The effects of oral 4-hydroxyandrostenedione on peripheral aromatisation in post-menopausal breast cancer patients

This study investigated the influence of the aromatase inhibitor 4-hydroxyandrostenedione (4OHA, formestane), given orally, on peripheral aromatase activity and plasma oestradiol (E ₂) levels in post-menopausal women with advanced breast cancer. The aim was to establish whether an optimal dose could be identified that had a pharmacological effectiveness comparable with that of parenteral 4OHA. A total of 13 post-menopausal women were studied before treatment and after a minimum of 4 weeks on treatment with one or more of the following doses: 125 mg once daily (od), 125 mg b.i.d. (bd) and 250 mg od. In all, seven aromatase studied were performed at 125 mg od; four, at 125 mg bd; and ten, at 250 mg od. Three patients were studied at all doses. E₂ was measured concurrently and was available at all dose increments for seven patients. Given at doses of 125 mg od, 125 mg bd and 250 mg od, treatment with formestane inhibited in vivo aromatisation by 62.3%±9.5%, 70.0%±5.1% and 57.3%±5.3%, respectively (mean±SEM). Corresponding values for plasma E₂ suppression were 30.7%±6.5%, 43.4%±4.5% and 42.9%±6.7%, respectively. Thus, apart from a somewhat better suppression of plasma E₂ levels by the two higher doses as compared with 125 mg od, no significant difference in the degree of aromatase inhibition or plasma E₂ suppression was observed. The suppression of E₂ by oral 4OHA at 125 mg bd or 250 mg od approaches that achieved by the recommended parenteral schedule of 250 mg fortnightly, but inhibition of aromatase at this dose was substantially inferior. The findings are consistent with a hypothesis that 4OHA given orally may cause substantial plasma oestrogen suppression during part of the day, but neither the od nor the bd regimens investigated in the present study were capable of producing optimal aromatase inhibition.     

���ٵ�������ͷ״������7���ٴ�����

目的 探讨乳腺导管内乳头状瘤(intraductal papillomas，IP)癌变的临床表现、生物学行为、诊断、治疗及预后。方法 对1980年1月至2001年12月间7例IP癌变病人临床资料进行回顾性分析。结果 7例IP癌变占同期113例IP的5．19％，术前均未能确诊，5例术中冰冻考虑IP癌变。结论 IP有癌变潜能，其癌变者术前确诊困难，术中冰冻对诊断治疗意义重大，应重视术后随访。     

聚合酶链反应单链构象多态性检测乳腺癌中P53基因突变

应用聚合酶链反应单链构象多态性方法，对２４例原发性乳腺癌肿瘤组织基因组ＤＮＡ进行了分析，结果表明：其中７例存在Ｐ５３基因的突变，突变频率约为３０％。同时对其中１０例进行Ｓｏｕｔｅｒｎｂｌｏｔ分析，有２例在ｃｈｒ１７Ｐ上存在等位基因的缺失，而其另一等位基因上均存在基因突变。     

男性乳腺癌研究进展

男性乳腺癌是一种少见的恶性肿瘤。本文综述与男性乳腺癌相关的分子生物学特征(BRCA-1、BRCA-2、HER-2/new、p53 Bcl-2 p21waf1、p27kip1)、诊断、治疗。诊断主要依靠病理学;淋巴结转移是主要预后因素。治疗以手术为主,综合治疗有利于提高生存率。     

女性乳头湿疹样癌与乳腺癌浸润乳头之间区别的探讨

本文对１９８０～１９８２年间．天津肿瘤医院收治可手术原发女性乳腺癌７１５侧重新复习。根据镜下在乳头皮肤见到ｐａｇｅｔ细胞以及癌直接浸润（或累及）乳头，确定乳头湿疹样癌２０例，乳腺癌浸润乳头６９例。比较两组在临床表现、病理形态和预后的差异。结果发现，乳头湿疹样癌的临床表现以乳头糜烂，结痂为主，而乳腺癌浸润乳头则以乳头凹陷、皮肤粘连、桔皮样变和乳头抬高为主；镜下形态，乳头湿疹样癌主要是在乳头表皮内见到Ｐａｇｅｔ细胞，晚期亦可浸及乳头基质。乳腺癌浸润乳头主要特点是癌细胞浸润乳腺导管，管壁可完整或被浸破，癌亦可直接浸润乳头基质，绝大多数皮肤正常，直接累及皮肤少见，均无Ｐａｇｅｔ细胞。通过本文研究，作者认为乳头湿疹样癌为乳腺癌的独立类型，其在临床表现、病理形态及预后等方面，均与乳腺癌浸润乳头有显著区别。     

