Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0268596 (EMA)
 2,520 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We report a primary choriocarcinoma of the urinary bladder in a 63-year-old man who presented with painless hematuria. He was diagnosed as having an invasive carcinoma and underwent a total cystectomy. The tumor was diffusely hemorrhagic and occupied the dome of the bladder. Histologically, it consisted of cyto-and syncytiotrophoblasts with extensive hemorrhage. No coexisting transitional cell carcinoma component was present. By immunohistochemistry, the tumor expressed beta-hCG and low-molecular weight cytokeratin intensely while it was negative for CEA or EMA. The post-cystectomy serum beta-hCG was 237mlU/ml, and decreased later. The pertinent literature is reviewed and diagnostic criteria are discussed.
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PMID:Primary choriocarcinoma of the urinary bladder--a case report. 129 42

This is a report on a 33 year old patient with a metastatic gestational choriocarcinoma. The patient was hospitalized with the picture of a spontaneous left kidney rupture and nephrectomy was performed. Under primary mono-dose methotrexate chemotherapy, the patient showed rapidly progressive metastases in both lungs, liver, right kidney and soft tissue. With the use of multiple-chemotherapy, according to the EMA-CO scheme, we observed complete remission. To date, there has been no indication of any tumour recurrence.
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PMID:[Treatment of primary therapy refractory choriocarcinoma using the EMA-CO protocol]. 160 19

Determination of maternal serum alpha-fetoprotein (MSAFP) has become an important screening test for a variety of fetal and maternal abnormalities. A 33-year-old multiparous white woman had a markedly elevated MSAFP level (140 multiples of the median). Extensive antepartum work-up for fetal anomalies, fetal-maternal transfusion, or maternal etiology revealed no explanation. The patient subsequently delivered a healthy male infant. Pathologic examination of the placenta demonstrated a small, discrete area of choriocarcinoma. Computed tomography showed a solitary pulmonary metastasis. Because the patient did not desire future pregnancies, a total abdominal hysterectomy was performed, followed by four courses of EMA-CO chemotherapy. Her serum hCG levels subsequently became undetectable. Choriocarcinoma of the placenta must be considered in the differential diagnosis of an otherwise unexplained elevated MSAFP level.
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PMID:Markedly elevated maternal serum alpha-fetoprotein associated with a normal fetus and choriocarcinoma of the placenta. 170 89

Thirty-nine patients with choriocarcinoma and one with post molar trophoblastic tumour are presented. It was often found that there had been a long interval between the preceding pregnancy and the time of diagnosis or presentation. As a result, there was a high incidence of non-gynaecological presenting symptoms and 95 pc of our patients belonged to the high risk or poor prognosis group. The highest rate of cerebral metastases from choriocarcinoma so far reported in the world literature is presented here. At the beginning of 1987, a modified EMA regimen as introduced and has produced a great improvement in survival. The mortality from choriocarcinoma in Harare from 1985 to 1986 was 81 pc. In 1987 to 1988, this has fallen to 31 pc. The follow-up for the patients on the modified EMA regimen varies from four to twenty-four months.
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PMID:Improvement in survival from choriocarcinoma in Harare. 172 4

We have treated eight patients with various tumours producing hCG or AFP with the high risk gestational choriocarcinoma regimen EMA/CO. Marker response was seen in two of three tumours producing AFP and in all of five tumours producing hCG. Three further patients were treated with EpPt/OMB, a regimen used in relapsed germ cell tumors. All responded biochemically. All complete biochemical responses were accompanied by anatomical response. These responses may reflect particular sensitivity in the marker producing tumours and marker measurements would identify this subgroup. These findings do not preclude the possibility that these cytotoxic regimens may have activity against a wide range of solid tumours.
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PMID:Is ectopic production of human chorionic gonadotrophin (hCG) or alpha fetoprotein (AFP) by tumours a marker of chemosensitivity? 243 42

Experience gathered during the last 20 years in the treatment of gestational trophoblastic neoplasia (GTN) is presented. Fifty-eight cases were treated at the Karolinska Hospital during the period of 1966-86. This number accounts for approximately 50% of the cases in Sweden during this period of time. Thirty-four patients developed their malignancy after a molar pregnancy. Thirty-three patients were nonmetastatic and of the 25 metastatic cases, 6 patients were staged to a high-risk group. Chemotherapy was given to all patients except one who had a primary choriocarcinoma in an ectopic pregnancy. Surgery was performed in elective cases or when chemotherapy failed. Surgical procedures were also performed in a few emergency situations. Since 1978 all patients were started on methotrexate--folinic acid ad modum Goldstein. When this medication failed, either the CHAMOMA (vincristine, methotrexate--folinic acid, actinomycin D, melphalan, adriamycin) or later the EMA/CA (etoposide, methotrexate--folinic acid, actinomycin D, cyclophosphamide, adriamycin) regimen ad modum Bagshawe was given. An overall remission rate of 96.5% was achieved. The minimum period of follow-up was 2 years. The 2 patients who died (in 1966 and 1982) were referred to our department in a late stage. Five patients had a late recurrence and all but one were successfully treated.
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PMID:Twenty years' experience of treating gestational trophoblastic neoplasia in Sweden. 255 41

