Estimation of epidermal growth factor receptor in 177 breast cancers: correlation with prognostic factors

Steroid receptors (ER, PR) and EGF-receptor were determined on 177 loco-regional primary breast cancers. Binding assay for EGF receptor was performed using a single saturating concentration of 125I-EGF incubated with membranes in the presence or absence of unlabeled EGF. With threshold values of 5 fmol/mg and 10 fmol/mg for EGF-R and steroid receptors respectively, we noted an inverse relationship between the expression of EGF-R, and ER and PR. EGF-R expression is decreased with tumor differentiation.

Sequential combination of 5-fluorouracil, cis-platinum and irradiation in unresectable non-small cell lung cancer

Twenty patients with unresectable non-small cell lung carcinoma, 15 stage III and 5 stage IV (supraclavicular lymphadenopathy) were treated with a combination of three courses of chemotherapy and hypofractionated irradiation followed after 3 weeks by split-course radiotherapy. Each course was repeated every 3 weeks with the following sequence. Cis-platin (CDDP) (20 mg/m2) was given in a 20-min infusion, followed by a 2-h infusion of 5-fluorouracil (5-FU) (400 mg/m2) on days 1, 2, 5 and 6. Radiation with a dose of 3 Gy on the target volume was given on days 3 and 4, after a 2-h infusion of 5-FU (400 mg/m2). Split course of irradiation consisted of 16 Gy in 5 fractions repeated after 3 weeks interval. The objective response rate was 75%. Median follow-up was 24 months, the median survival was 14 months. The 1-year survival was 53% and the 2-year survival was 16%.

Value of cytoprognostic classification in breast carcinomas

Two hundred and four cases of breast carcinoma were classified according to cytological features, and these were related to prognosis. A disease free interval of seven years was 95% for patients with grade I, 70% for those with grade II, and 45% for those with grade III tumours. The risk of recurrence was also related to tumour size and the presence or absence of steroid receptors in the tumour. Cytological classification of breast carcinoma based on fine needle aspiration provides valuable information concerning the prognosis of patients, which is relevant to their clinical management.

[Estradiol and progesterone receptors in loco-regional breast cancer. Clinical and prognostic correlations]

Estradiol (ER) and progesterone (PR) receptor assay was performed in breast cancer specimens from 133 women, 31 to 83 years of age. Mean ER levels increase significantly from one ten year age group to the next, ranging from 59.9 + 46.2 femtomoles/mg cytosolic protein in the 30-40 year group to 627 + 479 fmol/mg protein in the 89-90 year group. Mean ER values were found to be 50 + 20.4 fmol/mg protein in premenopausal patients and 176.8 + 55 after menopause. PR concentrations were similar in pre and post-menopausal patients (62.2 + 25.8 and 73.8 + 33.8 fmol/mg protein respectively. Receptor level was not correlated with T.N.M. clinical staging or lymph node involvement. Analysis of ER and PR levels according to histologic (Scarff and Bloom) grading showed a positive correlation between receptor concentration and cellular differentiation. Disease-free survival rate two years after initial therapy was significantly higher in ER positive cases (p = 0.01), although 79% of ER negative patients received adjuvant systemic therapy. In PR positive cases, this difference nearly disappears (p = 0.09), even though 70% of PR negative patients were submitted to adjuvant systemic therapy. Chemotherapy is therefore justified in RE negative patients who carry a poor prognosis.

[Conservative treatment of breast carcinoma with or without prophylactic chemotherapy. Preliminary results in 45 cases (author's transl)]

Between February 1969 and December 1979, 45 breast carcinomas T1 NO or T2 NO (greater than 3cm) were treated by tumorectomy and radiotherapy. Axillary dissection was performed in 22 cases. Twenty-one pre-menopausal patients were castrated either by oophrectomy (13 cas) or by pelvic irradiation (8 cases). From 1977 on, (10 cases) prophylactic chemotherapy using cyclophosphamide, 5 FU, methotrexate, vincristine, was administered for 4 to 6 months according to the number of poor prognostic factors. The five-year actuarial remission rate was 93% (84-100), the metastatic remission rate was 88% (72-100). Indications of prophylactic chemotherapy in forms with good prognostic factors are discussed.

