Breast-conserving therapy (BCT), consisting of lumpectomy followed by radiotherapy, has become the standard form of treatment for invasive breast carcinomas up to 4 cm 1 and 5 cm 2,3 and is increasingly being used for ductal carcinoma in situ (DCIS) 4–6 and larger tumors. 7–9 However, with BCT for large tumors, there can be difficulty in obtaining clear excision margins, and the cosmetic outcome is often poor. 10,11 The tumor size in relation to the breast size is one of the most important factors when attempting to obtain a cosmetically favorable result. A conflict exists, therefore, between performing a resection wide enough to obtain optimal oncologic control and not removing so much breast tissue as to leave a deformed breast or a large discrepancy compared with the other side. One way of resolving this conflict is to use plastic surgery techniques such as remodeling mammaplasty to reshape the breast immediately following lumpectomy. This novel approach, referred to as “oncoplastic surgery” (W. Audretsch), has rapidly gained acceptance in Europe and is now widely practiced in some dedicated breast units. 12–18 When a remodeling mammaplasty is performed, because of the volume excised, contralateral symmetrization is often indicated to achieve symmetry. The aim of this prospective study was to assess the oncologic and cosmetic outcomes for patients who underwent BCT using oncoplastic techniques with a symmetrizing procedure on the opposite breast.

Oncoplastic Techniques Allow Extensive Resections for Breast-Conserving Therapy of Breast Carcinomas

Mitoxantrone is a dihydroxyanthracenedione derivative which as intravenous mono- and combination therapy has demonstrated therapeutic efficacy similar to that of standard induction and salvage treatment regimens in advanced breast cancer, non-Hodgkin's lymphoma, acute nonlymphoblastic leukaemia and chronic myelogenous leukaemia in blast crisis; it appears to be an effective alternative to the anthracycline component of standard treatment regimens in these indications. Mitoxantrone is also effective as a component of predominantly palliative treatment regimens for hepatic and advanced ovarian carcinoma. Limited studies suggest useful therapeutic activity in multiple myeloma and acute lymphoblastic leukaemia. Regional therapy of malignant effusions, hepatic and ovarian carcinomas has also been very effective, with a reduction in systemic adverse effects. Mitoxantrone inhibits DNA synthesis by intercalating DNA, inducing DNA strand breaks, and causing DNA aggregation and compaction, and delays cell cycle progression, particularly in late S phase. In vitro antitumour activity is concentration- and exposure time-proportional, and synergy with other antineoplastic drugs has been demonstrated in murine tumour models. Leucopenia may be dose-limiting in patients with solid tumours, whereas stomatitis may be dose-limiting in patients with leukaemia. Other adverse effects are usually of mild or moderate severity although cardiac effects, particularly congestive heart failure, may be of concern, especially in patients with a history of anthracycline therapy, mediastinal irradiation or cardiovascular disease. Mitoxantrone displays an improved tolerability profile compared with doxorubicin and other anthracyclines, although myelosuppression may occur more frequently. Thus, mitoxantrone is an effective and better tolerated alternative to the anthracyclines in most haematological malignancies, in breast cancer and in advanced hepatic or ovarian carcinoma. Further studies may consolidate its role in the treatment of these and other malignancies.

Mitoxantrone. A review of its pharmacodynamic and pharmacokinetic properties, and therapeutic potential in the chemotherapy of cancer.

Purpose Recurrent squamous cell carcinoma of the head and neck (SCCHN) or new second primary tumor (SPT) in a previous radiation field, if not curable by surgery or radiation, is almost always fatal. Chemotherapy alone yields a median survival time (MST) of no more than 10 months and 1-year overall survival (OS) of 35% at best. Concurrent reirradiation and chemotherapy is an alternative strategy. Patients and Methods Eligibility for Radiation Therapy Oncology Group (RTOG) protocol 9911 stipulated recurrent SCCHN or SPT in a previous radiation field. Patients received twice-daily radiation (1.5 Gy per fraction bid × 5 days every 2 weeks ×4), plus cisplatin 15 mg/m2 intravenously (IV) daily × 5 and paclitaxel 20 mg/m2 IV daily × 5 every 2 weeks ×4. Granulocyte colony-stimulated factor was administered days 6 through 13 of each 2-week cycle. Results One hundred five patients were enrolled from March 2000 through June 2003; 23% had SPT. Oropharynx (40%) and oral cavity (27%) were the predominant primary sites...