VP-16 (VePesid) was incorporated into combinations for first-line treatment of patients with malignant germ-cell tumors or gestational choriocarcinoma. The basic combination consists of POMB (vincristine, methotrexate, bleomycin, and high-dose cis-platinum) and ACE (VP-16, actinomycin D, and cyclophosphamide). Patients receive two courses of POMB, then ACE, then POMB again. Patients with larger volume disease continue with POMB and ACE until biochemical remission is achieved, as indicated by tumor marker levels. Of 112 male patients with malignant germ-cell tumors, some of whom had previous radiotherapy or chemotherapy, and more than 50% of whom had advanced disease, the current survival rate is 87%. The survival rate is 77% for the worst-prognosis patient group. Patients with brain metastases from germ-cell tumors have not required surgery or radiotherapy to achieve a durable complete remission. Among patients who have multiple resistance to drugs such as vinblastine, bleomycin, and cis-platinum, 50% have achieved remission when treated with the EP/OMB schedule (VP-16 and cis-platinum alternated with vincristine, methotrexate, and bleomycin) repeated at short intervals. In 76 drug-resistant patients with gestational choriocarcinoma (medium risk), VP-16 was given intravenously (IV) 100 mg/m2/d for five days as initial therapy, with methotrexate given 11 to 13 days later. Overall response rate including partial response and improvement is 78%. In high-risk gestational choriocarcinoma patients, a weekly schedule of chemotherapy, alternating EMA (VP-16, methotrexate, actinomycin D, and folinic acid) with CO (vincristine and cyclophosphamide), has resulted in an overall survival of 84%; survival in patients who received previous chemotherapy is 73%; and survival in those who did not receive previous chemotherapy, 93%. Mucosal toxicity has not been a major problem. It is recommended that in patients with germ-cell tumors and in medium- and high-risk gestational choriocarcinoma patients, VP-16 be used in initial therapy and not be retained for relapse therapy only.
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PMID:VP-16 in combinations for first-line treatment of malignant germ-cell tumors and gestational choriocarcinoma. 257 42

From June 1980 through December 1985, 36 high-risk GTT patients received Bagshawe's EMA/CO regimen, 22 as first-line, and 14 as second-line treatment, after primary chemotherapy with CHAMOCA, or cyclic regimen, or MTX-CF. All treated patients were metastatic at the start of treatment with EMA/CO; three showed liver metastases and one brain metastasis. Seventeen patients had a high score, greater than 15. Nineteen patients had histologically confirmed diagnosis of choriocarcinoma. The overall response rate was 86% with 81% survival during a median observation time of 32 months. The median number of courses needed to achieve complete remission was 3 (range 3-7). Toxicity was acceptable, and was less than with CHAMOCA and MAC regimens. Only 1 out of 17 high-risk patients developed drug resistance, and 3 needed urgent surgery. The relapse rate of responders was 19% after a median of 5.5 months. The survival rate of high-risk patients was 88%, of which 76% are alive with no evidence of disease, while 12% have still detectable beta-chorionic gonadotrophin. The remission rate in the second-line treatment group was 64%, higher than using other regimens such as MAC or CHAMOCA. In conclusion, we consider EMA/CO to be the best choice for patients with high-risk GTT, because it is effective and well tolerated. In our opinion, the cure rate of high-risk GTT could perhaps be improved by starting trials to establish what salvage treatment to employ after EMA/CO failure and using more aggressive first-line chemotherapy in selected high-risk patients, on the basis of the scoring system.
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PMID:EMA/CO regimen in high-risk gestational trophoblastic tumor (GTT). 284 14

From January 1976 through December 1985, methotrexate (MTX) with citrovorum factor (CF) was administered as primary treatment to 57 patients with low-risk gestational trophoblastic tumor (GTT); 51 patients were non-metastatic and 6 were metastatic GTT. The median number of courses needed to achieve biochemical remission was two (range, 1-7). Complete remission was attained in 95% of non-metastatic GTT patients with postmolar persistent trophoblastic disease, but when choriocarcinoma was histologically confirmed, this fell to 60%. The cure rate of metastatic GTT patients was only 50%. The overall remission rate with the MTX-CF combination was 84.2%. Toxicity was mild, consisting of myelosuppression and mucositis. Fifteen patients were resistant to MTX-CF, or relapsed subsequently, but they all achieved remission with chemotherapy rescue treatment (VP 16 alone, EMA/CO, CHAMOCA). Two patients required a pulmonary lobectomy. They are all still alive in biochemical remission with a median survival of 54 months. Our experience suggests that drug resistance and relapse rate seem related to a beta-HCG value higher than 10(4), an enlarged uterus with myometrial deep involvement, and a histologically confirmed diagnosis of choriocarcinoma. In conclusion, the MTX-CF combination is effective in postmolar GTT, whereas a different therapeutic approach may be considered for a "special" low-risk group of patients, on the basis of prognostic factors.
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PMID:Methotrexate with citrovorum factor in low-risk gestational trophoblastic tumor. 303 44

A case of successful pregnancy following two hydatidiform moles and a choriocarcinoma, treated with the EMA-CO regime, is reported. This is the first reported successful pregnancy after administration of etoposide.
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PMID:Term pregnancy after three trophoblastic disease events. 333 77


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