Neoadjuvant chemotherapy with cyclophosphamide, doxorubicin and 5-fluorouracil (CAF) or cyclophosphamide, methotrexate and 5-fluorouracil (CMF) in 69 cases of locally advanced (stage IIIb) breast cancer.

Sixty nine patients with a median age of 45 years, 62.3 per cent of whom were premenopausal, with locally advanced breast cancer (T 4, N 0-3, M 0; Stage IIIb) were treated with 3 cycles of either neoadjuvant cyclophosphamide, doxorubicin and 5-fluorouracil, being the CAF group: 36 patients, or cyclophosphamide, methotrexate and 5-fluorouracil, being the CMF group: 33 patients. Patients achieving complete response or with residual disease of less than 2 cm in diameter received radical radiotherapy while those with more residual disease underwent radical mastectomy. Nine cycles of adjuvant chemotherapy were administered. Complete responses and disease control by radiotherapy with complete breast preservation were more frequently observed after CAF than CMF, being 25 per cent vs 3 per cent (p = 0.025) and 48.5 per cent vs 12 per cent (p = 0.002), respectively. Overall response rates, adverse effects, disease control following radiotherapy/surgery, local relapses and metastases were similar for both regimes. Relapsing patients were young, with a median age of 38 years, 68.4 per cent of relapses occurred at metastatic sites and 42 per cent of relapses occurred during adjuvant chemotherapy. This study suggests that in locally advanced breast cancer, a greater proportion of patients can be rendered disease free after neoadjuvant CAF and radiotherapy compared to neoadjuvant CMF and radiotherapy.

Phycomycosis infection in acute leukaemia.

Fungal infections are increasingly being reported in patients with acute leukaemia on intensive induction chemotherapy protocols. The common fungi seen are candida, aspergillus and mucormycosis. We have seen 3 cases of mucormycosis over the last 4 years. All 3 patients had acute leukaemia-two had acute lymphoblastic and one acute myeloid leukaemia. All patients were in neutropenic phase after induction chemotherapy. Features suggestive of fungal infection were fever and development or progression of pulmonary infiltrates despite antibiotic therapy. Repeated body fluid cultures were negative in two patients. In the first patient, the diagnosis was confirmed after biopsy of a palatal mass; he was treated successfully with amphotericin-B. In two patients the diagnosis was confirmed at autopsy. A high degree of suspicion in febrile, neutropenic cancer patients on chemotherapy and early administration of amphotericin-B may improve the outcome. With dissemination, the prognosis is poor.

Embryonal rhabdomyosarcoma of the vagina associated with pregnancy; a case report.

A case of embryonal rhabdomyosarcoma of the vagina associated with pregnancy is described. This patient delivered a healthy baby by elective classical Caesarean section; following this she was treated by radiotherapy and chemotherapy. The patient is well after 3 years of treatment.

Prognostic assessment of various parameters in chronic myeloid leukemia.

In 152 cases of chronic myeloid leukemia (CML) (actuarial median survival [MS], 59.2 months), the statistical relation of individual parameters with survival was studied to ascertain their prognostic value. The following parameters were found to be unrelated to the survival: age, sex, duration of symptoms, sternal bone tenderness, degree of hepatomegaly, level of hemoglobin, and leukocyte and platelet counts at the time of diagnosis. Splenomegaly of less than 10 cm and duration of first remission of 6 months or more were associated with significantly longer survival (MS, 70.5 and 68.5 months, respectively) as compared to bigger spleen size and duration of remission of less than 6 months (MS, 50.5 and 26 months; P less than 0.01 and P less than 0.05, respectively). The most significant prognostic parameter was the time required to achieve first remission. MS was 70 months in patients who achieved first remission in 2 months or less; it was 23.5 months in the remaining patients. This difference was statistically highly significant (P less than 0.001).

Acute viral hepatitis with bridging necrosis. Collaborative study on chronic hepatitis.

Bridging necrosis was recorded in 14% of 361 patients with acute viral hepatitis on examination of the liver biopsy. The clinical and biochemical features of acute viral hepatitis with bridging necrosis were compared with acute viral hepatitis with no bridging necrosis (NBN). It was noted that fever of more than 8 days' duration in the preicteric phase, the presence of mild ascites and pedal edema during the icteric phase, increasing or persistently high levels of serum bilirubin even 4 weeks after the onset of the icteric phase and positive hepatitis-B surface antigen were significantly more common in acute viral hepatitis with bridging necrosis. Hepatitis-B surface antigen clearance was slow in this group. The long-term complication of chronic hepatitis was more frequent in patients with acute viral hepatitis with bridging necrosis.