Concomitant adjuvant chemo-radiation therapy with anthracyclinebased regimens in breast cancer: a single centre experience

Purpose

This study was done to evaluate the toxicity related to concurrent radiotherapy and anthracycline (AC)-based chemotherapy in the adjuvant treatment of early breast cancer and to investigate the impact of treatment interruptions and the feasibility of this uncommon therapeutic approach.

Materials and methods

From September 2002 to December 2007, 60 patients were treated at our Centre. The mean age at presentation was 48.5 (range 38?C64) years. All patients underwent conservative surgery, and radiotherapy to the entire breast (mean dose 50 Gy; range 46?C52 Gy). AC-based regimens consisted of four cycles of AC (doxorubicin plus cyclophosphamide) or four cycles of epirubicin (EPI) followed by four courses of cyclophosphamide, methotrexate and 5-fluorouracil (CMF).

Results

Concomitant treatment caused acute skin G3 toxicity in 8.9% of patients and one case of G4 toxicity (1.7%). Concerning cardiac assessment, six of the 56 evaluable patients (10.7%) developed an asymptomatic decline of left ventricular ejection fraction >10% and <20% of the baseline value. Radiotherapy was temporarily stopped in 21.3% and chemotherapy in 57.1% of patients.

Conclusions

In our experience, concomitant chemotherapy did not emerge as a significant factor in radiotherapy interruption. Moreover, no severe cardiac events were recorded.     

Pretreatment laparotomy in carcinoma of the cervix

In cases of advanced carcinoma of the uterine cervix, control of regional pelvic disease is not always equated with survival. While early disease often does remain localized within the pelvis, more advanced cervical cancers are observed to metastasize to paraaortic nodes and to distant sites. This study reports a surgical protocol designed to define extent of disease in patients having invasive cervical carcinoma prior to administering primary radiation therapy. Three questions have been raised: (1) Which individual patients have disease outside the pelvis? (2) Is it possible to modify therapy to control disease outside the pelvis and thereby influence survival? (3) Are positive paraaortic nodes found at pretreatment laparotomy indicative of systemic spread of disease? This pretreatment laparotomy was done on 127 patients, 31 of whom were found to have positive paraaortic nodes (24.4%). Sixteen patients had metastatic disease within the peritoneal cavity. Standard pelvic radiotherapy was subsequently given, supplemented with a paraaortic field in those cases with positive paraaortic nodes. Survival was not significantly different in patients with or without paraaortic nodal disease. It was further noted that 17 of the 31 patients (54.8%) who had positive paraaortic nodes later had distant metastases (median time 8 months), compared to $\text{24}\text{96}$ (25.0%) with negative nodes having a median time to metastases of 10 months.     

Unilateral monorchidism and cryptorchism. Clinical and biological findings useful in the differential diagnosis

Eighteen prepuberal children with only one testis palpable in the scrotum were studied in order to review the clinical and endocrinological data useful for differentiating monorchidism from unilateral cryptorchidism. Compensatory testicular hypertrophy, high LH and FSH response to LH-RH (100 micrograms/1.73 m2) and well preserved Leydig cell function after HCG (5,000 IU/m2) should lead to the diagnosis of monorchidism, either both congenital or secondary to severe atrophy of the unpalpable testis. When these findings are lacking the diagnosis of unilateral cryptorchidism should be considered.     

Intragastric cannulation procedures and rats' food intake and body weight maintenance

Effects upon food and water intakes and body weight maintenance of two procedures for preparing rats with chronic intragastric cannulae were examined. A transient aphagia and rapid weight loss followed installation of the classic nasopharyngeal cannula. Growth was resumed after about a week, but subsequent food and water intakes were chronically depressed in comparison to sham operated animals of the same age. Body weight was also chronically subnormal. The response of these animals to caloric dilution of the diet was, however, normal. In contrast to the nasopharyngeal procedure, a method involving direct cannulation of the stomach wall did not lead to either behavioral or weight regulatory deficits and is therefore recommended.     

The role of external radiation and brachytherapy in unresectable non-small cell lung cancer

The role of radiation therapy in the management of non-small cell lung cancer is rapidly changing. Preoperative radiation, with the exception of the superior sulcus tumor, has not been found to benefit patients. The issue of postoperative radiation in completely resected patients with non-small cell lung cancer remains controversial. Current postoperative trials suggest, however, that postoperative radiation in these patients prevents local recurrence and, in combination with chemotherapy, prolongs survival. Primary radiation therapy in inoperable non-small cell lung cancer is associated with a small but definite cure rate. Better definition of treatment volume, proper selection of dose-time, state-of-art treatment planning, and, whenever possible, intraoperative radiation have improved local control rates and decreased severe complications.     

Combined modality therapy of extrahepatic biliary system cancer

From January 1985 to December 1988, 10 patients with local/regional extrahepatic biliary system cancer (gallbladder: 2, Klatskin: 4, common bile duct: 4) underwent combined modality therapy. Laparotomy and biopsy or subtotal resection were performed in six patients and endoscopic retrograde cholangiopancreatography, percutaneous transhepatic cholangiogram, and biliary drainage in four patients. Patients initially received 5000 cGy to the tumor bed and primary nodal area. Eight received an additional 1500 cGy boost to the tumor bed. Chemotherapy (5-FU/mitomycin-C) was delivered at the beginning of each radiation treatment course. Four patients received an additional 1-4 cycles of maintenance chemotherapy and six received a boost with brachytherapy. The mean survival was 32 months and the median survival was 16 months. Five patients are currently NED at 16, 17, 17, 48, and 52 months. The overall 3-year actuarial survival was 50%. The cumulative incidence of failure as a component of failure was local/regional: 50%, abdominal: 40%, and distant: 10%. Of the five patients who developed failure, all developed a component of local/regional failure. Our data show that this approach is feasible and offers similar results to those reported in the literature. However, further follow-up will be needed to determine if this combined modality approach offers improved local control and survival rates compared with surgery or biliary bypass/drainage alone.