[Is breast saving therapy of breast carcinoma without postoperative radiotherapy justified?]. / Ist die brusterhaltende Therapie des Mammakarzinoms ohne postoperative Strahlentherapie gerechtfertigt?

We report a retrospective analysis of 388 patients treated by breast preserving surgery without postoperative radiotherapy. The lymphatic invasion by the carcinoma is one of the most important factors for local recurrence. The local recurrence shows a highly significant negative influence on metastases free survival and overall survival. However, we could not define any (sub) group of patients in whom a postoperative radiotherapy was not necessary.

[Surgical and adjuvant therapy of breast cancer]. / Chirurgische und adjuvante Therapie des Mammakarzinoms.

This is a report on 512 patients operated on for primary breast cancer in 1988 and 1989 at the Central Institute of Cancer Research in Berlin-Buch. Most patients were postmenopausal (52%), 17.7% were aged 45 to 49 years. The average duration of the symptoms was 6.1 months. 45.4% of all the tumours were located in the upper outer quadrant, 47.3% in the right and 52.7% in the left breast. Clinical evaluation and mammography had a sensitivity of 89%, 93.7% respectively. Invasive ductal carcinomas were histologically proven in 319 cases, less frequently (n = 118) invasive lobular tumours. Predominant surgical procedures were the quadrantectomy with axillary dissection (33%) and the modified radical mastectomy according to Auchincloss-Madden (25.5%). In the case of medially/centrally located tumours and axillary lymph node involvement greater than or equal to 4 nodes independent of the tumour site we performed the IMN-biopsy in 129 patients. The majority of the premenopausal node positive patients received adjuvant chemotherapy (94.4%), postmenopausal node positive patients with positive ER received adjuvant tamoxifen. Postoperative irradiation indicated was applied in 25 patients.

Mitotic rate, DNA distribution, and chromatin in situ sensitivity to heparin in breast cancer.

The purpose of this study was to characterize breast carcinomas by cell kinetic parameters. Mitotic rate (MR) and flow cytometrically (FCM) measured cell cycle distribution as well as chromatin testing in situ employing heparin for determination of activated chromatin, provided the following results: MR counted in 73 unselected carcinomas showed an increase up to a tumor size of 4.2 cm (p less than 0.05); beyond this diameter, the MR was found to decrease. In T1-T2 carcinomas, cell cycle stage analysis yielded higher percentages of cells in S and G2M phase for ductal (13% and 12%, N = 22) than for lobular (8% and 7%, N = 8) node-negative carcinomas (p less than 0.002). In ductal carcinomas, lymph node involvement was reflected by higher % G2M values (15%, N = 26) compared with negative cases (12%, N = 22) (p less than 0.05). Ductal node-positive T3-T4 carcinomas (N = 10) revealed a higher % S value (16%) than their T1-T2 counterparts. A correlation between MR and % G2M was established only up to a tumor size of 4.2 cm (r = 0.39, p less than 0.05). A highly sensitive ('H') and a poorly sensitive ('P') subgroup of carcinomas with respect to heparin-induced changes in fluorescence intensity of the G1/0 peak of the DNA aneuploid cell line were identified, as previously shown. These subgroups were here updated with a larger number of carcinomas and were limited to T1-T2 cancers (N = 57). Group 'H' included more younger patients (p less than 0.005), less cases with nodal involvement in ductal carcinomas (p less than 0.05), and lower % G2M values in lobular node-negative cases (p less than 0.05), than group 'P'. DNA diploid cells always existing in DNA aneuploid carcinomas are more sensitive than their aneuploid counterparts (p less than 0.01); however, they strengthen the stratification to 'H' and 'P'. We suggest 'H' carcinomas to be less aggressive than 'P' carcinomas. Small breast carcinomas are recommended to cell kinetic investigations for individualizing adjuvant therapy.

[Breast cancers in pregnancy and lactation]. / Mammakarzinome in Schwangerschaft und Laktationsperiode.

Four cases of rare coincidence of pregnancy and mammary carcinoma are described in this paper. Tumour growth was at an advanced stage and prognosis thus deteriorated due to delayed diagnosis. The therapeutic concept should be in keeping with the stage of tumour growth and should be formulated with due consideration of the patient's individual peculiarities.

[X-ray diagnosis of small breast cancers]. / Zur Röntgendiagnostik des kleinen Mammakarzinoms.

