Inflammatory breast cancer: enhanced local control with hyperfractionated radiotherapy and incisional vincristine, ifosfamide and epirubicin

Local control rate for inflammatory breast cancer (IBC) is <50% with standard chemotherapy-radiotherapy regimen. Nineteen women (age range 40–65, median 50 years) with IBC (18 patients) or with a primary tumour of >10 cm (one patient) received a novel treatment comprising hyperfractionated radiotherapy (HFRT) sandwiched between two cycles of infusional chemotherapy using vincristine, ifosfamide and epirubicin (VIE). The primary endpoint was local control.
VIE was continuously infused for six weeks via a Hickman's line using a Deltec CADD-1 ambulatory pump. Ifosfamide (3 gm/m²) mixed with equi-dose mesna was infused for seven days and alternated every week with an infusion of epirubicin (50 mg/m²) mixed with vincristine (1.5 mg/m²). HFRT consisted of 1.5 Gy twice daily for 34 fret (51 Gy) followed by a boost of 15 Gy in 10 fret. The total treatment time was less than 22 weeks.
Median follow-up was 37 months. Local control rate was 58%. Three patients failed to respond initially and five relapsed in the breast at a median time of 36.8 months. Median overall and disease-free survival was 18 and 25.3 months respectively. Toxicity from VIE was minimal (WHO gd 3 emesis - two patients, gd 3 mucositis - one patient, neutropenic sepsis - three patients). Radiotherapy caused moist desquamation in 17/19 patients. Twenty-four central lines were complicated by seven line infections, three thromboses, and one extravasation.
The local control rate of 58% with VIE+HFRT appears similar to reported chemoradiotherapy regimen, although the treatment time of 22 weeks is much shorter than other regimens which take up to 12 months. Toxicity is acceptable. Hickman-related complications need to be reduced. The study is ongoing.     

The effect of amniocentesis and drainage of amniotic fluid on lung development in Macacafascicularis

Summary. Amniocentesis and withdrawal of amniotic fluid was performed on pregnant monkeys ( Macaco fascicularis ) at two stages in development, either between 47 and 64, or between 85 and 95 days gestation. After birth the lungs of each infant monkey were studied using precise morphometric techniques, and compared with those in a control group of animals. The lungs after amniocentesis had alveoli of normal maturity but reduced in number and increased in size, features which both reduce the relative area for gas exchange. There was also a reduction in the number of respiratory airways. These changes occurred regardless of the time of amniocentesis, the amount of fluid removed and even if the membranes were simply punctured with no fluid removal. There is some evidence to suggest that similar sublethal effects may be present in human infants after maternal amniocentesis.