopenia observed likely would prevent further dose escalation of ifosfamide or addition of other myelosuppressive agents without additional means of bone marrow support in this population of patients.
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PMID:Phase II study of ifosfamide with mesna in adult patients with recurrent diffuse astrocytoma. 190 6

A new treatment strategy for jugular foramen tumors using radiosurgery is reported. Six jugular foramen tumors, including 2 glomus tumors and 4 lower cranial neurinomas, were involved. Among them only one tumor was confined in the jugular foramen, but the others extended into the posterior fossa, the upper cervical portion or both. As an initial treatment, 3 cases underwent operative resection from suboccipital or transcervical route. The tumor sizes at radiosurgery ranged from 14.3 to 36.1 mm with a mean of 22.4 mm in diameter. They were treated with a marginal dose between 13 to 16.5 Gy (mean 15.6 Gy). Follow-up MRI showed an apparent tumor shrinkage in 4 and no change in 2. Central tumor necrosis was found in 4 cases, but tumor progression was never observed in the mean follow-up period of 19 months. No complication occurred during and after the radiosurgery. These results indicate that radiosurgery is effective for the control of jugular foramen tumors with acceptable risk. Large tumors extending to the upper cervical portion and posterior fossa can be treated by operative resection combined with radiosurgery.
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PMID:[A new strategy for the treatment of jugular foramen tumors using radiosurgery]. 766 37

Optic gliomas occur in 15% of patients with neurofibromatosis type 1 (NF 1) and are a significant cause of morbidity. Of these tumors, 20-30% become symptomatic, usually before age 10 years. Previous studies have suggested that visual evoked potentials (VEPs) are a sensitive method for the detection of asymptomatic optic gliomas. Because routine neuroimaging of children with NF 1 is currently not recommended, the role of pattern-shift VEPs (PS VEPs) as a screening test for optic gliomas was evaluated. PS VEPs were performed on 10 children with NF 1 and optic gliomas and 20 children with NF 1 and normal visual pathways (as defined on MRI). PS VEPs had 90% sensitivity for detecting optic gliomas, with an increase in sensitivity to 100% when hemifield stimulation was used. The specificity of the test was 60%. Four of 20 children without optic gliomas had thickened optic nerves on computed tomography which represented dural ectasia with normal visual pathways on MRI; PS VEPs were normal in these patients. The efficacy of PS VEPs as a routine screen for optic gliomas is limited by the age at which children will cooperate with the test procedure and the high incidence of false-positive results; however, VEPs do provide a useful adjunct to routine clinical ophthalmologic assessment in the detection of optic gliomas in children with NF 1. Abnormal test results provide a stronger indication for neuroimaging. The early detection of optic gliomas allows for close monitoring of tumor progression and earlier intervention prior to significant visual loss.
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PMID:Optic gliomas in neurofibromatosis type 1: role of visual evoked potentials. 774 70

Brain stem tumors are among the most resistant brain tumors to therapy. The majority progress within 18 months of diagnosis and treatment. Multiple-fraction-per-day (MFD) radiotherapy would theoretically allow higher total doses of radiotherapy to be delivered in order to improve local tumor control without increasing neurotoxicity secondary to treatment. Seventeen patients with brain stem tumors were evaluated and treated at Duke University Medical Center (DUMC) from 1985 to 1991 with a MFD regimen. Six patients were accrued to Pediatric Oncology Group (POG) Protocol 8495 and were not included in this analysis, leaving eleven patients for review. Local fields were treated with fraction sizes of 110 or 117 cGy twice daily. There were 3 patients who received a total of 60.5-68.2 Gy and 8 who received 70.2-71.5 Gy. Initial and follow-up CT and/or MRI studies were available for review on all but one patient. All patients had progression of disease and have died. Median time to tumor progression was 5.8 months. Median overall survival was 11.2 months. There was no significant influence upon time to tumor progression or survival by total radiation dose received. Patients were classified by imaging group per the criteria of Stroink et al. based on review of their pre-treatment CT or MRI scans. One patient had no initial films available, 2 were in Group II (no contrast was given to separate A or B), 3 in IIA, 4 in IIB, and 1 in III. Autopsy in 3 patients failed to demonstrate histologic evidence of injury attributable to radiotherapy.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Multiple fraction-per-day radiotherapy for patients with brain stem tumors. 814 56

