Breast cancer remains the second leading cause of cancer death despite numerous advances in medical science. In vitro, preclinical, and clinical trials have shown that chemotherapy dose intensity is an important component of therapy. Many clinical trials addressing the use of high-dose chemotherapy and hematopoietic cellular rescue have been conducted over the past decade. Early trials undertaken in heavily pretreated patients who had metastatic disease were associated with high treatment-related mortality rates; good response rates were noted but overall survivals were short. Subsequent technological advances, including the use of recombinant hematopoietic growth factors and peripheral blood progenitor cells as the source of cellular rescue, have dramatically lowered the morbidity and mortality of the procedure, as well as shortened hospital stay and markedly reduced cost. As a result, the high-dose chemotherapy approach has been used earlier in the disease course, both in patients with metastatic diseas...

Hematopoietic progenitor cell transplantation in breast cancer: current status and future directions.

The role of radiotherapy in the management of the axilla in early breast cancer is examined. A few, carefully selected, clinically node-negative postmenopausal women may require no intervention to the axilla. Otherwise, surgical clearance is the preferred sole management of the axilla, resulting in an excellent level of local control and providing optimal information for the use of systemic adjuvant therapy. Axillary radiotherapy can also provide equivalent levels of long-term control in the clinically node-negative axilla, but the chronic disabling syndrome of brachial plexopathy is documented at all radiation doses that can sterilize microscopic disease, irrespective of the radiotherapy technique. A combination of radiotherapy and axillary surgery results in an increased morbidity rate compared with either alone. Women who receive radiotherapy to the breast alone are not at risk of brachial plexopathy.

Radiotherapy and the management of the axilla in early breast cancer

Congenital thrombocytopenia with absent radii (TAR syndrome) is characterized by defective thrombopoiesis and bleeding in early infancy. To determine the frequency and responsiveness to cytokines of megakaryocyte progenitors (CFU-Meg) in TAR syndrome, the authors studied marrow samples from 3 patients and 6 normal controls, using optimally standardized megakaryocyte growth media incorporating interleukin-3, interleukin-6, stem cell factor, and granulocyte-monocyte colony-stimulating factor, with and without pegylated recombinant human megakaryocyte growth and development factor (PEG-rHuMGDF). CFU-Meg was identified with a specific staining system utilizing monoclonal antibodies to glycoprotein IIb/IIIa. Growth of small CFU-Meg colonies (3-20 cells/colony) was observed in all patients in cultures without PEG-rHuMGDF, with a mean frequency of 8 (range 5-12) per 2.25x105 mononuclear cells plated (control mean 23; range 2-70). Identical cultures of marrow cells from patients and controls with added PEG-rHuMGD...

THROMBOCYTOPENIA WITH ABSENT RADII: Frequency of Marrow Megakarycyte Progenitors, Proliferative Characteristics, and Megakaryocyte Growth and Development Factor Responsiveness

Sir We were interested to read the Review by Dr Falk on radiotherapy and the management of the axilla in early breast cancer (Br J Surg 1994; 81: 1277-81) which included mention of axillary morbidity as a consequence of treatment. Despite detailed discussion of brachial plexus neuropathy, only brief mention was made of the much more common upper limb swelling and impaired upper limb mobility. Of patients treated for breast cancer, significant upper limb oedema and/or restriction of shoulder movement occurs in 25 per cent of patients who have undergone axillary radiotherapy with no surgery, 50 per cent of those who have undergone axillary sampling and radiotherapy and 84 per cent of those who have undergone formal axillary dissection and radiotherapy’. While definition of early breast cancer is open to debate, in women undergoing mastectomy for operable breast cancer (To-z, N,, or N1, M?), shoulder mobility was significantly impaired both subjectively and objectively in those who received radiotherapy to the chest wall and axilla compared with those in whom the axilla was treated by surgery alone2. Women having breast conservation and axillary therapy for unilateral breast cancer (tumour less than 4 cm in diameter) appear to suffer significant upper limb morbidity even at 12 months’ f o l l o w ~ p ~ . ~ . Measures of upper limb oedema increase significantly with more extensive axillary surgery with or without the addition of radiotherapy. However, shoulder girdle mobility was significantly reduced only by the addition of radiotherapy to axillary surgery. The combination of axillary node dissection (levels I and 11) and radiotherapy carried the highest morbidity3s4. Clearly, upper limb morbidity reflects the extent of axillary surgery and the use of axillary radiation. The standard recommended therapy of the axilla, both in the USA and Europe, is to perform axillary clearance without the addition of radiotherapy. Current randomized studies of axillary node sample and axillary radiation if node positive versus axillary clearance will determine how to balance disease control with upper limb and shoulder morbidity.

https://bjssjournals.onlinelibrary.wiley.com/doi/pdf/10.1002/bjs.1800820946

Retroperitoneal endoscopic adrenalectomy

High-dose chemotherapy (HDC) with autologous progenitor cell support (APCS) for breast cancer patients with high risk stage II–III, and stage IV with no evidence of disease (NED)

Comparative assays of megakaryocyte progenitors in CD34+ peripheral blood progenitor cell fractions.

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High-dose chemotherapy (HDC) with autologous progenitor cell support (APCS) for breast cancer patients with high risk stage II–III, and stage IV with no evidence of disease (NED)

Comparative assays of megakaryocyte progenitors in CD34+ peripheral blood progenitor cell fractions.