[Non-gonadic complications of chemoradiotherapy in Hodgkin's disease. A study of eighty-three patients (author's transl)]

Eighty-three patients with Hodgkin's disease were treated with a combination of chemotherapy and radiotherapy. 43 were included in protocol 1 (from january 1970 to january 1974) and 40 in protocol 2 (february 1974 to december 1977). In protocol 1, staging laparotomy was not systematically performed (20 cases). Treatment consisted of 2 intravenous injections in Vinblastine and total nodal irradiation. In protocol 2, laparotomy was systematic in patients over 50 (35 cases). Patients with stages 1 and II treated as mentioned above. Patients with stage III received two Mopp courses followed by total nodal irradiation. Patients older than 50 with stages I and II and poor prognosis factors received chemotherapy only. Laparotomy was associated with a 0% mortality rate and a 3,6% morbidity rate. No myelitis or pericarditis were observed. Herpes zoster occurred in 24% of the patients, pulmonary apex fibrosis in 6%, hypothyroiditis in 2,4%, and leucopenia in 3,6%. Two late infectious complications were fatal. No solid tumor was apparent. Acute leukemia and non-Hodgkin malignant lymphoma developed in two patients. Good tolerance, shortness of treatment, and remission rate, warrant the pursuit of protocol 2 in which systematic laparotomy for patients under 50 allows total nodal irradiation and therefore reduction of chemotherapy.

[Mammary lymphatic scintiscans by intratumoral injection in the assessment of breast cancer. 105 examination in 100 patients (author's transl)]

One hundred and five scintiscans of the mammary lymphatic system were performed in 100 patients with breast cancer by intratumoral injection of 99 m Tc-labelled colloidal rhenium. The progression of the radioactive colloidal agent was followed on a series of films taken 1, 2 and 4 hours after the injection, and the images obtained were compared with post-operative findings of lymph node involvement. Patients with more than 3 carcinomatous lymph nodes had less than 2 foci of activity, while those with less than 3 carcinomatous lymph nodes had more than 2 foci of activity, owing to more rapid progression of the compound. The difference was highly significant (p less than 0,001).

[The injection of the lymphatic system of the stomach during surgery by vital staining dye: an anatomical or surgical interest? (author's transl)]

The authors present the report of their experience of 20 injections of the lymphatic system of the stomach during surgery by vital staining dye: 19 times by Pontamine sky blue 6 BX, 1 time by patent blue violet. The results of this study are analysed; the anatomical interest is specified. Nevertheless, this technique presents no surgical interest concerning the stomach, in spite of many authors' opinion.

[Analysis of loco-regional control rate, metastatic remission and survival in 178 breast cancer patients treated by radical modified mastectomy and post-operative irradiation (author's transl)]

178 cases of post-operative irradiation for breast cancer (145 T1, T2, T3 and 33 T4) are analyzed. According to the surgical procedure there are 146 cases of radical modified mastectomy (Patey) and 32 cases of radical mastectomy (Halsted). The axillary status reveals 50% of involved nodes, but radiotherapy has been systematic on chest wall and supra-clavicular, parasternal, axillary lymph nodes areas. Loco-regional failures are only situated on chest wall (3,9%) and in the supraclavicular area (1,7%). The five year actuarial rate of locoregional control is 93% and 98% if we exclude 7 locoregional failures contemporaneous or consecutive to a metastatic evolution. The five year actuarial rate of metastatic remission for patients with negative axillary nodes (N-) is 83% against 55% for N+ (p < 0,001). The five year actuarial survival rate is 92% (N-) and 64% (N+) (p < 0,001). We discuss about indications of selective irradiation of chest wall and parasternal area for patients with negative axillary nodes and also about post-operative immuno-suppression, and chronology of chemotherapy.

[Bilateral lobular in situ carcinoma discovered by sub-cutaneous mastectomy (author's transl)]

The authors relate the observation of a 42 years old woman with antecedents of mastodynia from several years and numerous operations for fibroadenoma. During the follow-up a sub-cutaneous mastectomy is realized owing to the discovery of clustered calcifications on mammographic study, which reveals a bilateral lobular in situ carcinoma. They talk over surgical procedures in this form of carcinoma.

[Carcinoembryonic antigen in carcinoma of the uterine cervix. Correlations with clinical stage, histopathology, and survival about 115 cases (author's transl)]

Carcinoembryonic antigen is elevated in the serum of approximately 35% (35/98) of patients with carcinoma of the uterine cervix. The incidence of elevated serum CEA is not related to stage of disease, histopathology, lymphangiogram and survival rate. Carcinoembryonic antigen levels return to normal after curative radiation therapy (25/32). Persistently high values after irradiation are indicative of residual disease (3/32). Reappearance of CEA, with a progressive rise evoke a recurrence, and may precede the clinical diagnosis.