Extra-axillary sentinel node biopsy in breast cancer staging--is it necessary?

AIMS: The aim of this study was to assess the value of lymphoscintigraphy in general and extra-axillary lymph node biopsy in particular, based on our experience with sentinel biopsy in 128 consecutive woman undergoing surgery for breast cancer. METHODS: Sentinel node biopsy was performed with the aid of isotope, hand held gamma probe, blue dye and lymphoscintigraphy in 83 patients. Injection technique was peritumoral or intratumoral. Lymphoscintigraphy was performed 2-4 h following isotope injection. RESULTS: Eighteen lymposcintigraphies were negative (21.7%). The sentinel node was found in 14 of these cases. We were unable to identify the sentinel node(s) in four patients (4/83; 4.8%). All in all 20/25 (80%) extra-axillary nodes were located and taken out. Only two of these (2/20, 10%) were positive for metastatic disease on histological examination. The adjuvant treatment plans for these patients were not altered in response to these findings. No positive extra-axillary node(s) with simultaneous normal axillary sentinel node was found. CONCLUSIONS: In this serie, lymphoscintigraphy and biopsy of extra-axillary sentinel nodes added nothing but time, risk and cost to the procedure.

Paclitaxel-ifosfamide for anthracycline-resistant advanced breast cancer.

Thirty-one patients with advanced breast cancer either resistant to anthracycline-based regimens or relapsing after anthracycline-based adjuvant chemotherapy received a combination of a 3-h infusion of paclitaxel 135 mg/m2 on day 1 and a 4-h infusion of ifosfamide 1.7 g/m2 on days 2 to 4 of a 22-day cycle. For inclusion in the study, patients had to have measurable or evaluable progressive metastasis or local disease, and to have received only one prior regimen for metastatic disease; 31 patients with a median age of 49 years (range: 30-69) entered the study. Nine patients (29%) had lung metastasis, while 17 (55%) had liver metastasis, and 19 (61%) had bone metastasis. Only seven patients (23%) had lymph node metastasis and four (13%) had skin metastasis. A median of seven cycles of treatment was delivered. Responses were evaluated according to World Health Organization (WHO) guidelines and side effects according to National Cancer Institute (NCI) criteria. A panel of oncologists and one radiologist reviewed all responses. At baseline, only three patients (10%) were free from the adverse effects of the prior therapy; severe nonhematological toxicity occurred in less than 8% of patients. However neutropenia grade 3-4 occurred in 88%, while only 3% had severe infections. Severe thrombocytopenia and anemia were rare (4% and 8%, respectively). The overall response rate was 42% (13% complete response). Median survival and progression-free survival rates after initiation of treatment were 19.3 months and 6.1 months, respectively. With an objective response rate of 42% and median survival of 19 months, the combination of paclitaxel and ifosfamide seems to offer a promising regimen with acceptable side effects in advanced breast cancer patients relapsing after anthracycline-based adjuvant treatment or resistant to anthracycline treatment.

Oral carmofur in advanced gastrointestinal cancer.

One hundred and twenty-four patients with a diagnosis of metastatic gastrointestinal cancer and no prior therapy were included in this clinical study of carmofur monotherapy, 300-500 mg/m2 daily for 6 weeks. For the 115 evaluable patients, the response rates were 19.4% in gastric cancer, 27.2% in cancer of mobile colon, and 12.5% in rectal cancer. No objective responses were seen in 38 patients with pancreatic cancer, although the disease of 13 of these patients has remained stable over a considerably long period of follow-up. The toxicity profile was interesting; the main adverse effects were urinary bladder symptoms and flush. Hematologic toxicity was minimal. The treatment proved to be safe and could be used for outpatients.