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)

A neoadjuvant (preradiotherapy) chemotherapy regimen consisting of either cyclophosphamide alone (60 to 80 mg/kg) or a modified multidrug regimen (vinblastine, bleomycin, cyclophosphamide, and cisplatin) was administered to 15 newly diagnosed patients with histologically confirmed, fully staged, primary germ-cell tumors (GCT's) of the central nervous system (CNS). There were 11 patients with germinomas and four with non-germinoma malignant GCT's. There were six females and nine males, whose median age was 13 years (range 4 months to 24 years). Seven germinoma patients (64%) had disseminated disease. For the germinoma patients, the subsequent radiotherapy dose was modified based on the response to the neoadjuvant chemotherapy, and craniospinal radiotherapy was given only to those with disseminated CNS disease at diagnosis. Ten of the 11 germinoma patients had complete disappearance of all evaluable disease after two courses of chemotherapy (cyclophosphamide in eight and multidrug in three) and one had a partial response. The planned dose of radiotherapy to the primary tumor was reduced from 5500 to 3000 rads, and the craniospinal dose was lowered from 3600 to 2000 rads. Ten patients remain in continuous disease-free remission 20+ to 89+ months after diagnosis (median follow-up period 47 months). All four patients with non-germinoma GCT's received the multidrug regimen, and two fo three patients with evaluable disease had a partial response. High-dose regional and craniospinal radiotherapy was administered thereafter, but only two patients remain in their first remission. Previously untreated germinoma is a highly chemosensitive disease and the neoadjuvant treatment strategy permits the identification of active chemotherapy regimens in newly diagnosed patients. Patients who have complete responses to neoadjuvant chemotherapy tolerate a significant radiotherapy dose reduction without compromising long-term survival, thereby allowing a reduction of some of the late effects of therapeutic radiation. Germinomas tend to disseminate early in the course of the disease and a pre-therapy staging evaluation permits individualized radiotherapy treatment planning.
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PMID:Neoadjuvant chemotherapy for newly diagnosed germ-cell tumors of the central nervous system. 243 68

Four children with yolk sac tumor were treated with an aggressive combination chemotherapy program. Three children had presacral primary tumors, one having pulmonary metastases, and one had a testicular primary tumor with pulmonary metastases. Three children were treated when they had measurable disease, and one had no measurable disease. The chemotherapy program consisted of a 6-wk induction period with vincristine (VCR), cis-diamminedichloroplatinum (DDP), and bleomycin. Maintenance therapy consisted of VCR, actinomycin D, and cyclophosphamide (cytoxan) every 3-4 wk as tolerated. Treatment was discontinued after 12 mo of complete remission. All three patients with evaluable disease had a partial response (PR) to induction therapy. Two underwent surgical exploration following induction therapy, one a laparotomy and the other a thoracotomy, and were found to have only scar tissue at the sites of presumed residual disease. The third child with measurable disease progressed to a clinical complete response (CR) during maintenance therapy. Two patients have had no evidence of disease (NED) for 42+ and 41+ mo since starting therapy (28+ and 27+ mo since completing treatment). Two patients are NED 11+ and 7+ mo since starting therapy and remain on treatment. We have encountered no significant renal or pulmonary toxicity, and there have been only two hospitalizations during maintenance therapy for fever and neutropenia. These preliminary results employing different induction and maintenance chemotherapy programs and planned second-look surgical intervention appear encouraging.
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PMID:The use of different induction and maintenance chemotherapy regimens for the treatment of advanced yolk sac tumors. 619 71

