Sequential Adjuvant CMF Chemotherapy Followed by Radiotherapy in the Treatment of Early-Stage Breast Cancer: The Lankenau Hospital Experience

Abstract: The optimal timing of systemic cyclophosphamide, methotrexate, 5-fluorouracil (CMF) chemotherapy and local radiation in adjuvant breast cancer has been a debatable subject. To evaluate the Lankenau Hospital experience with sequential CMF chemotherapy followed by radiation in the adjuvant therapy of stage I and stage II breast cancer we reviewed the records of patients at our center. This group of 34 patients was treated in a homogenous manner, all receiving standard CMF for six cycles followed by radiotherapy after lumpectomy with axillary lymph node dissection. The radiation course was 5040cGy to the entire breast (28 fractions in 45 elapsed days) followed by a boost to the tumor site of 1800cGy in 10 fractions. Thirty-four patients were identified and followed for an average of 5 years (range 1.5–11.5 years). One patient had local recurrence and with subsequent treatment is disease-free at 5 years postrecurrence (8 years from initial diagnosis). Two deaths were not breast-cancer related (1 myocardial infarction at year 3, 1 melanoma at year 7.5). The estimated probability of no relapse at 5 years and 8 years by Kaplan-Meier analysis is 79% and 60% respectively. Overall and disease-free survival in this group of patients treated with breast-conserving surgery and CMF chemotherapy followed by radiation is excellent. There appears to be no detriment to delaying radiotherapy until full doses of systemic treatment are given as local recurrence was rare (6%) and was amenable to further treatment.     

Effect of age, breast size, menopausal and hormonal status on mammographic skin thickness

Background/purpose: The localized or generalized skin thickness detected on mammography may reflect an underlying pathology of breast or a systemic disease involving the skin. The aim of this report is to describe the range of normal breast skin thickness in women using a film-screen mammographic technique.
Methods: Measurement of the mammographic skin thickness over different parts of the breast was performed in 144 women who had normal findings in a combined mammographic and ultrasonographic examination. Patients were grouped as premenopause, postmenopause and surgical menopause who were under continuous oestrogen treatment. The skin thickness in four regions (superior, inferior, medial, lateral) of both breasts was compared, and their relations with age, breast size, menopausal and hormonal status were investigated. The interobserver reliability was tested in a small subgroup of patients.
Results: Interobserver agreement was good for all measurements. The range of normal breast skin thickness was between 0.50 and 3.10 mm. There were no differences in skin thickness between the corresponding regions of the breasts, with significant differences between the regions in the same breast. While breast size increased with age, skin thickness decreased in all regions.
Conclusion: The breast size, age, regional variations and hormonal status of the patients should be considered when defining the normal range of skin thickness in mammographic examinations. We assume that upper limit of mammographic skin thickness should be set as 3.0 mm, regardless of the focal spot size and film-focus distance.     

乳腺癌术后双肺及骨转移

疾病的正确诊断和合理治疗是患者和医务工作者共同的心愿。在广东省人民医院肿瘤中心，吴一龙教授指导临床医生应用循证医学理论进行肿瘤的多学科综合治疗，开展临床病例讨论。讨论会上各学科共同围绕一个病例或一个病种进行会诊，临床、病理、B超、放射影像等资料齐全。除相关科室提前准备的中心性发言外，到会人员各抒己见，气氛热烈。参会人员受益匪浅，提高了对疑难病例的诊治水平。为了将他们的诊治经验传播出去，让更多的临床医生获益，我刊开辟“循证病例讨论”栏目，希望广大医务工作者关注此栏目。[编者按]     

Excretion of oxazepam in breast milk

Summary Oxazepam was measured in plasma and breast milk during 3 days of medication and 10 and 34 h after the last dose. The half-life estimated from levels in plasma and milk was approximately 12 hours. Less than 1/1000 of the maternal dose would have been excreted in 11 breast milk.     

Atopic dermatitis and breast feeding of Somali children living in Somalia and in Italy

The aim of this study was to investigate the feeding habits in the first year of life and prevalence of atopic dermatitis (AD) in a group of Somali children born and living in Italy and in a group of Somali children born and living in Somalia. The first group comprised 59 children (median age 15 months; range: 12–24 months) and the second group 95 children (median age 16 months; range: 12–24 months). The mothers were asked to fill in a questionnaire on the duration of breast feeding and weaning age of their children. In the Somali children born and living in Rome we observed earlier introduction of cow's milk (p < 0.001), and earlier weaning (p < 0.001). The prevalence of AD was higher in the Somali children born and living in Italy (p < 0.001).     

