Improved survival with combined modality treatment for stage IV breast cancer.

Between November 1974 and March 1977, 85 patients with breast cancer at first postmastectomy relapse were irradiated (Radiation 3500–6000 rad-3/5 weeks) to all clinically evident lesions. Radiation fields were properly shaped to include a maximum 40% active bone marrow. After 3–4 weeks rest, chemotherapy was started as adjuvant therapy for residual or subclinical disease (ADR 30 mg/M² Day 1 and 8, 5-FU 400 mg/M² Day 1 and 8, CY 100 mg/M² Day 1 through 14: repeated after 14 days). ADR was discontinued at 500/M² and substituted by MTX 30 mg/M² Day 1 and 8 for a total of 2 years. Irradiated sites were chest wall in 35, supraclavicular and internal mammary nodes in 22, bone in 56, single lung lesions in 12, brain in 24. Controls were 52 comparable but non-randomized patients treated with chemotherapy only. Forty days after x-irradiation 68 patients (80%) were free of disease (NED) while in 17 cases (20%) some residual was still present (RED). In 28 of 68 cases (41%) NED after x-irradiation and 13 of 17 (76%) in RED group developed second relapse after a median interval of 26 and 20 mos, respectively. Four of 52 patients (8%) in the control group had complete regression with a median interval to second relapse of 7 mos. Median survival was 30 mos., 24 mos. and 13 mos., respectively, for NED, RED and chemotherapy only. Eighteen patients (269o) are free of disease after 36–48 mos. in the combined modality group; none in the chemotherapy group. Combined treatment cases did not show untolerable mylodepression: in 41 patients (60%) the average chemotherapy dose had to be reduced during the first 4–5 cycles because of marrow depression. In 10 long-surviving patients a marked subcutaneous and skin fibrosis developed because of drug additive effect. Stage IV breast cancers rendered clinically free of disease with x-irradiation and subsequently treated with chemotherapy survive significantly longer than with chemotherapy alone.     

TARGeted Intraoperative radiotherapy (TARGIT): an innovative approach to partial-breast irradiation

A revolution is challenging the dogma that local treatment for all patients with breast cancer treated with breast conservation therapy must include postoperative radiotherapy delivered to the whole breast. Such prolonged postoperative radiotherapy is a burden to patients and hospitals and forces many women to chose mastectomy instead. Furthermore, for patients receiving chemotherapy, the start of conventional radiotherapy may be delayed so long as to increase the risk of local relapse. These problems might be eliminated if effective radiotherapy could be given as a single treatment intraoperatively, immediately after the surgery. Local recurrence after breast-conserving surgery usually occurs in the portion of the breast in the immediate proximity of the tumor, even when radiotherapy is omitted. Therefore, it should usually be possible to restrict radiotherapy to only the area adjacent to the tumor in selected women. Based on this premise, we have devised a new technique of partial breast irradiation, with the intention of completing all local treatment in a single session. In this article, we elaborate on the rationale and on the different methods of delivering intraoperative radiotherapy. If this approach is validated in ongoing randomized trials, it could save time, money, and breasts.     

Perforation in gastric malignancy

Perforation in gatric malignancy is a rare condition, occurring in only 20 patients at the New York Hospital-Cornell Medical Center between 1932 and 1969. Two patients are reported in whom plication followed by gastrectomy produced a satisfactory result. Early diagnosis of gastric cancer can be achieved by gastrointestinal x-rays, allowing for appropriate therapy prior to perforation. If perforation does occur, the edge of the perforation should be biopsied and diagnostic analysis carried out. If feasible, primary gastrectomy is considered the treatment of choice. Otherwise, plication soon followed by definitive gastrectomy is recommended.     

Low dose CT in early lung cancer diagnosis: Prevalence data

PURPOSE: Lung cancer has a high mortality rate and its prognosis largely depends on early detection. We report the prevalence data of the study on early detection of lung cancer with low-dose spiral CT underway at our hospital. MATERIALS AND METHODS: Since the beginning of 2001, 519 asymptomatic volunteers have undergone annual blood tests, sputum tests, urinalyses and low-dose spiral CT. The inclusion criteria were age (=/> 55 years old), a history of cigarette smoking and a negative history for previous neoplastic disease. The diagnostic workup varied depending on the size and CT features of the nodules detected. RESULTS: At baseline, the CT scan detected nodules > 5 mm in 22% of subjects; the nodules were single in 42 and multiple in 71. In 53% of cases the findings were completely negative, while in 122 (23.4%) nodules with a diameter < 5 mm were detected. Six cases of lung cancer were identified, of which four were stage I, one stage was IIIB and one was stage IV with adrenal metastases. CONCLUSIONS: Our preliminary data on spiral CT as a potential new diagnostic tool for lung cancer screening, although less promising than the Japanese and ELCAP results, confirm the feasibility of the technique. Additional validation is, however, required.     

The concomitant presence of polymorphic alleles of interleukin-1beta, interleukin-6 and apolipoprotein E is associated with an increased risk of myocardial infarction in elderly men. Results from a pilot study

Genetic background of inflammatory or anti-inflammatory molecules may be helpful in identifying subjects with increased or decrease risk of developing cardiovascular disease. Bi-allele polymorphism (C > T) in the promoter region (-511) of the interleukin-1beta (IL-1beta) gene and the bi-allele polymorphism (G > C) in the promoter region (-174) of interleukin-6 (IL-6) gene were determined in elderly men patients with myocardial infarction (MI) and healthy controls. Each subject was also genotyped for the triallelic polymorphism of the apolipoprotein E epsilon gene. The IL-6C and APOE epsilon4 alleles were independently associated with a mild or moderate increased risk of MI, whilst the allele C of the IL-1beta was not independently linked to MI risk. However, the simultaneous presence of the allele C of IL-1beta, the allele C of IL-6 and epsilon4 allele of APOE was strongly associated with the disease. Data from this cross-sectional study suggest that the functional interaction of these three genes affects pathogenetic mechanisms of MI and an impaired regulation of immune responses plays a pivotal role in the disease. Furthermore, genetic background of inflammatory genes may influence longevity of human species by affecting inflammatory responses associated to cardiovascular diseases. The administration of anti-inflammatory compounds to middle age healthy subjects with increased genetic susceptibility of developing MI might decrease the incidence and prevalence of cardiovascular events in aging.     

A new interventional procedure in the treatment of iatrogenic pseudoaneurysm

PURPOSE: The incidence of iatrogenic pseudoaneurysms as a complication of angiographic procedures is increasing. The purpose of this study was to test the validity and the efficacy of a new interventional procedure in the treatment of iatrogenic pseudoaneurysms. MATERIAL AND METHODS: Between April 1999 and June 2000, 14 patients suffering from a iatrogenic pseudoaneurysm were treated with the new technique which consists of the direct puncture of the aneurysmal cavity using the Seldinger technique and the introduction of a movable-core Teflon-coated guide wire into the hollow of the sac. Mild external compression with Femostop is then applied for no longer than 120 minutes. The puncture was also performed with colour-Doppler US guidance. RESULTS: We observed the complete healing of the pseudoaneurysms in all of the treated patients with no immediate complications or recurrence in the follow-up period. DISCUSSION AND CONCLUSIONS: The procedure applied to treat our group of patients proved valid, easy to perform and capable of producing satisfactory RESULTS: This new interventional method for treating iatrogenic pseudoaneurysms may be considered an effective alternative to surgery and US-guided compression and capable of achieving a quick recovery. The procedure is particularly suitable in those patients that may suffer discomfort or complications from the widely applied technique of sonographically-guided compression of pseudoaneurysms.