D.P. Kelsen, J.M. Daly, S.E. Kern, B. Levin, J.E. Tepper (eds). Gastrointestinal Oncology, Principles and Practice

D. P. Kelsen, J. M. Daly, S. E. Kern, B. Levin, J. E. Tepper(eds). Lippincott Williams & Wilkins, Philadelphia/Baltimore/NewYork/London/Buenos Aires/Hong Kong/Sydney/Tokyo, 2001, 976 pp,i195.00, £120.00, US$175.00 This new volume promises a comprehensive coverage of the variousissues of significance to a full understanding of the biology,development, prevention, diagnosis and management of gastrointestinal(GI)     

Breast conservation therapy as a treatment option for the elderly. The M. D. Anderson experience

BACKGROUND: Although almost half of all incidents of breast carcinoma occur in women age > or = 65 years, not enough is known about appropriate care for patients in this age group. The objective of the current study was to evaluate the role of breast conservation therapy in the management of breast carcinoma in women age > or = 65 years. METHODS: From 1970 to 1994, 1325 patients with carcinoma of the breast were treated with breast conservation therapy (segmental mastectomy and radiation therapy with or without axillary lymph node dissection) at The University of Texas M. D. Anderson Cancer Center. From this patient group, the authors identified 184 elderly women (> or = 65 years) with Stage 0-III disease at the time of diagnosis. RESULTS: The median patient age was 70 years (range, 65-88 years). The distribution of disease by stage among the women was Stage 0 disease in 12 patients (7%), Stage I disease in 107 patients (58%), Stage II disease in 63 patients (34%), and Stage III disease in 2 patients (1%). Comorbid conditions that may have influenced treatment planning were reported in 91 patients (50%). An axillary lymph node dissection was performed in 135 patients (73%), with positive axillary lymph nodes found in 30 patients (22%). Adjuvant chemotherapy was given to 10 patients (5%), and tamoxifen therapy was given to 63 patients (34%). Complications from treatment were reported in 24 patients (13%). With a median follow-up of 7.3 years (range, 0.25-23.5 years), 9 patients developed locoregional disease recurrence (5%), 10 patients developed contralateral breast carcinoma (5%), and 21 patients developed distant metastasis (11%). At last follow-up, 113 patients (61%) were alive, 15 patients (8%) were dead of disease, and 56 patients (30%) were dead of other causes. The 5-year and 10-year disease specific survival rates were 96% and 91%, respectively. CONCLUSIONS: Breast conservation therapy with segmental mastectomy and postoperative radiation therapy with or without axillary lymph node dissection provides excellent local control and disease free survival in elderly women with breast carcinoma. This treatment should be considered as the standard of care for elderly patients without severe comorbid disease.     

Personage Column： Prof. Jǒrg F. Debatin, M.D., MBA

Born in 1961 in Bonn, Germany, Jǒrg F. Debatin stud- ied medicine at the Medical School of the University of Heidelberg where he graduated in 1987. He completed his residency in Diagnostic Radiology at Duke University Medical Center and subsequently moved to Stanford University Medical Center for fellowship in Abdominal Imaging. As a diplomate of the American Board of Radiology he took up a position as Associate Professor of Radiology and Chief of Magnetic Resonance Imaging in July 1993 at Ziirich University Hospital. He was appointed Professor and Chairman of the Department of Diagnostic and Interventional Radiology at the University Hospital in Essen in August 1999. Here he built a most powerful clinical and research organization, impacting the course of Diagnostic Radiology throughout the world.     