We report the effect of cranial irradiation on seizure frequency in five adults with unresected (biopsy-proven) cerebral hemisphere low-grade astrocytoma and medically intractable epilepsy. Seizures were refractory to standard antiepileptic drugs for 7 months to 27 years. Treatment with 5,400 cGy to 6,120 cGy focal radiation reduced seizure frequency by more than 90% in three patients (one of whom became seizure-free) and by more than 75% (but less than 90%) in one patient. One patient had no response. Brain CT or MRI showed a partial tumor response to radiation in three of the four patients with reduced seizure frequency. In three patients, the reduced seizure frequency continued to the most recent follow-up of 1 to 1.5 years. In the patient who became seizure-free, seizures recurred at 8.2 years and were associated with tumor progression. Irradiation can reduce seizure frequency in some patients with unresected cerebral hemisphere low-grade astrocytoma and medically intractable epilepsy.
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PMID:Effect of cranial irradiation on seizure frequency in adults with low-grade astrocytoma and medically intractable epilepsy. 835 Oct 19

Previous work has demonstrated the importance of the Protein Kinase C (PKC) signal transduction system in regulating the growth rate of malignant gliomas in vitro. Tamoxifen inhibits PKC in a minority of malignant gliomas within the micromolar concentration range in vitro, a property distinct from its estrogen receptor blockade effect. Tamoxifen was administered orally in very high dosages to 11 patients (9 males:2 females, age range 26-73, mean 45 years) with malignant gliomas (anaplastic astrocytoma or glioblastoma multiforme) who had failed treatment with external beam radiation therapy (and additional chemotherapy in 2). The dosage administered was estimated to be that necessary to achieve tissue concentrations within the low micromolar range, shown necessary to inhibit PKC in these tumors in vitro, and is approximately 5 times that used for standard antiestrogen therapy. Tumor reduction on radiographic images (MRI and PET [18FdG uptake]) with clinical improvement occurred in 3 patients; halting of tumor progression clinically and radiographically occurred in an additional patient. Of the remaining seven patients, three patients had marked and rapid progression of their disease despite treatment (dead after 3, 4, and 6 months respectively). Complications of treatment included a deep venous thrombosis requiring anticoagulation in one patient, nausea in one patient, and "hot-flashes" in a third patient. Tumor biopsy and measurement of tamoxifen and its active metabolite within the tumor of one patient (non-responder) showed levels within the middle of the in vitro therapeutic range. Follow-up of alive patients ranges from 4-18 months (mean 10 months). These encouraging preliminary results in a minority of these patients suggests some potential for this type of therapy.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Clinical and radiographic response in a minority of patients with recurrent malignant gliomas treated with high-dose tamoxifen. 838 28

Profound clinical deficits may be associated with insults to the brainstem, making management of patients with brainstem gliomas very complex. Small changes in the radiographic appearance of a brainstem tumor may be associated with significant clinical deterioration. Furthermore, both magnetic resonance imaging and computed tomography are frequently unable to differentiate between therapy-related tissue reactions and progressive tumor. Two clinical scenarios particularly difficult to resolve include: (1) transient radiographic and clinical deterioration following hyperfractionated radiotherapy, and (2) clinical deterioration in a patient who has failed initial therapy, but has stable radiographic findings following a second therapy. We report a child with a pontine glioma whose tumor progression was demonstrated more convincingly with a 18F-deoxyglucose positron emission scan than with magnetic resonance imaging. PET scans may be helpful in confirming that tumor progression is responsible for clinical deterioration in a patient whose MRI scans remain stable.
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PMID:Comparison of serial PET and MRI scans in a pediatric patient with a brainstem glioma. 846 27

