Response of locally advanced breast cancer to primary chemotherapy; is it eligible for breast conservation

Assess the eligibility of breast-conserving surgery for large tumours after response to primary chemotherapy [PCT]. 50 patients with locally advanced cancer breast presented to Alexandria Surgical Oncology Unit. All patients had complete breast examination, mammography, and US and core biopsies before started of PCT in the form of 4 cycles of either Adryamicine or Cyclophosphamide [AC] or 5-flurouracil, Epirubicin, and Cyclophosphamide [FEC]. All responders underwent modified radical mastectomy. Single histopathologist had reviewed all operative specimens. The questionable area which is the difference between pre and post PCT sizes were examined carefully for at least 4 different radial par-tumour areas, searching for any residual tumour tissue. 5 patients [10%] achieved complete clinical response [CR] and 38 patients [76%] partial clinical response [PR]. Total of 402 slides were examined from questionable areas with positive tumour tissue present in only 22 of them, which belong to 7 patients only out of 43 responders [16.3%]. Multivariate analysis showed that: smaller initial tumour size < 5cm, absence of ductal carcinoma insitue and absence of vascular invasions were the best predictors of absence of tumour tissue in questionable area slides. Those factors were good indicators of eligibility of breast conserving surgery in responders locally advanced breast tumours to PCT

High versus standard dose prophylactic cranial irradiation for patients with limited sm allcell lung cancer incomplete remission

Small cell lung cancer [SCLC] accounts for approximately 20% of all patients with lung cancer. Limited-disease [LD] is considered potentially curable. The role of prophylactic cranial irradiation [PCI] in those patients who achieved a complete cure [CR] to induction therapy remains uncertain. Eligible patients were randomized to receive either high dose PCI [20 patients received 2.4 Gy once daily in 10 fractions for a total dose of 24 Gy] or a standard dose PCI [25 patients were treated with 2 Gy once daily in 18 fractions for a total dose of 36 Gy, while there was another group [15 patents] who refused PCI. Results: The results confirmed the observable reduction of brain metastases with the high dose PCI compared to the standard dose PCI and also for those who did not receive PCI [16%, 35%, and 53% respectively]. Also this result confirmed the loss of significant survival advantage between those who receive PI and those who did not. No evidence of consistent difference regarding neurological and cognitive impairment between patients given or not PCI