Assessment of response of locally advanced breast carcinoma to docetaxel and epirubicin neoadjuvant combination regimen: a prospective phase II study

This study aimed to evaluate the efficacy and toxicity of neoadjuvant chemotherapy [NCT] with docetaxel/epirubicin combination in patients with locally advanced breast carcinoma. In addition, to stratify the pathological response to chemotherapy according to a proposed grading system of response. Between July 2000 till December 2002, 24 patients with locally advanced breast carcinoma were recruited and completed their treatment with neoadjuvant chemotherapy, followed by surgery, adjuvant chemotherapy and radiotherapy +/- tamoxifen; following a proposed regimen. Clinical and pathological results of neoadjuvant chemotherapy were evaluated. The patients' median age was 50 years, 54.2% were postmenopausal and all patients had stage III disease with minimum T3 tumour. Clinically positive axilla was detected in 70.8% of patients and 91.7% had infiltrating duct carcinoma. Patients were treated with 4 cycles of NCT formed of epirubicin 90 mg/m2/i.v plus docetaxel 75 mg/m2, one-hour infusion on day one, repeated every 3 weeks upon full marrow recovery. The post treatment clinical assessment revealed that 6 patients [25%] showed clinical complete response, 70.8% achieved clinical partial response [overall response rate 95.8%] with significant reduction of the tumour and axillary nodes dimension. Twenty-two patients underwent surgical interference [10 conservative resection and 12 modified radical mastectomy]. Pathological assessment of the specimen showed that the objective pathological response of breast lesion was 59.1% with 18.2% pathological complete response [Grade 5]. Similarly pathological complete response of axillary involved lymph nodes [Grade D] was achieved in 50% of patients. The clinical and pathological responses were significantly higher for patients with negative hormone receptors. Grade 3 and 4 neutropenia were the major side effect encountered in 79.2% of patients during NCT phase. Patients were followed up for a median of 15 months, the median disease free survival [DFS] was 15 months and the median overall survival [OAS] was not reached. The estimated 2-year DFS was 70% and 2-year OAS was 84%. It was concluded that this regimen of NCT proved to be efficient for treatment of locally advanced breast cancer in terms of clinical, pathological responses as well as the rate of conservative surgery that could be achieved. The pathologic grading of response may be useful for selection criteria of the subset of patients that could benefit from maximizing adjuvant chemotherapy. Future trials should incorporate growth factor support in the treatment regimen to avoid undue toxicity

Factors delaying the diagnosis of cancer in children

In this study, an interview questionnaire including the patient's age, the number of siblings as well as the order of the patient among them, the level of education of the parents and the primary complaint was administered to 150 patients and their families. 59% of the patients were younger than 5 years and 66% were males. 73% of the parents were illiterate and only 17% of them were colleague graduate. The primary complaint was fever and/or fatigue in 42% of the patients, mass in abdomen in 21% and lump in the neck in 18.5%, respectively. The patients included in the current study had leukemias and lymphomas [45%] as well as solid tumor [45%]. The delayed diagnosis was represented in an interval of more than three weeks between the first appearance of symptoms or signs and the diagnosis. Only 41 patients were diagnosed within the first 3 weeks of onset of symptoms

Parental factors in childhood malignancies

The current study included 125 children with cancer, in addition to 125 age and sex matched healthy children as a control group. 49% of the cancer patients were coming from rural places versus 35.2% of the controls, this difference was statistically significant. As regards the degree of consanguinity, there was a statistically significant high prevalence of first degree of consanguinity among children of cancer group than the controls; this was the same for children with solid tumors, but not for those with lymphoma and leukemia. The present study showed an increased percentage of parental exposures to pesticides, paints and dyes as well as maternal exposures to irradiation among children in the cancer group. However, this difference was mot statistically significant, may be due to the small number of the study group. However, there was a significant increase of the parental exposure to motor exhaust products in the cancer group