Review of imaging techniques for the diagnosis of breast cancer: a new role of prone scintimammography using technetium-99m sestamibi

Imaging techniques currently used for the diagnosis of breast cancer are reviewed and compared. Besides mammography, magnetic resonance imaging, positron emission tomography, and thallium-201 scintimammography, a new role of technetium-99m sestamibi scintimammography is discussed. It is concluded that while mammography remains the procedure of choice in screening asymptomatic women for breast cancer, other imaging methods play an important role in detecting malignancies in symptomatic patients.^99mTc-sestamibi scintimammography has high sensitivity and improves the specificity of conventional mammography for the detection of breast cancer; with this technique, prone imaging is preferable to supine imaging.^99mTc-sestamibi scintimammography thus deserves further study as a screening technique.     

Post-treatment sarcoma in breast cancer patients

Background: Many patients treated for breast cancer with radiotherapy will survive their disease and be at risk for treatment-related sarcoma for many years. Methods: In order to identify patients with post-treatment sarcoma and define this disease, we examined the records of 99 patients treated for sarcoma with a history of antecedent breast carcinoma. Of these patients, 51 were felt to have a sarcoma unrelated to breast cancer treatment and 48 were felt to have a treatment-related sarcoma (secondary to lymphedema and/or radiation). Results: Lymphangiosarcoma of the extremity was the most common histologic subtype of post-treatment sarcoma, accounting for 22 of 48 cases (46%). Twenty-six patients (54%) developed nonlymphangiosarcoma post-treatment sarcoma; all of these were radiation-associated sarcomas. The median latency interval between the diagnosis of breast cancer and the development of sarcoma was 11 years (range 4–44) and was not different between the two groups. However, patients with nonlymphangiosarcoma were significantly younger when diagnosed with breast cancer than were those with lymphangiosarcoma of the extremity (median 43 vs. 51 years, p<0.001). The survival of all 48 patients was poor: 5-year survival was 29%. Five-year survival of patients with other types of post-treatment sarcoma was just as poor as those with lymphangiosarcoma of the extremity (30% vs. 28%, p=0.98). Conclusions: Patients who develop sarcoma after treatment for breast cancer have a poor prognosis whether it occurs as Stewart-Treves syndrome or other types of post-treatment sarcoma. Younger patients may be at higher risk than are older patients for the development of nonlymphangiosarcoma post-treatment sarcoma.Presented at the 46th Annual Cancer Symposium of the Society of Surgical Oncology, Los Angeles, March 18–21, 1993.     

A new method of stabilizing the chest wall following major chest wall resection

Summary Prosthetic materials, such as metals, marlex mesh and methyl methacrylate have been used for stabilization of the chest wall after resection of large areas of rib cage. Such materials are contraindicated in an infected area. A new method of providing a stable chest wall using autogenous tissue is presented.     

保留肋间臂神经在乳腺癌改良根治手术中的应用

目的探讨乳腺癌改良根治手术中保留肋间臂神经的可行性和方法。方法乳腺癌患者78例，其中49例在改良根治术中保留肋间臂神经．29例未保留肋间臂神经。结果49例保留肋间臂神经的患者中，46例术后腋窝及上臂感觉良好．3例出现感觉障碍，但在短时间内恢复。未保留肋间臂神经的29例患者均出现不同程度的腋窝及上臂感觉障碍。经随访无1例出现局部复发。结论乳腺癌改良根治术中保留肋间臂神经可以预防术后腋窝及上臂感觉障碍的发生，不增加局部复发的风险，应成为乳腺癌改良根治手术的标准组成部分。