乳癌病人单次卡铂和阿霉素化疗诱发的染色体损伤和细胞生物学毒性

应用常规染色体畸变分析和胞浆分裂阻滞微核（ｃｙｔｏｋｉｎｅｓｉｓｂｌｏｃｋｍｉｃｒｏｎｕｃｌｅｉ，ＣＢＭＮ）法对１０例接受单次卡铂（平均剂量为４６２．９ｍｇ／ｍ２）和单次阿霉素（平均剂量为４８．１ｍｇ／ｍ２）化疗的乳癌病人血样进行了淋巴细胞染色体畸变（ｃｈｒｏｍｏｓｏｍｅａｂｅｒａｔｉｏｎ，ＣＡ）和微核（ｍｉｃｒｏｎｕｃｌｅｉ，ＭＮ）的观察分析，并通过有丝分裂指数（ｍｉｔｏｔｉｃｉｎｄｅｘ，ＭＩ）及核分裂指数（ｎｕｃｌｅａｒｄｉｖｉｓｉｏｎｉｎｄｅｘ，ＮＤＩ）观测了细胞毒性。结果表明，单次卡铂和阿霉素化疗均引起了ＣＡ和ＭＮ显著性增加，所观察到的ＣＡ主要为单体畸变，其中单体间隙（ｃｈｒｏｍａｔｉｄｇａｐ，ｃｔｇ）的增加最为显著，染色体型畸变未见显著性变化；卡铂引起ＭＩ明显减低，阿霉素对ＭＩ的影响不显著；两种化疗药物均未对ＮＤＩ产生显著性影响；通过ＭＩ及ＮＤＩ测量的细胞毒性之间显著性相关，但ＣＡ分析和ＣＢＭＮ法测得的染色体损伤之间缺乏相关性。     

Breast Cancer Genes

Abstract: The identification of familial breast cancer genes heralds an era of directed breast cancer treatment. Currently, two hereditary breast cancer genes have been identified, BRCA-1 and BRCA-2 . Although accounting for only approximately 5% of all breast cancers, they are being used to identify women with germ-line alterations that are at high risk of developing breast or ovarian cancer. With the identification of such genes comes a need for consideration of the ethical issues associated with testing. These genes are also being examined from a biochemical standpoint encompassing both their biological roles and biochemical pathways in which they reside. Such studies are likely to lead to novel breast cancer therapies.     

术前动脉灌注化疗加乳腺区段切除治疗乳腺癌的探讨

目的　探索早期乳腺癌保留乳房治疗的新途径。方法　 1995 - 1997年采用术前动脉插管化疗加乳腺区段切除治疗Ⅰ、Ⅱ期乳腺癌共 2 6例 ,并随访 5年以上。结果　 2 6例中 1例术后 2年 4个月死于肺转移 ,另 1例术后 4年死于其他疾病。 1例术后 1年复发 ,行全乳房切除后至今无瘤生存 6年。本组 3年生存率 (OS) 96 .15 % ,3年无瘤生存率 (DFS) 92 .3% ;5年OS 88.4 6 % ,5年DFS 88.4 6 %。结论　术前动脉插管化疗能提高肿瘤区域的药物浓度 ,杀灭部分癌细胞 ,减少术后复发。该疗法对部分Ⅰ、Ⅱ期乳腺癌病例是可行的。     

Atributable risk of breast,prostate, and lung cancer in Hawaii due to saturated fat

The dietary data from case-control studies of breast, prostate, and lung cancer in Hawaii revealed that saturated fat was a risk factor for these malignancies. The dietary intakes from the three studies were used to calculate the attributable risk (AR) due to saturated fat. For all ethnic groups combined, the ARs for the highest quartiles of intake were 14.9 percent for female breast cancer, 13.0 percent for prostate cancer, and 23.1 percent for male lung cancer. Our results suggested that a reduction of saturated fat to the lowest quartiles of intake could result in a 10 to 20 percent decrease in risk for these three cancers in Hawaii. We also examined the ethnic-specific risks associated with saturated fat consumption among the Japanese and the Caucasians in the three studies. The ARs for the highest quartiles of intake were notably higher among the Caucasians than the Japanese, primarily due to the difference in their dietary patterns. Although the calculated AR due to saturated fat was higher among the Caucasians than among the Japanese, all persons in the population would derive considerable benefit by reducing their intake of this nutrient.Authors are with the Epidemiology Program, Cancer Research Center of Hawaii, University of Hawaii, 1236 Lauhala Street, Honolulu, HI 96813, USA. Address correspondence to Dr Hankin. This study was supported in part by NIH Grant PO1 CA 33619.