possibility of avoiding axillary lymph node dissection after preoperative chemotherapy for locally advanced breast cancer

The poor prognosis of patients with locally advanced breast cancer [LABC], systemic combination chemotherapy [CT] was introduced as the primary treatment in these patients. Sentinel lymph node biopsy [SLNB] is demonstrated, a proportion of initially node positive patients could eventually be spared from an axillary dissection if their involved sentinel nodes become uninvolved after the administration of neoadjuvant chemotherapy. This study aimed to assess if sentinel lymphadenectomy after neoadjuvant chemotherapy for locally advanced breast cancer is reliable to prevent axillary dissection or not. The study was conducted on twenty female patients with LABC who received neoadjuvant chemotherapy at the Department of Clinical Oncology and Nuclear Medicine for histologically proven carcinoma of the breast and who underwent sentinel lymphadenectomy during the definitive surgical procedure performed at the Surgical Oncology Unit Alexandria Main University Hospital. Clinical response of breast carcinoma to induction chemotherapy [3 cycles CAF] was complete in 20% of patients and partial in 80% of patients, on the other hand, 20% of patients showed downstaging in axillary LNs. Sentinel lymph node was commonly located at level I [90%], also its detection after neoadjuvant chemotherapy; was only in 60% of patients. Neoadjuvant chemotherapy increases the false negative rate of sentinel lymph node biopsy; [33% of cases]. There was no statistically significant difference neither in sentinel node identification rate nor in false negative rate as regards age, clinical tumor size, clinical nodal status, tumor location within the breast, or clinical response of the tumor to chemotherapy. SLN identification rate and accuracy after neoadjuvant chemotherapy for breast carcinoma were good however there is potential for inaccuracy after less than complete pathological tumor response. This technique is a potential way to guide the axillary treatment of patients who are clinically node negative after neoadjuvant chemotherapy. Therefore, until further prospective randomized trials are conducted, it cannot be assumed that all the regional nodes have the same biologic response to chemotherapy as the SLN

Study the effect of adding CIS retinoic acid during and after conventional treatment for pediatric neuroblastoma patient

Cis-retinoic acid has been used as maintenance therapy for treatment of advanced neuroblastoma in paediatric patients after BMT showing significant advantage in 3-year event-free survival than patients receiving no maintenance therapy. However, there is no data available about using Cis-retinoic acid during induction phase of chemotherapy. The Aim of this study is to evaluate the efficacy of Cis-retinoic acid when used in combination with conventional chemotherapy in the paediatric patient who is newly diagnosed with locally advanced Neuroblastoma. Seventeen newly diagnosed children with locally advanced Neuroblastoma who are candidate to receive chemotherapy also received oral Cis retinoic acid starting at a dose of 160 /m[2] day oral [day 2-15 of chemotherapy]. Patients received at least 6 cycles of OPEC/OJEC regimen. N- Myc was tested in 12 patients. Median follow up was 6 months. Median age 2.4 years. Male: Female ratio was 1.4:1. Most patients were stage III or IV [70%] with only 30% stage II. Abdominal mass was the presenting symptom in 88%. Maximum tolerated dose was 130mg/m[2]. Thirty percent of patients achieved complete remission, 40% had very good response short of complete remission, 12% had partial response, 18% had disease progression. Median disease free survival was 12 months [95% confidence interval: 10.6 - 13.4]. The observed toxicities were hypercalcemia; rash, elevated liver enzymes and hematological toxicities in the form of thrombocytopenia and neutropenia were the main dose limiting effect of Cis retinoic acid. Cis-retinoic acid at dose 130mg/m[2] is a well tolerated drug with chemotherapy. Response to treatment is better than historical control. Randomized phase III trial is warranted

study comparing two different combination chemotherapy protocol in metastatic breast cancer patients previously treated with anthracycline chemotherapy regimen

Treatment for systemic disease is palliative in intent. Goals of treatment include improving quality of life and prolongation of life. Although median survival has been reported to be 18 to 24 months, some patients experience long-term survival. Several combination chemotherapy has been used with comparable results. Quality of life and cost of treatment are an important factor to determine the best combined chemotherapy. In this study. To compare a Taxane based regimen versus If osphamide fluorouracil and mitomycin combined regimen [FILM]. This study was designed to recruit a total of 52 patients with metastatic breast cancer who has received anthracycline chemotherapy in their initial treatment and were randomized between 4 cycles of FILM chemotherapy [Group A] or Taxane based chemotherapy [Group B] to be given every 3 weeks. Patients were assessed for response and toxicity, statistical analysis was used to estimate survival and disease control. Between January 2006 and January 2007, a 52 female patients with metastatic breast cancer have been randomized to either Taxane based or FILM [26 patients in each arm]. Patients were evenly distributed as regards age, staging at first diagnosis, chemotherapy that was previously used, hormonal receptors status and Her-2, and sites of metastases. All patients received the planned treatment. As regards response rate, overall response rate was 73% for group A and 92% for group B P= .047. Progression free survival was better in taxan based regimen 7.3 +/- 3.4 than FILM based 5.6 +/- 2.8 the difference was statistical significant with P= .02. On the other hand, cost of treatment was extremely higher for group B than group A. The cost of treatment was significantly higher in taxan group than FILM P 0.00002. There was no significant difference in quality of life in both groups. Taxan based chemotherapy is significantly better than FILM in terms of PFS. However, there was no significant difference as regards quality of life or overall survival. On the other hand, cost of treatment is significantly higher in Taxane based chemotherapy