Between April 1992 and March 1994, 48 patients with skull base meningiomas were treated at our department. The age of these patients ranged from 10 to 76 years. The male:female ratio was 1:3. Thirty-seven of these patients had primary open surgery for partial removal and subsequent radiosurgical treatment. In 1 patient a recurrent meningioma after so-called total microsurgical removal was treated radiosurgically. Radiosurgery was performed as a primary treatment in 11 patients. The mean tumor volume was 13.7 cm3 (range: 0.8-82 cm3). These tumor volumes could be covered by mean isodose volumes of 44% (range: 30-70%) and were treated by a mean dose of 15 Gy (range: 8-25 Gy) at the tumor border. One patient underwent radiosurgery with a staged treatment protocol with a 4.6-month interval. In 37 patients, a total of 102 follow-up scans were available. The remaining 11 patients have not been included in the postradiosurgical evaluation, since the observation time was either too short or the patients were lost to follow-up. The mean interval between Gamma Knife treatment and the last follow-up scan was 12 months, with a range from 2.3 to 22.7 months. Follow-up imaging (CT, MRI or both) revealed a decreased volume of the tumor in 9 cases (24%). In 25 cases (68%), tumor progression was stopped, and in 3 cases (8%) increased tumor volumes could be observed (2 patients with malignant meningiomas). In 3 cases marked central tumor necrosis was seen. Neurological follow-up examinations (n = 38 patients) showed a stable neurological status in 74%, ameliorated status in 13% and worsening in 13% of the patients.
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PMID:Stereotactic radiosurgery of skull base meningiomas. 858 17

Although bone scintigraphy is an extremely sensitive method for the detection of focal bone disease, small lesions below the resolution of planar imaging may be missed. This is a report of a patient with carcinoma of the breast who showed tumor progression 1 year after initial treatment. Complete evaluation was performed in order to detect the origin of increased level of a tumor marker. Although planar bone scintigraphy could not demonstrate any lesion in the spine, multiple metastases were detected in the lumbar and the thoracic spines on SPECT imaging. Only some of these lesions were seen with MRI. Repeat planar bone imaging 6 weeks later showed multiple bone lesions in the lumbar and thoracic areas.
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PMID:Metastases seen on SPECT imaging despite a normal planar bone scan. 867 88

The treatment results of cavernous sinus meningioma with gamma-radiosurgery are reported. There were 18 cases of cavernous sinus meningioma, including 2 males and 16 females, whose age ranged from 39 to 63 with an average of 51.0 years. As prior treatments, operative tumor resection or biopsy had been carried out in 14 cases, and the pathology was verified. The other 4 cases were diagnosed clinically with radiological studies. The mean tumor diameter was 28.3mm (17.7-35.0) during the radiosurgery. The maximum dose ranged from 22 to 36Gy (mean 28.0Gy), with the marginal tumor dose ranging from 11 to 18Gy (mean 13.9Gy). Irradiation to the near-by optic nerves was less than 10Gy. Follow-up period ranged from 12 to 50 months with a mean of 25.5 months. MRI showed a minor tumor shrinkage in 9 (50.0%) and no obvious change in 8 (44.4%), and tumor progression in 1 (5.6%), which required a 2nd radiosurgery. Neurologically facial pain and facial dysesthesia were well improved (7/13). However the ophthalmoparesis was usually unchanged and only 1 out of 11 (9.1%) improved after radiosurgery. Deterioration of neurological signs was rare. Symptomatic edema presenting neurological signs was not seen. In conclusion, radiosurgery with a gamma-knife is one of the useful alternatives to operative intervention in the treatment of cavernous sinus meningiomas, not only for tumor control, but also for relief from the symptoms.
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PMID:[Radiosurgery of cavernous sinus meningiomas with gamma-knife]. 867 1


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