The incidence of breast carcinoma is steadily increasing in the developed countries. Mortality increases with tumour size. For a reduced mortality early detection must be achieved. Mammography is of high diagnostic value for the detection of small breast carcinoma.

[Inflammatory breast carcinoma--possibilities and results of surgical treatment and adjuvant chemotherapy, especially when done preoperatively]. / Das inflammatorische Mammakarzinom--Möglichkeiten und Resultate operativer Behandlung bei adjuvanter Chemotherapie, insbesondere präoperativem Beginn.

The so-called "inflammatory" cancer represents a rare but fatal malignancy of the female breast, due to rapid growth and early dissemination. The traditional therapeutic approach, locoregional treatment at first, largely irradiation, but chemotherapy in disseminated disease only, results in a poor outcome: in our experience, all patients died within two years. Compared to it, reversal of treatment modalities, i.e. beginning with an aggressive mode of polychemotherapy, locoregional treatment postponed, does prolong disease-free and overall survival. The locoregional treatment consisted in our series in surgical procedures, predominantly extended radical mastectomy. The reason for this approach was twofold: a) no need to discontinue chemotherapy administration b) Involvement of internal mammary nodes (70%) 8/20 patients, treated 1979-1981, survive 60 months or more No advantage has been seen so far in cases with supraclavicular and/or disease beyond the involved breast. The traditional approach will be justified.

[Pretherapeutical testing of antineoplastic drugs in vitro (author's transl)]. / Prätherapeutische Testung von Antineoplastischen Pharmaka in vitro.

Prediction tests were performed in vitro an organ cultures of different solid human tumors. The effectivity of the antineoplastic drugs was determined by means of the remained 3H-thymidine incorporation into DNA. DNA control values of different tumors (without drug) varying in a very high degree are analyzed and correspond to drug response rate in vitro. The correlation between results of sensitivity tests in vitro and therapeutic effectivity in vivo is discussed.

High risk breast cancer: long-term surgical adjuvant therapy based on predictive tests - preliminary report.

A surgical adjuvant therapy trial was started in 1974, in locoregionally advanced breast cancer. The adjuvant hormonal and cytostatic therapeutic regimen was administered according to the results of predictive tests: estrogen receptor (ER) assay and oncobiogram (group I); in the control group (0) no adjuvant therapy was given until relapse, but tests were performed like in group I. Preliminary results. In a subgroup with adjuvant chemotherapy, using one or more substances according to oncobiogram, with or without hormonal treatment, the treated women did highly-significantly better, compared with the untreated group. No advantage was seen from ovariectomy and/or anabolic steroids, either with or without Cytoxan (Test results: ER +, in vitro not growing tumours). Some doubt exists about the results: resistant, especially in testing cytostatics. This doubt and the rate of tumours, not growing in vitro, limit the use of predictive tests, concerning cytostatics. Further, one has to be cautious in the use of additive hormonal treatment in surgical adjuvant therapy: in some cases stimulation can not be excluded.

Recent results of in vitro drug prediction in human tumour chemotherapy.

To assess the clinical value of the organ culture drug prediction assay in the present study we summarize the results of two randomized trials in lung carcinoma (61 patients) and ovarian carcinoma (74 patients) comparing predicted and non-predicted or no surgical adjuvant chemotherapy. No real progress could be achieved by predicted cancer chemotherapy. The reasons of the negative results of our studies are discussed.

[Hormonal treatment of breast cancer from surgical point of view (author's transl)]. / Hormonelle Behandlung des Mammakarzinoms aus chirurgischer Sicht

At present the best results in treating breast cancer of stage I and II appear to be achieved by surgery alone. As an alternative method preference should be given to the so-called classical radical mastectomy. Restriction or widening of operative management may be useful in some cases, but the indication is problematic. There is a high risk of applying appropriate procedures to inappropriate patients. In radical mastectomy the incidence of errors and complications comes within reasonable limits. On the contrary, in stage III additional treatment is well justified. At this stage, surgery alone gives poor results. The fate of stage III patients first of all depends on the presence or absence of metastases; therefore, preference should be given to systemic additional treatment, but on the basis of individualized tried measures. Polypragmasia and blind systemic treatment are to be avoided. The time schedule of such additional treatment are to be avoided. The time schedule of such additional treatment has to be established, by controlled clinical trials. From these considerations, the following requirements can be formulated: 1. improvement of the oncologic level 2. centralisation in oncologic treatment and diagnostics 3. enlargement of existing or creation of new facilities for bi-chemical and other testing, and for scientific investigation at the oneologic centers.