RESUMO
Background: Unfortunately, locally advanced cancer breast [LABC] represents more than 50% 0f the newly diagnosed breast cancer patients. There are 2 approaches for treating these patients. The first is modified radical mastectomy [MRM] 0r radical mastectomy [RM] followed by adjuvant systemic therapy and radiotherapy. While the second is preoperative chemotherapyfollowed by surgery and radiotherapy
Aim: The aim of this prospective randomized study was to evaluate two different lines in the management of operable LABC
Methods: This study had been conducted on 40 patients with operable LABC presented to surgical or medical oncology units, Alexandria University Hospital. These patients were equally divided at random by closed enve10pes method into two groups: Group 1. who received 6 cycles of neoadjuvant chemotherapy followed by surgery and postoperative Adjuvant radiotherapy. Group II. who had been treated by surgery with early postoperative chemotherapy where first cycle chemotherapy started immediate] y after tissue diagnosis independent of the time of surgery. In both groups completion of the adjuvant chemotherapy, radiotherapy and hormonal therapy had been applied
Results: After completion of neoadjuvant chemotherapy for group 1, two patients [5%] showed complete clinical response [CRc], while 10 patients [50%] had partial clinical response [PRC]. This gave a total clinical response rate of 55%. At pathologic examination of the mastectomy specimen; none of studied patients had CR, while 13 patients [65%] had smaller diameter tumors [PR]. No statistical significant difference was found in the postoperative wound complications in both groups. Postoperative pathological examination of mastectomy specimens in both groups showed that there were significant decrease in tumor size, nodal number and size in group I after Iry chemotherapy with significant increase in lymphocytic infiltration. 65 %of patients in group I survived with no evidence of loco-regional or distant recurrence compared to 70% in group II with no significant difference. Systemic recurrence alone or in combination with loco-regional was found in 18% and 20% of cases in each of the two groups respectively. 75% of patients in group I survived compared to 80% in group II with no significant statistical difference
Conclusions: Primary ehemotherapy in operable LABC resulted in significant reduction in tumor and nodal stage with reduction of their size and fixation that allowed their treatment with less radical surgery and direct wound closure. Complete clinical response to neoadjuvant chemotherapy doesn't mean complete pathological response. Preoperative chemotherapy had no impact on postoperative wound complications or patient tolerance to postoperative adjuvant chemo and radiotherapy. There was no significant disease free or overall sun'ival benefit of neoadjuvant over adjuvant chemotherapy in treatment of patients with operable LABC. Also better overall survival rates [OS] were correlated with better diseasefree survival rates [DFS]
RESUMO
130 patients with different stages of endometrial adenocarcinoma were analyzed retrospectively between 1974 and 1984 divided into two groups according to the primary line of treatment whether surgical or radiotherapeutic. Group [A] 54 patients treated by surgery followed by postoperative external irradiation and/or brachytherapy. Group [B] 76 patients primarily treated by radiotherapy due to medical contraindication to surgery, refusal of surgery OF inoperability. Upper vaginal recurrences were significantly reduced by the addition of intracavitary irradiation in both groups. Five year direct survival was 40.0% while at ten years it was 25.3%. Survival was found be influenced by treatment modality, stage, and grade