The use of neoadjuvant CMF to avoid mastectomy.

AIMS: Large operable cancers have traditionally been treated surgically by mastectomy. More recently centres have investigated the use of neoadjuvant chemotherapy to allow breast-conserving surgery. Between 1991 and 1995, a prospective study into the response of large operable breast cancers to CMF neoadjuvant chemotherapy was performed. METHODS: Patients with cancers requiring mastectomy, and with or without clinically involved non-fixed lymph nodes, were offered neoadjuvant CMF chemotherapy. Patients declining neoadjuvant treatment underwent mastectomy and appropriate axillary surgery. Clinical response was assessed after two cycles in the neoadjuvant group. Subsequent surgical or non-surgical management was planned after this. RESULTS: Thirty-eight patients were suitable for neoadjuvant treatment. Twenty-two underwent two cycles of CMF and were then reassessed. Seventy-three per cent achieved a response [three (14%) complete remission, 13 (60%) partial remission]. Fifteen (68%) patients avoided mastectomy, with six (27%) requiring no surgery at all with no clinically detectable residual disease. Sixteen (42%) declined neoadjuvant chemotherapy and opted for immediate mastectomy, seven of whom accepted chemotherapy post-operatively. After 3 years' follow-up there is no statistical difference in local recurrence, distant recurrence or overall survival. CONCLUSION: Approximately 40% of patients offered neoadjuvant chemotherapy will demand prompt surgical treatment but will consider the use of adjuvant chemotherapy post-operatively. Sixty-eight per cent of patients receiving neoadjuvant CMF will successfully avoid mastectomy.

Synchronous extra-parotid Warthin's tumour.

Warthin's tumour (also known as adenolymphoma or papillary cystadenoma lymphomatosum) is benign and accounts for 12 per cent of all neoplasms of the parotid gland. A case of extra-parotid Warthin's tumour occurring synchronously in a peri-parotid lymph node is described. This is not a metastatic phenomenon and occurs as a result of salivary gland inclusions of local lymph nodes during the embryological development of the parotid. Extra-parotid Warthin's tumour should be regarded as a benign incidental finding and the prognosis is excellent.

An evaluation of peripheral essential amino acid infusion following major surgery.

To assess postoperative progress 43 patients undergoing major abdominal procedures were randomized to be given normal postoperative electrolyte solutions alone or with the addition of 400 ml of essential amino acids. Postoperative measurements confirmed a nitrogen retention significant at 0.1%. Decreased breakdown of muscle was also shown by measuring the upper arm muscle circumference and by following the grip strength. Those treated had no significant muscle loss postoperatively but there was significant loss in those not receiving amino acids. The intravenous cannulae survived equally well in both groups. There was no demonstrable difference in the overall clinical progress.

Aspiration cytology in the preoperative management of breast cancer.

The value and accuracy of aspiration cytology was assessed in the management of 444 patients presenting with a solid breast lump. The first 233 patients were assessed cytologically and frozen-section histology was performed when indicated. In this group a correct positive cytological diagnosis was made in 80% of cases. There were no false positive results. The next 211 patients were assessed cytologically and, when a firm diagnosis of malignancy was made, definitive treatment was carried out without frozen-section histology. In this group cytology was 90.6% reliable in diagnosing malignancy. No mastectomies were performed for benign disease. The use of frozen-section histology has been reduced by about 80%.