Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0677930 (primary tumor)
 20,210 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Surgical therapy of lung metastases nowadays is an established procedure. The operation's purpose is the radical and therefore potential curative resection. Beside there are diagnostic and palliative indications. Beside there are diagnostic and palliative indications. Median sternotomy is the standard approach for revision of both lungs even in unilateral seeming disease. Preoperative staging is not reliable concerning number and extension of metastases. From 1972 to 1991 843 operations for lung metastases were carried out in 729 patients in the surgical department of the "Thoraxklinik Heidelberg-Rohrbach". 30-day-mortality amounted to 2.9%, 5-year-survival-rate was 33% overall from date of metastases resection. The best results were achieved in testicular cancer with 67% 5-years-survival-rate, poorest survival was observed in melanomas with 12% 3-years-survival. Beside the primary tumor and partly dependent on it several prognostic factors were relevant: radicality, sarcoma vs carcinoma in favour of carcinomas, disease-free interval, type of resection, thoracic lymphnode involvement. As figured out by multivariate analysis the prognostic influence of the factors varies considerably due to the kind of primary tumor. Surgery of lung metastases is part of an interdisciplinary oncological therapeutical concept and offers a prolonged survival to most of the patients and the possibility of cure to some. Even if prolongation of life is not feasible an improved quality and therefore a good palliation is obtained.
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PMID:[Surgery of lung metastasis--indications, results and prognostic factors as an interdisciplinary concept]. 752 62

In patients with clinical stage I non-seminomatous germ cell tumor the relapse rate seen after orchiectomy alone is approximately 30%. If retroperitoneal lymph node dissection is adopted the relapse rate in patients with histologically negative retroperitoneal nodes is reduced to approximately 10%. Nevertheless, follow-up is still mandatory and 70-80% of clinical stage I patients undergo unnecessary surgery. Metastases and relapses are mostly seen in patients with histological evidence of vascular invasion, growth beyond the testicular capsule and/or embryonal carcinoma in the primary tumor. We conducted a prospective trial of two cycles of cisplatin-based adjuvant chemotherapy for 43 patients with clinical stage I non-seminomatous germ cell tumors and at least one of these risk factors (vascular invasion n = 5, pT > 1 n = 21, embryonal carcinoma n = 42). After a median follow-up of 42 months (12-82 months) 40/41 patients (97.5%) who received the planned chemotherapy remain relapse-free. One patient had surgical excision of a mature teratoma in the ipsilateral iliac region 26 months after orchiectomy and is now disease-free without further treatment after 25+ months. No life-threatening toxicity from chemotherapy was encountered. Two patients who refused the chemotherapy relapsed. In patients with high-risk clinical stage I non-seminomatous testicular cancer two cycles of adjuvant chemotherapy are highly effective in preventing relapses and may be used as an alternative to a 'wait and watch' program or retroperitoneal lymph node dissection, particularly in patients with a compromised follow-up.
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PMID:Adjuvant chemotherapy after orchiectomy in high-risk patients with clinical stage I non-seminomatous testicular cancer. 768 49

A total of 13 patients with advanced germ cell testicular cancer underwent initial PVB chemotherapy without previous orchiectomy. Complete response (CR) of metastases was observed in 5 patients following chemotherapy alone. The residual mass persisted in 8 patients (in 5 of them in the retroperitoneum, in two patients in the lungs only and in one patient in both localizations). The residual masses were removed surgically. There were no viable malignant tumors in the removed tissue on histological examination. Delayed orchiectomy was performed simultaneously with surgical removal of the residual mass in the retroperitoneum or in the lungs in 8 patients, and in 5 patients as a separate procedure in complete responders following chemotherapy alone. Residual viable tumor in the testis was found in three patients, necrotic or fibrotic tissue in 5 patients, and mature teratoma in 5 patients. In patients with advanced germ cell testicular cancer preference must be given to early beginning of intensive chemotherapy without tissue diagnosis of primary tumor by orchiectomy. Benefit of this therapeutic approach is the timely management of acute abdominal and/or pulmonary symptoms of life-threatening distant metastases.
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PMID:Neo-adjuvant chemotherapy with delayed orchiectomy in patients with advanced germ cell testicular cancer. 768 71