The 5 year survival for patients with malignant intracranial non-germinoma germ cell tumors (NGGCT) which include endodermal sinus tumors, embryonal carcinomas, choriocarcinomas and immature teratomas is less than 25% following a small resection and radiotherapy. In an effort to improve the survival of these patients, an approach using an attempt at radical resection where feasible followed by multi-modality 'sandwich' therapy (chemotherapy-radiation-chemotherapy) was used to treat 18 newly diagnosed patients between 1986 and 1994 in a multi-institution study. Fourteen patients had histologically proven NGGCT and four were presumed NGGCT because of markedly elevated concentrations of serum and/or CSF alpha fetoprotoin (AFP) and/or beta human chorionic gonadatrophin (b-HCG). The primary tumor was confined to the pineal region in 12 patients, the suprasellar region in five, and a cerebral hemisphere in one. None of the patients had central nervous system metastases at diagnosis by MRI imaging of the spine and CSF cytology. Radical surgical resection was performed initially in 11 patients (gross total -6, subtotal -5): four had a biopsy and three had no surgery. All patients then received 3 or 4 cycles of neoadjuvant chemotherapy with cisplatin (100 mg/m2/cycle) and VP-16 (500 mg/m2/cycle). Of the 12 patients with evaluable disease there were 9 responses to the neoadjuvant chemotherapy (5 CR, 4 PR); 2 patients had stable disease and I progressed during chemotherapy. Six patients with no evaluable disease after a gross total resection had a continuous complete response. Seventeen patients received radiation therapy (involved field -11, involved field + craniospinal -4, involved field + whole brain -2). Twelve patients received 4 cycles post-radiation chemotherapy with vinblastine (6.5 mg/m2/cycle). bleomycin (15 U/m2/cycle), VP-16 (300 mg/m2/cycle, carboplatin (450 mg/m2/cycle). A total of four patients have died (3-progressive/recurrent disease, 1-metabolic). Four year actuarial event-free and total survival rates are 67% and 74%. This multi-modality adjuvant therapy approach appears to dramatically improve the outcome of malignant intracranial NGGCT.
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PMID:Improved prognosis of intracranial non-germinoma germ cell tumors with multimodality therapy. 904 65

The prognostic significance of DNA ploidy in relation to clinical and histopathologic factors was evaluated in a retrospective study of 370 patients treated at the Norwegian Radium Hospital from 1970 to 1982 with complete follow-up of median 149 months. Evaluable flow cytometric DNA histograms from paraffin-embedded tissue from the primary tumor were obtained in 321 cases, 293 (91%) were diploid and 28 (9%) were aneuploid. Aneuploidy was associated with older age, more advanced disease and non-serous histologic types. By multivariate analysis the only parameters with prognostic significance for corrected survival (death from disease) were ploidy, stage, histologic type and age. The patients with aneuploid tumors had a 19-fold increased risk of dying of disease compared with patients with diploid tumors. In tumor-free operated patients the extent of surgery had no influence on survival, neither had postoperative treatment. Using the prognostic factors the patients could be divided into risk groups. The large group of patients with diploid stage I tumors belonged to the low risk group. Fertility-saving operations can be offered to patients with diploid stage IA tumors, all others should have bilateral salpingo-oophorectomy and omentectomy with or without hysterectomy. Patients with diploid stage I tumors should not receive adjuvant treatment. The value of adjuvant chemotherapy in the high risk group needs further investigation.
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PMID:DNA ploidy; the most important prognostic factor in patients with borderline tumors of the ovary. 1157 68

In this study we investigated the use of cancer cell protein expression of ABCG2 to predict efficacy of systemic first-line irinotecan containing therapy in patients with metastatic colorectal cancer (mCRC). From a Danish national cohort, we identified 119 mCRC patients treated with irinotecan containing therapy in first-line setting. Among these, 108 were eligible for analyses. Immunohistochemistry (IHC) analyses were performed on the primary tumor tissue in order to classify samples as high or low presence of ABCG2 protein. Data were then associated with patient outcome (objective response (OR), progression free survival (PFS) and overall survival (OS)). ABCG2 protein expression in the basolateral membrane was high (score 3+) in 33% of the patients. Exploratory analyses revealed a significant interaction between ABCG2 score, adjuvant treatment and OR (p = 0.041) in the 101 patients with evaluable disease. Patients with low ABCG2 (score 0-2) and no prior adjuvant therapy had a significantly higher odds ratio of 5.6 (Confidence Interval (CI) 1.68-18.7; p = 0.005) for obtaining OR. In contrast, no significant associations between ABCG2 expression and PFS or OS were found. These results suggest that measurement of the ABCG2 drug efflux pump might be used to select patients with mCRC for irinotecan treatment. However, additional studies are warranted before conclusions regarding a clinical use can be made. Moreover, patients with high ABCG2 immunoreactivity could be candidates for specific ABCG2 inhibition treatment in combination with irinotecan.
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PMID:ABCG2 Protein Levels and Association to Response to First-Line Irinotecan-Based Therapy for Patients with Metastatic Colorectal Cancer. 3270 25