Phase II Study of Low-Dose Paclitaxel and Cisplatin in Combination With Split-Course Concomitant Twice-Daily Reirradiation in Recurrent Squamous Cell Carcinoma of the Head and Neck: Results of Radiation Therapy Oncology Group Protocol 9911

PURPOSEThe natural history of inflammatory breast cancer and the recent advances in its management were reviewed.DESIGNThe English medical literature from 1924 to 1990 was reviewed using the Cancerline and Medline retrieval systems, and through a manual review of bibliographies of identified articles.RESULTSThe majority of patients with inflammatory breast cancer treated only with local therapies died 18 to 24 months after diagnosis. A combined modality approach with chemotherapy, surgery, and radiation therapy has improved disease-free and overall survival rates for inflammatory breast cancer. Approximately 35% to 55% of patients treated with combined modality regimens remain disease-free and alive at 5 years.CONCLUSIONInduction combination chemotherapy administered with radiation therapy, mastectomy, both, or with additional chemotherapy favorably alters the natural history of inflammatory breast cancer. New drug combinations and high-dose chemotherapy with autologous bone marrow support are being evalu...

Inflammatory breast cancer: a review.

Cancer of the breast.

Twenty-six consecutive patients with nonmetastatic inflammatory breast cancer (IBC), were treated in a single institution using the same protocol, and all were followed for at least 48 months. The first phase of treatment consisted of two monthly cycles of combination chemotherapy with Adriamycin (Adria Laboratories, Columbus, OH), vincristine, cyclophosphamide and 5-fluorouracil. Local treatment was then undertaken using in all cases a cobalt 60 beam to deliver 45 Gy to the entire mammary gland and lymph-draining areas. Local treatment was completed either by mastectomy, or by conservation of the breast and interstitial irradiation of the primary tumor site. Chemotherapy was resumed after completion of local treatment for a total of 6 cycles. Metastatic disease occurred in 19 of 26 patients from 8 to 55 months; five patients are alive and free of disease from 48 to 81 months. Failure to control local disease or local recurrences was noted in two of ten patients undergoing mastectomy, and in seven of 13 patients with conservation of the breast. While this difference is not statistically significant we concluded that methods of breast conservation which limit the high dose volume to the tumor site do not assure local control in IBC. The median disease-free survival and overall survival of 12 and 31 months, respectively, are not satisfactory. Better systemic treatment is needed.

Treatment of inflammatory breast cancer with combination chemotherapy and mastectomy versus breast conservation.

Management of breast cancer in the elderly

Resume Objectif de l'etude Analyse retrospective de huit nouveaux cas de sarcome radio-induit apres une radiotherapie pour un cancer du sein et revue de la litterature. Patientes et methodes Onze patientes atteintes de sarcome radio-induit apres une radiotherapie pour cancer du sein ont ete traitees entre 1983 et 1997 a l'hopital HenriMondor de Creteil. Huit tumeurs avaient les criteres requis par Cahan Les trois autres etaient atteintes d'un syndrome de Stewart-Treves et ont ete exclues de l'analyse. Une seule des huit patientes avait recu une chimiotherapie. Elles etaient en situation de remission complete au moment du diagnostic de sarcome survenu apres une periode de latence de 5 a 18 ans (moyenne: 10,3 ans). L'âge variait de 39 a 88 ans (moyenne: 57,6 ans) au moment du diagnostic de sarcome qui etait localise au sein traite (trois cas), a la paroi thoracique (deux cas), a la region claviculaire (un cas) et a la region axillaire (deux cas). Sur le plan histologique, il s'agissait de deux angiosarcomes, de trois fibrosarcomes, d'un osteosarcome, d'un mesenchymome malin et d'un sarcome indifferencie. Toutes les patientes ont eu, pour leur sarcome, une exerese chirurgicale, trois une chimiotherapie et une, une association de radiotherapie et de chimiotherapie. Resultats Deux patientes etaient en vie en situation de remission complete a 6 et 115 mois. Six patientes sont decedees dans un delai de 5 a 34 mois et avaient toutes une recidive locale et/ou metastatique. Conclusion La radiotherapie peut induire des tumeurs malignes apres une periode de latence de quelques annees. Le sarcome radio-induit est de pronostic defavorable. Son traitement est en general tardif et inefficace, d'ou la necessite d'une surveillance prolongee apres traitement d'un cancer du sein. Des incertitudes demeurent et beaucoup de questions restent posees en ce qui concerne les sarcomes radio-induits.

Sarcomes radio-induits après cancer du sein. Á propos de huit cas et revue de la littérature

Radiation-induced sarcomas following radiotherapy for breast cancer: six case reports and a review of the literature

A case report of intrauterine device (IUD)-associated tubo-ovarian actinomycosis is presented. The patient was a 37-year-old nulliparous woman with IUD usage for the last four years. She presented anemia and weight lost of 8 kg. Ultrasound and computed tomography showed an unilateral large mass in the right adnexum adherent to the uterus and compressing the urinary bladder. Preoperative diagnosis of ovarian cancer with liver metastases was made. Bilateral salpingoophorectomy and total abdominal hysterectomy were performed. After pathological and biological analyses, actinomycosis was diagnosed and the patient was treated postoperatively with penicillin. The purpose of this article is to add to the literature a new case of this rare disease which clinically mimics ovarian cancer.

Intrauterine device--associated pelvic actinomycosis: a rare disease mimicking advanced ovarian cancer: a case report

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