Approximately 30% of patients with disseminated testicular cancer who receive platinum-based chemotherapy will experience normalization of tumor markers but have persistent, radiographically evident disease in the retroperitoneum. These patients are usually subjected to retroperitoneal lymph-node dissection (RPLND). In all, 45 of 557 patients (8.1%) undergoing postchemotherapy RPLND at Indiana University Medical Center (IUMC) were found to have neoplastic elements distinct from the classic germ-cell tumor types within their resected specimens. Examples included various sarcomas in 14 patients (3.7%), other nonsarcomatous non-germ-cell cancers in 18 patients (3.2%), and cystic atypical choriocarcinoma in 8 patients (1.4%). No distinct patient characteristic or histologic pattern in the primary tumor was predictive of these unusual findings in the RPLND specimen, although sampling error in the orchiectomy specimen could be the reason for this lack of correlation. Surgical resection of these chemoresistant tumors is potentially curative, with disease-free survival being obtained in 13 of 19 patients (68.4%) with sarcoma, 10 of 18 patients (55.6%) with nonsarcomatous cancers, and 7 of 8 patients (87.5%) with cystic atypical choriocarcinoma at mean follow-up intervals of 30.6, 42.5, and 24.7 months, respectively.
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PMID:Unusual neoplasms detected in testicular cancer patients undergoing postchemotherapy retroperitoneal lymphadenectomy. 782 Jan 42

Phase III randomized clinical trials have greatly contributed to our understanding of the pathobiology of neoplastic disease and, particularly, to therapeutic progress. However, randomized Phase III studies are no better than or are critically dependent on Phase I and Phase II studies for positive therapeutic leads that are compelling enough to test in the Phase III arena. The variables involved in the series of randomized trials that led to the curative treatment of acute lymphocytic leukemia also resulted in an understanding of the principles of cancer therapy in therapeutic research. These principles, when applied to Hodgkin's disease in non-Hodgkin's lymphoma, testis cancer, childhood solid tumors, and others, resulted in a substantial cure rate for those diseases. However, for the adult epithelial common solid tumors, a second strategy, adjuvant chemotherapy, was required This has resulted in a 20% reduction in mortality in patients with node positive and node negative breast cancer. Tamoxifen has been similarly effective in patients with postmenopausal breast cancer. In colon cancer, adjuvant chemotherapy with fluorouracil plus levamisole has decreased mortality to a comparable degree. New agents, modulations, combination chemotherapy, and biotherapeutics are being addressed to the adjuvant situation which has proven effective in a variety of neoplastic diseases. A third strategy is neoadjuvant chemotherapy. This involves the use of chemotherapy first for patients with solid tumors, designed to down-stage the primary tumor thus making it more susceptible to less radical surgery and to organ- or limb-sparing procedures in osteogenetic sarcoma and in head and neck cancer. For example, neoadjuvant chemotherapy has not resulted in an increased survival as compared with the appropriate control but has allowed for important quality-of-life contributions, such as limb-sparing and radical surgery-sparing procedures. In addition to new agents and combination chemotherapy, dose is a critical variable. This is most evident clinically in the transplantation arena. Comparative studies recently completed, for example, in patients with adjuvant breast cancer and with acute leukemia indicate that dose is a significant factor in tumor control.
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PMID:Randomized clinical trials and other approaches in clinical research. 795 73

Approximately 30% of patients with disseminated testis cancer who receive platinum-based chemotherapy will experience normalization of tumor markers but have persistent, radiographically evident disease in the retroperitoneum. These patients usually undergo retroperitoneal lymph node dissection. Of 557 patients undergoing post-chemotherapy retroperitoneal lymph node dissection at our university medical center 45 (8.1%) had neoplastic elements distinct from the classical germ cell tumor types within the resected specimens. Examples include various sarcomas in 19 patients (3.7%), other nonsarcomatous nongerm cell cancers in 18 (3.2%) and cystic atypical choriocarcinoma in 8 (1.4%). No distinct patient characteristics or histological patterns in the primary tumor are predictive of these unusual findings in the retroperitoneal lymph node dissection specimen, although sampling error in the orchiectomy specimen could be the reason for this lack of correlation. Surgical resection of these chemoresistant tumors is potentially curative, with disease-free survival in 13 of 19 patients (68.4%) with sarcoma, 10 of 18 (55.6%) with nonsarcomatous cancer and 7 of 8 (87.5%) with cystic atypical choriocarcinoma at a mean followup of 30.6, 42.5 and 24.7 months, respectively.
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PMID:Unusual neoplasms detected in testis cancer patients undergoing post-chemotherapy retroperitoneal lymphadenectomy. 807 83