Clinical Outcomes of Patients With Breast Cancer in a Phase I Clinic: The M. D. Anderson Cancer Center Experience

PurposePatients with metastatic breast cancer (MBC) refractory to standard therapy have a poor prognosis. We assessed prognostic factors and clinical outcomes for patients with MBC referred to a phase I clinic focused primarily on targeted agents.Patients and MethodsWe reviewed the medical records of sequential patients with MBC who presented to our phase I clinic between September 2004 and May 2008 to assess baseline patient characteristics, overall survival (OS), and clinical benefit.ResultsA total of 92 patients were identified, with a median age of 53 years (range, 28–83 years). The median number of previous therapies was 5 (range, 1–16 therapies). Of 92 patients, 78 were eligible for and offered ≥ 1 phase I clinical trial. With a median follow-up of 7.4 months, the median OS was 6.7 months (95% CI, 5.2–9.7). In multivariate analysis, independent factors predicting shorter survival were ≥ 10 previous treatments (vs. < 10 previous treatments; hazard ratio [HR], 3.27; 95% CI, 1.37–7.81; P = .008), Eastern Cooperative Oncology Group (ECOG) performance status (PS) 2/3 (vs. 0/1; HR, 2.92; 95% CI, 1.28–6.66; P = .01), and albumin level < 3.5 g/dL (vs. > 3.5 g/dL; HR, 2.88; 95% CI, 1.41–5.89; P = .004).ConclusionPatients with locally advanced or metastatic breast cancer referred for our phase I studies had a median survival of 6.7 months. Heavily pretreated disease, poor ECOG PS, and/or low albumin levels were associated with significantly shorter survival in a multivariate analysis.     

Subtypes of Breast Cancer in Lao P.D.R.: A Study in a Limited-Resource Setting

Aim: The purpose of this study is to evaluate the prevalence of the immunohistochemical subtypes of breast canceramong Lao women by using immunohistochemistry (according to the St. Gallen 2017 guidelines) and to study theircorrelation to clinicopathological features in order to help guide better treatment plans for patients. Materials andmethods: Formalin-fixed and paraffin embedded tissue blocks of 76 cases of primary invasive breast cancer wereretrieved from the University of Health Sciences, Vientiane, Lao PDR, from 2013 to 2016. Patients’ information andprevious histological reports were reviewed. Immunohistochemistry was done using antibodies against estrogen receptor(ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2/neu) and Ki-67 (MIB-1). Results:The mean age of the patients was 49 years, and the major histologic type was invasive ductal carcinoma, NOS (90.7%).The proportion of each subtype was hormone receptor-positive and HER2-negative, 44.7%; hormone receptor-positiveand HER2-positive, 3.9%; hormone receptor-negative and HER2-positive, 13.2%; and triple-negative, 38.2%. ER waspositive in 40.8% of the cases, while PR was positive in 47.4%. More than half of the cases were poorly differentiatedcancer (65.8%), followed by moderately differentiated (34.2%). Tumors presented with pT2 (60.5%), followed by pT3(25.0%) and pT4 (7.9%). Conclusion: Breast cancer among Lao women is characterized by a large percentage of thetriple-negative subtype that is less susceptible to hormonal treatments. The empirical treatment with tamoxifen shouldbe reconsidered since it would be less effective to these patients. More importantly, basic pathology services shouldbe the first requirement in Lao PDR in order to provide adequate care.     

The Detection Of Breast Abnormalities By Thermography

Two years of operation of a thermographic breast screening unit in Western Australia have been analysed and a total of 1,512 women were seen. One third appear abnormal, two thirds normal. All the cases of proven cancer to date have come from the abnormal groups and it is suggested that as thermograpiiy is a harmless examination it can be well used to select those women who appear to be at greater risk from breast cancer than the rest, so that this group can then be subjected to further diagnostic examination methods.     

Prof.J(o)rg F.Debatin,M.D.,MBA

Born in 1961 in Bonn, Germany, J(o)rg F. Debatin studied medicine at the Medical School of the University of Heidelberg where he graduated in 1987. He completed his residency in Diagnostic Radiology at Duke University Medical Center and subsequently moved to Stanford University Medical Center for fellowship in Abdominal Imaging. As a diplomate of the American Board of Radiology he took up a position as Associate Professor of Radiology and Chief of Magnetic Resonance Imaging in July 1993 at Zürich University Hospital. He was appointed Professor and Chairman of the Department of Diagnostic and Interventional Radiology at the University Hospital in Essen in August 1999. Here he built a most powerful clinical and research organization, impacting the course of Diagnostic Radiology throughout the world.