Modified radical mastectomy or quadrantecomy and axillary clearance for management of early breast cancer

For the most part, surgery for patients with breast cancer is the first treatment. The surgical management has undergone extensive transitions over the past century. Breast conserving surgery [BCS] is a treatment modality for early-stage breast cancer that causes less physical disfigurement and psychological trauma to the patient. This study has been carried out to compare modified radical mastectomy [25 patients [group 1]] and quadrantectomy with axillary clearance [25 patients [group 2]], for 50 patients with stage I and stage II breast cancer. There were no statistical differences between both groups, regarding age, menstrual history, history of contraceptive pills, parity status, family history, tumour site as well as histopathological findings. Postoperative wound edge ischaemia was found in 3 [12%] of patients in group 1. Wound seroma occurred in 5 [20%] of patients in group 1 and 2 [8%] of patients in group 2. Wound infection occurred in 4 [60%] patients in group 1 and 2 [8%] of patients in group 2. Parasthesia and wound numbness occurred in 8 [24%] patients in group 1 and 3 [12%] of patients in group 2. There were no cases of upper limb oedema in this study. Regarding to cosmetic results in group 2, 15 patients [60%] showed excellent results, 7 [28%] showed good results; 3 [12%] showed fair results and no patients showed poor results. There were no postoperative recurrence or death from breast cancer during the follow up period [30 months] in our patients. Since breast conservation surgery yielded results similar to mastectomy, its use should be extended

Recnet management of non metastatic limb osteosarcoma

Osteosarcoma is the most common primary malignant bone tumor in children and adolescents. The specific aims of this study were to assess the response of the neoadjuvant chemotherapy [DOX/DDP] with non metastatic high grade limb osteosarcoma by MRI and correlate the results with histopathologic analysis. Twenty one patients with non metastatic high grade limb osteosarcoma, were entered between April 2003 and November 2006. Study of patients consist of 13 males and 8 females, age ranged from 10 to 23 years. All patients were treated in Surgical Oncology Unit and Clinical Oncology Department, Al-Azhar University hospitals with 3 cycles of Doxorubicjn and cisplatin [DOX/DDP] regimen followed by surgical resection. Limb sparing surgical resection was performed in 15 patients [71%] and amputation in 6 patients. The histologic response to chemotherapy was good [> 90% tumour necrosis] in 7 patients [33.3%], the response was complete [100% tumor necrosis] in two cases. The histologic response was related to tumor size and type as five patients out of 11 [45.5%] who had small tumour size achieved good histologic response versus only 18% of those who had large tumor size. MR imaging, provides an accurate study of the tumours volume than other imaging techniques and the clinical examination. All patients who had increased tumour volume in their MR images achieved poor histologic response [10 cases]. Seven out of 11 [66.7%] patients who had stable or reduction in tumour volume got good histologic response after 3 cycles of preoperative chemotherapy. In conclusion the combination of DOX/DDP in the neoadjuvant setting in patients with non metastatic primary limb osteosarcoma seems to be an effective and applicable regimen with an acceptable toxicity profile. The utilization of MRI especially dynamic study can be an important, non invasive tool to predict for histologic response early in the course of chemotherapy

Radiotherapy and weekly gemcitabine as radiosenstizer in locally advanced non-small cell lung cancer

About 30-40% of patients with non-small cell lung cancer [NSCLC] have locally advanced unresectable tumors at the time of diagnosis. This work included 18 patients with locally advanced non-small cell lung cancer. These patients were subjected to concurrent chemoradiotherapy. Radiotherapy lasted six weeks with a total dose of 50.4 Gy with daily fraction 1.8 Gy administered five days a week. Gemcitabine was administered at dose 200 mg/m2 on days 1, 8, 15, 22, 29 and 36 of radiotherapy. Response toxicity and response duration was calculated. The use of this regimen of gemcitabine and radiation appears to be active and well tolerated. The maximum tolerated dose and related toxicity of weekly gemcitabine and concurrent radiotherapy in patients with non-small cell lung cancer must be evaluated