The goal of this study was to determine if deoxyribonucleic acid (DNA) flow cytometric and quantitative histological parameters could predict occult metastases in clinical stage I nonseminomatous testicular cancer. Archival paraffin primary tumor tissue was available from 36 clinical stage I nonseminomatous germ cell testicular cancer patients who all had retroperitoneal lymphadenectomy and followup defining 2 groups: pathological stage I (23) and occult pathological stage II (13). Archival blocks were microdissected and individual histological components were subjected to flow cytometry. In addition, the primary histology was reevaluated for vascular invasion and per cent composition of histological components of embryonal carcinoma and other histologies. For flow cytometry parameters, no tumor was uniformly diploid, and the DNA index and per cent S phase cells were not useful in differentiating stages. Although mean per cent S phase for the aneuploid cell population and proliferative index were significantly greater for stage II cases by univariate logistic regression analysis, they are approximately 70% accurate in predicting occult disease as single tests and were not significant by multivariate analysis. The calculation of per cent embryonal carcinoma was also significantly greater in stage II cancer by univariate logistic regression testing and remained significant by multivariate analysis. Vascular invasion was marginally predictive of occult disease but was also not significant by multivariate analysis. Calculating the percentage of embryonal carcinoma of a primary testicular tumor may be a useful method to assess clinical stage I cancer patients for risk of occult disease. A larger study is needed to confirm the importance of per cent embryonal carcinoma and to clarify further if flow cytometry in combination is useful.
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PMID:Flow cytometric and quantitative histological parameters to predict occult disease in clinical stage I nonseminomatous testicular germ cell tumors. 839 44

Optimal management of testicular cancer requires a multidisciplinary approach. This paper reviews the present role of surgery at three different stages of therapy. Radical inguinal orchidectomy is the treatment of the primary tumor, retroperitoneal lymphadenectomy is an essential tool in staging and treatment of low stage non-seminomatous germ cell cancer, and cytoreductive surgery is an indispensable adjunct in post-chemotherapeutic residual masses. These surgical aspects are placed in the perspective of modern therapeutic strategies.
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PMID:Germ cell tumors of the testis: the place of surgery. 839 98

To appropriately treat patients with testicular cancer, accurate staging is mandatory. This manuscript addresses appropriate tumor markers, retroperitoneal imaging, chest imaging, and careful analysis of the histopathology of the primary tumor. All of these facets can be combined to generate a reasonably accurate clinical staging of an individual's testicular tumor. Even with all of these modalities, however, some clinical staging error still exists and cannot be reduced to zero. Classification of individual patients by stage is essential for decisions about therapeutic options.
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PMID:Testicular cancer: what staging investigations are indicated? 883 83

Testicular cancer has become a highly curable neoplasm, and research efforts in the 1990s are focusing on ways to improve staging and treatment so as to limit cost and morbidity. Our group has performed a number of recent studies that help to answer a number of important clinical questions. First, do we need to order computed tomography of the chest (CCT) to stage all newly diagnosed patients? Second, how accurate is contemporary era abdominal CT to stage the retroperitoneum in low-stage nonseminoma patients, and are there techniques that may improve accuracy? Third, can histological primary tumor factors be useful to predict stage in low-stage nonseminoma patients? In a study of 201 testicular cancer patients [117 (58%) NSGCT, 84 (42%) seminoma] who had both CCT and chest X-ray (CXR) in initial staging, CXR alone was found to be sufficient initial chest staging in all seminoma patients and in NSGCT patients who had a negative abdominal (CTA). For low-stage patients without retroperitoneal adenopathy, CCT had unacceptable false-positive rates, which precipitated additional invasive maneuvers. For higher stage NSGCT patients with retroperitoneal disease on initial CTA, CXR alone missed a significant number of occult thoracic metastases and CCT remains indicated. In a study of 57 clinical stage 1 NSGCT all having negative staging CTA followed by surgical staging, third and fourth generation CT had a 67% accuracy in predicting retroperitoneal metastases. This contemporary experience shows a 33% false-negative abdominal CT staging rate. Consideration of any nodes, regardless of size, in the primary echelon retroperitoneal areas as indicative of retroperitoneal metastases may hold promise for improving accuracy of CTA in low-stage NSGCT testis cancer. In a study of 92 clinical stage 1 NSGCT patients, determination of primary tumor vascular invasion (VI) and percentage of tumor composed of embryonal carcinoma component (%EMB) was found to be a useful staging tool. A multivariate model using VI and %EMB was able to predict correct stage in 86% of the study cohort, and a probability table with these two variables was created. Using these histological variables in a neural network artificial intelligence program, an expert correctly predicted stage in 92% of patients. In the 1990s chest staging should be tailored to tumor cell type and retroperitoneal disease status. Staging of the retroperitoneum utilizing abdominal CT remains problematic due to the inability to detect microscopic metastases. Primary tumor histological factors, particularly vascular invasion and quantitation of embryonal carcinoma, are clinically useful staging tools.
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PMID:Proper staging techniques in testicular cancer patients. 911 80


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