Management of patients with metastatic carcinoma of unknown origin

The clinical course of 54 patients with metastatic cancer of unknown primary origin seen at NEMROCK in 1991 were reviewed. Their mean age was 50.5 +/- 11.5 years [range 24 - 62 years]. A higher male predominance was found. 51.9% of cases presented with bone metastasis. 18.5% presented with brain metastasis. A number of investigative procedures were carried out to locate the primary malignant site. The primary site was detected among 16% of patients. Abdominal CT seems a reasonable procedure in the diagnostic evaluation of occult primary carcinoma. Radiation therapy is a good palliative method for bony pain

Recurrent breast cancer: Pattern of recurrences, locoregionally and metastases

The anatomical and patterns of recurrence were studied in 92 patients with first recurrence of breast cancer. Most patients recurred in a single site and 50% of the recurrences were diagnosed within the first 2 years from initial diagnosis. Generally, the status of primary demographic, clinical and pathoanatomical characteristics as well as primary treatment were not predictive as to the development of recurrences. Bone scanning is an effective method to exclude metastatic bone disease. A positive scan, however, requires radiologic confirmation [specificity: 64%]. The diagnostic value of clinical examinations and biochemical tests for liver metastases is satisfactory. Chest X-ray revealed intrathoracic recurrence in 25% [23 patients]. The location of unilateral pleural effusions was significantly related to same site as the primary tumor [P < 0.01]. Local and regional recurrences constituted the most common sites of soft recurrence [37% and 30%]

Tamoxifen adjuvant treatment in postmenopausal women with primary high risk breast cancer

Tamoxifen [Nolvadex], an anti-estrogen has been evaluated as an adjuvant to the local treatment of high risk breast cancer postmenopausal women. 79 patients were treated by total mastectomy with either axillary node clearance of axillary node sampling and then 42 patients received tamoxifen 10-15 mg twice daily for 6-24 months and 37 patients received no further treatment. Treatment failure [recurrent disease] at 20 months was reduced in patients receiving tamoxifen [21.4%] compared with controls [37.8%] [P- 0.01]. Subgroup analyses by age, axillarly lymph nodes status did not reveal a significantly different treatment effect in any of these subgroups. Thus, tamoxifen significantly delays recurrence in postmenopausal patients with early high risk primary breast cancer. The magnitude of the effect is comparable with that associated with adjuvant cytotoxic chemotherapy at a similar follow-up time, but with minimal toxicity

Early skin reactions of breast cancer patients following irradiation with cobalt 60 or electrons beam

Early skin reactions following irradiation with Cobalt-60 or electrons 8 Mev were evaluated. All studied were done prospectively with standardizied skin area, field size and radiation quality. All patients [52] were females with cancer breast and attended to NEMROCK after mastectomy. 25 patients [group A] received their post-operative irradiation on Cobalt-60. 27 patents [group B], received their treatment with electrons beam 8 Mev. Scoring of acute skin reaction used [brisk erythema] as a clinical assay of early skin reaction after different dose schedules. The patients were scored regularly. The number of patients at risk for a prescribed score versus time was calculated with life-table method. The early effects after 5x 2.0 Gy/wk, in dose of 50 Gy/5 weeks/25 treatments was evaluated. The risk of development of brisk erythema showed a significant difference between electron beam irradiated group [group B] and Cobalt 60 group [group A] at the end of the 3rd week of irradiation